Naresuan University Journal
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Intra-arterial vasodilators to prevent radial artery spasm: a systematic review and pooled analysis of clinical studies.
No full textOBJECTIVES: The aim of this study is to review the available literature on the efficacy and safety of agents used for prevention of RAS. BACKGROUND: Different vasodilator agents have been used to prevent radial artery spasm (RAS) in patients undergoing transradial cardiac catheterization. METHODS: We included studies that evaluated any intra-arterial drug administered in the setting cardiac catheterization that was undertaken through the transradial access site (TRA). We also compared studies for secondary outcomes of major bleeding, procedure time, and procedure failure rate in setting of RAS prevention, patent hemostasis and radial artery occlusion. RESULTS: 22 clinical studies met the inclusion criteria. For placebo, RAS rate was 12% (4 studies, 638 participants), which was similar to 2.5mg of verapamil 12% (3 studies, 768 participants) but greater than 5mg of verapamil (4%, 2 studies, 497 participants). For nicorandil, there was a much higher RAS rate compared to placebo (16%, 3 studies, 447 participants). The lowest rates of RAS was found for nitroglycerin at both 100μg (4%) and 200μg (2%) doses, isosorbide mononitrate (4%) and nicardipine (3%). We found no information regarding the procedure failure rates, patent hemostasis, and radial artery occlusion in these studies. CONCLUSIONS: In this largest and up-to-date review on intra-arterial vasodilators use to reduce RAS, we have found that the verapamil at a dose of 5mg or verapamil in combination with nitroglycerine are the best combinations to reduce RAS
Does non-farm sector employment reduce rural poverty and vulnerability? Evidence from Vietnam and India
No full textBarriers and Enablers for the Adoption of Patient Safety Tools to Improve Patient Safety in UK Primary Care
No full textContext: Patient safety in primary care lags behind secondary care in terms of research/ measurement and quality improvement work. There are tools available to explore and potentially improve patient safety in primary care. As part of the Patient Safety Toolkit project, a toolkit comprising a selection of these tools was piloted in UK general practice. The barriers and enablers relating to its implementation were explored at participating practices from the perspectives of clinicians and practice managers. Objective: To explore acceptability, feasibility and implementation factors relating to the use of a patient safety toolkit in UK primary care. Views about individual tools and the concept of a patient safety toolkit for use in primary care were obtained. Design: Qualitative study using Framework analysis. Setting: Primary care (general practice) in the Midlands and North-West of England. Participants: 35 general practice staff from 23 practices who piloted the toolkit comprising GP partners, GP registrars, practice managers and nurses participated in semi-structured interviews. Intervention: The patient safety toolkit piloted in this study contained a primary care trigger tool, two safety culture tools, a significant event analysis tool and a patient safety checklist. Participants had access to the complete toolkit but were asked to pilot 2/3 tools. Results: Overall, the participants were positive about using a patient safety toolkit as patient safety in general practice is viewed as paramount. Themes pertaining to acceptability, feasibility and implementation issues relating to individual tools and the overall toolkit were derived. Conclusions: This study enables the exploration of what might influence the use of tools that are designed to identify patient safety issues so that improvements can be made. The findings of this study will be useful to clinicians, managers, commissioners and policy makers who may be involved in encouraging the use of patient safety tools in primary care
The Additive Value of Femoral Ultrasound for Subclinical Atherosclerosis Assessment in a Single Center Cohort of 962 Adults, Including High Risk Patients with Rheumatoid Arthritis, Human Immunodeficiency Virus Infection and Type 2 Diabetes Mellitus.
No full textBACKGROUND: Presence of femoral atheromatic plaques, an emerging cardiovascular disease (CVD) biomarker additional to carotid plaques, is poorly investigated in conditions associating with accelerated atherosclerosis such as Rheumatoid Arthritis (RA), Human Immunodeficiency Virus (HIV) infection and Type 2 Diabetes Mellitus (T2DM). OBJECTIVE/METHODS: To assess the frequency of femoral/carotid subclinical atheromatosis phenotypes in RA, HIV and T2DM and search for each disease-specific probability of either femoral and/or carotid subclinical atheromatosis, we examined by ultrasound a single-center cohort of CVD-free individuals comprised of consecutive non-diabetic patients with RA (n=226) and HIV (n=133), T2DM patients (n=109) and non-diabetic individuals with suspected/known hypertension (n=494) who served as reference group. RESULTS: Subclinical atheromatosis--defined as local plaque presence in at least on arterial bed--was diagnosed in 50% of the overall population. Among them, femoral plaques only were found in 25% of either RA or HIV patients, as well as in 16% of T2DM patients and 35% of reference subjects. After adjusting for all classical CVD risk factors, RA and HIV patients had comparable probability to reference group of having femoral plaques, but higher probability (1.75; 1.17-2.63 (odds ratio; 95% confidence intervals), 2.04; 1.14-3.64, respectively) of having carotid plaques, whereas T2DM patients had higher probability to have femoral and carotid plaques, albeit, due to their pronounced dyslipidemic profile. CONCLUSION: RA and HIV accelerate predominantly carotid than femoral. A "two windows" carotid/femoral, rather than carotid alone ultrasound, screening improves substantially subclinical atheromatosis detection in patients at high CVD risk
Maternal obesity is associated with a reduction in placental taurine transporter activity
No full textBackground/Objectives:Maternal obesity increases the risk of poor pregnancy outcome including stillbirth, pre-eclampsia, fetal growth restriction and fetal overgrowth. These pregnancy complications are associated with dysfunctional syncytiotrophoblast, the transporting epithelium of the human placenta. Taurine, a β-amino acid with antioxidant and cytoprotective properties, has a role in syncytiotrophoblast development and function and is required for fetal growth and organ development. Taurine is conditionally essential in pregnancy and fetal tissues depend on uptake of taurine from maternal blood. We tested the hypothesis that taurine uptake into placental syncytiotrophoblast by the taurine transporter protein (TauT) is lower in obese women (body mass index (BMI)⩾30 kg m(-)(2)) than in women of ideal weight (BMI 18.5-24.9 kg m(-)(2)) and explored potential regulatory factors.Subjects/Methods:Placentas were collected from term (37-42-week gestation), uncomplicated, singleton pregnancies from women with BMI 19-49 kg m(-)(2). TauT activity was measured as the Na(+)-dependent uptake of (3)H-taurine into placental villous fragments. TauT expression in membrane-enriched placental samples was investigated by western blot. In vitro studies using placental villous explants examined whether leptin or IL-6, adipokines/cytokines that are elevated in maternal obesity, regulates TauT activity.Results:Placental TauT activity was significantly lower in obese women (BMI⩾30) than women of ideal weight (
