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Nigerian orphans face a range of challenges, including finding a suitable place to live, having to choose who to live with and this choice is influenced by various factors. This study determined the proportion of orphans’ resident in orphanages and family settings in selected states in Nigeria. It also assessed stakeholder’s input into placement option decision for orphans. The study examined orphans’ comfortability with residential placement and living with caregivers. The issues related to non-comfortability of orphans with residential placement were also investigated. The study employed the descriptive survey research design. The population for the study comprised all orphans in formal care (orphanages) and informal care (family settings) in Nigeria. A multistage sample procedure was employed. Five states were selected purposively in Nigeria. Indices such as poverty, high rates of insurgencies and HIV/AIDs were used in states’ selection. A sample of 1,475 in orphanages and 2,418 in family settings were selected for the study making a total of 3,893 orphans. Data was from a larger study on Needs and Vulnerability of Orphans in Orphanages and family settings in Nigeria. Questionnaire for Needs and Vulnerability of Orphans in Orphanages and Family settings in Nigeria was used to elicit information from the respondents. Data collected were analyzed using frequency distribution and percentages. The results showed that more orphans live in family settings (2,418) and orphans residing in both orphanages (30.5%) and family settings (44.2%) are staying there based on the decisions of relatives. As perceived by the orphans, (88.5%) in orphanages and (71.1%) in family settings are comfortable where they are living and (77.6%) in orphanages and (72.3%) in the family settings perceived that they are comfortable living with their caregivers. Finally, it was found out that most prominent of the issues related to the residential placement of orphans in the family settings were poor living conditions (49.7%) and access to resources (48.2%), while orphans in orphanages felt challenged with strict caregivers (46.2%) and lack of access to recreational facilities (16.2%). Based on the findings, it was suggested that families within the communities and stakeholders should support family members who are saddled with the responsibility of caring for orphans. It was also recommended that staffing patterns in orphanages should be restructured to enhance caregivers’ capacity to provide children with stable, warm, and consistent relationships.

Background & Objective: Guillain Barre' syndrome is an autoimmune neuropathy which is considered to be the most acute areflexic paralysis with albuminocytologic dissociation. Areflexia or hyporeflexia, pain in limbs, autonomic dysfunction, progressive bilateral and symmetric weakness of limbs, numbness and paresthesia are described as the clinical features of GBS.Nevertheless, with having less prognosis, the treatment is usually effective. Most patients diagnosed with GBS were previously infected with CMV or C.jejuni. Subtypes of the disease are either Axonal or Demyelinating. Due to increase use of Guillain Barre' in south of Iran, the present study has done a retrospective study on the epidemiology of Guillain Barre in the south part of Iran. Materials & Methods: We performed our retrospective study in Namazi hospital in Shiraz, Iran. Medical records were analyzed using computer and were presented through percentages. Results: 214 patients were studied in which 119 (55.6%) of them were men and 95 (44.4%) of them were women. 15 % of the participants had respiratory disturbance and 5.1% of them had histories of common cold and 1.4 of them were vaccinated before the study. Moreover, six people had died but 208 patients were treated and healed either by prescribed dosage of IVIg (69.2%) or plasmapheresis (24.3%) and one patient was also seen who had HIV virus. Conclusion: This study provides more details on the epidemiology of GBS in Shiraz, and south of Iran. Our study also revealed the difference in pattern of GBS in Iran and other countries. however, there is still a need for further clarification of the issues. [ABSTRACT FROM AUTHOR]

