Drug utilisation study in a tertiary care center: recommendations for improving hospital drug dispensing policies

Drug therapy accounts for a major portion of health expenditure. A useful strategy for achieving cost efficient healthcare is drug utilisation research as it forms the basis for making amendments in drug policies and helps in rational drug use. The present observational study was conducted to generate data on drug utilization in inpatients of our tertiary care hospital to identify potential targets for improving drug prescribing patterns. Data was collected retrospectively from randomly selected 231 medical records of patients admitted in various wards of the hospital. WHO Anatomical Therapeutic Chemical/Defined Daily Dose methodology was used to assess drug utilisation data and drug prescriptions were analysed by WHO core drug indicators. Antibiotics were prescribed most frequently and also accounted for majority of drug costs. The prescribed daily dose for most of the antibiotics corresponded to defined daily dose reflecting adherence to international recommendations. Brand name prescribing and polypharmacy was very common.78% of the total drugs prescribed were from the National List of Essential Medicines 2003. Restricting the use of newer and costlier antibiotics, branded drugs and number of drugs per prescription could be considered as targets to cut down the cost of drug therapysignificantly.

A review of the mechanisms and effectiveness of dietary polyphenols in reducing oxidative stress and thrombotic risk

Dietary sources of polyphenols, which are derivatives and/or isomers of flavones, isoflavones, flavonols, catechins and phenolic acids, possess antioxidant properties and therefore might be important in preventing oxidative-stress-induced platelet activation and attenuating adverse haemostatic function. Free radicals, including reactive oxygen and nitrogen species, promote oxidative stress, leading to platelet hyperactivation and the risk of thrombosis. The consumption of antioxidant/polyphenol rich foods might therefore impart anti-thrombotic and cardiovascular protective effects via their inhibition of platelet hyperactivation or aggregation. Most commonly-used anti-platelet drugs such as aspirin block the cyclooxygenase (COX)-1 pathway of platelet activation, similar to the action of antioxidants with respect to neutralising hydrogen peroxide (H2 O2 ), with a similar effect on thromboxane production via the COX-1 pathway. Polyphenols also target various additional platelet activation pathways (e.g. by blocking platelet-ADP, collagen receptors); thus alleviating fibrinogen binding to platelet surface (GPIIb-IIIa) receptors, reducing further platelet recruitment for aggregation and inhibiting platelet degranulation. As a result of the ability of polyphenols to target additional pathways of platelet activation, they may have the potential to substitute or complement currently used anti-platelet drugs in sedentary, obese, pre-diabetic or diabetic populations who can be resistant or sensitive to pharmacological anti-platelet therapy.

Cortisol and proinflammatory cytokine profiles in type 1 (reversal) reactions of leprosy

PURPOSE

Cortisol levels in the circulation and at the sites of peripheral inflammation regulate type 1 (Reversal) reactions in leprosy akin to delayed type hypersensitivity reactions (DTH). In this study we determine the extent to which the differential mRNA expression of genes encoding cortisone-cortisol shuttle enzymes (11 β hydroxysteriod dehydrogenase I & II (11 β HSD I & II)), circulatory levels of proinflammatory cytokines (IL-6, IL-7, IP-10, IL-17F, IL-23, TNF-α, IL-1β, PDGF BB and CRP) and cortisol are associated with development of type 1 reactions in leprosy.

METHODS

Urine, blood and incisional skin biopsy samples from site of lesions were collected from 49 newly diagnosed untreated leprosy cases in T1R and 51 cases not in reaction (NR). mRNA expression levels of genes encoding 11 β HSD I & II in skin biopsy samples were determined by realtime PCR. Cortisol levels from the lesional skin biopsies, serum and urine samples and serum proinflammatory cytokine levels were measured using ELISA.

RESULTS

The mean expression ratios of 11 β HSD I & II are significantly lower in leprosy cases with T1R when compared to the NR leprosy cases. Cortisol levels in lesional skin biopsies and in urine are significantly lower (p=0.001) in leprosy cases with T1R. Serum cytokine levels of IP-10, IL-17F, IL-IL-6 and TNF-α are significantly higher (p<0.05) in leprosy cases with T1R when compared the NR leprosy cases.

CONCLUSION

Our study indicated an association of urinary and lesional skin cortisol levels with the manifestation of T1R in leprosy. IP-10, IL-17F, IL-6 and TNF-α can be potential prognostic serological markers and gene expression markers for early detection of type 1 reactions in leprosy.

