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Feb 2026
The current research assessed gaps and barriers related to perinatal mental health service access by parents during COVID-19, as well as service providers’ knowledge and provision of PMAD services, in one Northern community, where rural and remote healthcare is a daily reality, and recruitment and retention of qualified professionals is a significant issue. Two mixed-methods surveys were designed, one to assess PMAD knowledge and service provision via a volunteer sample of service providers, and another to assess PMAD service need and access among a volunteer sample of new parents. Results indicated that many parents waited too long for services, and some parents in need of PMAD services didn’t receive them. Interestingly, higher-income parents were more likely than lower-income respondents to desire services and support for PMADs. Although most providers screened for, were trained in, and treated and/or referred patients with PMADs, they reported feeling as though they were working in silos, unaware of what other providers offered.
Dec 2025
Intensive Short-Term Dynamic Psychotherapy (ISTDP) has proven effective in over 120 outcome studies, particularly for anxiety, depression, and personality disorders. This conceptual paper proposes a theoretical integration of ISTDP with Solution- Focused Brief Therapy (SFBT) and clinical hypnosis. Each modality offers unique strengths—ISTDP enables rapid emotional processing, SFBT builds client resilience and solutions, and hypnosis enhances neuroplasticity and emotional receptivity. Drawing on existing empirical and neuroscientific literature, this paper synthesizes these modalities into a unified clinical framework. The integrated model emphasizes accelerated change through emotional access, strategic future orientation, and unconscious facilitation. Case examples illustrate the framework's practical applications across complex clinical presentations. The integration addresses gaps in single-modality treatments and provides a cost-effective, neurobiologically supported method of intervention. This article offers clinicians structured decision- making strategies and practical tools for real-time integration, while outlining future directions for empirical research.
Sep 2025 DOI 10.14302/issn.2768-0207.jbr-25-5706
Artificial Intelligence (AI) is emerging as a transformative force across many sectors, with healthcare representing both one of the most promising and most challenging areas of application. This review summarizes current and future applications of AI in healthcare, focusing on its potential to improve diagnosis, therapy, chronic disease management, and overall patient care, while also alleviating physicians’ workload. Recent literature demonstrates that AI systems can reduce diagnostic errors/delays by mitigating cognitive biases, support imaging and pathology through improved accuracy and speed, and prevent prescribing errors by integrating pharmacogenomic and clinical data into decision-support systems. In chronic disease management, AI-powered wearable devices enable continuous monitoring and early detection of conditions such as atrial fibrillation, thereby reducing the risk of stroke and long-term disability, particularly in elderly people. Therapeutic applications include AI-driven drug discovery, personalized oncology, and tailored medicine that integrates multi-omics and lifestyle data. Beyond direct medical intervention, AI contributes by automating routine tasks, optimizing workflows, and facilitating greater patient–clinician interaction. Despite these benefits, significant challenges remain, including issues of data quality, privacy, security, equity, and the need for transparency and trust in “black box” systems. Looking ahead, the integration of multimodal data, digital twins, and robotics is expected to advance more comprehensive, equitable, and human-centered care. We conclude that, when applied ethically and responsibly, AI should not replace clinicians but rather serve as a powerful partner that enhances medicine by restoring empathy and humanity.
May 2025 DOI 10.14302/issn.2641-5526.jmid-25-5466
Information on adverse drug event (ADE) assessment and prevention within Electronic Health Records (EHRs) is difficult for clinicians to use and produces wide-ranging results. Challenges include inconsistent ADE and drug product definition and documentation, workflows, terminology standardization, interoperability, and clinical decision support (CDS) to inform clinical decision-making within EHRs. These factors contribute to care issues for clinicians, such as alert fatigue and provider burden for clinicians and medical errors, patient harm, and even death for patients. Clinicians play the primary role in documenting, reviewing, detecting, and preventing ADEs within EHRs. It is essential that clinicians, clinical informaticists, nursing informaticists, pharmacy informaticists, and the health informatics profession understand the current electronic ADE paradigm to advocate for improved detection and prevention of ADEs within EHRs.
