Over-the-counter medications containing diphenhydramine and doxylamine used by older adults to improve sleep

International Journal of Clinical Pharmacy - Background The unintentional misuse of over-the-counter sleep aids among older adults is an important public health problem and a focus of Healthy...     

A content review of online naloxone Continuing Education courses for pharmacists in states with standing orders

Background

Many community pharmacists are uncomfortable educating patients about naloxone, an opioid reversal agent.

Asymptomatic malaria parasitaemia in sickle-cell disease patients: how effective is chemoprophylaxis?

BACKGROUND & OBJECTIVES: Sickle-cell trait confers protection against malaria while homozygote sickle-cell disease (SCD) patients are at greater risk of malaria infection, hence the use of malaria chemoprophylaxis in SCD patients. The use of malaria chemoprophylaxis and asymptomatic parasitaemia were studied in SCD and non-SCD patients. STUDY DESIGN: A semi-structured questionnaire was administered to both patients and controls; a thick blood film was also examined in both the groups. RESULTS: Sixty-nine percent of patients use proguanil, 22% do not use any form of chemoprophylaxis, while 9% use pyrimethamine. There was no significant difference between level of parasitaemia in patients and controls (p = 0.1), a positive smear was found in equal numbers of patients on chemoprophylaxis and those not on chemoprophylaxis (p = 0.3). In the month preceding the study, 31% of patients vs 18% of controls had received treatment for malaria. There were no significant differences between patients and controls in frequency of malaria attacks (p = 0.06), last episode of malaria (p = 0.2). Ten percent of patients and 2% of controls use bednets. CONCLUSION: This study did not find any advantage in the use of malaria chemoprophylaxis in SCD patients over controls or SCD patients not on chemoprophylaxis. Vector control should also be considered in the fight against malaria. There is a need to look into why both patients and controls fail to use bednets in a malaria endemic country.     

The effect of central (macula) sparing on contralateral line bisection bias: a study with virtual hemianopia

Hemianopic patients show a contralesional bisection bias, but it is unclear whether this is a consequence of their field loss or related to extrastriate damage. One observation cited against the former is that hemianopic bisection bias does not vary with the degree of central (macular) sparing; however, it is unclear to what extent central sparing should affect this bias. Our goal was to determine the effect of central sparing on line bisection biases from field loss alone, with two approaches. First, we studied 12 healthy subjects viewing lines under conditions of virtual hemianopia, created by a gaze-contingent technique. Second, we calculated the effect predicted by a visuospatial model of the effect of central magnification on line representations in the visual system. Our results first replicated the contralateral line bisection bias with hemianopia, confirming that this can be generated by visual hemifield loss in the absence of extrastriate damage. Central sparing had only a modest effect on hemianopic bisection bias, with only slightly less bias with 10° compared to 2° of central sparing. In accordance with these empiric data, computing the center of mass for line representations in our model showed only a shallow decline in bisection bias as central sparing increased from 0 to 10°. We conclude that contralateral bisection bias only decreases slightly with central sparing, and that the absence of a statistically significant effect of central sparing in patients cannot be taken as evidence against a visual origin of contralateral hemianopic line bisection bias.     

Intraepithelial and invasive squamous neoplasms of the conjunctiva in Ibadan,Nigeria: a clinicopathological study of 46 cases

Background/Aims To retrospectively evaluate the clinicopathological features, treatment modalities and factors affecting prognosis in patients with both conjunctival intraepithelial and invasive squamous neoplasms. Method Review and analysis of clinical and pathological records of all cases histologically diagnosed in the Department of Pathology, University College Hospital, Ibadan, Nigeria between January 1990 and December 2004. Results There were a total of 46 cases in 45 patients (eight intraepithelial carcinomas, 37 invasive squamous cell carcinomas (SCC) and a single case of mucoepidermoid carcinoma in a 71-year-old man). The intraepithelial neoplasms occurred in patients aged between 20 and 90 years. Seven of these patients had actinic changes on histology. For invasive SCC, patients’ ages ranged from 18 to 84 years with a mean age of 53 years. Male to female ratio was 1:1. The majority presented with an orbital mass and loss of vision. Twenty-two (60%) of the patients with invasive SCC had enucleation or exenteration as the primary modality of treatment with or without radiotherapy or chemotherapy. Altogether for intraepithelial and invasive squamous neoplasms, the duration of presenting complaints ranged from 1 month to 5 years with an average of 2 years. Human immunodeficiency virus (HIV) infection and smoking were not significantly associated with these cases but a significant number had outdoor occupation. Low socioeconomic status and inability to afford treatment was common among our patients. Conclusion Patients with invasive SCC in Nigeria present late and have significant delay before having any form of treatment. This contributes to the poor outcome. Human papilloma virus (HPV) and actinic aetiology are possible strong causative agents in Nigerians.     

Sexual and Contraceptive Practices among Female Undergraduates in a Nigerian Tertiary Institution

Background

The reproductive health of adolescents and young women is integral to the wellbeing of a society. This study was carried out to determine current sexual practices and contraceptive usage among female undergraduate students in a Southwest Nigerian tertiary institution.

Methods

It was a cross-sectional questionnaire based survey of female university undergraduates. Pre-tested questionnaire was used to elicit information on socio-demographic variables and sexual and contraceptive practices. Frequency tables were generated and univariate and multivariate logistic regressions were used to determine factors that influenced sexual and contraceptive practices. SPSS software version 16.0 was used for analysis.