Evaluation of fully covered self-expanding metal stents in benign biliary strictures and bile leaks

AIM: To investigate the use of fully covered metal stents in benign biliary strictures (BBS) and bile leaks.

METHODS: We studied 17 patients, at Harbor-UCLA Medical center (Los Angeles), with BBS (n = 12) and bile leaks (n = 5) from July 2007 to February 2012 that had received placement of fully covered self-expanding metal stents (FCSEMs). Fourteen patients had endoscopic placement of VIABIL^® (Conmed, Utica, New York, United States) stents and three had Wallflex^® (Boston Scientific, Mass) stents. FCSEMS were 8 mm or 10 mm in diameter and 4 cm to 10 cm in length. Patients were followed at regular intervals to evaluate for symptoms and liver function tests. FCSEMS were removed after 4 or more weeks. Resolution of BBS and leak was documented cholangiographically following stent removal. Stent patency can be defined as adequate bile and contrast flow from the stent and into the ampulla during endoscopic retrograde cholangiopancreatography (ERCP) without clinical signs and/or symptoms of biliary obstruction. Criterion for bile leak resolution at ERCP is defined as absence of contrast extravasation from the common bile duct, cystic duct remanent, or gall bladder fossa. Rate of complications such as migration, and in-stent occlusion were recorded. Failure of endoscopic therapy was defined as persistent biliary stenosis or continuous biliary leakage after 12 mo of stent placement.

RESULTS: All 17 patients underwent successful FCSEMS placement and removal. Etiologies of BBS included: cholecystectomies (n = 8), cholelithiasis (n = 2), hepatic artery compression (n = 1), pancreatitis (n = 2), and Whipple procedure (n = 1). All bile leaks occurred following cholecystectomy. The anatomic location of BBS varied: distal common bile duct (n = 7), common hepatic duct (n = 1), hepaticojejunal anastomosis (n = 2), right intrahepatic duct (n = 1), and choledochoduodenal anastomatic junction (n = 1). All bile leaks were found to be at the cystic duct. Twelve of 17 patients had failed prior stent placement or exchange. Resolution of the biliary strictures and bile leaks was achieved in 16 of 17 patients (94%). The overall median stent time was 63 d (range 27-251 d). The median stent time for the BBS group and bile leak group was 62 ± 58 d (range 27-199 d) and 92 ± 81 d (range 48-251 d), respectively. All 17 patients underwent successful FCSEMS removal. Long term follow-up was obtained for a median of 575 d (range 28-1435 d). Complications occurred in 5 of 17 patients (29%) and included: migration (n = 2), stent clogging (n = 1), cholangitis (n = 1), and sepsis with hepatic abscess (n = 1).

CONCLUSION: Placement of fully covered self-expanding metal stents may be used in the management of benign biliary strictures and bile leaks with a low rate of complications.

Addressing Antimicrobial Resistance in Dentistry

Background

Antimicrobial agents are life saving drugs which are used in management of various life threatening infections but irrational use of antibiotics have led to resurgence of multidrug resistant bacteria which are associated with global increase in mortality due to various infections. Dentists are one among important health care personnel who prescribe antibiotics routinely to treat various oral infections.

Objectives

To summarise the evidence of antimicrobial resistance (AMR) encountered in dental practice, discuss factors associated with it and suggest measures to prevent antimicrobial resistance in dentistry.

Methodology

Articles were identified by searching in electronic data bases such as PubMed, Medline, Embase, Google Scholar and Cochrane data bases using key words like antibiotics, antimicrobial resistance, and antibiotic resistance in dentistry. The articles fulfilling the objectives were included.

Results and Conclusions

Dentists also contribute significantly to the global burden of antimicrobial resistance due to irrational use of antibiotics. Antibiotic stewardship is essential to prevent antimicrobial resistance in dental practice and hence there is an urgent need to educate not only dentists but general public as well. The article describes the gravity of the AMR and the importance of prudent use of antibiotics is discussed.

Study of histopathological changes in atrophic rhinitis

A punch biopsy from the inferior turbinate was taken in 71 consecutive cases of atrophic rhinitis and studied for histopahtological changes. Squamous metaplasia was seen in 85 percent of cases. Tunica propria showed granulation tissue (41 percent) and chronic inflammatory cellular infiltrate (32 percent). Mucosal glands were decreased in 42 percent of cases and absent in 28 percent. Areas of dilated vessels were observed in 35 percent and decreased vascularity in 59 percent of cases. These observations are similar to those reported by others. Total squamous metaplasia with keratinisation and hypertrophy was seen by us in one case. This has not been reported earlier.

