Comparative Evaluation of Prophylactic and THP of CO (Hawthorn) Fruit with Atorvastatin in Murine Model of Dyslipidemia

Background: Dyslipidemia or hyperlipidemia is a consequential condition resulting from derangement in lipid profile. Standard treatment such as Atorvastatin though beneficial, causes many serious adverse effects thus an alternative like Crataegus oxyacantha (Hawthorn) with hypolipidemic potential was investigated. Aims: To evaluate prophylactic and therapeutic hypolipidemic potential of crataegus oxyacantha (hawthorn) fruit in comparison with atorvastatin in murine model of dyslipidemia through assessing physiological parameter i.e., weight and serum biochemical parameters i.e., lipid profile: TC, TGs, VLDL, LDL and HDL. Study design: This experimental study was carried out in research laboratory of Akhtar Saeed Medical and Dental College and National Health Research Centre (NHRC), Lahore Methods: A murine study of 60 days was conducted on 64 male albino Wistar rats (Age  6 weeks) divided into 8 groups with 8 rats each weighing 180-200 grams. Group 1 (healthy control) received normal diet and 2 ml of normal saline for 60 days. Group 2 (disease control) received HFD and 2 ml of normal saline for 30 days while 3-5 (prophylactic groups) were given HFD along with ethanolic extract of Crataegus oxyacantha fruit, atorvastatin and their combination in doses of 40 mg/kg OD, 80 mg/kg OD and 20+40 mg/kg OD orally respectively for the same period. 6-8 (therapeutic groups) received ethanolic extract of Crataegus oxyacantha fruit, atorvastatin and their combination respectively after induction of dyslipidemia from 30th till 60th day in the same doses as mentioned above. Each rat was weighed and fasting samples for biochemical parameters were drawn by cardiac puncture in all groups at baseline and repeated at 30th day in all groups while also at 60th day in therapeutic groups as well as healthy control group. The results were analyzed using one way ANOVA for Mean±SD, post hoc Tukey’s test for group comparison in the Graph-Pad Prism (V.5) software. A p-value ≤ 0.05 was considered as statistically significant. Study period: This study was conducted from September, 2020-November, 2020. Results: Our murine study concludes that Crataegus oxyacantha (40 mg/kg OD orally) when administered prophylactically and therapeutically shows a noteworthy hypolipidemic potential when compared with Atorvastatin (80mg/kg OD orally). Better results were obtained in prophylactic doses as well as in low dose combination with Atorvastatin (20 mg/kg + 40 mg/kg respectively). Conclusion: Results suggest that Crataegus oxyacantha can be used as alternative in treating hyperlipidemias. Keywords: Crataegus oxyacantha, Atorvastatin, Hyperlipidemia.

Adapting evidence-based group therapies following COVID-19 restrictions

Aim: The COVID-19 pandemic has created barriers to the running of group therapies due to the need to maintain social distance. This paper aims to describe modifications of existing therapeutic groups delivered to people diagnosed with serious and enduring mental illnesses (SMIs) to enable the therapies to continue in an online format due to the COVID-19 restrictions. Conclusions: Therapists and consumers were motivated to find a way to continue the therapies described despite the context of the restrictions imposed due to COVID-19. This paper describes what was involved in ‘pivoting’ to a new mode of practice and modifications that were required over time and as new regulations were put in place. Formal research is required to establish an evidence base if these therapies were required to be regularly delivered in an online mode.

