Patterns of prescribing and utilization of asthma medications in a tertiary hospital in Dubai, United Arab Emirates

Purpose: To assess the prescribing patterns of asthma medications in a hospital in Dubai, United Arab Emirates (UAE) with regard to the demographic pattern of the population. Methods: One hundred fifty four patients, 83 male and 71 female, were randomly selected from the outpatient respiratory diseases clinic of a tertiary hospital in Dubai, UAE over a 3-month period. Patients were asked to complete a structured questionnaire and data were analyzed using STATA 12 software. Results: Most of the patients were within the age range of 0 – 10 years. About 86 % of the patients were overweight. Half of the patients were non-smokers while 51 % of them had a family history of asthma. About 54 % of the patients received multiple drug therapy of which two-drug combinations were widely prescribed (31 %). The most utilized drug classes were short acting β-agonists (42 %), xanthine drugs (16 %), leukotriene modifiers (14 %) and oral and intravenous corticosteroids (13 %). Statistical significant differences among the age groups (F = 2.33, p = 0.0275) were found. Conclusion: Primary prevention to reduce the level of exposure to common risk factors for asthma would be a vital step to control the disease. More resources should be channeled into educating physicians and patients on rational drug utilization to improve the quality of patients’ care.

Awareness and prevalence of metabolic syndrome among high-risk individuals attending internal medicine clinics across Jordan

Purpose: To examine the prevalence and awareness of metabolic syndrome (MetS) in high-risk individuals attending 30 internal medicine clinics in Amman, Jordan, and also to evaluate the various factors associated with increased risk of MetS among them. Methods: This retrospective cross-sectional study was carried out across Amman, Jordan from October to December 2014. During the study period, 900 high-risk individuals (with hypertension, diabetes, central obesity and/or dyslipidemia) were recruited from thirty internal medicine clinics in Amman, Jordan. Data collection forms were filled based on patient interview and medical case file. Results: The prevalence of MetS among high-risk individuals was around 40 % (361/900), with around 79 % (284/361) of MetS patients unaware of their condition. Older age, lower income and family history of premature cardiovascular diseases were associated with a higher prevalence of MetS. Conclusion: Although MetS was found to be highly prevalent among high-risk individuals in this study, the awareness of the condition in this group is very poor. These findings support the need for educational programs that involve both health care providers and patients. These programs should especially target those at risk of MetS, in order to improve awareness of the concept of MetS.

Parental views of antibiotic use in children with upper respiratory tract infections in Jordan

Purpose: To assess the knowledge, attitudes and practices of parents towards antibiotics use for upper respiratory tract infections (URTIs) in Jordan. Methods: A cross-sectional study was carried out at 10 private outpatients’ pediatric clinics across Amman-Jordan from September to December 2013. During the study period, 1329 parents of young children who fulfilled the inclusion criteria and agreed to participate were interviewed, and completed a validated structured questionnaire. Results: A large proportion of parents (903, 68 %) believed that weather change was the main cause of acute URTIs in their children. Although 1098 (82.8 %) of parents were aware that the recurrent use of antibiotics leads to a decrease in effectiveness due to bacterial resistance, 859 (64.6 %) of the respondents reported that they would give antibiotics without prescription. Fathers (135, 40.2 %), were significantly more aware that URTIs follow its natural course without antibiotic administration compared to mothers (N = 327, 32.9 %), respectively (p = 0.005). Conclusion: There is a lack of adequate parental knowledge concerning the use and misuse of antibiotics in children in Jordan. National publicity campaign should be mounted to improve awareness. Furthermore, existing laws should be enforced to prevent parents from purchasing antibiotics over-thecounter (OTC).

Economic impact of political protests (strikes) on manufacturing firms : evidence from Bangladesh

Political protests in the form of strikes, locally known as hartal, remain quite common in the Indian subcontinent countries. Such a form of protests is associated with mass movement, intended to cause a total shutdown of economic activities and often results in coercion, violence, and damage to both public and private properties. Utilizing the World Bank Enterprise survey data of 2007 and 2013 of Bangladesh, this study examines the impacts of hartals on manufacturing firms. We find that political protests significantly increase costs for firms. Using flexible cost function based on factor analysis we see that the factor-neutral effect of strikes is positive and statistically significant, showing evidence of a reduction in firm productivity due to hartals. However, we did not find any evidence for systematic factor re-optimization by firms – in response to political strikes – suggesting that firms do not reallocate factor shares to tackle uncertain and irregular shocks like hartals.