The overweight: obesity and plasma lipids in adults with intellectual disability and mental illness

BACKGROUND

Previous studies in adults with intellectual disabilities (ID) have reported a higher prevalence of obesity than in the general population, and a trend to an increase in the prevalence of excess weight. However, little information is available on body weight status and lipids levels of adults with ID and co-existing mental illness. The aim of this study was to address this information gap, by conducting a stepwise multiple regression analysis to predict BMI, thereby allowing the investigation of (semi-)partial correlations, which assess the extent to which a particular predictor variable is associated with BMI over and above the other predictors.

METHODS

A study of the patients with ID and psychiatric illness registered in the service. Collected data included body mass index (BMI), age, gender, the presence of additional physical conditions, residential status, mental illness and use the psychotropic medication. We analysed the lipid profile including serum cholesterol together with low-density lipoprotein, high-density lipoprotein (HDL), triglycerides and the serum cholesterol/HDL ratio. Data for these variables were entered into a stepwise multiple linear regression to predict BMI.

RESULTS

28% of the participants were overweight and 41% obese. Most of the obese patients were men with mild ID (P = 0.039). Level of ID (P = 0.003), gender (P = 0.001) and serum triglycerides (P = 0.026) had significant predictive value in the regression model. There were no significant differences in either the mean serum cholesterol levels or the mean triglyceride levels between those taking and those not taking first-generation antipsychotics, second-generation antipsychotics or anti-epileptic medication.

CONCLUSIONS

The rate of obesity in our sample was higher than in previous studies. The most predictive combination of predictors to predict BMI was ID level, gender and serum triglyceride levels. Serum triglyceride and cholesterol levels did not appear to be unduly affected by first- or second-generation antipsychotic medication or by antiepileptic medication.

228 DOMINANT FOLLICLE ABLATION IMPROVES SUPEROVULATORY RESPONSE AND EMBRYO YIELD IN BUFFALOES SUBJECTED TO INTEGRATED SINGLE-OVULATION EMBRYO TRANSFER - MULTIPLE-OVULATION EMBRYO TRANSFER PROGRAM

Effect of the removal of inhibitory consequences of a dominant follicle (DF) on the recruitment, growth and ovulation of follicles in cyclic buffaloes induced to superovulate, was evaluated. Eight elite, multiparous, donor Murrah buffaloes, 80 to 120 days postpartum, were included in an integrated single-ovulation embryo transfer–multiple-ovulation embryo transfer (SOET-MOET) schedule. Superovulation with FSH (Folltropin® NIH-FSH-P1, Bioniche Animal Health, Belleville, ON, Canada) was preceded by nonsurgical single embryo (SOET) recovery on Day 5 or 6 after prostaglandin F2α (Lutalyse®, Pfizer, Madison, NJ, USA)-induced oestrus and AI (Day 0). For MOET, Folltropin was administered from Day 9 p.m. through to Day 13 p.m. in a twice-daily descending dose schedule (0–5, 5–4, 4–3, 3–2, 2–1 mL; total dose of 580 mg of NIH-FSH-P1). A dose of 25 mg of Lutalyse was administered on Day 12 a.m. and p.m. Donors were inseminated with proven semen on Day 14 a.m. and p.m. and Day 15 a.m. Nonsurgical embryo collection was carried out on Day 19 or 20 followed by administration of Lutalyse on Day 25. Following sexual rest for one complete oestrous cycle, Day 5 or 6 SOET was repeated. On Day 9, ultrasound-guided follicle aspiration was used to ablate the DF and the second MOET treatment was initiated at the same time. Mean diameter of DF at the start of superovulation treatment on Day 9 was similar between the first (12.5 ± 0.66 mm) and second (12.2 ± 0.33 mm) MOET cycles. At AI, mean number (9.6 ± 1.43 vs 13.4 ± 1.87) of follicles >9 mm were higher (P < 0.05) in the second (ablation) MOET cycle, though their mean diameters were similar (11.7 ± 0.21 vs 12.3 ± 0.21 mm; P = 0.17). On the day of ova/embryo collection, almost similar numbers of large follicles (4.1 ± 0.93 and 4.4 ± 0.84), with mean diameters of 12.9 ± 0.74 and 13.4 ± 0.83 mm, were observed for the first and second MOET, respectively. Mean (± SEM) numbers of corpora lutea (3.9 ± 0.81 and 4.9 ± 0.61; P = 0.19) and transferable quality embryos (0.6 ± 0.37 and 1.6 ± 0.37; P = 0.077) were counted in the first and second (ablation) MOET cycles, respectively. These preliminary findings suggest that ablation of DF before start of superovulatory treatment may be beneficial in improving the yield of transferable embryos in a buffalo MOET program. Director, CIRB, is acknowledged for the experimental facilities.

