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7. Pharmacies in informal settlements:a retrospective, cross-sectional household and health facility survey in four countries

Author

Bakibinga, P., Kabaria, C., Kasiira, Z., Kibe, P., Kyobutungi, C., Mbaya, N., Mberu, B., Mohammed, S., Njeri, A., Azam, I., Iqbal, R., Nazish, A., Rizvi, N., Shifat Ahmed, S.A.K., Choudhury, N., Alam, O., Khan, A.Z., Rahman, O., Yusuf, R., Odubanjo, D., Ayobola, M., Fayehun, O., Omigbodun, A., Osuh, M., Owoaje, E., Taiwo, O., Lilford, R.J., Sartori, J., Watson, S.I., Diggle, P.J., Aujla, N., Chen, Y.-F., Gill, P., Griffiths, F., Harris, B., Madan, J., Muir, H., Oyebode, O., Pitidis, V., de Albuquerque, J.P., Smith, S., Taylor, C., Ulbrich, P., Uthman, O.A., Wilson, R., Yeboah, G., Collaborative, Improving Health in Slums, Bakibinga, P., Kabaria, C., Kasiira, Z., Kibe, P., Kyobutungi, C., Mbaya, N., Mberu, B., Mohammed, S., Njeri, A., Azam, I., Iqbal, R., Nazish, A., Rizvi, N., Shifat Ahmed, S.A.K., Choudhury, N., Alam, O., Khan, A.Z., Rahman, O., Yusuf, R., Odubanjo, D., Ayobola, M., Fayehun, O., Omigbodun, A., Osuh, M., Owoaje, E., Taiwo, O., Lilford, R.J., Sartori, J., Watson, S.I., Diggle, P.J., Aujla, N., Chen, Y.-F., Gill, P., Griffiths, F., Harris, B., Madan, J., Muir, H., Oyebode, O., Pitidis, V., de Albuquerque, J.P., Smith, S., Taylor, C., Ulbrich, P., Uthman, O.A., Wilson, R., Yeboah, G., and Collaborative, Improving Health in Slums

Abstract

Background: Slums or informal settlements characterize most large cities in LMIC. Previous evidence suggests pharmacies may be the most frequently used source of primary care in LMICs but that pharmacy services are of variable quality. However, evidence on pharmacy use and availability is very limited for slum populations. Methods: We conducted household, individual, and healthcare provider surveys and qualitative observations on pharmacies and pharmacy use in seven slum sites in four countries (Nigeria, Kenya, Pakistan, and Bangladesh). All pharmacies and up to 1200 households in each site were sampled. Adults and children were surveyed about their use of healthcare services and pharmacies were observed and their services, equipment, and stock documented. Results: We completed 7692 household and 7451 individual adults, 2633 individual child surveys, and 157 surveys of pharmacies located within the seven sites. Visit rates to pharmacies and drug sellers varied from 0.1 (Nigeria) to 3.0 (Bangladesh) visits per person-year, almost all of which were for new conditions. We found highly variable conditions in what constituted a “pharmacy” across the sites and most pharmacies did not employ a qualified pharmacist. Analgesics and antibiotics were widely available but other categories of medications, particularly those for chronic illness were often not available anywhere. The majority of pharmacies lacked basic equipment such as a thermometer and weighing scales. Conclusions: Pharmacies are locally and widely available to residents of slums. However, the conditions of the facilities and availability of medicines were poor and prices relatively high. Pharmacies may represent a large untapped resource to improving access to primary care for the urban poor.

