47 research outputs found
Determinants and Policy Implications of Drug Utilization in the Philippines
No full textThe drug question has emerged recently, which is the crux of the Philippine health concerns today. While studies on the supply side of pharmaceuticals have been profuse, the demand side seems to be neglected. Hence, this paper investigates the determinants of the private/household drug utilization in the country and determines the aspects of the prescriber behavior that influence drug utilization patterns. Aside from the sample survey of households and prescribers, this paper also devotes some space for the analysis of drug supply and distribution from the broader picture of the pharmaceutical market.drugs/medicine, health sector, utilization, health care
Coevolving water sustainability in London
No full textLondon’s water infrastructure has been developed over many centuries. It is a system of centralised water distribution and drainage that has formed the model for water infrastructure systems in cities around the world. However, this system is unsustainable: its incapacity to respond to the growth of populations and increasing water consumption per capita has led to the degradation of aquatic environments. A fresh approach is needed in order to identify urban water cycle solutions that can address these problems. This paper outlines an amalgamated theoretical framework – coevolutionary actor–network theory – and its use by the author to develop a methodology capable of formulating how London’s urban water cycle might coevolve towards sustainability in the future. This framework allows the tracing of relationships between human and nonhuman influences and environments that coalesce into large infrastructural systems. Two coevolutionary possibilities towards water sustainability were identified. One lay in diversifying types of water reuse; the other in multifarious forms of waste harvesting. The paper further contends that this theoretical approach and set of methods could also be applied to other infrastructure systems such as energy, waste, and air pollution
Cerebellar degeneration in primary Sjögren syndrome: a case report
No full textBackground
Cerebellar degeneration is a rare and severe presentation of primary Sjögren syndrome. There are few case reports of cerebellar degeneration associated with different autoimmune diseases, especially with systemic lupus erythematosus and neuro-Behcet’s disease. There are only six patients reported worldwide to be affected by cerebellar atrophy associated with primary Sjögren syndrome. In this report, we describe a patient with primary Sjögren syndrome who presented with ataxia due to cerebellar degeneration.
Case presentation
We report the case of a 37-year-old Chinese woman with primary Sjögren syndrome who presented with ataxia over 3 months associated with tremor of the limbs. Magnetic resonance imaging of the brain revealed bilateral cerebellar atrophy. Based on the presence of cerebellar signs with magnetic resonance imaging brain findings, she was diagnosed as cerebellar degeneration secondary to primary Sjögren syndrome. She was treated with methylprednisolone, hydroxychloroquine, and two cycles of monthly intravenous cyclophosphamide. Subsequently, she refused further treatment, and her neurological symptoms remained the same upon the last clinic review. Primary cerebellar degeneration is rarely associated with primary Sjögren syndrome. The pathogenesis of the neurological manifestations in primary Sjögren syndrome is unclear. Treatment involves corticosteroids and immunosuppressive agents with no consensus of a specific therapy for the management of primary Sjögren syndrome with central nervous system involvement.
Conclusions
Cerebellar degeneration is a rare presentation of primary Sjögren syndrome. Early diagnosis and treatment of this condition is needed to ensure a good outcome
Systemic lupus erythematosus in Sarawak General Hospital: A 10-year update
No full textBackground/Purpose: Systemic lupus erythematosus (SLE) is a complex autoimmune disease with heterogeneous clinical presentation.
We published the Sarawak Lupus Cohort in 2014. Since then there have been many advances in SLE diagnosis and management. We aimed to examine the clinical manifestations and gender differences of an updated SLE cohort in Sarawak General Hospital. Methods: We collected demographics and clinical manifestation data in this prospective observational study from July 2018 until December 2023. All patients fulfilled the 2012 Systemic Lupus Collaborating Clinics (SLICC) Classification Criteria for SLE. Statistical
analysis was performed using SPSS, with means ± SD, Chi-Square or Fisher's exact test. A p-value<0.05 is considered significant.
Results: There were 637 patients in our cohort, with 567 (89%) women and 70 (11%) men. The mean age at SLE diagnosis was 31.17 ± 13.6 years. There were 234 (36.7%) Chinese, 224 (35.2%) Malay, 107 (16.8%) Iban, and 58 (9.1%) Bidayuh patients. Common SLE clinical manifestations were acute cutaneous lupus in 420 (65.9%), followed by renal in 309 (48.5%) and leucopenia or lymphopenia in 307 (48.2%) patients. The common immunological SLE manifestations
were antinuclear antibody (ANA) in 619 (97.2%) and anti-double stranded DNA (anti-dsDNA) in 366 (57.5%) patients. 285 (44.7%) patients had severe disease at presentation. There were 217 (34.1%) patients with a score of SLE Damage Index (SDI) >1, indicating the presence of at least one item of damage. There were 70 (11%) deaths in this cohort. The notable differences between men and women with SLE was a statistically significant higher percentage of men had
renal manifestation (men 41 (58.6%) vs women 268 (47.3%), p = 0.04) and serositis (men 18 (25.7%) vs women 91 (16.0%), p = 0.04). There were more women than men with oral ulcers (women 220 (38.8%) vs men 15 (21.4%), p = 0.004) and alopecia (women 278 (49.0%) vs men 13 (18.6%), p < 0.001). More men had severe disease at presentation
(men 42 (60%) vs women 243 (42.9%), p = 0.006). Among patients with SDI>1 (n = 217), there were more men with end-stage renal failure (ESRF) (men 7 (28%) vs women 11 (5.7%), p = 0.002), myocardial infarction (men 2 (8%) vs women (0), p = 0.01) and extensive skin scarring (men 3 (12%) vs women 4 (2.1%), p = 0.04). There was no gender difference in death in this cohort.