Age, breed, sex distribution and nutrition of a population of working farm dogs in New Zealand: results of a cross-sectional study of members of the New Zealand Sheep Dog Trial Association

AIM

To establish baseline information about age, breed, sex distribution and feeding practices for a population of working farm dogs owned by members of the New Zealand Sheep Dog Trial Association (NZSDTA) throughout New Zealand.

METHODS

Questionnaires were sent to members of the NZSDTA in August 2007, requesting information on the size and terrain of the farms where they worked, as well as the breed, weight, age and sex of each working dog they owned, feeding regime employed, diet fed, work levels, and general health of their dogs.

RESULTS

The survey was completed by 542/676 (81%) of the eligible sample population, and provided information on 2,861 dogs, excluding those <1 year old. All of the dog owners surveyed worked on sheep and beef-cattle farms. The median farm size was 440 [Inter-quartile range (IQR) 132-1,200] ha and varied with region. The majority of farms were situated on either hill country (184/542; 34%) or a mixture of hilly and flat terrain (260/542; 48%), and had a median of six (IQR 5-8) working dogs per farm. The median age of dogs was 3.0 (IQR 2.0-6.0) years. Heading dogs were the most common type of working dog (1,510/2,861; 52.8%), followed by Huntaways (1,161/2,861; 40.6%). The gender distribution of all dogs was biased towards males (57%), but this decreased with age. There was a positive association between the number of dogs on a farm and perceived level of tiredness of dogs (p<0.001), but there were no differences in levels of tiredness between farms of different terrain. Most owners (526/542; 97%) fed their dogs once a day. The most common diet fed was a combination of dry food and homekill, which was fed by 328/542 (61%) owners during peak and 313/542 (58%) during off-peak periods of work.

CONCLUSIONS AND CLINICAL RELEVANCE

This study has established baseline information on the age, breed, gender and nutrition of a large population of working farm dogs in New Zealand. Current feeding practices employed by owners include offering a substantial amount of homekill to their animals. Homekill may be deficient or marginal in vitamins and minerals, therefore opportunities could exist to improve the diets and therefore the longevity and performance of these dogs.

Trace metal concentration in different Indian tobacco products and related health implications

Concentrations of seven heavy metals, viz. Cd, Ni, Pb, Cr, Cu, Fe and Zn were determined in 30 samples of various brands of five different tobacco product types easily available in Indian markets. Three product types cigarettes, cigars and biri (tobacco rolled in dry leaf and smoked without filter) are consumed by smoking while chewing tobacco and snuff are consumed by chewing and sniffing, respectively. The metal content showed smoking and non-smoking type, brand and element specific variations. In the non-smoking type, chewing tobacco samples contained more heavy metals compared to snuff samples. Biri showed minimum metal content compared to cigarettes and cigars among the smoking types. This could be due to the metal enrichment during both chemical and physical processing in finished product; biri being the most raw and cheap product. The intra brand variations also indicate the same as the processing technologies are exclusive and different for each brand. The results are nearly comparable to the existing data with limited exceptions. We suggest that the smoke and ash produced could be significant contributor to metal load in the soil, air and water systems in addition to the adverse human health effects via direct tobacco consumption.

Perioperative risk predictors of cardiac outcomes in patients undergoing liver transplantation surgery

BACKGROUND

Cardiac risk assessment for perioperative outcomes of liver transplantation patients is limited. We examined the outcomes of an older intermediate-cardiac-risk group of patients undergoing liver transplantation surgery.

