UK: According to a research article published in Ophthalmologica,
researchers have pointed out that following pars plana vitrectomy (PPV), drop
regimen of one-week dexamethasone 0.1%/antibiotic and one-month ketorolac is as
effective as an anti-inflammatory. This regime is safer for Ocular hypertension
(OHT) compared to standard care one-month dexamethasone 0.1%.

It is already known that postoperative steroid/antibiotic drop
regimens effectively suppress inflammation and infection following Pars Plana
Vitrectomy. However, steroid induces OHT frequently. This requires additional
treatment and more frequent hospital visits in the postoperative period.

To address the concern mentioned above, a cohort-control study was
conducted led by Orlans et al. to assess the safety and efficacy of a novel
post-PPV drop regimen.

The study points are:

· The relevant electronic case notes were reviewed between December
2020-April 2021 of those patients who underwent PPV.

· The study was conducted at Vitreoretinal Service, St. Thomas'
Hospital, London, UK

· The intervention cohort had 58 (28 %) patients given postoperative
drops of one-week dexamethasone 0.1%/antibiotic QDS and one-month g. ketorolac
TDS.

· Standard care controls included 151 (72 %) patients who received
one-month g. dexamethasone 0.1%/antibiotic QDS.

· Total of 209 eyes from 192 patients were included.

· IOP≥30 mmHg two weeks postoperatively was the primary outcome measured
by the researchers.

· Secondary outcomes were rates of anterior uveitis, cystoid macular
oedema, endophthalmitis, and the number of eye hospital visits.

· Similarities were reported between baseline and <72hr postoperative
IOPs between groups.

· IOP ≥ 30 mmHg at the two-week postoperative visit (primary outcome
measure) occurred in none of the intervention groups but in 21 (14%) of the
controls.

· The difference in IOP change distribution between the two groups was
highly significant.

· There was no significant difference reported in secondary outcomes
between the groups.

· There were no cases of endophthalmitis in either cohort.

· The intervention cohort had fewer all-cause eye hospital visits in the
three months immediately following PPV.

The novel regimen used in the study reduced rate of subsequent OHT, a
lesser need for additional topical antihypertensive treatment, and fewer
patient visits to the eye hospital in the postoperative period.

Further reading:

Orlans HO, Yazdouni S, Williamson TH, Wong RS, Laidlaw DAH. A novel
postoperative drop regimen reduces the risk of ocular hypertension following
pars plana vitrectomy. Ophthalmologica. 2022 Dec 23. DOI: 10.1159/000528037

This was warned yesterday by epidemiologist-health worker Carlos Féliz Cuello, who advised the public not to stay at home if they experience the first symptoms of profuse diarrhea that causes cholera because the patient requires special hydration, which cannot be obtained simply by drinking water or other energy drinks that people are accustomed to consuming in case of diarrhea. He claims that cholera causes rapid electrolyte loss and dehydration, which can lead to death in less than three days if not treated properly.

The specialist recalled that cholera is a poverty-related disease that manifests itself in areas where there is no drinking water, they do not receive it through pipes, they consume water sold in bulk, they live in overcrowded conditions, and they lack adequate education on food handling and cooking. “All of these are social, economic, and environmental factors that facilitate the development of this bacterium that is acquired through food and water contamination,” he explained. He stated that to avoid the presence of outbreaks of this disease from time to time, countries must be concerned about changing the living conditions of the people who live in these vulnerable areas because otherwise, all they are doing is applying temporary palliative measures, as is currently happening in the country in sectors such as La Zurza, where an outbreak has been registered.

He stated that the cases that are reported are those in which people notify when their care mechanisms, such as drinking a lot of water, teas, and hydrating drinks, have already failed and they arrive at health centers in complicated conditions. He explained that the cholera disease’s profuse diarrhea quickly dehydrates, causing the kidneys to stop working and the circulatory, cardiac, and respiratory systems to shut down.

Living a healthy lifestyle is key to fighting off chronic illnesses like heart disease, stroke, and arthritis. It is also important to practise a healthy lifestyle to protect yourself against acute diseases and infections such as the common cold,...

PAHO issues alert on outbreaks of avian influenza in birds in ten countries of the Americas

Cristina Mitchell

17 Jan 2023

Pharmaceutical companies AbbVie and Eli Lilly have withdrawn from Britain's voluntary medicines pricing agreement, an industry body said on Monday. Reuters Health Information

sales — for its manufacturer AbbVie after coming just a few hundred million short of the $20 billion benchmark for three years in a row. However, while this news was no-doubt greeted warmly by the company, AbbVie’s fourth-quarter 2021

Published today in Nature Medicine, the research solves a 60-year problem of how to detect the hormone producing nodules without a difficult catheter study that is available in only a handful of hospitals, and often fails. The research also found that, when combined with a urine test, the scan detects a group of patients who come off all their blood pressure medicines after treatment.