Mar 2025 DOI 10.14302/issn.2693-1176.ijgh-25-5429
Malaria and bacteraemia are significant public health concerns and economic threats. In Africa, the intensity for simultaneous transmission and co-infection of Plasmodium spp and other bacteria pathogens are extremely high. It is believed that malaria suppress the immune system and enable the translocation of bacteria in the gastrointestinal tract to other cellular compartments in the body. Some of the factors that contributed to the co-emergence of these pathogens are poor access to clean water, sanitation and hygiene (WASH), poor infection control measures, inefficient health care systems. In addition, the similarities in the clinical signs and symptoms of these febrile diseases and the fact that the etiologic diagnostic testing can be complex, costly, and limited are the reasons why clinicians in resource-constrained setting often prescribe antibiotics empirically prior to or without laboratory testing to prevent severe outcomes in any patient hospitalized with malaria. However, this indiscriminate use of antibiotics has been identified as the driving force for antibiotic resistance, which is already at alarming rate in malaria endemic nations. In developed countries where malaria had been previously eradicated, there are increasing reports of imported malaria with concurrent bacteraemia. In this review, we emphasized the role of malaria in the indiscriminate use of antibiotics and the fact that eliminating malaria in Africa is one of the best strategies to address the emergence and the global spread of multi-drug resistance organisms.
Nov 2023 DOI 10.14302/issn.2381-862X.jwrh-23-4766
This study explored concerns and unsolicited advice relating to miscarriage shared on multiple social media platforms for mentions of questions, advocacy, medical advice, conflicts of interest, and terminology used to describe miscarriage. Public social media posts in English from January 1st, 2019 to June 30th, 2021 were searched using keywords related to miscarriage. A dataset of questions, advice, conflicts of interest, and terminology used was created from eligible posts determined by inclusionary and exclusionary criteria. The dataset was analyzed to identify themes and calculate statistics. Approximately 1000 posts were reviewed and 149 posts were found eligible for analysis. Of the total, 116 posts included advice and a subset of 71 posts offered questions. A total of 152 mentions of advice were identified from the total eligible posts with 82.9% of advice related to advocacy for destigmatizing miscarriage, enhancing community support, or expressing grief. 17.1% of posts offered medical advice eligible for evaluation of which 73% were accurate across all platforms. From the dataset, 103 questions were analyzed for common themes. The four most common themes of questions included grief, self-blame, quality of post-miscarriage counseling in different care settings, and inadequate medical counseling. This study indicates that women who experience miscarriage have many unanswered questions and powerful feelings relating to grief and self-blame that could have long-term impacts. Social media has become a place for women to self-advocate and connect with others for support, from which clinicians could increase their understanding of women’s unmet needs.
Mar 2023 DOI 10.14302/issn.2766-8630.jrnm-22-4093
Attenuation differences from 2 x-ray sources allow differentiation and characterization of stone types with similar radiation dose compared to single-energy CT scan. The difference is shown in colours, allowing preoperative prediction and management of stones. We determined the effect of DECT-KUB on urological management of patients with uric acid stones since it was first introduced in our centre. 50 patients with uric acid stones were selected from 2 year groups, each with 25 patients and their urological managements were reviewed retrospectively. We concluded that DECT-KUB is an accurate way of determining the chemical characteristics of renal calculi and can alter patients’ management. It has gained wide acceptance among clinicians in our centre and is now widely used to plan urological management of patients with renal calculi. Based on urological management comparison of patients who presented in the year 2011 with uric acid stones and patients in the year 2020, we concluded that patients with uric acid stones based on DECT-KUB findings can start dissolution therapy instead of surgical extraction or lithotripsy prior to biochemical analysis results become available. Although utility of DECT-KUB is widely accepted among clinicians in our centre it may not be available worldwide and this is the limiting factor in its universal use.
