Plasma level distribution, effect and toxicity of antiepileptic drugs among Ethiopian epileptics

Plasma phenytoin and phenobarbitone levels were estimated in 123 adult Ethiopian epileptics by gas-liquid chromatography. Thirty four (38.2%) of the patients on phenytoin, and 52 (52%) of those on phenobarbitone, had plasma levels in the conventional therapeutic ranges of 10-20 micrograms/ml and 10-30 micrograms/ml respectively. Of the 89 patients who were taking phenytoin either singly or combined with phenobarbitone, motor disturbances (ataxia and nystagmus) were seen in 31 (34.8%) and dysmorphic and idiosyncratic side effects including gum hypertrophy, hirsutism, acne and skin rash in 37 (41.6%). Subnormal serum calcium levels were noted in 15 (30.6%) and high alkaline phosphatase was found in 13 (26.5%). Phenobarbitone was found to be an effective anticonvulsant (78.1% seizure control rate), with adverse effects of sedation and intellectual depression. Seizure control was achieved in 77.1% of patients on a single drug as opposed to 55.6% on combination of phenytoin and phenobarbitone (p less than 0.05). The overall seizure control rate was 66%.     

Prevalence of Disability and Associated Factors among Registered Leprosy Patients in All Africa Tb and Leprosy Rehabilitation and Training Centre (ALERT), Addis Ababa,Ethiopia

Background

Delay in leprosy diagnosis and treatment causes disabilities due to nerve damage, immunological reactions and bacillary infiltration. Leprosy disability leads not only to physical dysfunction and activity limitation but also disrupts social interaction of affected individuals by creating stigma and discrimination. This study was aimed at assessing leprosy disability status in patients registered at All African TB and Leprosy Rehabilitation and Training Centre.

Methods

Medical records of leprosy patients registered from September 11, 2010 to September 10, 2013 G.C were reviewed. Prevalence of disability calculated, bivariate and multiple logistic regressions were used to determine crude and adjusted odds ratios with 95% confidence interval.

Results

The overall prevalence of disability was found to be 65.9% from all categories of patients (40.2% Grade I and 25.7% Grade II). The Prevalence among the new category was 62.8% (39.1% Grade 1 and 23.7% Grade 2). Those ageed above 30 years, with duration of symptoms 6–12 months and above 24 months, with sensory loss, nerve damage and reversal reaction were more likely to develop disability.

Conclusion

In this study the prevalence of disability, both Grade I and II, is very high. Disability was associated with age, duration of symptom, sensory loss, signs of nerve damage and reversal reaction. These risk factors indicate the existence of delay in diagnosis and treatment of leprosy cases. Therefore, the national leprosy control program should investigate leprosy case detection and diagnosis system in the country and work on improving early case detection and prevention of disability.     

Diabetes Control Among Hispanics in the Action to Control Cardiovascular Risk in Diabetes Trial

BACKGROUND

Hispanics in the United States represent diverse racial, ethnic, and socioeconomic groups, and manifest heterogeneous cardiovascular risks including diabetes. It is not known if there are residual differences in the control of diabetes among Hispanic groups given uniform access to diabetes care.

OBJECTIVE

To evaluate glucose control differences among Mexicans, Puerto Ricans, and Dominicans receiving substantial diabetes care and support in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial.

DESIGN

Secondary analysis of data from a randomized trial comparing two treatment strategies: intensive, targeting glycated hemoglobin below 6.0?%, and standard, targeting glycated hemoglobin between 7.0?% and 7.9?%.

PARTICIPANTS

Seven hundred and sixteen Hispanic and 6066 non-Hispanic white participants were recruited from 77 clinical sites across the United States and Canada. There were 243 Mexicans, 199 Puerto Ricans, and 150 Dominicans; and 135 of these Hispanic groups were born in the United States.

MAIN MEASURE

Glycated hemoglobin

RESULTS

Compared to Puerto Ricans, Mexicans were more likely (HR?=?1.38, CI:0.90?C2.10) and Dominicans as likely (HR?=?1.01, CI:0.66?C1.54) to achieve glycated hemoglobin goal in the intensive arm. Participants born in the United States achieved glycated hemoglobin goal at a higher rate than those born elsewhere (HR?=?1.57, CI:0.99?C2.51 in the intensive arm, HR?=?1.51, CI:0.95?C2.43 in the standard arm). These differences were not statistically significant. In the intensive arm, Puerto Ricans (OR?=?0.47, CI:0.31?C0.71), and Dominicans (OR?=?0.41, CI:0.26?C0.66) were less likely than non-Hispanic whites to achieve glycated hemoglobin goal, whereas the difference between non-Hispanic whites and Mexicans was not statistically significant, (OR?=?0.66, CI:0.43?C1.02).

CONCLUSIONS

Hispanic groups, given access to comprehensive diabetes care, differed from each other non-significantly and had a variable divergence from non-Hispanic whites in achieving intensive glycated hemoglobin goal. These differences, if confirmed, could be due to such factors as variable acculturation and functional health literacy levels that were not measured in the ACCORD trial, but should be further explored in future studies.     

