The use of bronchodilators represents the cornerstone drug management of chronic obstructive pulmonary disease (COPD), and the employed bronchodilating agents include β₂ -adrenergic agonists, anticholinergic agents, and the methylxanthines. Combination therapy combining bronchodilating agents with differing durations of action and from different classes provides greater symptomatic improvement and reduced risk of adverse drug effects. As a result of the observed tendency to precipitate steroid myopathy, oral glucocorticosteroids are not recommended for long-term use in COPD management, but the adjunctive use of inhaled forms in cases of COPD stages III and IV reduces the frequency of exacerbations and improves the patient's quality of life. The absence of medications modifying the lung function decline, a major hallmark describing the course of COPD, necessarily implies that drug management involves an amelioration of COPD symptoms. Preventive approach to COPD management involves measures aimed at reducing individuals' exposure to tobacco smoke and other airborne pollutants; measures geared towards smoking cessation is the most efficacious way of halting the progression of COPD.

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Aim: This study was designed to test the Sudanese parents' knowledge, attitudes and practice (KAP) toward self medicating their children. Design and Methods: A cross-sectional study was carried out by using a pretested questionnaire. Non probability convenient sampling method was used to select the participants. The total sample size was 1000 parents from different health settings in Khartoum State, Sudan in the period from January to June 2011. Results: The obtained response rate was 94.9%. The majority of Sudanese parents in this study 84% used to recommend western medicines to their children. More than one-third of children had received parental self medication in the month preceding this study. The results revealed that parents in 95.7% cases, self medicated their children from minor illnesses. The most frequently used medicines are antibiotics 36.6% followed by paracetamol 31.5%, even though the most common symptom reported was fever 39.7%. In case of self-treatment failure; 64.0% of responded parents used to consult physicians in public settings, while 8.0% seek advice from the community pharmacists. The main reasons of parental self medication were the expensive consultation fees and the long waiting time in the clinics. Conclusion: The study revealed that parents' knowledge was inadequate, and their parental self medication practice showed to be inappropriate. The study outcomes urge instant move toward educating parents on risk of liberal use of medicines in children.

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Introduction: Non-fermenting gram negative bacilli (NFGNB) are taxonomically diverse group of pathogens that has emerged as a major cause of health care associated infections especially in immunocompromised hosts. Identification of NFGNB and monitoring their susceptibility pattern are important for proper management of infections caused by them. Prevalence and antibiogram of NFGNB has not yet been reported from this part of India. Aim of the present study was to characterize the prevalence of NFGNB along with their antimicrobial sensitivity pattern among the patients coming to our hospital a tertiary care center. Materials and Methods: A total of 2585 various clinical specimens were received in laboratory and were processed. Non fermenters were identified using a standard protocol. Antimicrobial susceptibility testing was performed by Kirby Bauer disc diffusion method. Results: Among 2585 clinical samples 241 yielded NFGNB accounting for an isolation rate of 9.32% and a total of 246 non fermenters were grown as five samples yielded two types of NFGNB. Pseudomonas species (49.59%) and Acinetobacter species (43.09%) were the most commonly isolated NFGNB. A high level of antibiotic resistance was recorded for most of the first and second line drugs. Imipenem and amikacin were the drugs with maximum activity. Overall imipenem resistance was found to be 30.54%. Conclusion: Identification of NFGNB and monitoring their susceptibility patterns will help in proper management of infections caused by them. Improved antibiotic stewardship and infection-control measures will be needed to prevent or slow the emergence and spread of multidrug-resistant NFGNB in the healthcare setting.

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Background: Having a low birth weight (LBW) baby can cause emotional, social and financial stress for the family. Settings and Design: A longitudinal study of 1 year duration (June 2009-May 2010) was conducted in an urban slum of Mumbai. Universal sampling method was employed and every antenatal women registered at the urban health center from June 2009 to August 2009 were included as study participants. Materials and Methods: Of the 231 pregnant women that registered, 21 were excluded from analysis as - 5 home deliveries, 3 still births, 3 spontaneous abortions, and 10 that could not be traced. Thus for final analysis, sample size was 210. Inclusion and Exclusion criteria were: All antenatal care (ANC) subjects registered at the urban health center within 20 weeks of their gestational age were included as the study subjects. Subjects with only live hospital/institution birth were included. These registered women were then followed-up for next 9 months for monitoring maternal weight gain and neonatal birth weight. Statistical Analysis: Statistical analysis was done using SPSS version 17. Chi-square test was used for testing significance of association at P value of 0.05 and 0.001. Results: Proportion of LBW in the present study is 27.1% with mean birth weight 2.2285 kg with S.D. 0.2281 kg. Factors like maternal age, education, tobacco addiction, hemoglobin levels, gestational age, and interval between pregnancies were significantly associated with birth weight. Conclusions: LBW continues to be a significant public health problem and as multiple factors are associated with it, it requires a more holistic and multipronged approach for its reduction.