Mar 2023 DOI 10.14302/issn.2692-5257.ijgp-22-4071
Oral ulceration is a common disorder of the oral mucosa with individuals regularly presenting to primary care practitioners seeking advice and treatment. Diagnosis of oral ulceration remains a challenge for clinicians due to the overlap in clinical presentations and the diverse aetiological processes that can be involved in their development. A recent study evaluating general medical practitioners’ attitudes towards oral examination identified problems in clinicians’ confidence in differentiating between benign and malignant ulcers, with a lack of knowledge and training being cited as contributing factors. This article aims to provide an overview of the diagnosis and management of oral ulceration, providing a framework to guide clinical decision-making in a primary care setting.
May 2022 DOI 10.14302/issn.2379-7835.ijn-22-4190
Background Nutrition support during the acute phase post allogeneic haematopoietic stem cell transplantation (HSCT) is required to optimise short- and long-term outcomes for children. An algorithm was developed and evaluated to assist clinicians to make objective and consistent enteral feeding decisions. Methods The algorithm was evaluated on all patients who underwent allogeneic HSCT treatment between November 2017 - February 2019. Results Of the 48 patients, 43 had a nasogastric tube (NGT) inserted, of which 36 patients received a hydrolysed peptide-based formula, 5 patients received a whole protein formula only and 2 patients were fed an amino acid-based formula. Parenteral nutrition (PN) was used in 41 of the patients. Eleven did not have an NGT in-situ at the commencement of HSCT. Of the remaining 37 patients, 26 followed the algorithm and 11 patients did not comply. The group of patients who did not follow the algorithm had the longest median length of stay (LOS) of 49 days. Patients receiving only EN had the lowest median LOS of 30 days. The two groups that reported better weight outcomes were those who followed the algorithm and those who were fully EN fed. Conclusions Effective use of the HSCT feeding algorithm indicated improved patient outcomes for children undergoing HSCT, with better weight outcomes and reduced LOS. Recommendations to improve the efficacy and compliance of the algorithm include regular education/input to the oncology medical teams to better understand objective thresholds for EN and PN commencement.
Dec 2021 DOI 10.14302/issn.2692-1537.ijcv-21-4045
Introduction In December 2019, cases of serious illness causing pneumonia and death were first reported in Wuhan, China.2 The clinical features of Corona Virus Disease-19 (COVID-19) are ranging from asymptomatic to multi organ dysfunction. The disease can progress to pneumonia, respiratory failure and death.4 Thus, a tool is needed that can predict the severity and in-hospital mortality risk of a patient with COVID-19 Pneumonia. The PIRO (predisposition, insult, response, and organ dysfunction) scoring was developed for use in the emergency department to risk stratify sepsis cases.15 Eventually it was adapted in pneumonia cases to predict its severity. Objective To validate PIRO score as an assessment tool for COVID-19 mortality risk among patients with confirmed COVID-19 RT-PCR test among patients aged 19 and above admitted in World Citi Medical Center from March 2020 to August 2020 Methods This study included 93 patients aged 19 and above admitted in World Citi Medical Center with a primary diagnosis of COVID-19 Confirmed with pneumonia between March 2020 to August 2020. The patients’ charts were retrieved from the hospital medical records and case notes were reviewed. A severity assessment score was developed based on PIRO score (Predisposition comorbidities and age; Insult multilobar opacities and viremia; Response shock and hypoxemia; Organ Dysfunciton) were extracted. The patients were stratified in four levels of risk: a)Low,0-2 points; b)Mild,3 points; c)High,4 points; d)Very High,5-8 points. The PIRO score and the clinical outcome were compared. The discriminative ability of PIRO score to predict mortality risk was evaluated under receiver operating characteristic curve (AUC). Results The PIRO score had an excellent predictive ability for in-hospital mortality (AUC0.9197). Analysis of variance showed that higher levels of PIRO scores were significantly associated with higher mortality (p<0.001). Patients with Mild PIRO risk category were 98.65% less likely to expire (p<0.001, 95%CI 0.0015) and High PIRO risk category were 94.47% less likely to expire (p<0.001, 95%CI 0.0124), both compared to patients with Very high PIRO risk category. Finally, Very High PIRO risk category were more than 44 times likely to expire compared to patients with Low, Mild and High PIRO risk category (p<0.001, 95%CI 11.738). Conclusions The PIRO score is a valid risk model that can be used to predict in-hospital mortality, that can help clinicians provide timely and accurate assessment, and hence appropriate management to patients with COVID-19 Pneumonia.
