Dosage individualization proposed for anti-gout medications among the patients with gout: a bicentric study in Nepal

AbstractBackgroundThe conventional one-size-fits-all approach has been criticized for almost all drugs used especially for chronic diseases, including gout. The present study was aimed to individualize and optimize the dose of anti-gout medications among gout patients.Methods and findingsBicentric cross-sectional study was carried out among 384 randomly selected new gout patients visiting two gout treatment centers at Lalitpur Metropolitan City, Nepal and taking antigout medications. Patients not taking anti-gout medications and not showing unwillingness to participate were excluded. The eGFR was calculated with the CKD Epidemiology Collaboration (CKD-EPI) creatinine equation (2009). Doses to be individualized were decided based on the Renal Drug Handbook and BNF 80. Data were analyzed via R 4.0.3. Multinomial logistic regression analysis was performed to analyze statistical significance of risk with various predictors, considering a p-value <0.05 statistically significant. Comorbidities were coded as per the ICD-11 coding and ATC classification of medicines as per the WHO Guidelines for ATC classification and DDD assignment 2020. High risk of progression to CKD increased in the age range 54-63 and ≥84 years by 17.77 and 43.02 times, respectively. High risk of gout increased by 29.83 and 20.2 times for overweight and obese patients respectively. Aceclofenac 100 mg was prescribed for maximum patients (117, 30.5%). Need of dose individualization was realized altogether in case of 30 patients (8%), with maximum (7, 1.8%) in case of etoricoxib 90 mg (i.e., avoid if possible). There were 260 (67.7%) cases without associated comorbidities, followed by 37 (9.6%) patients with hyperthyroidism. Various glucocorticoids were prescribed for 141 (36.9%) patients, out of whom 14 (3.8%) required dose individualization. Altogether 61 (15.9%) patients were prescribed with xanthine oxidase inhibitors, out of whom 5 (1.3%) required dose individualization.ConclusionsThirty (8%) cases required dose individualization, which was although minimal but could have meaningful impact on clinical success of individual patient. Based on the recommendation on dose individualization, those patients could be optimized on their therapy on future follow ups. Also, future randomized controlled trials may be based on these to derive a more conclusive evidence base for gout management.Author summaryWhy was this study done?Dosage individualization helps optimize drug selection and dosing based on pathogenesis, mechanism of action of drugs, and their dose exposure-response relationships.Very limited researches have been undertaken in Nepal to individualize medications for chronic medication users including gout patients. The present study was probably the first of its kind in Nepal aiming to individualize the dose of anti-gout medications among gout patients.What did the researchers do and find?Bicentric cross-sectional study was carried out among 384 new gout patients visiting two gout treatment centers in Nepal and taking antigout medications.Doses to be individualized were decided based on standard references of the Renal Drug Handbook and the British National Formulary 80. Dose to be individualized was later discussed with the prescribing physicians.Need of dose individualization was realized altogether in case of 30 patients (8%), with maximum (7, 1.8%) in case of etoricoxib 90 mg (i.e., avoid if possible).What do these findings mean?The present simple effort of individualization of antigout medications might help the physicians optimize the therapeutic success for the patients, once they implement it and patients adhere to it.Since the study was limited to only two gout and rheumatic diseases treatment centers, it might not represent the whole gout patients in the nation but it might provide the evidence base for future large controlled clinical trials.

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Dosage individualization proposed for anti-gout medications among the patients with gout

PLoS ONE ◽

10.1371/journal.pone.0257082 ◽

2021 ◽

Vol 16 (9) ◽

pp. e0257082

Author(s):

Binaya Sapkota ◽

Suraj Chaudhary ◽

Prakash Gurung ◽

Anisha Humagain ◽

Sujan Sapkota

Keyword(s):