Introduction: Since its invention in 1897, aspirin (ASA) has been the most widely used and cost-effective antiplatelet agent to prevent and treat atherosclerotic cardiovascular disease (ASCVD). We aimed to study the trends and expenditures associated with ASA use in the USA., Methods: We conducted a serial cross-sectional analysis using the Medical Expenditure Panel Survey data from January 2000 to December 2021, focusing on adults aged ≥ 40 years. Total and out-of-pocket expenditures associated with ASA were estimated to 2021 US dollars (USD). Trends, demographics, and predictors of ASA use among patients with and without ASCVD were also evaluated., Results: A total of 53 million adults were identified during the study period. The number of ASA users increased from 2.9 million to 6.6 million with increased female (36.7%-49.7%; p trend = 0.02) and African American (13%-18.9%; p trend = 0.03) representation amongst all ASA users during the survey period. The use of low-dose ASA increased, while high-dose ASA declined significantly. Only 50% of all ASA users had known ASCVD. The most prevalent ASA users among patients with ASCVD were those aged ≥ 70 years, while patients without ASCVD, it was the 50-69 age group. The total annual expenditure on ASA averaged approximately 60 million USD, with 27.3 million USD out-of-pocket., Conclusion: Total and low-dose (81 mg) ASA use has increased, while high-dose (325 mg) ASA has declined. ASA use for primary prevention has risen among adults aged 50-69 years, and patients ≥ 70 years continue to use ASA without known ASCVD. Further studies are needed to understand the implications of increased ASA use, especially among those without ASCVD., (© 2024. The Author(s).)

Background and Aims: Congestive heart failure is a complex multifactorial syndrome due to tissue hypoperfusion that is affected by some factors like inflammatory cytokines. In our study, we investigated the exact gene expression of three inflammatory cytokines in ischemic and idiopathic cardiomyopathy patients., Methods: From 49 studied recipients in the ischemic group, 23 (46.9%) were male and from 40 studied recipients in the idiopathic dilated cardiomyopathy group, 19 (47.5%) were male. For the quantitative analysis of interleukin (IL)-1, IL-27, and tumor necrosis factor (TNF)-α messenger RNAs expression level, the SYBR Green real-time polymerase chain reaction method was performed using SYBRPremix Ex TaqTM II (Tli RNaseH Plus; Takara) and designed primers specific for each gene in an iQ5 thermocycler (BioRad Laboratories) according to the manufacturer's instructions., Results: Our results showed that the expression level of IL-1 and TNF-α were significantly higher in the ischemic patients compared to healthy controls ( p  < 0.001, p  < 0.01, respectively); also, we found higher levels of IL-1 and IL-27 gene expressions in idiopathic patients compared to healthy controls ( p  < 0.001, p  < 0.001, respectively). There were not any significant differences in IL-1, IL-27, and TNF-α expression levels between ischemic patients and idiopathic ones., Conclusion: Although we would introduce IL-1, IL-27, and TNF-α as effective inflammatory cytokines on myocardial functions in ischemic and idiopathic cardiomyopathy patients, there is not any difference between these two groups in gene expression of three main inflammatory cytokines., Competing Interests: The authors declare no conflict of interest., (© 2022 The Authors. Health Science Reports published by Wiley Periodicals LLC.)

Objectives: A greater proportion of non-pregnant smokers attempted to stop smoking during compared to before the COVID-19 pandemic. The objective of this study was to determine if a greater proportion of pregnant women also attempted to stop smoking during the pandemic rather than before., Methods: The use of antenatal smoking cessation services and nicotine replacement therapies (NRT) in pregnant women was audited before (2019-2020) and during the COVID pandemic (2020-2021). Anonymised data from January 2019 to March 2021 were analysed from the Lambeth and Southwark smoking cessation service., Results: A total of 252 pregnant women who smoked were referred to their local antenatal smoking cessation service, of which 90 (35.7%) (median age: 31 years [19-52 years]) chose to attend smoking cessation clinics. The COVID-19 pandemic was not associated with an increase in the number of women attending smoking cessation clinics, (2020-2021 n=46 [40.8%] of 110); compared to (2019-2020 n=44 [30.9%] of 142 referred pregnant women pre-pandemic) p=0.061. Eighty-two women utilised NRT to help them stop smoking and the frequency of NRT use did not change during the pandemic (2019-2020 n=39, 2020-2021 n=43; p=0.420). No significant difference in smoking cessation rates between the two periods was observed at either the four-week (p=0.285) or twelve-week follow-up (p=0.829)., Conclusions: Smoking cessation rates in pregnant women and the demand for antenatal smoking cessation services was unchanged during compared to before the COVID-19 pandemic., (© 2022 Nadja Bednarczuk et al., published by De Gruyter, Berlin/Boston.)