Cardiopatía isquémica crónica del anciano. Documento de consenso. Sociedades Españolas de Cardiología, Medicina Interna, Atención Primaria y Geriatría

SIN FINANCIACIÓN

Cardiopatía isquémica crónica en el anciano

Este artículo pretende tener en cuenta las peculiaridades y características específicas de los pacientes ancianos con cardiopatía isquémica crónica desde una perspectiva multidisciplinar, con la participación de la Sociedad Española de Cardiología (secciones de Cardiología Geriátrica y Cardiopatía Isquémica/Cuidados Agudos Cardiovasculares), la Sociedad Española de Medicina Interna, la Sociedad Española de Médicos de Atención Primaria y la Sociedad Española de Geriatría y Gerontología. En este documento de consenso se detalla cómo el abordaje de estos enfermos de edad avanzada exige una valoración integral de la comorbilidad, la fragilidad, el estado funcional, la polifarmacia y las interacciones medicamentosas. Concluimos que en la mayoría de los pacientes el tratamiento médico es la mejor opción y que, a la hora de programarlo, se deben tener en cuenta los factores anteriores y las alteraciones biológicas asociadas al envejecimiento.

Comparison of 1-year outcome in patients with severe aorta stenosis treated conservatively or by aortic valve replacement or by percutaneous transcatheter aortic valve implantation (data from a multicenter Spanish registry)

The factors that influence decision making in severe aortic stenosis (AS) are unknown. Our aim was to assess, in patients with severe AS, the determinants of management and prognosis in a multicenter registry that enrolled all consecutive adults with severe AS during a 1-month period. One-year follow-up was obtained in all patients and included vital status and aortic valve intervention (aortic valve replacement [AVR] and transcatheter aortic valve implantation [TAVI]). A total of 726 patients were included, mean age was 77.3 ± 10.6 years, and 377 were women (51.8%). The most common management was conservative therapy in 468 (64.5%) followed by AVR in 199 (27.4%) and TAVI in 59 (8.1%). The strongest association with aortic valve intervention was patient management in a tertiary hospital with cardiac surgery (odds ratio 2.7, 95% confidence interval 1.8 to 4.1, p <0.001). The 2 main reasons to choose conservative management were the absence of significant symptoms (136% to 29.1%) and the presence of co-morbidity (128% to 27.4%). During 1-year follow-up, 132 patients died (18.2%). The main causes of death were heart failure (60% to 45.5%) and noncardiac diseases (46% to 34.9%). One-year survival for patients treated conservatively, with TAVI, and with AVR was 76.3%, 94.9%, and 92.5%, respectively, p <0.001. One-year survival of patients treated conservatively in the absence of significant symptoms was 97.1%. In conclusion, most patients with severe AS are treated conservatively. The outcome in asymptomatic patients managed conservatively was acceptable. Management in tertiary hospitals is associated with valve intervention. One-year survival was similar with both interventional strategies.

Conservative management in very elderly patients with severe aortic stenosis: Time to change?

Despite current recommendations, a high percentage of patients with severe symptomatic aortic stenosis are managed conservatively. The aim of this study was to study symptomatic patients undergoing conservative management from the IDEAS registry, describing their baseline clinical characteristics, mortality, and the causes according to the reason for conservative management. Consecutive patients with severe aortic stenosis diagnosed at 48 centers during January 2014 were included. Baseline clinical characteristics, echocardiographic data, Charlson index, and EuroSCORE-II were registered, including vital status and performance of valve intervention during one-year follow-up. For the purpose of this substudy we assessed symptomatic patients undergoing conservative management, including them in 5 groups according to the reason for performing conservative management [I: comorbidity/frailty (128, 43.8%); II: dementia 18 (6.2%); III: advanced age 34 (11.6%); IV: patients’ refusal 62 (21.2%); and V: other reasons 50 (17.1%)]. We included 292 patients aged 81.5 ± 9 years. Patients from group I had higher Charlson index (4 ± 2.3), higher EuroSCORE-II (7.5 ± 6), and a higher overall (42.2%) and non-cardiac mortality (16.4%) than the other groups. In contrast, patients from group III had fewer comorbidities, lower EuroSCORE-II (4 ± 2.5), and low overall (20.6%) and non-cardiac mortality (5.9%). Patients with severe symptomatic aortic stenosis managed conservatively have different baseline characteristics and clinical course according to the reason for performing conservative management. A prospective assessment of comorbidity and other geriatric syndromes might contribute to improve therapeutic strategy in this clinical setting.