Published
2021

8. Pharmacies in informal settlements : a retrospective, cross-sectional household and health facility survey in four countries

Author

Bakibinga, P., Kabaria, C., Kasiira, Z., Kibe, P., Kyobutungi, C., Mbaya, N., Mberu, B., Mohammed, S., Njeri, A., Azam, I., Iqbal, R., Nazish, A., Rizvi, N., Shifat Ahmed, S.A.K., Choudhury, N., Alam, O., Khan, A.Z., Rahman, O., Yusuf, R., Odubanjo, D., Ayobola, M., Fayehun, O., Omigbodun, A., Osuh, M., Owoaje, E., Taiwo, O., Lilford, R.J., Sartori, J., Watson, S.I., Diggle, P.J., Aujla, N., Chen, Y.-F., Gill, P., Griffiths, F., Harris, B., Madan, J., Muir, H., Oyebode, O., Pitidis, V., de Albuquerque, J.P., Smith, S., Taylor, C., Ulbrich, P., Uthman, O.A., Wilson, R., Yeboah, G., Collaborative, Improving Health in Slums, Bakibinga, P., Kabaria, C., Kasiira, Z., Kibe, P., Kyobutungi, C., Mbaya, N., Mberu, B., Mohammed, S., Njeri, A., Azam, I., Iqbal, R., Nazish, A., Rizvi, N., Shifat Ahmed, S.A.K., Choudhury, N., Alam, O., Khan, A.Z., Rahman, O., Yusuf, R., Odubanjo, D., Ayobola, M., Fayehun, O., Omigbodun, A., Osuh, M., Owoaje, E., Taiwo, O., Lilford, R.J., Sartori, J., Watson, S.I., Diggle, P.J., Aujla, N., Chen, Y.-F., Gill, P., Griffiths, F., Harris, B., Madan, J., Muir, H., Oyebode, O., Pitidis, V., de Albuquerque, J.P., Smith, S., Taylor, C., Ulbrich, P., Uthman, O.A., Wilson, R., Yeboah, G., and Collaborative, Improving Health in Slums

Abstract

Background: Slums or informal settlements characterize most large cities in LMIC. Previous evidence suggests pharmacies may be the most frequently used source of primary care in LMICs but that pharmacy services are of variable quality. However, evidence on pharmacy use and availability is very limited for slum populations. Methods: We conducted household, individual, and healthcare provider surveys and qualitative observations on pharmacies and pharmacy use in seven slum sites in four countries (Nigeria, Kenya, Pakistan, and Bangladesh). All pharmacies and up to 1200 households in each site were sampled. Adults and children were surveyed about their use of healthcare services and pharmacies were observed and their services, equipment, and stock documented. Results: We completed 7692 household and 7451 individual adults, 2633 individual child surveys, and 157 surveys of pharmacies located within the seven sites. Visit rates to pharmacies and drug sellers varied from 0.1 (Nigeria) to 3.0 (Bangladesh) visits per person-year, almost all of which were for new conditions. We found highly variable conditions in what constituted a “pharmacy” across the sites and most pharmacies did not employ a qualified pharmacist. Analgesics and antibiotics were widely available but other categories of medications, particularly those for chronic illness were often not available anywhere. The majority of pharmacies lacked basic equipment such as a thermometer and weighing scales. Conclusions: Pharmacies are locally and widely available to residents of slums. However, the conditions of the facilities and availability of medicines were poor and prices relatively high. Pharmacies may represent a large untapped resource to improving access to primary care for the urban poor.

Published
2021

19. Elemental Analysis of Breast Calcifications

Author

Galkin, B. M., Feig, S. A., Patchefsky, A. S., Muir, H. D., Herfarth, Ch., editor, Senn, H. J., editor, Baum, M., editor, Diehl, V., editor, von Essen, C., editor, Grundmann, E., editor, Hitzig, W., editor, Rajewsky, M. F., editor, Brünner, Sam, editor, and Langfeldt, Bent, editor

Published
1987
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28. Oxidative stress in critical care and vitamins supplement therapy: "a beneficial care enhancing".

Author

ZANZA, C., THANGATHURAI, J., AUDO, A., MUIR, H. A., CANDELLI, M., PIGNATARO, G., THANGATHURAI, D., CICCHINELLI, S., RACCA, F., LONGHITANO, Y., and FRANCESCHI, F.