Introduction: COVID-19 pandemic has affected the self-management of patients with chronic disease all over the world. The present study COVID-19 is a review to investigate the chronic patient self-management challenges during the corona epidemic, and providing solutions to solve this problem., Methods: The relevant literature on chronic patient self-management is investigated (from March 2019 to Jan 2021). Databases including Google Scholar, PubMed, Science Direct, Springer were used to search articles from the Latin articles. Also, keywords in this study included self-management, chronic disease, COVID-19. Finally, 26 relevant articles were used in this study., Results: Studies assessed the effective role of self-management in control and prevention of complications of chronic diseases and the challenges related to self-management programs during COVID-19, in addition the role of the health team in patients' self-management during the corona epidemics., Conclusion: the main challenges for chronic patients during the COVID-19 include decreased healthcare service and regular follow-ups because of physical restrictions; economic problems, change in lifestyle, and lack of rapid compliance with the changes. In this regard, the health team should provide the best healthcare services using the available resources to reduce suffer and pain of the patients., Competing Interests: Conflict of interest statement The authors declare no conflict of interest., (©2021 Pacini Editore SRL, Pisa, Italy.)

The cardiac lipid panel (CLP) is a novel panel of metabolomic biomarkers that has previously shown to improve the diagnostic and prognostic value for CHF patients. Several prognostic scores have been developed for cardiovascular disease risk, but their use is limited to specific populations and precision is still inadequate. We compared a risk score using the CLP plus NT-proBNP to four commonly used risk scores: The Seattle Heart Failure Model (SHFM), Framingham risk score (FRS), Barcelona bio-HF (BCN Bio-HF) and Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) score. We included 280 elderly CHF patients from the Cardiac Insufficiency Bisoprolol Study in Elderly trial. Cox Regression and hierarchical cluster analysis was performed. Integrated area under the curves (IAUC) was used as criterium for comparison. The mean (SD) follow-up period was 81 (33) months, and 95 (34%) subjects met the primary endpoint. The IAUC for FRS was 0.53, SHFM 0.61, BCN Bio-HF 0.72, MAGGIC 0.68, and CLP 0.78. Subjects were partitioned into three risk clusters: low, moderate, high with the CLP score showing the best ability to group patients into their respective risk cluster. A risk score composed of a novel panel of metabolite biomarkers plus NT-proBNP outperformed other common prognostic scores in predicting 10-year cardiovascular death in elderly ambulatory CHF patients. This approach could improve the clinical risk assessment of CHF patients.

Aims: The Cardiac Lipid Panel (CLP) is a newly discovered panel of metabolite-based biomarkers that has shown to improve the diagnostic value of N terminal pro B type natriuretic peptide (NT-proBNP). However, little is known about its usefulness in predicting outcomes. In this study, we developed a risk score for 4-year cardiovascular death in elderly chronic heart failure (CHF) patients using the CLP., Methods and Results: From the Cardiac Insufficiency Bisoprolol Study in Elderly trial, we included 280 patients with CHF aged >65 years. A targeted metabolomic analysis of the CLP biomarkers was performed on baseline serum samples. Cox regression was used to determine the association of the biomarkers with the outcome after accounting for established risk factors. A risk score ranging from 0 to 4 was calculated by counting the number of biomarkers above the cut-offs, using Youden index. During the mean (standard deviation) follow-up period of 50 (8) months, 35 (18%) subjects met the primary endpoint of cardiovascular death. The area under the receiver operating curve for the model based on clinical variables was 0.84, the second model with NT-proBNP was 0.86, and the final model with the CLP was 0.90. The categorical net reclassification index was 0.25 using three risk categories: 0-60% (low), 60-85% (intermediate), and >85% (high). The continuous net reclassification index was 0.772, and the integrated discrimination index was 0.104., Conclusions: In patients with CHF, incorporating a panel of three metabolite-based biomarkers into a risk score improved the prognostic utility of NT-proBNP by predicting long-term cardiovascular death more precisely. This novel approach holds promise to improve clinical risk assessment in CHF patients., (© 2020 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)