Dec 2021 DOI 10.14302/issn.2577-2279.ijha-21-4012
Knowledge of accurate surface anatomy is essential for safe clinical practice. Different views and opinions for clinically important surface markings exist between clinicians. Pericardiocentesis is performed as an emergency procedure in conditions aggravating cardiac tamponade. The approach of pericardiocentesis should be held by the hands of an experienced operator because of the surrounding relations. Nowadays, the introduction of imaging-guided procedures, especially echo-guided procedures, has significantly improved the safety and feasibility of pericardiocentesis and has provided the possibility of choosing the best anatomical approach among the apical, subcostal and parasternal approaches. This case report also emphasizes the importance of instillation of agitated saline as a supplementary technique while performing echo-guided pericardiocentesis in order to reduce the likelihood of cardiac chamber perforations.
Nov 2021 DOI 10.14302/issn.2470-0436.jos-21-4016
Malignant transformation of peripheral nerve sheath tumor (MPNST) may develop from a plexiform type of Neurofibromatosis 1 (NF1) or previously irradiated areas. Generally, MPNSTs occur in about 2% to 5% of neurofibromatosis patients. In this paper, we present a 58-year-old male patient with neurofibromatosis who developed MPNST of the eyelids and nasal area. The patient had a history of multiple excision biopsies for facial tumors in 22 years at different institutions, allegedly revealing neurofibromas on histopathological evaluation. A recent consult with the Otorhinolaryngology Service (ORL) prompted an excision biopsy with results consistent with neurofibroma. The mass recurred and enlarged even more rapidly compared to the previously excised tumor. The patient also developed four tumors on the eyelids hence the referral to Ophthalmology Service. The eyelid masses and nasal mass were excised by the Ophthalmology and ORL Services. Histopathology revealed identical MPNST characteristics on all excised tumors. The patient was eventually referred to the Oncology Service to evaluate radio and chemotherapy. A rapid change in the size of a preexisting neurofibroma, infiltration of the adjacent structures, intralesional hemorrhage, and pain usually indicates a possible malignant transformation into MPNST. A high index of suspicion is helpful for clinicians when presented with a case of a recurrent neurofibromatosis, even if the only sign is the rapid growth of the mass since management of MPNST is very different from neurofibromatosis.
Dec 2020 DOI 10.14302/issn.2998-4785.ijne-20-3617
Background Overuse and abuse of antibiotics resulted in emergence of multidrug-resistant organisms (MDRO), increased rates of invasive candidiasis, prolonged hospital stay, NEC (Necrotizing enterocolitis), LOS (Late onset sepsis) or death. Restriction of the prescription, switching to a narrower spectrum and stopping antibiotics when not needed are some of the major approaches to antibiotic stewardship. Methods We identified restricted antimicrobials and devised an antimicrobial justification form. Clinicians needed to fill the form before prescribing restricted antimicrobials thereby comparing the antimicrobial usage pattern before and after the introduction of form. Babies enrolled before the introduction of the justification form were labelled as Group 1, and as Group 2 after justification form. The HIC (hospital infection control) staff nurse paid daily visits to NICU to monitor number of babies started on restricted antibiotics and whether the forms were duly filled or not. Any lag would be intimated to the Head HIC team for rectification. Any change of antibiotic within the restricted group also warranted justification. Culture report notified within 48 – 72 hrs so as to facilitate the stoppage of antibiotics in case of negative culture. Results There was a statistically significant reduction in the usage of restricted antimicrobials in the Group B as compared to Group A 150 (40.54%) vs 190 (49.35%) (p = 0.01). There was a statistically significant increase in the % of babies de-escalated from high end antimicrobials in Group B as compared to Group A 90 (60%) vs 56 (29.47%) (p = <0.0001). Duration of restricted antimicrobials reduced from 13.78 ± 2.7 days in Group A to 9.9 ±1.8 days in Group B (p = <0.0001). No difference in the number of babies started on any antibiotic between both the groups (p = 0.1). Conclusion Introduction of the antibiotic justification form as a part of antimicrobial stewardship program resulted in an overall reduced usage of restricted antimicrobials along with rapid de-escalation.