METHODS AND RESULTS

Patients who had liver transplantation surgery between 2001 and 2005 were studied. The 3 outcomes analyzed were nonfatal myocardial infarction, death, and either outcome within the first 30 days after the liver transplantation surgery. Of 403 patients (mean age, 52+/-9 years; 67% male), 106 (26%) were diabetic, 84 (21%) were hypertensive, and 173 (43%) had a history of smoking. There were 48 total events (12%), 25 myocardial infarctions (7%), and 38 deaths (9%) recorded during the perioperative period. From the final multivariate model, history of coronary artery disease, prior stroke, and postoperative sepsis predicted greater risk (P=0.014; odds ratio [OR], 4.0; 95% confidence interval [CI], 1.3 to 11.8; P=0.025; OR, 6.6; 95% CI, 1.3 to 33.8; and P<0.001; OR, 7.5; 95% CI, 3.3 to 17.1, respectively). Use of perioperative beta-blockers was protective (P=0.004; OR, 0.20; 95% CI, 0.1 to 0.6) for combined cardiac outcomes. For the outcome of death on multivariate analysis, postoperative sepsis and increased interventricular septal thickness predicted risk (P<0.001; OR, 8.6; 95% CI, 3.5 to 20.9; and P=0.027; OR, 2.8; 95% CI, 1.1 to 7.2, respectively), whereas the use of perioperative beta-blockers was again protective (P=0.012; OR, 0.07; 95% CI, 0.01 to 0.56).

CONCLUSIONS

In our study of cardiac risk assessment for liver transplantation surgery, history of stroke, coronary artery disease, postoperative sepsis, and increased interventricular septal thickness were markers of adverse perioperative cardiac outcomes, whereas use of perioperative beta-blockers was significantly protective.

Dermatophytes, related keratinophilic and opportunistic fungi in indoor dust of houses and hospitals

Dermatophytes, related keratinophilic and opportunistic fungi were isolated from indoor dust samples of 46 hospitals and 47 houses in Kanpur. A total of 19 fungi represented by 11 genera were isolated by the hair-baiting technique from 230 and 235 samples from hospitals and houses respectively. The isolated fungi are Acremonium implicatum (Indian Type Culture Collection) ITCC 5266, A. strictum (Germplasm Centre for Keratinophilic Fungi) GPCK 1137, Aphanoascus fulvescens GPCK 1081, Arthroderma simii GPCK 1275, Chrysosporium queenslandicum ITCC 5270, C. indicum ITCC 5269, C. pannicola GPCK 1022, C. tropicum GPCK 1269, Ctenomyces serratus ITCC 5267, Gymnoascus reessii ITCC 5265, Malbranchea fulva GPCK 1075, Malbranchea pulchella ITCC 5268, Micosporum gypseum GPCK 1038 , Microsporum cookei GPCK 2001, M. fulvum GPCK 2002, Paecilomyces lilacinum GPCK 1080, Penicillium expansum GPCK 1082, Trichophyton mentagrophytes GPCK 2003 and T. terrestre GPCK 2004. In hospitals, the minimum frequency was of Ctenomyces serratus ITCC 5267 while the maximum frequency was of Arthroderma simii GPCK 1275. In houses, Chrysosporium queenslandicum ITCC 5270 and C. tropicum GPCK 1269 were with minimum and maximum frequencies respectively. This makes the first report of these fungi with keratinolytic ability in the indoor dust of hospitals and houses.

The effect of exercise and training status on platelet activation: Do cocoa polyphenols play a role?

Sedentary and trained men respond differently to the same intensity of exercise, this is probably related to their platelet reactivity and antioxidant capacity. There is growing interest in the utilization of antioxidant-rich plant extracts as dietary food supplements. The aim of this study was to investigate the effect of an acute bout of sub maximal exercise on platelet count and differential response of platelet activation in trained and sedentary subjects and to observe if cocoa polyphenols reverse the effect of exercise on platelet function. The practical significance of this study was that many sedentary people engage in occasional strenuous exercise that may predispose them to risk of heart disease. Fasting blood samples were collected from 16 male subjects, pre and post 1-h cycling exercise at 70% of maximal aerobic power (VO2max) before and after consumption of cocoa or placebo. Agonist stimulated citrated whole blood was utilized for measuring platelet aggregation, adenosine triphosphate (ATP) release and platelet activation. Baseline platelet count (221 +/- 33 x 10(9)/L) and ATP release (1.4 +/- 0.6 nmol) increased significantly (P < 0.05) after exercise in all subjects. Baseline platelet numbers in the trained were higher (P < 0.05) than in the sedentary (235 +/- 37 vs. 208 +/- 34 x 10(9)/L), where as platelet activation in trained was lower (P < 0.05) than sedentary (51 +/- 6 vs. 59 +/- 5%). Seven days of cocoa polyphenol supplementation had little effect on any of the parameters measured. We conclude that trained subjects show decreased activation of stimulated platelets when compared to the sedentary subjects and short-term cocoa polyphenol supplementation did not decrease platelet activity in response to exercise independent of prior training status.

