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Kannan O Ahmed,1 Imad Taj Eldin,2 Mirghani Yousif,1 Ahmed A Albarraq,3 Bashir A Yousef,4 Nasrein Ahmed,5 Anas Babiker6 1Department of Clinical Pharmacy, Faculty of Pharmacy, University of Gezira, Wad Medani, Sudan; 2Department of Pharmacology, Faculty of Pharmacy, University of Gezira, Wad Medani, Sudan; 3Pharmacy Practice Research Unit, Department of Clinical Pharmacy, College of Pharmacy, Jazan University, Jazan, Saudi Arabia; 4Department of Pharmacology, Faculty of Pharmacy, University of Khartoum, Khartoum, Sudan; 5Department of Cardiology, Ahmed Gasim Cardiac Surgery and Renal Transplantation Centre, Khartoum, Sudan; 6Department of Cardiology, Royal Care International Hospital, Khartoum, SudanCorrespondence: Kannan O AhmedDepartment of Clinical Pharmacy, Faculty of Pharmacy, University of Gezira, Hospital Street No. 1, Wad Medani, 21112, SudanTel +249 121860001Fax +249 511861180Email omerkannan@gmail.comBackground: Medications known to improve outcomes in heart failure (HF) are either not prescribed or prescribed at sub-therapeutic doses. The addition of clinical pharmacists to the HF team positively impacts optimizing prognostic medications for a patient with HF with reduced ejection fraction (HFrEF).Objective: To assess the intervention of the clinical pharmacist as part of the multidisciplinary (MD) team in up-titration to achieve target doses of key therapeutic agents for HFrEF.Methods: This was a prospective one group pretest-posttest interventional study; a comparison of the target dose achievement of key therapeutic agents for HFrEF was performed before and after clinical pharmacist interventions.Results: Out of 110 HFrEF patients, 57.3% were males, and the mean age of patients was 55.8 years (SD 12.6). Cardiomyopathy was the leading cause of HF. At baseline, 86% were on angiotensin-converting enzyme inhibitors/angiotensin receptor blockers/angiotensin receptor-neprilysin inhibitors (ACEIs/ARBs/ARNi) and 93.6% on beta blockers (BBs). At the end of study, the proportion of patients achieved the target dose was significantly increased (0 vs 77.4%, 6.8 vs 85.4%, and 0 vs 55.6%) for ACEIs, ARBs and ARNi, respectively, and (8.6% vs 66.1%; P = 0.001) for BBs. Moreover, the up-titration process was associated with significant improvement in most clinical as ejection fraction and New York Heart Association (NYHA) scale and laboratory characteristics.Conclusion: As a part of the MD team in the outpatient HF clinic, the clinical pharmacists increased the percentage of HFrEF patients achieving the target or maximal doses of key therapeutic agents and improving clinical and laboratory parameters.Keywords: clinical pharmacist, intervention, heart failure, medications titration, Sudan

Background: The growth rate of elderly is the fastest in most of the developing countries including Bangladesh. Nutrition plays fundamental role in maintaining good health especially in old age. This study was an attempt to assess the nutritional status of elderly and to compare it with their location.Methods: A total of 400 elderly in urban and rural area of Sunamgonj district have been interviewed through a structured questionnaire during July to September, 2019. A person aged 60 and above is included in the sample. Body mass index (BMI), mini nutritional assessment (MNA) short form, descriptive statistics, and Chi square test for association have been used for data analysis.Results: The analysis revealed that 17 percent elderly were under-weight, 66 percent were normal nutrition, 13 percent were over-weight and 4 percent were obese. The prevalence of malnutrition was found to be 40 percent. The rural elderly were at more risk of being malnourished compared to urban elderly. The mean BMI and MNA score of urban elderly were significantly different from the rural elderly.Conclusions: The findings show that more proportion of urban elderly are over-weight and obese compared to rural elderly. Therefore, measures should be taken to improve the nutrition status of elderly especially in rural area.