Dec 2020 DOI 10.14302/issn.2474-7785.jarh-20-3650
Background The coronavirus Covid-19 strain that emerged in December 2019, continues to produce a widespread and seemingly intractable negative impact on health and longevity in all parts of the world, especially, among older adults, and those with chronic health conditions. Aim The first aim of this review article was to examine, summarize, synthesize, and report on the research base concerning the possible use of vitamin-D supplementation for reducing both Covid-19 risk and severity, especially among older adults at high risk for Covid-19 infections. A second was to provide directives for researchers or professionals who work or are likely to work in this realm in the future. Methods All English language relevant publications detailing the possible efficacy of vitamin D as an intervention strategy for minimizing Covid-19 infection risk published in 2020 were systematically sought. Key words used were: Vitamin D, Covid-19, and Coronavirus. Databases used were PubMed, Scopus, and Web of Science. All relevant articles were carefully examined and those meeting the review criteria were carefully read, and described in narrative form. Results Collectively, these data reveal vitamin D is a powerful steroid like compound that is required by the body to help many life affirming physiological functions, including immune processes, but its deficiency may seriously impact the health status and well being of the older adult and others. Since vitamin D is not manufactured by the body directly, ensuring those who are deficient in vitamin D may prove a helpful overall preventive measure as well as a helpful treatment measure among older adults at high risk for severe Covid-19 disease outcomes. Conclusions Older individuals with chronic health conditions, as well as healthy older adults at risk for vitamin D deficiency are likely to benefit physically as well as mentally, from efforts to foster adequate vitamin D levels. Geriatric clinicians can expect this form of intervention to reduce infection severity in the presence of Covid-19 infection, regardless of health status, and subject to careful study, researchers can make a highly notable impact in this regard.
Mar 2020 DOI 10.14302/issn.2575-1212.jvhc-20-3225
Objective To evaluate/ determine the risk factors for dogs presented with Gastric Dilation- Volvulus (GDV) to a referral veterinary centre and to compare the results with those currently reported in veterinary literature. Materials and Methods The observational case-control study comprised a population of 215 dogs that attended the referral centre between 2000 and 2018. Medical records were searched for GDV and those matching the criteria were manually reviewed. A questionnaire was completed by the owners of the dogs involved in the study (both case and control populations) in order to gain further information that could be considered relevant to GDVs. In particular, information included the dogs’ behaviour and the dogs daily activities. Results The study included 115 cases of GDV and 115 controls. Out of the GDV dogs 13% (15/115) were small breed dogs and the remaining 87% (100/115) either large or giant breeds. The following risk factors for developing a GDV have been identified: Purebred dogs over 3 years old and either large of giant breeds, weighing > 30 kg. Foreign body ingestion, diarrhoea, and grass consumption were also associated to increase the likelihood in developing GDV. Behavioural temperament was not associated with developing GDV. Clinical Significance The findings support previously identified risk factors in the development of GDV, but characteristics related to the dogs temperament warrant further investigation. Knowledge of these results will further allow clinicians to make evidence‐based recommendations to owners in attempting to prevent GDV in dogs. Furthermore this paper confirms that the risk of GDV in certain breeds and in certain conditions is always high and that GDV is still an extremely current disease.