High Risk ◽

Multinomial Logistic Regression ◽

Clinical Success ◽

Statistical Significance ◽

Cross Sectional Study ◽

P Value ◽

Willingness To Participate ◽

Cross Sectional ◽

Dose Individualization ◽

The Individual

Background The conventional one-size-fits-all approach has been criticized for almost all drugs used especially for chronic diseases, including gout. The present study was aimed to explore the need of individualization and optimization of the dose of anti-gout medications among gout patients. Methods Cross-sectional study was carried out among 384 randomly selected new gout patients visiting two gout treatment centers at Lalitpur Metropolitan City, Nepal and who were taking antigout medications. Patients not taking anti-gout medications and not showing willingness to participate were excluded. The eGFR was calculated with the CKD Epidemiology Collaboration (CKD-EPI) creatinine equation (2009). Doses to be individualized were decided based on the Renal Drug Handbook and verified with the BNF 80. Data were analyzed via R 4.0.3 by applying the multinomial logistic regression to analyze statistical significance of risk with various predictors, and considering a p-value <0.05 statistically significant. Comorbidities were coded as per the ICD-11 coding and medicines were coded according to the WHO Guidelines for ATC classification and DDD assignment 2020. Results The high risk of progression to CKD increased in the age range 54–63 and ≥84 years by 17.77 and 43.02 times, respectively. Also, high risk increased by 29.83 and 20.2 times for the overweight and the obese respectively. Aceclofenac 100mg was prescribed for maximum patients (30.5%). Need of dose individualization was realized in 30 patients, with maximum (7) in case of etoricoxib 90mg. Various glucocorticoids were prescribed for 36.9% patients, out of whom 3.8%required dose individualization and 15.9% patients with xanthine oxidase inhibitors, out of whom 1.3% required dose individualization. Conclusion Thirty cases required dose individualization, which was although minimal but could have meaningful impact on the clinical success of the individual patient. Based on the recommendation on dose individualization, those patients could be optimized on their therapy on future follow ups.

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Colostrum Avoidance Practice among primigavida Mothers in Urban Northwest Ethiopia. A Cross-Sectional Study

10.21203/rs.3.rs-108002/v1 ◽

2020 ◽

Author(s):

Tilksew Ayalew ◽

Eden Asmare

Keyword(s):

Statistical Significance ◽

Cross Sectional Study ◽

Northwest Ethiopia ◽

P Value ◽

Sectional Study ◽

Cross Sectional ◽

Normal Delivery ◽

Childhood Illnesses ◽

Complete Form ◽

Strength Of Association

Abstract Background: Breast milk is the ideal and complete form of nutrition for infants colostrum contains all the necessary nutrients for infants’ growth and development and antibodies that can protect from many childhood illnesses. Understanding the extent of and barriers to colostrum avoidance in Ethiopia is important for learning how to best improve optimal breastfeeding. No single study has been conducted on primigavida mothers in the country. Therefore, this study aimed to assess the rate of colostrum avoidance practice and associated factors among primigavida mothers Method: A community- based cross-sectional study was conducted from March to April 2016 among (n=398) randomly selected primigavida mothers in Bahir Dar city, northwest Ethiopia. Data were collected using a structured interviewer-administered questionnaire and analyzed using SPSS version25. Bivariate and multivariate logistic regression analyses were carried out. Odds ratio with 95% confidence interval was used to measure the strength of association. Statistical significance was declared at P-value ≤0.05.Results: Out of 398 primipara mothers, 8.8% discarded colostrum. The most common reasons for discarding colostrum were; yellow and creamy (39.2%), bad for infant (35.2%), traditional/cultural reason (17.1%) and infant unable to feed (8.5%).Married mothers (OR=4.52, p<0.05), employed mothers (OR=3.46, p<0.05), mothers underwent normal delivery (OR=5.20, p<0.05) and mothers who initiated breastfeeding within 1 hr. (OR=2.79, p=0.05) were less likely to discard colostrum.Conclusion: The current study revealed that colostrum was discarded by 8.8 % of premiparious mothers. Primipara mothers who were married, unemployed, underwent normal delivery and initiated breastfeeding within one hour were less likely to discard colostrum. These results suggest that multi-sectorial and multi-disciplinary approaches are needed to increase optimal breastfeeding among premiparious mothers.