Results

Of 350 students sampled, 306 completed the questionnaire. One hundred and eighty six (60.8%) students were currently sexually active. The mean age of sexual debut was 19.11 years. Sixty-six (35.5%) had more than one sexual partners. Contraceptive knowledge was 100%, but consistent use was 34.4%. A third of the respondents had sex for material rewards and/or under the influence of alcohol and recreational drugs. Students who were less than 20 years old (Adjusted OR: 3.52; 95%CI=2.10–6.82) were more likely to be sexually active while those from polygamous/separated families (Adjusted OR: 0.32; 95% CI=0.18–0.58) were less likely to be sexually active.

Conclusion

There is a high level of sexual activity and low contraceptive use among female undergraduate students in Southwest Nigeria. More reproductive health education and promotion is necessary to safeguard their sexual health.     

Relationship between Bone Histology and Markers of Bone and Mineral Metabolism in African-American Hemodialysis Patients

Background and objectives: Racial differences in mineral metabolism exist in the chronic kidney disease population, especially as it relates to intact parathyroid hormone (iPTH) levels. Few data exist on the relationship of these markers to bone biopsy findings in African-American (AA) hemodialysis patients across the spectrum of renal osteodystrophy (ROD).Design, setting, participants, & measurements: In prevalent AA hemodialysis subjects, we prospectively evaluated subjects by performing transiliac bone biopsy and correlating biochemical and clinical data to bone histology.Results: Study patients (n = 43) had an average age of 53.7 (±11.6) yr, with dialysis vintage of 40.4 (±24.5) mo, 30% with diabetes, and 51% male. Bone histology revealed adynamic bone disease (ABD) (16%), mild to moderate hyperparathyroidism (HPT) (72%), severe (12%) HPT, and no osteomalacia or mixed uremic osteodystrophy. At the time of biopsy, mean corrected calcium was 9.1, 8.9, and 9.4 mg/dl (P = 0.344); calcium-phosphorus (Ca × PO₄) product was 42, 55, and 62 mg²/dl² (P = 0.002); phosphorus was 4.6, 6.2, and 6.7 mg/dl (P = 0.005); and iPTH was 225, 566, and 975 pg/ml (P = 0.006), respectively. Median values for bone-specific alkaline phosphatase (BS-AP) were 16, 34, and 64 ng/ml (P < 0.0001) among the three groups.Conclusions: These data demonstrate that across the spectrum of ROD, iPTH levels are higher than expected in AA hemodialysis subjects. iPTH, PTH peptides, and bone-specific alkaline phosphatase correlated directly with histomorphometric measurements of bone turnover and when subjects were grouped by histologic diagnosis. Only 9.5% of subjects were simultaneously within suggested Kidney Disease Outcomes Quality Initiative (K/DOQI) ranges for Ca × PO₄, phosphorus, and iPTH, of which 75% demonstrated ABD on biopsy.Abnormalities in bone and mineral metabolism occur frequently in chronic kidney disease (CKD) patients, leading to bone lesions. This disorder has more recently been termed chronic kidney disease-related mineral and bone disorder (CKD-MBD) by the Kidney Disease Improving Global Outcomes (KDIGO) foundation (1). Bone and mineral disorders in CKD patients have been associated with significant morbidity and mortality (2–5). The bone lesions, coined renal osteodystrophy (ROD), in this population can manifest symptoms such as intense pruritus, bone pain, myopathies, muscle tendon rupture, and increased incidence of fractures. Beyond symptoms, however, ROD manifests in derangements in bone histologic findings such as abnormalities in bone turnover, mineralization, and volume (6), a classification system that has been adopted by the KDIGO committee (1). Bone histology remains the “gold standard” for definitive diagnosis of the osteodystrophic lesion. However, in routine clinical practice nephrologists rely on noninvasive methods for assessment of bone turnover, such as intact parathyroid hormone (iPTH) levels.The Kidney Disease Outcomes Quality Initiative (K/DOQI) Clinical Practice Guidelines (CPG) for Bone Metabolism and Disease in Chronic Kidney Disease, released in 2003, provided the first integrated clinical action plan for the treatment of CKD-MBD (7). The treatment goals provided by these CPGs were developed through a systematic review of the literature to date (January 1, 2001) in addition to a broad-based review by experts, organizations, and the public. However, it is unclear if the recommended goals of therapy in the guidelines are also applicable to African-American (AA) hemodialysis patients. Differences in mineral metabolism between AA and non-AA individuals without CKD have been demonstrated previously in relation to calcium balance (8,9) and bone histomorphometry (10,11). These differences have been seen in the nondialysis CKD population as well, with AA CKD patients demonstrating differences in their levels of bone and mineral parameters that would suggest a more severe degree of secondary hyperparathyroidism (12). A recent study involving AA hemodialysis patients suggests that a higher serum iPTH threshold may be necessary in this ethnic group to avoid the development of adynamic bone disease (ABD) (13), which has been associated with adverse outcomes such as vascular calcifications, (14,15) fractures (16,17), and increased mortality (5,18). In particular, a iPTH of less than 200 pg/ml or a combination of a iPTH of less than 178 pg/ml with a higher serum phosphorus and calcium were associated with increased mortality in hemo- and peritoneal dialysis patients (5,18).African Americans constitute a significant proportion of patients on hemodialysis in the United States, approaching 32% in 2005 (19). Therefore, it is important to explore any potential differences in the assessment and treatment of bone and mineral disorders in this population. Although the work of Sawaya et al. and Gupta et al. has led to the recognition that there are differences between AA and non-AA hemodialysis subjects in relation to iPTH, the optimal serum levels of iPTH across the histologic spectrum of bone and mineral disorders have yet to be established in this population (13,20). The purpose of this study was to evaluate the relationship of bone histology across the spectrum of ROD to classical biochemical markers of bone and mineral metabolism in prevalent AA hemodialysis patients receiving the current standard of care for CKD-MBD.