Apr 2019 DOI 10.14302/issn.2641-5518.jcci-19-2700
Rheumatic heart disease is becoming far less common in the developed world, and therefore expsoure to its complications are been seen less by clinicians. With the increasing ease of world travel, patients with less commonly seen medical conditions are increasingly presenting to Hospitals requiring management of their complications. We present a case of an elderly lady who was a tourist in Australia, who presented with complications of her rheumatic heart disease, and her subsequent radiological and echocardiographic investigations were a significant surpirse for her treating clinicians.
Feb 2019 DOI 10.14302/issn.2689-5773.jcdp-19-2611
An anatomical variant of the Stafne bone cavity (SBC) located in the right subcondylar region of the mandible is presented. Such an occurrence of the SBC in this region near the parotid gland is considered rare and poses a diagnostic challenge for the dentist and radiologist. Knowledge of head and neck clinical anatomy and imaging studies such as plain film panoramic radiographs and cone beam CT scans can assist the clinician in arriving at a correct definitive diagnosis without surgical intervention.
Sep 2018
This letter presents a clinician's perspective on the biological basis of diabetes mellitus at the cellular level. Drawing on neurosurgical practice, the author argues that persistent dysglycemia hinders recovery and may reflect long-standing intracellular processes, calling for causal, interdisciplinary management beyond symptomatic care. The piece outlines testable hypotheses and invites further laboratory validation.
Aug 2018 DOI 10.14302/issn.2470-5020.jnrt-18-2258
We present a case of a 77-year-old male patient who was treated in our outpatient clinic for memory disorders because of episodic confusion and retrograde amnesia. The patient reported having symptoms repeatedly following intraocular treatment with Anti-Vascular Endothelial Growth Factor Agents (Ranibizumab and Bevacizumab) as a treatment for wet macular degeneration. EEG showed a localized deceleration that intensified under prolonged voluntary hyperventilation. Symptoms resolved after the intraocular Anti-Vascular Endothelial Growth Factor treatment was stopped and anticonvulsive treatment with lamotrigine was begun. This case is important in that it describes a potential association between intraocular treatments with Anti-Vascular Endothelial Growth Factor Agents and seizures. Symptoms occurred in temporal correlation with intraocular treatment. Clinicians should be aware of this potential side effect on intraocular treatment with Anti-Vascular Endothelial Growth Factor Agents in patients with high risk for seizures.
Aug 2018 DOI 10.14302/issn.2640-690X.jfm-18-2252
Background: Feeding problems are common in autism. Parents are frequently worried about the health status of their children, which may be threatened by some consequent nutritional deficiencies. Despite this, feeding behaviours remain little explored by clinicians working with children with autism spectrum disorders and researches are lacking especially in Tunisia. Aims: To evaluate the frequency and the types of feeding problems in children with autism spectrum disorders. Settings and Design: A comparison was made between 57 children with autism spectrum disorders and 57 control groups regarding the feeding problems. Parents completed the children’s eating behavior inventory (CEBI). Autism severity is evaluated using the Childhood Autism Rating Scale. The SPSS statistical package, version 20.0 was used. Results: According to the CEBI, children with autism spectrum disorders showed more feeding problems than the control group (82.4% versus 56.1%, p=0.002). In fact, the parents of these children observed more pica habits on their children compared to the control group (p=0.000). They also observed more selectivity for starchy foods compared to the control group (p=0.000). The more the autistic symptoms were severe, the more children exhibited feeding problems (p=0.02). Conclusions: Our findings suggest that feeding problems are more common in children with autism. Clinical implications trigger the need for clinicians to provide the necessary assessment and treatment.