Evidencia sobre la eficacia de cannabinoides en el dolor neuropático oncológico

Contexto: La eficacia de los cannabinoides en el dolor neuropático es desconocida. El control del dolor es determinante en los pacientes ya que genera un impacto negativo en la calidad de vida de los pacientes. Objetivo: El presente trabajo pretende demostrar la evidencia sobre la eficacia de los medicamentos cannabinoides en el control del dolor neuropático oncológico, mediante la evaluación de la literatura disponible. Metodología: Se realizó una revisión sistemática de literatura incluyendo estudios experimentales, observacionales y revisiones sistemáticas en un periodo de 15 años. Se incluyeron todos los estudios desde el años 2000 con evidencia IB según la escala de evidencia de Oxford. Resultados: Cuatro estudios cumplieron criterios para su inclusión, sin embargo la evidencia es baja y no permite recomendar o descartar los cannabinoides como terapia coadyuvante en control del dolor neuropático oncológico. La combinación de THC/CDB (Sativex®) parece ser un medicamento seguro pues no se reportaron muertes asociadas a su uso, sin embargo la presentación de eventos adversos a nivel gastrointestinal y neurológico podría aumentar el riesgo de interacciones medicamentosas y tener un impacto negativo en la calidad de vida de los pacientes oncológicos. Conclusiones: No hay suficiente literatura y la evidencia no es suficiente para recomendar o descartar el uso de los cannabinoides en dolor neuropático oncológico. Futuros estudios deben realizarse para analizar el beneficio de estos medicamentos. Aunque ética y socialmente hay resistencia para el uso de los cannabinoides, actualmente hay una gran discusión política en el mundo y en Colombia para su aceptación como terapia en el control del dolor.

Comparación de política exterior de Estados Unidos y Rusia con ocasión del conflicto en Siria (2011-2013)

El presente documento académico explica el papel del conflicto en Siria como escenario para la manifestación de la política exterior tanto de Estados Unidos como de Rusia, con el fin de demostrar que la guerra civil en Siria es una confrontación interna que se ha metamorfoseado como tensión diplomática y de confrontación de políticas exteriores de Rusia y EE.UU. Se hará uso del método de investigación cualitativo, pues este permitirá el análisis e interpretación de eventos, datos y conceptos importantes para el análisis del problema a estudiar. Por último, se hará uso de la teoría realista de las Relaciones Internacionales para tener una mejor perspectiva de los acontecimientos estudiados.

Independencia literaria: una carrera contra la finitud

El reportaje realiza un diagnóstico de la independencia literaria en Bogotá a partir de la historia de tres editoriales, cinco librerías y cuatro escritores. Las historias se entrelazan en tanto los escritores emprendieron el camino de las letras intentando publicar en sellos editoriales pequeños o independientes, unos con más éxito que otros. Los relatos de las editoriales dan cuenta del arduo trabajo de los editores independientes, quienes, sin un gran músculo financiero, buscan promover contenidos con unas cualidades literarias significativas, intentando abrir la oferta editorial que proveen las grandes casas editoriales europeas, Penguin Random House y Planeta. Asimismo, las librerías independientes se han querido promover los sellos independientes y los autores colombianos mediante actividades culturales, a la par que amplían el espectro de la oferta editorial existente.

Soft Power del Vaticano en el reconocimiento de Palestina como Estado

Desde 1945, el inicio de la cuestión palestina, el país ha sufrido una serie de transformaciones e intervenciones en su soberanía y en legitimidad, las cuales siguen en discusión actualmente; y han dado como resultado el estudio del reconocimiento de Palestina como Estado. Es pertinente hacer un acercamiento a este tema desde la variable religiosa (Vaticano), teniendo en cuenta el gran número de lugares sagrados que hay en la región de Palestina y la variable religiosa del conflicto Palestino-israelí. Desde la mirada del Soft Power, concepto que ha venido tomando fuerza en la academia desde 1980, podemos acercarnos al objeto de estudio y dilucidar las injerencias de este actor. Mediante una aproximación cualitativa, que conlleva análisis del discurso, análisis histórico y análisis de política exterior, se logrará obtener el resultado esperado, que es entender de qué manera el Vaticano ejerce influencia (ideológica y cultural) en el Sistema Internacional, en el asunto del reconocimiento de Palestina como Estado.

Advances on apple production under semiarid climate: N fertigation

The fertilizing management for apple tree is essential, especially for nitrogen, one of the most important nutrients affecting fruit yield. Thus, an experiment was conducted in 2012 and 2013 to evaluate the fruit production, yield and leaf chlorophyll of ?Princesa? and ?Eva? apples as a function of nitrogen fertigation under Brazilian semiarid conditions. The experimental design consisted of randomised blocks, with treatments distributed in a factorial arrangement 2 x 4, corresponding to apple cultivars (Eva and Princesa); and nitrogen doses (160, 120, 80 and 40 kg of N ha-1), with four replications and three plants. Calcium nitrate was used as nitrogen source (15.5% of N) with applications twice a week during 40 days, reaching 12 fertilizing performances through irrigation water. The following variables were evaluated: i) fruit production per plant (kg plant-1); ii) fruit yield (t ha-1); iii) number of fruits per plant; iv) leaf chlorophyll meter readings (index); and v) leaf nitrogen concentration (g kg-1). Princesa apple cultivar if compared to ?Eva? presents a better fruit production performance under Brazilian semiarid. Furthermore, nitrogen doses fertilized through irrigation water have no effect on fruit production of Eva and Princesa apple cultivars during the first production cycle.