Abstract

OBJECTIVE: Critical illnesses are a significant public health issue because of their high rate of mortality, the increasing use of the Intensive Care Units and the resulting healthcare cost that is about 80 billion of dollars per year. Their mortality is about 12% whereas sepsis mortality reaches 30-40%. The only instruments currently used against sepsis are early diagnosis and antibiotic therapies, but the mortality rate can also be decreased through an improvement of the patient's nutrition. The aim of this paper is to summarize the effects of vitamins A, B, C and E on the balance between pro-oxidants and anti-oxidants in the critical care setting to confirm "a beneficial care enhancing". MATERIALS AND METHODS: The peer-reviewed articles analyzed were selected from PubMed databases using the keywords "critical care", "intensive care", "critical illness", "sepsis", "nutritional deficiency", "vitamins", "oxidative stress", "infection", and "surgery". Among the 654 papers identified, 160 articles were selected after title and abstract examination, removal of duplicates and of the studies on pediatric population. Finally, only the 92 articles relating to vitamins A, C, E and the B complex were analyzed. RESULTS: The use of vitamins decreased morbidity and mortality in perioperative period and critically ill patients, especially in ICU. Among the most encouraging results, we found that the use of vitamins, both as monotherapy and in vitamins combinations, play a crucial role in the redox balance. Vitamins, especially vitamins A, C, E and the B complex, could help prevent oxidative damage through the breakdown of the oxidizing chemical chain reaction. CONCLUSIONS: Even if the results of the studies are sometimes discordant or inconclusive, the current opinion is that the supplementation of one or more of these vitamins in critically ill patients may improve their clinical outcome, positively affecting the morbidity and the mortality. Further, randomized studies are required to deeply understand the potentiality of a vitamin supplementation therapy and develop homogeneous and standardized protocols to be adopted in every critical care scenario. [ABSTRACT FROM AUTHOR]

Published
2019

29. Non-infarctual ST elevation and acute cardiopulmonary failure in carbon monoxide poisoning: a case report.

Author

LONGHITANO, Y., CANDELLI, M., MUIR, H. A., AUDO, A., MEDA, S., LUMB, P. DENNET, BERGER, J. MARSHALL, PIGNATARO, G., CICCHINELLI, S., ZANZA, C., and FRANCESCHI, F.

Abstract

OBJECTIVE: Carbon monoxide is produced by the incomplete combustion of organic fuel. In the United States, it is responsible for about 500 deaths annually. Increased carboxyhemoglobin concentration and hypoxia disrupt cardiac myocyte integrity and cause dysrhythmias, acute cardiac failure and coronary artery disease. We described a case of a patient with CO-poisoning and ST elevation at ECG precordial leads who developed severe transient heart failure. CASE PRESENTATION: A 57-year-old man was admitted to the emergency department for acute carbon monoxide poisoning that led to respiratory and cardiac failure. The electrocardiogram showed ST elevation in precordial leads, but the coronary angiography was normal. The patient was successfully treated and discharged. Three days later he was readmitted for similar symptoms and subsequently died. We hypothesize that the ECG findings were related to transient coronary vasospasm due to CO poisoning and that acute respiratory and cardiac failure related to carbon monoxide toxicity caused death. CONCLUSIONS: The management of patients poisoned by carbon monoxide requires early identification and intensive treatment and a careful evaluation of the home environment prior to discharge. ST elevation in such patients may be related to coronary vasospasm. [ABSTRACT FROM AUTHOR]

Published
2019

38. Chondrocyte phenotype and cell survival are regulated by culture conditions and by specific cytokines through the expression of Sox-9 transcription factor

Author

Evangelos Kolettas, Muir, H. I., Barrett, J. C., and Hardingham, T. E.

Subjects
Collagen Type IX/genetics, Fetus/cytology, Gene Expression/drug effects/immunology, Antimetabolites, Antineoplastic/pharmacology, Cricetinae, Biglycan, Animals, Lectins, C-Type, Aggrecans, Cell Survival/immunology, Cell Line, Transformed, Mesocricetus, RNA, Messenger/analysis, Apoptosis/drug effects/immunology, SOX9 Transcription Factor, Chondrocytes/*cytology/*immunology, High Mobility Group Proteins/*genetics/immunology, Azacitidine/pharmacology, Insulin-Like Growth Factor I/*pharmacology, Phenotype, Transcription Factors/*genetics/immunology, Proteoglycans/genetics, Proteins/genetics, Extracellular Matrix Proteins, Interleukin-1/*pharmacology, Collagen Type II/genetics
Abstract