128 people participated in the study of a new scan after doctors found that their Hypertension (high blood pressure) was caused by a steroid hormone, aldosterone. The scan found that in two thirds of patients with elevated aldosterone secretion, this is coming from a benign nodule in just one of the adrenal glands, which can then be safely removed. The scan uses a very short-acting dose of metomidate, a radioactive dye that sticks only to the aldosterone-producing nodule. The scan was as accurate as the old catheter test, but quick, painless and technically successful in every patient. Until now, the catheter test was unable to predict which patients would be completely cured of hypertension by surgical removal of the gland. By contrast, the combination of a ‘hot nodule’ on the scan and urine steroid test detected 18 of the 24 patients who achieved a normal blood pressure off all their drugs.

The research, conducted on patients at Barts Hospital, Cambridge University Hospital, and Guy’s and St Thomas’s, and Universities of Glasgow and Birmingham, was funded by the National Institute for Health and Care Research (NIHR) and Medical Research Council (MRC) partnership, Barts Charity, and the British Heart Foundation.

Professor Morris Brown, co-senior author of the study and Professor of Endocrine Hypertension at Queen Mary University of London, said: “These aldosterone-producing nodules are very small and easily overlooked on a regular CT scan. When they glow for a few minutes after our injection, they are revealed as the obvious cause of Hypertension, which can often then be cured. Until now, 99% are never diagnosed because of the difficulty and unavailability of tests. Hopefully this is about to change.”

Professor William Drake, co-senior author of the study and Professor of Clinical Endocrinology at Queen Mary University of London, said: “This study was the result of years of hard work and collaboration between centres across the UK. Much of the ‘on the ground’ energy and drive came from the talented research fellows who, in addition to doing this innovative work, gave selflessly of their time and energy during the national pandemic emergency. The future of research in this area is in very safe hands.”

In most people with Hypertension (high blood pressure), the cause is unknown, and the condition requires life-long treatment by drugs. Previous research by the group at Queen Mary University discovered that in 5-10% of people with Hypertension the cause is a gene mutation in the adrenal glands, which results in excessive amounts of the steroid hormone, aldosterone, being produced. Aldosterone causes salt to be retained in the body, driving up the blood pressure. Patients with excessive aldosterone levels in the blood are resistant to treatment with the commonly used drugs for Hypertension, and at increased risk of heart attacks and strokes.

Reference:

Troy H. Puar, Chin Meng Khoo, Colin Jingxian Tan, Aaron Kian Ti Tong, Michael Chien Sheng Tan, Ada Ee Der Teo, Keng Sin Ng, Kang Min Wong, Anthonin Reilhac, Jim O’Doherty, Celso E. Gomez-Sanchez, Peng Chin Kek, Szemen Yee, Alvin W.K. Tan, Matthew Bingfeng Chuah, Daphne Hui Min Lee, Kuo Weng Wang, Charles Qishi Zheng, Luming Shi, Edward George Robins, Roger Sik Yin Foo. 11C-Metomidate PET-CT versus adrenal vein sampling to subtype primary aldosteronism: a prospective clinical trial. Journal of Hypertension, 2022; 40 (6): 1179 DOI: 10.1097/HJH.0000000000003132

Because the mode of transmission is fecal-oral, that is, associated with water and food contaminated with fecal matter, greater care should be directed to food handling, cleanliness and hygiene at home, and constant hand washing.

As the Dominican Society of Intectology has pointed out, state and local governments must also ensure access to safe water and tools to maintain hygiene measures.

Watery and whitish diarrhea, like rice water, vomiting, dry mouth, weakness, and drowsiness are all symptoms of cholera, which can lead to death if not treated quickly.

Companies are increasingly arguing that it is no longer possible to justify the UK's "voluntary scheme" to global boardrooms and investors as repayment rates in 2023 have surged to 26.5% of revenue, the Association of the British Pharmaceutical Industry (ABPI) said in a statement."The current scheme has harmed innovation, with costs spiralling out of control, and the UK falling behind other major countries to be left as a global outlier," said Laura Steele, president and general manager for Eli Lilly's Northern Europe division.ABPI said it was seeking early talks with the government to set out a new future settlement.In December, the industry body had said the government raised the amount manufacturers of branded medicines within the voluntary scheme will be required to return to almost 3.3 billion pounds ($4.02 billion) in sales revenue from an earlier amount of 1.8 billion pounds.The demand from the UK's National Health Service (NHS) and use of new medicines to treat patients have grown faster than the industry's pre-pandemic projections, which has driven repayment rates far beyond sustainable levels, ABPI added.The current voluntary scheme, which will end in Decmeber, is an agreement between the British government and the pharmaceutical industry with roots going back to the foundation of the NHS, ABPI said.

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