Rickettsial diseases in Haryana: not an uncommon entity

Rickettsioses have not been reported from the plains of North India and Haryana in particular. Here we are reporting three cases of scrub typhus and one cases of Indian tick typhus in the state of Haryana, all of which presented with fever and multi organ dysfunction, rash and without eschar. All were successfully treated with doxycycline.

Abstract B68: Emblica officinalis, a citrus flavonone, protects against radiation-induced chromosomal damage in Swiss albino mice bone marrow

B68

Free radicals are responsible for the induction of damage to the cellular DNA that leads to the formation of chromosome aberrations.

Antioxidants are known to scavenge free radicals,thereby decreasing the degree of such effects.Radiation is a well-known inducer of free radicals and compounds that can scavenge free radicals may reduce radiation-induced DNA damage. Emblica officinalis (Amla) a bioflavonoid predominant in citrus fruits, has been found to scavenge free radicals, therefore it may also reduce radiation-induced damage. The aim of the present study was to evaluate the radioprotection action of 100 mg/kg Emblica in the bone marrow of mice exposed to different doses of Co60 gamma radiation by scoring the frequency of asymmetrical chromosomal aberrations.The irradiation of mice resulted in a dose-dependent elevation in the frequencey of aberrent cells, acentric fragments,chromatid and chromosome breaks, dicentric and exchanges. All these aberrations were elevated with scoring time up to 24 hour post irradiation and declined thereafter, except chromatid breaks,which were maximum at 12 hour post-irradiation. Treatment of mice with 100 mg/kg b.wt. Emblica officinalis before exposure to various doses of gamma radiation resulted in a significant reduction in the frequencies of aberrent cells and chromosomal aderrations like acentric fragments,chromatid and chromosomal breaks, centric rings, dicentrics, and exchanges. The evaluation of free radical scavenging activity of Emblica officinalis revealed a dose-dependent scavenging of hydroxyal,superoxide and 2,2'-diphenyl-1-picrylhydrazyl radical.Our study demonstrates that Emblica officinalis can protects mouse bone marrow cells against radiation-induced chromosomal damage.

Citation Information: Cancer Prev Res 2008;1(7 Suppl):B68.

Abstract A124: Radiomodulation by rosemary extract

A124

Radiomodulation by rosemary extract

Dhanraj Soyal, Abhilasha Sharma, Inder Singh and P.K.Goyal+

Radiation and Cancer Biology Laboratory, Department of Zoology,

Rajasthan University, Jaipur 302004

* E-mail; pkgoyal2002@rediffmail.com

Rosemary (Rosmarinus officinalis, Labiateae) is widely used for its antioxidant activities in many parts of the world. The present study investigates the radioprotective and antioxidative potential of rosemary leaves extract (ROE). Swiss albino mice were administered ROE orally once daily for 5 consecutive days, then exposed to a single dose of 3, 6 and 9 Gy of gamma radiation. lipid peroxidation (LPx), Glutathione (GSH), acid phosphatase estimations in liver were carried out. Radiation-induced increases in the levels of lipid peroxidation (LPO) and acid phosphatase were significantly ameliorated by ROE pre-treatment, and radiation-induced depletion in the level of glutathione (GSH) was significantly inhibited by ROE administration. These alterations were found to be dose dependent. The life-span was increased in the ROE treated irradiated mice in comparison with their respective control mice. Radiation-induced deficits in body and organ weight were significantly reduced or prevented in ROE pretreated mice. The protection afforded by ROE may be attributed to the constituents of the rosemary, which include rosmarinic acid, rosmanol, carnosol which appear to play an important role in free radical scavenging and singlet oxygen quenching. The study does not rule out the possibility of a prophylactic potential of ROE against radiation-induced degenerative changes in liver.

Citation Information: Cancer Prev Res 2008;1(7 Suppl):A124.