Conclusion: This updated SLE cohort showed acute cutaneous lupus, renal, ANA and anti-dsDNA as the most common SLE manifestations. Men had more severe disease at presentation, with more renal and serositis SLE manifestation. Men had more ESRF, myocardial infarction and extensive skin scarring in the SLE Damage Index
Mobile Cone\u2010Beam CT\u2010Guided Transbronchial Cryobiopsy of a Penicillium Granuloma via the Right Post\u2010Eparterial Bronchus
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The Use of Microsoft Poverpoint Programme in Teaching Economics to Learn teh Theme "Demand and Supply"
No full textDiplomdarba mērķis ir izveidot jaunus mācību metodiskos materiālus biznesa ekonomisko pamatu stundām, izmantojot Microsoft PowerPoint programmu, par tematu „Pieprasījums un piedāvājums” un aprobēt tos.
Diplomdarbs izstrādāts, lai atvieglotu skolotāju darbu un lai dažādotu, kā arī padarītu aizraujošākas un mūsdienīgākas biznesa ekonomikas stundas.
Diplomdarbs sastāv no četrām nodaļām:
1.Aprakstīti mācību metožu izvēles nosacījumi un kritēriji,
2.Aprakstīta informācijas un komunikāciju tehnoloģijas (IKT) izmantošana mācību procesā,
3.Izstrādāti 6 mācību stundu tematiskie plāni, stundu vizuālie materiāli,
4.Apkopoti anketu un interviju rezultāti.
Diplomdarbs sastāv no 64 lappusēm, tajā atrodami 14 attēli, 8 tabulas un 7 pielikumi. Izmantotās literatūras un avotu saraksts ietver 28 nosaukumus.The aim of the research is to introduce new methodical materials for teaching the topic „Demand and Offer” in Business economics basics with the help of Microsoft PowerPoint program and to approbate them.
The research is completed to help the teachers to variegate their every day work and also to make Business Economics lessons more attractive and interactive.
The research consists of four chapters:
1.The conditions and criteria of choice of teaching methods are described,
2.Communication technologies (ICT) in learning process,
3.The author offers 6 lessons’ lay-outs,
4.The results of questionnaires and.
The work consists of 64 pages, it includes 14 pictures, 8 charts and 7 appendixes
VKORC1 Haplotypes in patients treated with warfarin
No full textBackground: Warfarin has very narrow therapeutic windows and large individual variability. Genetic variants encoding VKORC1 gene has resulted in altered sensitivity to warfarin or warfarin resistance. Nine haplotypes (H1-H9) of VKORC1 had been categorized with reference to 10 SNPs (Gen Bank accession number AY587020).
Objective: To determine the haplotypes frequencies of VKORC1 gene among the patients prescribed warfarin and to correlate the dose, INR and bleeding with haplotypes.
Method: A total of 158 patients prescribed warfarin and met the inclusion criteria were recruited after informed consent. Five ml of blood was drawn from each patient and DNA was extracted for genotyping of VKORC1 variants. Two steps PCR methods were developed to identify all the 10 SNPs. The optimized method was validated by direct sequencing.
Result: Twenty-six (26) haplotypes were inferred from 10 common SNPs. Only four haplotypes have frequency more than 2.5%. The VKORC1 haplotypes with the highest frequency was H1 (72.5%) followed by H6 (3.8%), H7 (7.3%) and H10 (2.5%). Two haplotypes (H1 and H10) were associated with a low warfarin dose requirement (2.9 and 2.63 mg per day; p<0.01)) while H6 and H7 were associated with high dose requirement (4.55 and 4.83 mg per day; p<0.01). The average INR was approximately 2.4 and did not differ significantly among the patients classified according to VKORC1 haplotype combination (P value=0.196). The multiple regression analysis (Enter method) indicated that VKORC1 accounted for 24.8 % the variation in warfarin dose.
Conclusion: VKORC1 haplotype provided a good correlation for different warfarin dose requirements. Genotyping of patients before warfarin is thus useful to predict more accurately dose required.
Corresponding author: M. Z. Salleh, Head, Pharmacogenomics Centre, Faculty of Pharmacy, Universiti Teknologi MARA Malaysia.
Acknowledgement: This study was supported by kecermerlangan’s UiTM
Therapeutic Hypothermia Improves Survival and Neurological Outcomes by Akt -Mediated Anti-Apoptotic Protection of the Brain
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