Nov 2017 DOI 10.14302/issn.2575-1212.jvhc-17-1764
Leishmaniasis treatment monitoring is an important problem, since patient’s frequently present clinical signs improvements with positive indirect immunofluorescence (IFI) titers of anti-Leishmania antibodies, thus making difficult the clinician understand the therapy efficacy. The study aimed 1) to identify over a short period of 30 days, which of the main changes on the serum proteinogram fractions in patients treated with meglumine antimoniate and allopurinol, can be pointed as indicator to classify patients as slower or faster responsive to treatment. A sample of 56 dogs (n=56) with leishmaniasis diagnosis was followed-up for clinical condition, proteinograms and titers of anti-Leishmania antibodies during the treatment period considering three different time points: M0 (diagnosis moment), M1 (15 days after therapy start), and M2 (30 days after therapy start). Two groups of patients were considered according to their clinical condition evolution rate: faster recovery group (FRG) and slower recovery group (SRG). Statistical significant results were considered for p-value <0.05. Statistically significant differences in proteinogram variations between FRG and SRG were registered for TPs (p= 0.03), and for the fractions β (p=0.04), γ (p=0.04), amongst M0 and M2.The PT, β and γ-globulin fractions of proteinogram, in association with patient clinical assessment evolution should be considered as an indicator and a simple way to appoint the efficacy response of the patients to the therapy.
Sep 2017 DOI 10.14302/issn.3070-5657.je-17-1638
Development of the hand occurs as a complex series of events. In order to understand the mechanisms of developmental hand anomalies, the clinician has to understand the normal embryonic development of the hand. In this review, we present the development of the hand in the light of new literature knowledge.
Aug 2017 DOI 10.14302/issn.2694-1201.jsn-17-1527
Cervicogenic headaches are a significant cause of head and neck pain, and occipital neuralgia is a common component of these cervicogenic headaches. Occipital injections are commonly performed at the occipital ridge, but this site does not address more proximal entrapments of the nerve in the suboccipital region. Because of the potentially dangerous structures in this region, clinicians have tended to avoid the suboccipital region, despite the pathologies seen in this region. This article discusses the pathology of the region, the alternative techniques, and the novel interventional approach developed for this region, specifically the “Stealth” approach of occipital decompression.
Jul 2017 DOI 10.14302/issn.3070-5835.jcpn-17-1562
Second-generation antipsychotics have relatively recently become available in long-acting intramuscular formulations (LAIs) and have been receiving a substantial amount of pharmaceutical industry promotion on the grounds that they improve treatment adherence in patients with psychotic illness. LAIs do have some drawbacks, however, which is the topic area covered by this review. A Global Scholar search of the nursing and medical literature reveals several factors that can negatively impinge on the clinical efficacy of LAIs: 1. The extent of training of injection personnel 2. The quality of surveillance of patient symptoms and side effects 3. The skilled use of the full range of injection techniques 4. The extent of drug accumulation over time 5. The potential loss of drug dose flexibility 6. The impact of exercise and temperature on drug distribution 7. The burden of the medication routine and the social burdens of LAIs 8. The safety of LAIs during pregnancy 9. The perceived coerciveness of LAIs 10. Issues of overdose and polypharmacy 11. Issues of cost 12. The important issue of responsibility for self-management of illness. Although the evidence is clinical and anecdotal, LAIs appear to work well for many patients, but their drawbacks are not negligible. Clinicians need to weigh individual risks and benefits when making treatment decisions.
Jun 2017 DOI 10.14302/issn.2576-9359.jot-17-1603
Single-nucleotide polymorphisms (SNPs) in genes involved in immune responses and in the pharmacokinetics/pharmacodynamics of immunosuppressive drugs influence transplant outcomes of patients receiving the same immunosuppressive therapy. The aim of our preliminary study was to determine the SNPs profiles of ABCB1/MDR-1, UGT1A9, IMPDH2, IL-10 and TNF-α genes associated with acute rejection (AR) events in renal allograft recipients. DNA was extracted from whole blood samples of 220 individuals in 3 experimental groups; Case: 41 kidney transplant patients with AR event(s), Control I: 109 kidney transplant patients without AR event, Control II: 70 healthy blood donors. Acute rejection defined as rapid, unexplained rise in serum creatinine was biopsy-proven. 19 SNPs were analyzed by Sanger Sequencing. Analysis of allele and genotype frequencies and gene-disease association tests were performed. Allele frequencies of healthy persons are in line with ones reported from Europe indicating that the studied population is representative. Statistically significant differences only by the comparison of kidney transplant patients with AR event(s) and healthy individuals are found for rs2032582 and rs1045642 SNPs of ABCB1/MDR1, the latter is also not in Hardy-Weinberg equilibrium in our population. Patients with specific alleles for these SPNs are more prone to have acute rejection events. Certain allele variants of ABCB1/MDR1 by modifying the effectiveness of the drugs may compromise the success of the immunosuppressive therapy and put patients at higher risk to reject the new organ. Therefore screening for these polymorphisms before transplantation would help clinicians to more accurately personalize medications.