OBJECTIVE: To investigate the effects of culture conditions, serum and specific cytokines such as insulin-like growth factor (IGF) 1 and interleukin (IL) 1alpha on phenotype and cell survival in cultures of Syrian hamster embryonic chondrocyte-like cells (DES4(+).2). METHODS: Proteins and RNA extracted from subconfluent and confluent early- and late-passage DES4(+).2 cells cultured in the presence or absence of serum and IL-1alpha or IGF-1 or both cytokines together were analysed for the expression of chondrocyte-specific genes and for the chondrogenic transcription factor Sox-9 by Western and Northern blotting. Apoptosis was assessed by agarose gel electrophoresis of labelled low-molecular weight DNA extracted from DES4(+).2 cells and another Syrian hamster embryonic chondrocyte-like cell line, 10W(+).1, cultured under the different conditions and treatments. RESULTS: Early passage DES4(+).2 cells expressed chondrocyte-specific molecules such as collagen types alpha1(II) and alpha1(IX), aggrecan, biglycan and link protein and collagen types alpha1(I) and alpha1(X) mRNAs, suggesting a prehypertrophic chondrocyte-like phenotype. The expression of all genes investigated was cell density- and serum-dependent and was low to undetectable in cell populations from later passages. Early-passage DES4(+).2 and 10W(+).1 cells survived when cultured at low cell density, but died by apoptosis when cultured at high cell density in the absence of serum or IGF-1. IGF-1 and IL-1alpha had opposite and antagonistic effects on the chondrocyte phenotype and survival. Whereas IL-1alpha acting alone suppressed cartilage-specific gene expression without significantly affecting cell survival, IGF-1 increased the steady-state mRNA levels and relieved the IL-1alpha-induced suppression of all the chondrocyte-specific genes investigated; it also enhanced chondrocyte survival. Suppression of the chondrocyte phenotype by the inflammatory cytokine IL-1alpha correlated with marked down-regulation of the transcription factor Sox-9, which was relieved by IGF-1. The expression of the Sox9 gene was closely correlated with the expression of the chondrocyte-specific genes under all conditions and treatments. CONCLUSIONS: The results suggest that the effects of cartilage anabolic and catabolic cytokines IGF-1 and IL-1alpha on the expression of the chondrocyte phenotype are mediated by Sox-9. As Sox-9 appears to be essential for matrix production, the potent effect of IL-1alpha in suppressing Sox-9 expression may limit the ability of cartilage to repair during inflammatory joint diseases. Rheumatology (Oxford)

Published
2001

43. Improved oxidation-resistant carbon and graphite materials

Author

Muir, H. M

Subjects
Materials, Nonmetallic
Abstract

A variety of silicon-carbide treated carbon and graphite products were prepared, and oxidation and strength properties determined. Carbon and graphite materials used in the preliminary study include fiber, tape, felt, foam, bulk, and laminar configurations. The silicon-carbide treatment used in preparing the oxidation resistant specimens employs either vacuum or ultrasonic impregnation of various silicone-silicon mixtures into the matrix material. The impregnation phase is followed by controlled thermal reaction at which time the silicon carbide is synthesized and takes the form of an integral protective boundary layer. Thickness of the layer ranges from a fraction of a mil to 10 mils, depending on the matrix material and processing parameters. Oxidation resistance of all the silicon-carbide-treated specimens investigated was found to be significantly improved. Mechanical strengths of the laminar composites were also found to be somewhat improved. At room temperature the specific strength of the silicon-carbide treated fibers and tapes was degraded to some extent; however, their relative strengths were significantly increased at elevated temperatures in oxidizing atmosphere.

Published
1972

45. ASA PHYSICAL STATUS CLASSIFICATION - A PREGNANT PAUSE

Author

Barbeito, A., primary, Schultz, J., additional, Muir, H., additional, Dwane, P., additional, Olufolabi, A., additional, Breen, T., additional, Habib, A., additional, Millar, S., additional, Drysdale, S., additional, and Spahn, T., additional

Published
2002
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