Recent advances in targeting the autotaxin-lysophosphatidate-lipid phosphate phosphatase axis in vivo

Extracellular lysophosphatidate(LPA) is a potent bioactive lipid that signals through six G-protein-coupled receptors.This signaling is required for embryogenesis,tissue repair and remodeling processes.LPA is produced from circulating lysophosphatidylcholine by autotaxin(ATX),and is degraded outside cells by a family of three enzymes called the lipid phosphate phosphatases(LPPs).In many pathological conditions,particularly in cancers,LPA concentrations are increased due to high ATX expression and low LPP activity.In cancers,LPA signaling drives tumor growth,angiogenesis,metastasis,resistance to chemotherapy and decreased efficacy of radiotherapy.Hence,targeting the ATX-LPA-LPP axis is an attractive strategy for introducing novel adjuvant therapeutic options.In this review,we will summarize current progress in targeting the ATX-LPA-LPP axis with inhibitors of autotaxin activity,LPA receptor antagonists,LPA monoclonal antibodies,and increasing low LPP expression.Some of these agents are already in clinical trials and have applications beyond cancer,including chronic inflammatory diseases.     

Low baseline serum creatinine concentration predicts mortality in critically ill patients independent of body mass index

OBJECTIVE: Malnutrition and low muscle mass reduce the ability of patients to fight critical illness. Low serum creatinine is a better surrogate marker of low muscle mass than a low body mass index and has been associated with poor outcome in some patient populations. We hypothesized that low baseline serum creatinine would predict poor outcome in the critically ill. DESIGN: In this retrospective cohort study, data including age, gender, race, postoperative status, and Acute Physiology and Chronic Health Evaluation (APACHE) III scores were collected from the institutional APACHE III database. Baseline serum creatinine levels and body mass index were collected from the hospital laboratory database. The main outcomes measured were hospital mortality and intensive care unit length of stay. PATIENTS: Consecutive critically ill patients >18 yrs of age admitted to three ICUs from January 2003 to December 2006, excluding those who denied research authorization, did not have a baseline serum creatinine measured, were pregnant at the time of intensive care admission, had a history of chronic renal replacement, were in intensive care for <12 hrs, or were admitted for low-risk monitoring only. SETTING: Three intensive care units of two tertiary care hospitals. RESULTS: Of 11,291 patients who met the inclusion criteria, 1185 (10%) died in the hospital. Of the patients, 54% were male and 90% were white, with a mean age (+/-sd) of 63 +/- 17 yrs. Median body mass index was 27.3 (interquartile range [IQR], 23.5-32.1), median APACHE III score was 53 (IQR, 38-69), and median baseline serum creatinine was 1.1 (IQR, 0.9-1.4). When adjusted for APACHE III-predicted mortality, age, gender, postoperative state, and body mass index, low baseline creatinine was associated with increased mortality in a dose-response manner: odds ratio (OR) 2.59 (95% confidence interval [CI], 1.82-3.61) for baseline creatinine < or =0.6 mg/dL (p < .001) and OR 1.28 (95% CI, 1.03-1.60) for baseline creatinine 0.6-0.8 mg/dL (p = .023). Adjusted intensive care length of stay in survivors was 0.48 days (95% CI, 0-0.98) longer for patients with baseline creatinine < or =0.6 mg/dL (p = .058). CONCLUSION: Low baseline serum creatinine concentrations increase the risk of mortality in critically ill patients.     

Diabetes mellitus,metabolic syndrome,and physical activity among Ethiopians: A systematic review

Background and aimsThe incidence of diabetes mellitus (DM) is increasing worldwide, and there is growing appreciation for the impact of limited physical activity on the disease. This study aimed to determine whether the current research on DM in Ethiopia has sufficiently identified and focused on the importance of limited physical activity according to the Global Physical Activity Questionnaire (GPAQ) in the disease etiology.MethodsThis was a systematic review, performed according to the PRISMA checklist. We searched primary studies of diabetes, diabetes-related complications, determinants, and magnitude of related morbidities in Ethiopia in PubMed, Medline, and ISI Web of Science databases. Reviews, editorial communications, reports, and letters were excluded.ResultsAmong 363 articles that were identified from all databases, 28 were included. It was found that 39% of the studies measured and included limited physical activity as a predisposing lifestyle factor in diabetes, while 17.86% either did not report or did not include this variable at all. Although 42.86% of the studies identified limited physical activity as an etiological factor in diabetes, it was not measured according to the GPAQ guidelines.ConclusionsThese data suggest that Ethiopian researchers do not give sufficient attention to the role of physical activity and its definition per GPAQ as a preventative factor for reducing the severity of diabetes symptoms. We suggest that physical activity research and promotion should be advocated in Ethiopia, and that researchers should seek advice on how to re-frame their work in the future.