Jul 2016 DOI 10.14302/issn.2572-5424.jgm-16-1066
Lactic acidosis is a condition commonly encountered in the hospital setting particularly in critically ill patients and is very often used as a diagnostic adjunct when encountering cases of ischaemia or other hypoperfusion states. Despite its use many clinicians have long forgotten the biochemical mechanisms that give rise to hyperlactataemia. One reason for this is because the basic science regarding lactate metabolism is taught in the early years of the medical undergraduate course, and unless one specialises in metabolic medicine, is unlikely to encounter it again. In this article we aim to elucidate the basic mechanisms of lactate metabolism and the accompanying acidosis, and illustrate various clinical settings that give rise to this biochemical abnormality.
Mar 2016 DOI 10.14302/issn.2470-5020.jnrt-15-800
Although clinical trials in refractory epilepsy are currently carried out, the field of deep brain stimulation (DBS) in epilepsy is still at its initial stage. Little is known about where, when and how to stimulate and what would be the short and long consequences. Animal studies might provide clinicians with new ideas regarding targets for DBS. Here an overview is given regarding old and new targets in rodent models of temporal lobe epilepsy. The evidence from animal models showed that stimulation of the subiculum – either in responsive or scheduled manner - is anticonvulsant in different seizure and epilepsy models, indicating that the subiculum might be a promising candidate for DBS targets. For the rest, the antiepileptic effects of low frequency stimulation were established mostly in kindling models. The presence of a critical time window in which stimulation was effective following after discharges on kindling acquisition, demonstrates that timing of DBS is an important factor for the anticonvulsant effects of DBS.
Jun 2015 DOI 10.14302/issn.2470-0436.jos-14-528
A previously healthy 25 year old Chinese male presented with left eye blurring of vision and was diagnosed to have left eye branch retinal vein occlusion. Initial blood investigations and thrombophilia screen were negative. The patient subsequently improved with observation and conservative management, with no further events over a 2 year follow up period. The blood investigations were repeated 2 years later as part of a health check-up and he was then tested to be heterozygous for the factor V leiden mutation. This was confirmed by sequencing of his genome that identified the mutation. The laboratory was contacted to provide details regarding the testing methods and was noted to have performed the two tests via different methods. While false negative rates in genetic testing are low, we believe that there is greater need to standardize testing methods as ascertaining genetic conditions play a great role in clinical diagnosis, treatment and prognosis. Clinicians should be aware of the limitations of these tests. When clinical suspicion is high, there may be a role for repeat tests with different methods or in different laboratories.
Nov 2013 DOI 10.14302/issn.2324-7339.jcrhap-13-304
Antiretrovirals have traditionally been associated with much toxicity. Newer antiretrovirals are considered much less toxic relative to older antiretrovirals. Upon its FDA-approval in 2009, raltegravir’s adverse drug reaction profile was found to be similar to placebo. However, recently there have been reports of increased creatine kinase and rhabdomyolysis following the initiation of raltegravir. We describe a 52-year-old, African-American man who developed rhabdomyolysis after starting raltegravir for HIV. Rhabdomyolysis resolved upon discontinuation of raltegravir. Use of the Naranjo adverse drug reaction probability scale indicated a probable relationship (score of 6). Although raltegravir is a well-tolerated antiretroviral, clinicians should be aware of the possibility of rhabdomyolysis when prescribing this medication.