Predicting Global Fund grant disbursements for procurement of artemisinin-based combination therapies

BACKGROUND

An accurate forecast of global demand is essential to stabilize the market for artemisinin-based combination therapy (ACT) and to ensure access to high-quality, life-saving medications at the lowest sustainable prices by avoiding underproduction and excessive overproduction, each of which can have negative consequences for the availability of affordable drugs. A robust forecast requires an understanding of the resources available to support procurement of these relatively expensive antimalarials, in particular from the Global Fund, at present the single largest source of ACT funding.

METHODS

Predictive regression models estimating the timing and rate of disbursements from the Global Fund to recipient countries for each malaria grant were derived using a repeated split-sample procedure intended to avoid over-fitting. Predictions were compared against actual disbursements in a group of validation grants, and forecasts of ACT procurement extrapolated from disbursement predictions were evaluated against actual procurement in two sub-Saharan countries.

RESULTS

Quarterly forecasts were correlated highly with actual smoothed disbursement rates (r = 0.987, p < 0.0001). Additionally, predicted ACT procurement, extrapolated from forecasted disbursements, was correlated strongly with actual ACT procurement supported by two grants from the Global Fund's first (r = 0.945, p < 0.0001) and fourth (r = 0.938, p < 0.0001) funding rounds.

CONCLUSION

This analysis derived predictive regression models that successfully forecasted disbursement patterning for individual Global Fund malaria grants. These results indicate the utility of this approach for demand forecasting of ACT and, potentially, for other commodities procured using funding from the Global Fund. Further validation using data from other countries in different regions and environments will be necessary to confirm its generalizability.

Dendrimers and their pharmaceutical applications--a review

Dendrimers are hyperbranched macromolecules having tree like structure, consisting of a core molecule and alternating layers of monomers. They can be synthesized by divergent and convergent growth methods. During synthesis, properties like dendrimer size, molecular mass, surface group can be controlled and configured to the desired need. The ability of dendrimers to encapsulate and bind the guest molecule can be used for solubility enhancement, sustained release and drug delivery applications. In this review we tried to delineate the properties, synthesis methods and expound potential pharmaceutical applications along with toxicological considerations of dendrimers.

Medullary carcinoma in a lingual thyroid

Total ectopia of thyroid is a rare phenomenon and malignant change in an ectopic thyroid is even rarer. We report a case of medullary carcinoma in a total ectopic lingual thyroid occurring in a 45-year-old woman who presented with dysphagia, plummy voice and a round sessile mass at the base of the tongue. The mass was extirpated using Trotter's midline approach. Upon examination, it was found to be medullary carcinoma in an ectopic thyroid. Permanent substitution therapy with thyroxine secured the euthyroid status of the patient. The embrylogical basis and a review of literature regarding carcinomatous change in an ectopic thyroid are also discussed. There is a need to investigate for an ectopic thyroid, or even total ectopia, in the case of any smooth mass found at the base of the tongue.

The morphology of central tympanic membrane perforations

The objective of this study was to assess the extent of conductive hearing loss in relation to different sizes and sites of simple central tympanic membrane perforations. Total 100 cases attending ENT OPD, BPKIHS during period of April 2003 to Mar 2004 without any discrimination of sex, race and religion were taken for the cross sectional prospective study. Dry, clean central tympanic membrane perforations due to various causes like chronic suppurative otitis media-tubotympanic, post acute suppurative otitis media residual perforations or simple traumatic perforations with conductive hearing loss and without preexisting hearing loss were clinicoaudiologically evaluated and analyzed. Hearing loss was found to be directly proportional to the size of perforation irrespective of their cause, which was statistically significant. Hearing loss in the study was found to range from negligible to 53dB. Overall, perforations involving posterioinferior quadrant were found to have maximum hearing loss.

Why are we waiting? A study of the patients' perspectives about their protracted stays in an emergency department

The overcrowding of Emergency Departments compromises their critical function and the safety of patients and staff. This study asked the patients how the wait in overcrowded conditions impacted on them and the care they received and what they believed the reasons for the overcrowding were. A prospective questionnaire based structured interview study was performed. Over half (57.7%) of patients felt that the lack of inpatient beds and wards was the main reason that they experienced delays. An overwhelming 85.9% felt that the Health Authorities were not doing enough to address the overcrowding issue. Overcrowding of Emergency Departments has been identified as a major problem the solution is to be found in increasing the capacity of the acute hospital system according to the majority of our study population.