Ethnopharmacological Relevance: Trianthema portulacastrum L. (Aizoaceae) is used in traditional African Medicine for the treatment of various illnesses including dropsy, inflammation and rheumatism., Aim of the Study: This study was designed to investigate the anti-nociceptive and anti-arthritic properties of the aqueous whole plant extract of Trianthema portulacastrum (AETP), possible mechanisms of action and characterize some of the active constituents., Materials and Methods: Antinociceptive activity was evaluated using the acetic acid-induced writhing and hot plate tests in mice. The carrageenan test was used to induce a transient inflammation while arthritis was induced with complete Freund's adjuvant (CFA) in rats. On completion of CFA-induced arthritis macroscopic observations, the rats were euthanized to isolate the spleen, liver and limbs for estimation of oxidative stress and histological analysis., Results: AETP (10, 50, or 250 mg/kg; p.o.) produced significant (p < 0.05) and dose-dependent inhibition (41.10, 50.40, and 67.10%, respectively) of writhing response elicited by acetic acid. Also, increased pain threshold of supraspinally mediated nociceptive behaviour, with peak maximum possible effect (MPE) obtained at 250 mg/kg (22.98%; 30 min post-treatment). However, the pre-treatment of mice with Nitro-L-arginine (L-NNA) or naloxone reversed AETP-induced antinociception. In another experiment, AETP produced time course inhibition of carrageenan-induced paw oedema with peak effect (50.60%) at 250 mg/kg as well as significant reduction in CFA-induced arthritis by 58.56%, on day 27 and arthritic index (26.84%). Similarly, AETP attenuated CFA-induced MDA generation and deficit in antioxidant enzyme activities. Histological analysis of rat joints revealed a reduction in the synovial hyperplasia and mononuclear infiltration induced by CFA in AETP treated groups., Conclusion: Findings from this study showed that T. portulacastrum possesses anti-nociceptive action through nitrergic and opioidergic signalling as well as anti-arthritic effect through enhancement of antioxidant defense system and inhibition of release or actions of inflammatory mediators., (Copyright © 2019. Published by Elsevier B.V.)

Background Atherosclerotic cardiovascular disease ( ASCVD ) accounts for approximately one third of deaths in women. Although there is an established relationship between positive patient experiences, health-related quality of life, and improved health outcomes, little is known about gender differences in patient-reported outcomes among ASCVD patients. We therefore compared gender differences in patient-centered outcomes among individuals with ASCVD . Methods and Results Data from the 2006 to 2015 Medical Expenditure Panel Survey, a nationally representative US sample, were used for this study. Adults ≥18 years with a diagnosis of ASCVD , ascertained by International Classification of Diseases, Ninth Revision ( ICD-9) codes and/or self-reported data, were included. Linear and logistic regression were used to compare self-reported patient experience, perception of health, and health-related quality of life by gender. Models adjusted for demographics, socioeconomic status, and comorbidities. There were 21 353 participants included, with >10 000 (47%-weighted) of the participants being women, representing ≈11 million female adults with ASCVD nationwide. Compared with men, women with ASCVD were more likely to experience poor patient-provider communication (odds ratio 1.25 [95% confidence interval 1.11-1.41]), lower healthcare satisfaction (1.12 [1.02-1.24]), poor perception of health status (1.15 [1.04-1.28]), and lower health-related quality of life scores. Women with ASCVD also had lower use of aspirin and statins, and greater odds of ≥2 Emergency Department visits/y. Conclusions Women with ASCVD were more likely to report poorer patient experience, lower health-related quality of life, and poorer perception of their health when compared with men. These findings have important public health implications and require more research towards understanding the gender-specific differences in healthcare quality, delivery, and ultimately health outcomes among individuals with ASCVD .