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Background: This study aimed to perform a bibliometric analysis of Randomized Controlled trials (RCTs) published in palliative care journals. Settings and Design: Systematic review of palliative care journals. Materials and Methods: MEDLINE database was searched for journals with name 'palliative' in their title, and articles published from January 2007 - December 2011 were then searched in individual journals with search limits activated for 'randomized controlled trials.' The reporting rates of all journals were compared. The selected articles were categorized into practice, education, research, and administration (PERA). The articles were also grouped under participants, interventions, comparisons, and outcomes (PICO) format for analysis. Quality scoring of RCTs was done using Jadad scale. Statistical Analysis: Quality scores were compared between journals and article categories (PERA, PICO) using one-way ANOVA with Bonferonni test, Chi-square test were done at 95% confidence interval using SPSS for Windows version 16.0. Results: The overall reporting rate of RCTs in palliative care journals was 1.04%, and the overall RCTs' quality score was 2.8.99 out of a total score of 5 on Jadad scale. PSC had the highest reporting rate of 3.27% (8/244) followed by JPC at 1.53% (3/196) and PM at 1.353% (8/591). The RCTs in IJPN had the highest quality score at 3, followed by AJHPC (3 ± 1) and JPPCP (3 ± 2.82). Significant association was found between cancer patients as study population and practice as RCT category. Comparison between PERA and PICO categories for quality of RCTs was not significant (P > 0.05). Conclusions: The 12 palliative care journals analyzed in this study published few RCTs at a five-year reporting rate of 1.04%, with Palliat Support Care having the highest reporting rate. Overall quality of the RCTs was moderate-low category.

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Background: Data on prevalence of human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) infections among pregnant women in non-institutionalized health facilities in Nigeria are missing. Aim: This study aimed at determining the prevalence and associated risk factors of HIV, HBV, and HCV infections among pregnant women receiving antenatal care in a traditional birth home in Nigeria. Setting and Design: This was a cross-sectional study conducted in a traditional birth home. Materials and Methods: Blood and sera samples obtained from 360 pregnant women were tested for the presence of HIV, HBV, and HCV antibodies and hemoglobin concentration determined using standard technique. Questionnaires were used to obtain demographic information. Statistical Analysis: INSTAT ^® statistical software. Results: The prevalence of HIV infection was significantly higher among pregnant women with no formal education and among those with multiple marriages (P = 0.008 and P = <0.0001 respectively). Only HIV infection was associated with anemia (OR = 4.154, 95% CI = 1.699, 10.157, P = 0.002). Age, gravidity, parity, marital status, history of blood transfusion, and educational status did not significantly affect the prevalence of HBV and HCV infections. Conclusions: The prevalence of HIV, HBV, and HCV infections were 7.2%, 2.2%, and 0.8%, respectively. Anemia was significantly associated with HIV infection only. Intervention effort at reducing HIV, HBV, and HCV infections and associated sequelae among pregnant women receiving antenatal care in traditional birth homes is strongly advocated.

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Background: Cardiovascular diseases (CVD) are responsible for one-third of deaths worldwide. Hypertension is an extremely prevalent risk factor for CVD. Different guidelines were set to control the treatment practices of hypertension including the British guidelines, the US guidelines, and the Saudi guidelines. The adherence of physicians to guidelines is a key issue in the success of therapy and avoidance of serious health complications. However, there are no enough data about the trends of hypertension treatment in Saudi Arabia and its compliance to guidelines. Aim: The present study aims to explore the profile of antihypertensive agents prescribed, investigate the extent of adherence to the national guidelines as well as the detection of some common prescription errors in treating hypertension in the western region of Saudi Arabia. Methods: Data were collected through a semi-structured interview with prescribers using prescription profile questionnaire. Results: The results indicated great degree of deviations from the guidelines. Some deviations may be major and might seriously affect the patients' health, such as prescribing direct vasodilators for angina patients. Other deviations might be minor, where physicians frequently prescribed nonrecommended drugs.The study revealed that reasons behind such deviation included lack of information and awareness of Saudi guidelines, the impact of marketing and promotion activities of different companies, tendencies to prescribe cheaper drugs, and limited number of drugs available in hospitals. Conclusion: Results obtained showed different degrees of deviation due to complex underlying causes that necessitate arranging awareness campaigns, reviewing the hospital drug lists as well as setting regulations to guarantee adherence to guidelines.