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Perinatally acquired HIV-positive status disclosure and associated factors in Dire Dawa and Harar, Eastern Ethiopia: a health facility-based cross-sectional study

BMJ Open ◽

10.1136/bmjopen-2017-019554 ◽

2018 ◽

Vol 8 (8) ◽

pp. e019554 ◽

Cited By ~ 3

Author(s):

Melkamu Merid Mengesha ◽

Yadeta Dessie ◽

Aklilu Abrham Roba

Keyword(s):

Health Status ◽

Statistical Significance ◽

Cross Sectional Study ◽

Hiv Treatment ◽

Hiv Positive ◽

P Value ◽

Sectional Study ◽

Cross Sectional ◽

Eastern Ethiopia ◽

Dire Dawa

ObjectivesThe aim of this study was to assess the level and factors associated with caregivers’ disclosure of perinatally HIV-infected (PHIV+) children’s seropositive status.DesignWe conducted a cross-sectional study in five public health facilities providing HIV treatment and care in Dire Dawa and Harar, Eastern Ethiopia. The data were collected from 310 caregivers through face-to-face interviews and record reviews. Data analyses were done using STATA V.14.2 and statistical significance was declared at p value <0.05.ResultsThe study revealed that the level of PHIV+ diagnosis disclosure was 49.4% (95% CI 43.8 to 54.9). Mean age at disclosure was 11.2 years. Disclosure level was higher among children who frequently asked about their health status (aOR (adjusted OR) 2.04, 95% CI 1.04 to 4.03) and when caregivers knew other people who had a disclosure experience (aOR 2.49, 95% CI 1.17 to 5.32). Disclosure level was less among children of 12 years or below (aOR 0.04, 95% CI 0.02 to 0.09) and among caregivers practising deception about the children’s HIV positive status (aOR 0.38, 95% CI 0.19 to 0.74).ConclusionOnly half of the caregivers disclosed their child’s PHIV+ diagnosis. To facilitate disclosure, caregivers should be counselled about the appropriate age of disclosure and related misconceptions that hinder it. It is also apparent that caregivers need to be guided as to how to address children’s frequent questions about their health status. These interventions can be made in a one-on-one approach or through patient group counselling when they come to get healthcare services.

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Correlation of Ship Sanitation with Cockroach Density in Kendari Port Area

MIRACLE Journal Of Public Health ◽

10.36566/mjph/vol4.iss1/243 ◽

2021 ◽

Vol 4 (1) ◽

pp. 102-112

Author(s):

Sriwani Supardin

Keyword(s):

High Risk ◽

Cross Sectional Study ◽

P Value ◽

Sectional Study ◽

Cross Sectional ◽

Exact Test ◽

Fisher's Exact Test ◽

Port Area ◽

Fisher’S Exact Test ◽

The Relationship

Ship sanitation is an indicator of vessel cleanliness, vector control in 2017 no high-risk vessels were found, in 2018 there were 7 high-risk vessels and in 2019 there were 15 high-risk vessels. This study aims to determine the relationship between kitchen sanitation, food raft space and warehouse with cockroach density on ships in the Kendari port area. This type of research is an observational, Cross-Sectional Study design. The population is all ships berthed in the Kendari port area as many as 41 ships and a sample of 37 vessels taken by purposive sampling. Data analysis used fisher's exact test. The results showed that of the 37 ships, the highest density of cockroaches met the requirements (75.7%), the rest did not meet the requirements (24.3%). The kitchen sanitation met the requirements (75.7%), the rest did not meet the requirements (24.3%), then the food raft room sanitation met the requirements (83.8%) and did not meet the requirements (16.2%). Furthermore, warehouse sanitation fulfills the requirements (62.2%) and does not meet the requirements (37.8%). The results of Fisher's exact test obtained p value (0,000). The conclusion of this study is that there is a relationship between kitchen sanitation, food raft space and warehouse with cockroach density on ships in the Kendari port area. Suggestions for the KKP to establish policies to prevent cockroach development.