The androgen receptor is a major driver of prostate cancer and inhibition of its transcriptional activity using competitive antagonists, such as enzalutamide remains a frontline therapy for prostate cancer management. However, the majority of patients eventually develop drug resistance. We propose that targeting the androgen receptor for degradation via Proteolysis Targeting Chimeras (PROTACs) will be a better therapeutic strategy for targeting androgen receptor signaling in prostate cancer cells. Here we perform a head-to-head comparison between a currently approved androgen receptor antagonist enzalutamide, and its PROTAC derivative, ARCC-4, across different cellular models of prostate cancer drug resistance. ARCC-4 is a low-nanomolar androgen receptor degrader able to degrade about 95% of cellular androgen receptors. ARCC-4 inhibits prostate tumor cell proliferation, degrades clinically relevant androgen receptor point mutants and unlike enzalutamide, retains antiproliferative effect in a high androgen environment. Thus, ARCC-4 exemplifies how protein degradation can address the drug resistance hurdles of enzalutamide., Competing Interests: C.M.C. is the founder, consultant, and shareholder in Arvinas, LLC, which also supports research in his lab. D.P.M. is a consultant for Arvinas, which provided research support for his lab. R.R.W., N.J.V., J.W., H.D., M.J., A.P.C. and T.K.N. are shareholders in Arvinas, LLC.

Targeted therapies for cancer are typically small molecules or monoclonal antibodies that act by inhibiting the activity of specific proteins that drive tumor growth. Although many of these drugs are effective in cancer patients, the response is often not durable because tumor cells develop resistance to the drugs. Another limitation of this strategy is that not all oncogenic driver proteins are "druggable" enzymes or receptors with activities that can be inhibited. Here we describe an alternative approach to targeted therapy that is based on co-opting the cellular quality-control machinery-the ubiquitin-proteasome system-to remove specific cancer-causing proteins from the cell. We first discuss examples of existing cancer drugs that work by degrading specific proteins and then review recent progress in the rational design and preclinical testing of small molecules that induce selective degradation of specific target proteins., (Copyright © 2017, American Association for the Advancement of Science.)

Aim: Abnormal daily sleep duration and quality have been linked to hypertension, diabetes, stroke, and overall cardiovascular disease (CVD) morbidity& mortality. However, the relationship between daily sleep duration and quality with subclinical measures of CVD remains less well studied. This systematic review evaluated how daily sleep duration and quality affect burden of subclinical CVD in subjects free of symptomatic CVD., Methods: Literature search was done via MEDLINE, EMBASE, Web of Science until June 2016 and 32 studies met the inclusion criteria. Sleep duration and quality were measured either via subjective methods, as self-reported questionnaires or Pittsburg Sleep Quality Index (PSQI) or via objective methods, as actigraphy or polysomnography or by both. Among subclinical CVD measures, coronary artery calcium (CAC) was measured by electron beam computed tomography, Carotid intima-media thickness (CIMT) measured by high-resolution B-mode ultrasound on carotid arteries, endothelial/microvascular function measured by flow mediated dilation (FMD) or peripheral arterial tone (PAT) or iontophoresis or nailfold capillaroscopy, and arterial stiffness measured by pulse wave velocity (PWV) or ankle brachial index (ABI)., Results: Subjective short sleep duration was associated with CAC and CIMT, but variably associated with endothelial dysfunction (ED) and arterial stiffness; however, subjective long sleep duration was associated with CAC, CIMT and arterial stiffness, but variably associated with ED. Objective short sleep duration was positively associated with CIMT and variably with CAC but not associated with ED. Objective long sleep duration was variably associated with CAC and CIMT but not associated with ED. Poor subjective sleep quality was significantly associated with ED and arterial stiffness but variably associated with CAC and CIMT. Poor objective sleep quality was significantly associated with CIMT, and ED but variably associated with CAC., Conclusions: Overall, our review provided mixed results, which is generally in line with published literature, with most of the studies showing a significant relationship with subclinical CVD, but only some studies failed to demonstrate such an association. Although such mechanistic relationship needs further evaluation in order to determine appropriate screening strategies in vulnerable populations, this review strongly suggested the existence of a relationship between abnormal sleep duration and quality with increased subclinical CVD burden.