This study was investigated with the time series data to know the trend of foreign visitors in Bangladesh. To estimate the trend of visitors, data was used for the year 1976–2008. The several growth models were used and found that semi-log trend model was more suitable for foreign visitors. It is also found that the number of foreign tourists visiting Bangladesh has registered a significantly upward trend with a growth rate of 5.79 percent per annum. The monthly arrivals data reveal pronounced seasonality. The best arrival month is January with seasonal index of 122.99 percent which implies that seasonally arrivals are increased by 22.99 percent in that month. September is the slower or worse month with seasonal index 81.81 percent which implies that seasonally arrivals are decreased by 18.19 percent in the month.

We assessed response to immunisation with trivalent split virus influenza vaccine in children with non-leukaemic malignant disease. Children with solid tumours and lymphoma received one or two doses of influenza vaccine, according to current UK guidelines, in autumn 2001 and/or 2002. Children were currently receiving chemotherapy or were within 6 months of completing chemotherapy. Pre and post vaccination sera were assessed for antibodies to the prevalent influenza strains by haemagglutination inhibition (HI). Sixty six children were assessed prior to 69 episodes of vaccination. In 30% episodes, children were susceptible to all three circulating influenza viruses (65% to H1N1, 42% to H3N2 and 90% to B) and only one patient showed protective titres (HI ⩾ 32) against all three strains. Seroresponse rates (⩾4-fold rise in HI) for H1N1, H3N2 and B were 52%, 33% and 51% in 65 episodes. Following immunisation protective titres to all three viruses were seen in 25 episodes (38%) and protective responses to one or two viruses were seen in a further 12 (19%) episodes. There was no significant difference in response rates among children on treatment and off treatment and by intensity of chemotherapy. Children with solid tumours and lymphoma are highly susceptible to influenza infection. Influenza vaccine was well tolerated in this patient group and children showed a significant response to immunisation. These findings support the recommendation for annual influenza vaccination in these children.

BACKGROUND Mxi1, an antagonist of c-Myc, maps to human chromosome 10q24-q25, a region altered in a substantial fraction of prostate tumors. Mice deficient for Mxi1 exhibit significant prostate hyperplasia. We studied the ability of Mxi1 to act as a growth suppressor in prostate tumor cells. METHODS We infected DU145 prostate carcinoma cells with an Mxi1-expressing adenovirus (AdMxi1) in vitro, and measured Mxi1 expression, cell proliferation, soft agar colony formation, and cell cycle distribution. To explore mechanisms of Mxi1-induced growth arrest, we performed gene expression analysis. RESULTS AdMxi1 infection resulted in reduced cell proliferation, reduced soft agar colony formation, and a higher proportion of cells in the G2/M phase of the cell cycle. This G2/M growth arrest was associated with elevated levels of cyclin B, and reduced levels of c-MYC and MDM2. CONCLUSIONS The ability of AdMxi1 to suppress prostate tumor cell proliferation supports a role for Mxi1 loss in the pathogenesis of a subset of human prostate cancers. Prostate 47:194–204, 2001. © 2001 Wiley-Liss, Inc.

Background Diabetes mellitus is a heterogeneous group of disorders characterized by abnormalities of carbohydrate, protein and lipid metabolism. Type 1 diabetes mellitus is an autoimmune disease caused by destruction of pancreatic beta cells and characterized by defect in insulin secretion while type 2 diabetes mellitus results from abnormalities in insulin secretion and/or insulin action or both. Objectives The present study was conducted to investigate the clinical hypoglycemic effects of Allium cepa in type 1 and type 2 diabetic patients. Results In assessment of hypoglycaemic activity of Allium cepa in type 1 and type 2 diabetic patients, ingestion of crude Allium cepa (100 g) caused a considerable reduction in fasting blood glucose levels by about 89 mg/dl in relation to insulin (145 mg/dl) in type 1 diabetic patients and it reduced fasting blood glucose levels by 40 mg/dl, compared to glibenclamide (81 mg/dl) in type 2 diabetic patients, 4 hours later. The same dose of crude Allium cepa produced a significant reduction in the induced hyperglycemia (GTT) by about 120 mg/dl compared to water (77 mg/dl) and insulin (153 mg/dl) in type 1 diabetic patients and considerably reduced GTT by 159 mg/dl in relation to water (55 mg/dl) and glibenclamide (114 mg/dl) in type 2 diabetic patients, after 4 hours. Conclusion It was evident that, crude Allium cepa produced hypoglycemic effects, thus it could be used as a dietary supplement in management of type 1 and/or type 2 diabetes mellitus.