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Prevalence of depression and its association with parental neglect among adolescents at governmental high schools of Aksum town, Tigray, Ethiopia, 2019: A cross sectional study

10.21203/rs.2.17823/v1 ◽

2019 ◽

Author(s):

Enguday Tirfeneh ◽

Mengesha Srah

Keyword(s):

High Schools ◽

Statistical Significance ◽

Sampling Technique ◽

Cross Sectional Study ◽

Mental Illnesses ◽

P Value ◽

Sectional Study ◽

Cross Sectional ◽

Parental Neglect ◽

Prevalence Of Depression

Abstract Background depression is one of the most serious and prevalent mental illnesses that can result in serious disability and ending life by committing suicide and homicide. The risks of having depression are substantially higher in persons who have parental neglect when compared to the general population.Objective To detect prevalence of depression and its association with parental neglect among adolescents in governmental high schools at Aksum town, Tigray, Ethiopia 2019Method A facility based cross-sectional study was conducted from January 1-30/2019 at Aksum town high schools. Public health questionnaire was used in this study to detect Depression. Study participants were selected using simple random sampling technique. Data was collected with face to face interview. Data was analyzed using statistical package for social science version 22. Bivariate and multivariate logistic regressions were used to see the association between depression and parental neglect. Adjusted Odds ratio at a p-value <0.05 with 95% confidence interval was taken to declare statistical significance of variables.

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Knowledge of prevention of COVID-19 among the general people in Bangladesh: A cross-sectional study in Rajshahi district

PLoS ONE ◽

10.1371/journal.pone.0243410 ◽

2020 ◽

Vol 15 (12) ◽

pp. e0243410

Author(s):

Md. Masud Rana ◽

Md. Reazul Karim ◽

Md. Abdul Wadood ◽

Md. Mahbubul Kabir ◽

Md. Mahidul Alam ◽

...

Keyword(s):

Family Income ◽

Preventive Measures ◽

Nuclear Family ◽

Statistical Significance ◽

Sampling Technique ◽

Cross Sectional Study ◽

P Value ◽

Sectional Study ◽

Cross Sectional ◽

The Government

Background Until now, no vaccine or effective drug is available for the control, prevention, and treatment of COVID-19. Preventive measures are the only ways to be protected from the disease and knowledge of the people about the preventive measures is a vital matter. Objectives The aim of the study was to assess the knowledge of the general people in Rajshahi district, Bangladesh regarding the COVID-19 preventive measures. Methodology This cross sectional study was conducted from March 10 to April 25, 2020. Data were collected with a semi-structured questionnaire from 436 adult respondents selected by using a mixed sampling technique. Frequency analysis, chi-square test, and logistic regression model were utilized in this study. SPSS (IBM, Version 22) was used for data analysis. 95% confidence interval and p-value = 0.05 were accepted for statistical significance. Results Only 21.6% of the respondents had good knowledge of the COVID-19 preventive measures. The highest 67.2% of them knew that washing hands with soap could prevent the disease, but contrarily, the highest 72.5% did not know that avoidance of touching mouth, nose, and eyes without washing hands was a preventive measure. Only 28.4% and 36.9% of the respondents knew that maintaining physical distancing and avoiding mass gatherings were measures of prevention of COVID-19 respectively. The younger age (≤25 years), low family income (≤15,000 Bangladeshi Taka (BDT), occupation others than business and service, and nuclear family had the lower odds of having no/less knowledge about the preventive measures. Conclusions The knowledge level of the general people regarding prevention of COVID-19 was alarmingly low in Bangladesh. The government of Bangladesh, health policy makers and donor agencies should consider the findings and take immediate steps for improving knowledge of the public about prevention of the disease.