Objectives: Students of medical sciences are exposed to many emotional and mental problems. In light of the importance of sleep quality in learning and liveliness, this study was conducted to examine the relationship between psychological variables (stress, anxiety, and depression) and sleep quality of students., Design: This research is a cross-sectional analytical study, where all students studying at Fasa University of Medical Sciences in 2012-2013 year were selected. To examine the students' stress, anxiety, and depression values, the standardized 21-item DASS-21 was used, and to examine their sleep quality, Pittsburgh Sleep Quality Index (PSQI) was used., Results: The results of the study demonstrated that 73% of the students have moderate and severe stress, and 46.4% of them have PSQ scores ≥ 5. The students' mean sleep quality score was 4.65 ± 2.37, and their stress score was 8.09 ± 5.14. A statistically significant relationship was found between the students' stress levels and sleep quality ( P < 0.001)., Conclusion: The high stress levels decrease students' sleep quality. High stress levels and also the significant relationship between stress value and decrease in students' sleep quality call for more attention to and care for students' emotional and mental issues and timely proper interference on the part of authorities.

Proteolysis Targeting Chimera (PROTAC) technology is a rapidly emerging alternative therapeutic strategy with the potential to address many of the challenges currently faced in modern drug development programs. PROTAC technology employs small molecules that recruit target proteins for ubiquitination and removal by the proteasome. The synthesis of PROTAC compounds that mediate the degradation of c-ABL and BCR-ABL by recruiting either Cereblon or Von Hippel Lindau E3 ligases is reported. During the course of their development, we discovered that the capacity of a PROTAC to induce degradation involves more than just target binding: the identity of the inhibitor warhead and the recruited E3 ligase largely determine the degradation profiles of the compounds; thus, as a starting point for PROTAC development, both the target ligand and the recruited E3 ligase should be varied to rapidly generate a PROTAC with the desired degradation profile., (© 2016 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.)

Aberrant activation of S6 kinase 1 (S6K1) is found in many diseases, including diabetes, aging, and cancer. We developed ATP competitive organometallic kinase inhibitors, EM5 and FL772, which are inspired by the structure of the pan-kinase inhibitor staurosporine, to specifically inhibit S6K1 using a strategy previously used to target other kinases. Biochemical data demonstrate that EM5 and FL772 inhibit the kinase with IC50 value in the low nanomolar range at 100 μM ATP and that the more potent FL772 compound has a greater than 100-fold specificity over S6K2. The crystal structures of S6K1 bound to staurosporine, EM5, and FL772 reveal that the EM5 and FL772 inhibitors bind in the ATP binding pocket and make S6K1-specific contacts, resulting in changes to the p-loop, αC helix, and αD helix when compared to the staurosporine-bound structure. Cellular data reveal that FL772 is able to inhibit S6K phosphorylation in yeast cells. Together, these studies demonstrate that potent, selective, and cell permeable S6K1 inhibitors can be prepared and provide a scaffold for future development of S6K inhibitors with possible therapeutic applications.