Limited information is available on the use of positron emission tomography (PET) in paediatric oncology. The aim of this study was to review the impact of PET on the management of paediatric patients scanned over a 10-year period. One hundred and sixty-five consecutive oncology patients aged 11 months to 17 years were included. Two hundred and thirty-seven scans were performed. Diagnoses included lymphoma (60 patients), central nervous system (CNS) tumour (59), sarcoma (19), plexiform neurofibroma with suspected malignant change (13) and other tumours (14). A questionnaire was sent to the referring clinician to determine whether the PET scan had altered management and whether overall the PET scan was thought to be helpful. One hundred and eighty-nine (80%) questionnaires for 126 patients were returned (63 relating to lymphoma, 62 to CNS tumours, 30 to sarcoma, 16 to plexiform neurofibroma and 18 to other tumours). PET changed disease management in 46 (24%) cases and was helpful in 141 (75%) cases. PET findings were verified by histology, clinical follow-up or other investigations in 141 cases (75%). The returned questionnaires indicated that PET had led to a management change in 20 (32%) lymphoma cases, nine (15%) CNS tumours, four (13%) sarcomas, nine (56%) plexiform neurofibromas and four (22%) cases of other tumours. PET was thought to be helpful in 47 (75%) lymphoma cases, 48 (77%) CNS tumours, 24 (80%) sarcomas, 11 (69%) neurofibromas and 11 (61%) cases of other tumours. PET findings were verified in 44 (70%) lymphoma cases, 53 (85%) CNS tumours, 21 (70%) sarcomas, 12 (75%) neurofibromas and 11 (61%) other tumour cases. PET imaging of children with cancer is accurate and practical. PET alters management and is deemed helpful (with or without management change) in a significant number of patients, and the results are comparable with the figures published for the adult oncology population.

Background Bezoars result from the accumulation of ingested foreign material in the form of masses or concretions and consist of three major types depending on their composition: (1) phytobezoars (compressed vegetable matter), (2) trichobezoars (hair), (3) pharmacobezoars (compacted amounts of undigested medication). Symptoms may vary depending on the location of the bezoar. Gastric bezoars may present with abdominal pain, nausea, vomiting, early satiety, anorexia, and gastric outlet obstruction, whereas esophageal bezoars present with dysphagia, odynophagia, and regurgitation of food. Therapy for bezoars should be tailored to the composition of the concretion and to the underlying pathophysiologic process. Available treatment methods include chemical dissolution, endoscopy, or surgery. Case Report A 56-year-old African American, female, active smoker with a history of CNS toxoplasmosis, HIV on highly active antiretroviral therapy (HAART) treatment, and bronchial asthma presented with dysphagia, odynophagia, and regurgitation of solid food. Physical examination and laboratory analysis did not reveal any significant abnormalities. The patient underwent upper GI endoscopy and was found to have a large pill bezoar (2-3 cm) occluding the lumen above a Schatzki ring. The pills were broken using a polypectomy snare and flushed into the stomach and the Schatzki ring was dilated. The patient improved symptomatically and was advised to take crushed pills/liquid medication where possible with a semisolid diet. Teaching Point Pharmacobezoars (most commonly associated with nifedipine, ASA, sucralfate, etc) have become increasingly recognized and are typically found in the lower GI tract. Esophageal bezoars are very rare, and pharmacobezoars as a result of HAART are rarer. The potential for complications in untreated patients emphasizes the importance of early diagnosis and treatment along with prevention of recurrence.