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Body Shape Dissatisfaction and Overweight Noesis among Polytechnic College students in Puducherry- A Cross Sectional Study

International Journal of Indian Psychology ◽

10.25215/0204.064 ◽

2015 ◽

Vol 2 (4) ◽

Author(s):

Vishnu Prasad R ◽

Kanimozhy K ◽

Venkatachalam J ◽

Madhanraj K ◽

Zile Singh

Keyword(s):

College Students ◽

Weight Reduction ◽

Body Shape ◽

Lifestyle Modification ◽

Statistical Significance ◽

Cross Sectional Study ◽

Overweight And Obesity ◽

P Value ◽

Sectional Study ◽

Cross Sectional

The prevalence of obesity has doubled since 1980 worldwide. With the changing dietary and life style habits, overweight and obesity have become a threat globally. As on 2011, more than 40 million children worldwide are overweight and more than 30 million of them are living in developing countries. Body image perception of an individual plays a major role in determining the diet and lifestyle modification to alter their body shape.Materials and methods: The study was carried out among 1034 polytechnic college students in Puducherry aged 15-25 years as a cross sectional study. Stunkard’s visual figures scale was used to measure Body Shape Dissatisfaction.Statistical analysis: Chi-square test was used to test the statistical significance in difference between proportions, p value < 0.05 was considered statistically significant.Results:The prevalence of Body Shape Dissatisfaction in our study subjects was found to be 62.2%. More female students wanted a thinner body shape while more male students wanted a bigger body shape than their current body shape. 45.3% of the students with normal BMI were satisfied with their current body shape, 26% of them wanted a bigger shape and 28.7% of the students wanted to have a thinner shape.Conclusions:The prevalence of BSD was considerably high in our study population. Body shape misconception might lead to unnecessary weight reduction measures and students tend to follow unhealthy methods for weight reduction. Proactive preventive measures could be initiated targeting towards weight management and dietary practices of college students.

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Maternal Education and Acute Diarrhea Among Children Aged 2-5 Years In Pakistan: Cross Sectional Study

10.53350/pjmhs211561944 ◽

2021 ◽

Vol 15 (6) ◽

pp. 1944-1947

Author(s):

Fatima Ehsan ◽

Ayesha Ehsan ◽

Wajahat Ullah Khan ◽

Rizwan Masud ◽

Hamad Hanif ◽

...

Keyword(s):

Acute Diarrhea ◽

Maternal Education ◽

Statistical Significance ◽

Cross Sectional Study ◽

Military Hospital ◽

Ethical Review ◽

P Value ◽

Sectional Study ◽

Childhood Diarrhea ◽

Cross Sectional

Childhood diarrheal disease is the second leading cause of death globally. All over the world, children below five years of age experience, on average, 3.2 episodes of diarrhea per year. Objectives: To explore an association of maternal education with childhood diarrhea in Pakistan. Study Design: Cross sectional study. Methodology: This study was conducted from Aug 2016 to Jan 2017 in Combined Military Hospital (CMH), Peshawar following approval from ethical review board. Total children under study were 363 aged 2 to 5 years, amid whom 121 were acute diarrhea cases and 242 were healthy controls leading to cases control ratio as 1:2. Data collection was done through semi structured questionnaire asked from mothers. Statistical analysis: Data was analyzed by SPSS software, version 22. To compare the association of maternal education with acute diarrhea, chi square test was applied at 5% level of significance. Statistical significance was taken at p value <0.05. Results: In present study, there was significant association between formal education of mothers and acute diarrhea with a highly statistically significant association (p < 0.001) observed showing increased proportion of childhood diarrhea, with increasing levels of education in mothers. Conclusion: We concluded that a significant increase in childhood diarrhea with higher levels of maternal education refutes the commonly observed finding. We need to further probe the underlying causes to minimize this high observed morbidity. Key Words: Maternal Education, Child Health and Safety and Acute Childhood Diarrhea

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Distribution of risks and Factors Associated with Unscreened Hypertension among Adults Living in Rural of Dano District, West Shewa, Oromia, Ethiopia, 2020: Community-based cross-sectional study

10.21203/rs.3.rs-762687/v1 ◽

2021 ◽

Author(s):

Firaol Regea

Keyword(s):