Ethnopharmacological Relevance: Lecaniodiscus cupanioides is widely used in West African folk medicine for the treatment of inflammatory conditions, fevers and bacterial infections., Aim of the Study: To evaluate the potential toxic effects of the ethanolic dried leaf extract of Lecaniodiscus cupanioides (LC) on antioxidant enzymes in selected organs and biochemical parameters., Materials and Methods: Crude ethanolic extract of Lecaniodiscus cupanioides dried leaves was prepared. A 90-day sub-chronic toxicity study was conducted using albino rats. Reconstituted Lecaniodiscus cupanioides was administered at a dosage of 400, 800 and 1600 mg/kg (high dose) with a control group receiving 10 ml/kg orally. Histopathological studies of major organs and blood chemistry analysis were performed on blood obtained via cardiac puncture after euthanization. Selected organs (liver, kidney and brain) were harvested for antioxidant and histopathological assessments., Results: The extract produced significant (p<0.05) increases in the weights of liver, kidney and brain at 800 mg/kg and 1600 mg/kg compared to the control. Biochemical analysis showed significant increase in Alanine transferase (ALT) at 800 mg/kg and 1600 mg/kg. Assay for antioxidant enzymes showed a reversible decrease in the activity of Catalase (CAT), Superoxide dismutase (SOD) and Glutathione (GSH) with an increase in Malondialdehyde (MDA) at 800 mg/kg and 1600 mg/kg Lecaniodiscus cupanioides. Histopathological study showed reversible congestion in the brain, liver, and kidney at 800 mg/kg and 1600 mg/kg., Conclusion: Findings in this study reveal that the ethanolic dried leaf extract of Lecaniodiscus cupanioides has the potential for inhibiting in vivo antioxidant enzymes activity and causing hepatotoxicity after prolonged exposure., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Background: Amlodipine is a dihydropyridine calcium channel antagonist that is useful in the treatment of hypertension and angina pectoris. In addition to the innovator brand of this molecule, several generic brands are marketed in Nigeria., Objective: To evaluate the physicochemical equivalence of eight brands of amlodipine tablets marketed in Lagos, Nigeria., Methods: Physicochemical properties such as identity, weight uniformity, friability, hardness test, disintegration test, dissolution test and assay of active ingredients were performed using the methods described in the British and the United States Pharmacopoeia. Ultra-violet spectrophotometric and High performance liquid chromatographic methods were used for assay of the labelled amount of amlodipine in the products., Results: All the products passed weight uniformity and disintegration tests. Only one brand failed the friability test. Two brands had mean crushing strength less than 4 kg/cm²; while only 4 brands passed dissolution test by releasing >75% of the labelled amlodipine within 45 minutes. One brand failed both assay and dissolution tests by returning less than official specifications in the general monograph for conventional tablets. In all, four of the eight sample products analyzed passed all the tests. These can be said to be physicochemically equivalent and may be clinically interchangeable or substituted., Conclusion: This study further highlights the concerns over the quality of drug products marketed in a developing country.

We studied the nonoperative treatment of proximal humeral fractures in severe injuries usually treated surgically. The natural history of 63 patients was followed prospectively for 2 to 9 years (mean, 42 months) with a nonrandomized protocol. A 3-dimensional classification system based on computed tomography scans was used to categorize the fractures. Assessment was made for range of motion, function via a validated testing instrument (Simple Shoulder Test), analog pain score, avascular necrosis (AVN), and fracture union. Magnetic resonance imaging for early signs of AVN was done in 16 cases. After conservative treatment of complex fractures of the shoulder, motion is considerably compromised but pain is minimal and functional status is acceptable to most individuals in this predominantly older patient population. Status comparable to a successful surgical shoulder fusion is achieved in most cases-Nature's fusion. Contrary to common belief, AVN, even in severely displaced injuries, is rare. Future randomized studies based on a 3-dimensional classification need to be done to compare these natural history results with various types of surgical interventions.

The effect of subminimum inhibitory concentration (subMIC) of ceftriaxone on adherence of two isolates of Pseudomonas aeruginosa onto inert surfaces (catheter, plastic and glass) was studied. It was found that the phase of growth of Ps. aeruginosa and the nature of the inert surfaces affected the adherence. One-twenty fourth of the M.I.C. increased the adherence of the clinical isolate in the exponential phase of growth but decreased it during the stationary phase; the reverse was the case for the wild type isolate. When the inert surfaces were coated with serum, the adherence of the clinical isolate also increased during the exponential phase of growth, while that of the wild type increased in the stationary phase. Changes in the surface properties of the test organisms indicated that the subMIC of Ceftriaxone mediated increase in hydrophobicity at both phases of growth. These results suggest that sub-inhibitory levels of Ceftriaxone may decrease the virulence of P. aeruginosa since a good polymorphnuclear leucocytebacterium contact will result in the bacterium being strongly phagocytosed because adherence has also been implicated in the process of phagocytosis.

Hydrophobicity generally increased as the cells passed from lag to exponential phases of growth and declined in the stationary phase. All concentrations of ampicillin used increased hydrophobicity, although still subject to effect of phase of growth. Chloramphenicol caused decline in hydrophobicity. Combination of the two antibiotics gave a concentration dependent balance of the two forces observed. Protein synthesis inhibition may render cells resistant to phagocytic uptake by lowering surface hydrophobicity. This phenomenon is probably involved in cases of therapeutic failures, persistent of recurrent infections. This is a further indication of the undesirability of antibiotic abuse.