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Background: The plant has been used for treatment of number of diseases in folklore medicine but not used for anemia. The present study is aimed to investigate its effect on anemia and related blood indices and body weights (BWs). Materials and Methods: Two sets of Albino rats each of four groups of six animals were used in this study. In each set one group for the control and the three groups for experimental doses. Two groups of rabbits each of five animals were also used for control and experiment. In one set of Albino rats, leaves of Solenostemma argel extracted in ethanol were used to test for its effect alone although in the second set, Albino rats were used to test for anemia. However, the rabbits were tested for the effect of S. argel on blood indices and BW. Blood parameters were measured by Sysmex, electrolytes by spectrophotometer, and flame photometer and BW by Mettler balance. Measurements were conducted after 30 days. Results: The present study revealed significant increases (P < 0.05) in mean cell hemoglobin concentration (MCHC) and packed cell volume (PCV) in rats provided with 600 mg/kg and PCV in the group provided with 300 mg/kg, whereas no significant changes in the group provided with 150 mg/kg. For rabbits significant increase (P < 0.05) was restricted in hemoglobin (Hb) and mean cell volume (MCV). However, no significant changes (P > 0.05) occurred in BWs of experimental animals. In the meantime, significant decreases (P < 0.01) in red blood cell counts, Hb, MCHC, PCV and Fe as well as increase in MCV occurred in those treated with Aluminum chloride (AlCl ₃ ) alone (Al) group or Aluminum chloride co-administered with 600 mg/ kg of S. argel extract (AlS) group. The results also showed significant increase (P < 0.01) in PCV and MCHC and significant decrease in MCV in group treated with AlCl ₃ co-administered with plant when compared to those provided with AlCl ₃ alone. Moreover, administration of plant extracts alone (S) group lead to significant increase (P < 0.05) in MCHC, PCV, K, P, and Ca when compared to the control group (CG). Conclusion: The present study concludes that S. argel is of high nutritional values and of significance in mitigating anemia.

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Human brucellosis is a multisystem and potentially lethal disease of zoonotic origin with highly variable and non-specific clinical presentation. We report here on a 4-year-old pediatric patient who was presented with fever, chills, frequency, urgency of urine, and pain in lower abdomen. Blood cultures yielded slow-growing gram-negative coccobacilli that were later identified as Brucella melitensis. To the best of our knowledge, this is one of the few rare case reports of Brucellosis with symptoms of urinary tract infection in a female child.

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Dental agenesis is the most common developmental anomaly in humans which can occur in an isolated fashion, or as a part of syndrome. Isolated cases of missing teeth can be familial or sporadic in nature. In the literature, many terms are used to describe missing teeth like oligodontia, anodontia, aplasia of teeth, congenitally missing teeth, absence of teeth, agenesis of teeth and lack of teeth. Oligodontia is defined as the developmental absence of six teeth or more, excluding third molars. It can be isolated or as a part of a syndrome such as in ectodermal dysplasia. The present case report describes agenesis of lower anterior permanent teeth which are non-familial and with no apparent systemic abnormalities.

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Epidermoid cyst in the spinal cord is a rare condition. It constitutes of only 0.6-1.1% of all spinal tumors. We are reporting a case of a 22-year-old female who presented with complaints of tingling and numbness in both lower limbs since past 3 years and weakness in both lower limbs since past 1 year, which gradually progressed. Since last 3 months she was unable to walk and get up from their squatting position. Magnetic resonance imaging of spine revealed a mid-thoracic intramedullary mass with obliteration of anterior and posterior subarachnoid space, which was confirmed as an intramedullary epidermoid cyst at surgery. Total excision of intramedullary epidermoid tumor was performed. Histopathological examination of resected specimen confirmed the diagnosis of epidermoid cyst. The patient recovered progressively after initial deterioration in neurological status.

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The patient on chronic anticoagulation (warfarin and aspirin) underwent therapeutic pleural paracentesis for massive tubercular pleural effusion, developed thromboembolic stroke within 48 hours after the procedure, after stopping anticoagulants for one day prior to the pleural paracentesis. To examine the rationale and problems associated with preoperative/pre-procedure anticoagulation withdrawl. Review of the medical literature. When anticoagulation(warfarin) is stopped prior to any minor therapeutic procedure where the patient is at increased risk for thromboembolism, the bleeding risk is extremely low and can be easily managed.In view of narrow therapeutic index and the drug interaction between warfarin with anti-tubercular drugs like rifampicin, risk of thromboembolism significantly increases further. Warfarin should not be discontinued prior to any minor therapeutic paracentesis/procedure because the risk of thromboembolism over weighs the risk of bleeding.

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Community onset necrotizing pneumonia due to community acquired methicillin resistant Staphylococcus aureus (CA-MRSA) is an emerging clinical entity, especially, following a viral infection, with substantial morbidity and mortality and survivors, have long-term pulmonary complications requiring treatment. The infectious diseases society of America guidelines has recently addressed the issue of MRSA as a possible pathogen that warrants empiric antibiotic therapy for community-acquired pneumonia (CAP) in patients requiring inpatient intensive care unit treatment, recommending the use of vancomycin or linezolid, with linezolid having an advantage due to its documented suppression of panton valentine leukocidin toxin production in CA-MRSA. We report a case of a child presenting with pyothorax and multiple subcutaneous absceses over the deltoid region. The pus from the abscesses and pyothorax and the expectorated sputum showed the growth of MRSA. The case was diagnosed as CA-MRSA pneumonia and was successfully treated with vancomycin but the patient required pulmonary decortications and long-term physiotherapy. The case highlights the importance of considering CA-MRSA in the initial empirical therapy for severe CAP and the long-term morbidity associated with this otherwise fatal disease.

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