Blood Pressure ◽

Associated Factors ◽

Statistical Significance ◽

Cross Sectional Study ◽

P Value ◽

Multivariable Logistic Regression Analysis ◽

Sectional Study ◽

Community Based ◽

Cross Sectional ◽

Measuring Device

Abstract Background: Hypertension affects more than one quarter of adults worldwide and one in three peoples in developing countries. Although Hypertension is known to be a silent medical condition, there is limited information on the prevalence of unscreened hypertension and associated factors among rural dwellers in Ethiopia in general and Dano district in particular. Objective: To assess the prevalence of Unscreened hypertension and associated factors among adults living in the rural area of Dano district, West Shewa, Oromia, Ethiopia 2020.Methods and materials - A community-based cross-sectional study was employed. A multi-stage sampling technique was used to select 605 Adults from the rural community of Dano District from May 23 -July 5, 2020. Data were collected by trained BSc nurses and Public health officers. Standardized WHO STEPS survey tool was used to collect socio-demographic and behavioral characteristics of the participants. Standardized digital blood pressure device was used to measure Blood pressure. The mean score of three blood measurements was used to classify hypertension after intra-class correlation was tested. GmateTM blood glucose measuring device was used to measure blood sugar. Multivariable logistic regression analysis was done to identify factors independently associated with unscreened hypertension. Adjusted Odds Ratio with 95% CI was estimated to measure the strength of association. The level of statistical significance was declared at p-value < 0.05. The results presented by tables and figures. Result: The prevalence of Unscreened Hypertension was 14.6%, (95% CI: 11.95%, 17.4%). Being in age of 19-33 years[(AOR: 2.5,95%CI:( 1,6)], having family history of hypertension [AOR=3.1,95%CI:(1.23,7.77)],having other chronic disease [AOR=0.28,95%CI:(0.11, 0.72)], Participants’ health-seeking behaviour to hypertension[AOR=3.3,95%CI:(1.6,6.5)] and participants knowledge about hypertension[AOR=2.3,95%CI:(1.2,4.5)]were independently associated with unscreened Hypertension.Conclusion - The evidence from this study shows unscreened hypertension is prevalent among adults in the study area. Therefore, opportunistic screening of adults regardless of their age and health status is important.

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Predictors of unrecognised comorbid depression in patients with schizophrenia at Amanuel mental specialized hospital, Ethiopia: a cross-sectional study

BMJ Open ◽

10.1136/bmjopen-2021-049026 ◽

2021 ◽

Vol 11 (9) ◽

pp. e049026

Author(s):

Mohammed Ayalew ◽

Yared Reta ◽

Semira Defar

Keyword(s):

Negative Symptoms ◽

Statistical Significance ◽

Depression Scale ◽

Cross Sectional Study ◽

P Value ◽

Sectional Study ◽

Comorbid Depression ◽

Cross Sectional ◽

Adherence To Medication ◽

Specialized Hospital

BackgroundThe occurrence of depression in patients with schizophrenia (PWS) increases the risk of relapse, frequency and duration of hospitalisation, and decreases social and occupational functioning.ObjectiveThis study aimed to assess prevalence of unrecognised comorbid depression and its determinants in PWS.MethodA cross-sectional study was conducted from 1 to 30 March 2019 at Amanuel mental specialized hospital among 300 PWS. The 9-item Calgary Depression Scale for Schizophrenia was used to assess comorbid depression. Logistic regression was used to determine the association between outcome and explanatory variables. Statistical significance was declared at p value <0.05 with 95% CI.ResultsThe prevalence of unrecognised comorbid depression was found to be 30.3%. Living alone (adjusted OR (AOR)=3.49, 95% CI=0.45 to 8.36), having poor (AOR=4.43, 95% CI=1.45 to 13.58) and moderate (AOR=4.45, 95% CI=1.30 to 15.22) social support, non-adherence to medication (AOR=3.82, 95% CI=1.70 to 8.55), presenting with current negative symptoms such as asocialia (AOR=4.33, 95% CI=1.98 to 9.45) and loss of personal motivation (AOR=3.46, 95% CI=1.53 to 7.84), and having suicidal behaviour (AOR=6.83, 95% CI=3.24 to 14.41) were the significant predictors of comorbid depression in PWS.ConclusionThis study revealed considerably a high prevalence of unrecognised comorbid depression among PWS. Therefore, clinicians consider timely screening and treating of comorbid depression in PWS.

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