POST ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY PANCREATITIS PROPHYLAXIS: EVALUATION OF TWO DIFFERENT NSAID REGIMENS

ABSTRACT BACKGROUND: Endoscopic retrograde cholangiopancreatography is a widely used therapeutic modality for the pancreaticobiliary tree. However, it is responsible for the highest rates of complications among the endoscopic procedures, especially post-endoscopic retrograde cholangiopancreatography pancreatitis. The preventive methods include mechanical and pharmacological approaches, such as the use of non-steroidal anti-inflammatory drugs. OBJECTIVE: To compare the efficacy of two different strategies using non-steroidal anti-inflammatory drugs for the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis, and to clarify the uncertainty about the route of administration of non-steroidal anti-inflammatory drugs in the prevention of this complication. METHODS: This was a prospective trial. Two therapeutic groups were compared with a control group that was composed of patients who underwent endoscopic retrograde cholangiopancreatography, performed in the same service and by the same team in the period preceding the study (historical series), without the administration of any type of prophylaxis. The first group received 100 mg rectal diclofenac. The second group received 100 mg intravenous ketoprofen. Both groups were compared, separately and jointly, with the control group. RESULTS: Post-endoscopic retrograde cholangiopancreatography pancreatitis occurred in 4.39% (12/273) of the participants. In the group without prophylaxis, the incidence was 6.89% (10/145). Among those who received intravenous ketoprofen, the incidence was 2.56% (2/78). No cases of acute post-procedural pancreatitis were observed in the group that received rectal diclofenac (0/52). Although there was no statistical difference between the therapeutic groups when they were separately analyzed, a statistical difference in the prevention of post-procedural pancreatitis was observed when they were analyzed together (P=0.037). CONCLUSION: This study provides evidence for the efficacy of non-steroidal anti-inflammatory drugs in the prophylaxis of post-endoscopic retrograde cholangiopancreatography pancreatitis.

Oleanolic Acid Improves the Symptom of Renal Ischemia Reperfusion Injury via the PI3K/AKT Pathway

<b><i>Purpose:</i></b> The aim of this study was to investigate the therapeutic effect of oleanolic acid (OA) on the renal ischemia reperfusion injury (RIRI) and the possible mechanism. <b><i>Methods:</i></b> The RIRI model was successfully established in rats. OA, LY294002 (a PI3K inhibitor), and OA combined with LY294002 were dosed to rats in 3 therapeutic groups, respectively. The blood was collected to detect the concentration of Cr and BUN by ELISA. The kidney of each rat was collected to detect the concentration of renal injury factor (Kim-1) and the HE staining was performed. Western blot was used to detect the expression level of PI3K, p-AKT, AKT, PDK1, Skp2, and p27 in the renal tissue homogenate. <b><i>Results:</i></b> The symptom of vacuolar degeneration and interstitial edema was greatly improved in the rat kidney from the 3 therapeutic groups, compared with that from the RIRI model group. No significant difference was observed among the 3 therapeutic groups. The concentration of Cr in the 3 therapeutic groups was greatly lower than that in the RIRI model group. The expression level of p-AKT/AKT, PI3K, PDK1, Skp2, and p27 in OA group, LY294002 group, and OA combined with LY294002 group was significantly lower than that in the RIRI model group, respectively. <b><i>Conclusion:</i></b> OA could improve the symptom of RIRI, possibly by inhibiting PI3K/AKT signal pathway.

DECISION-MAKING IN THERAPEUTIC GROUPS

The major focus in the group literature on decision-making processes has been in the area of task groups. Relatively little attention has been given to these processes in relation to therapeutic groups. There are linkages between the stages of group decision making and group development which can add understanding and knowledge to practice in therapeutic groups.Publisher’s note: We are now putting all back issues of Groupwork on line. Articles in this issue have been scanned to pdf files as viable original typesetting files no longer exist. Though they may not look it, these files are to some extent searchable. This issue was published nearly 30 years ago. We have stated author professional details as received at time of publication.

Health workers’ health in face of disasters: what the experience in Brumadinho, Brazil, taught us

When the Dam I of Córrego do Feijão mine ruptured, in the municipality of Brumadinho, Minas Gerais, Brazil, on 25/01/2019, the released mudflow of iron mining residues caused environmental, human, social, cultural and economic damages in 18 municipalities. It also resulted in psychosocial suffering for all the populace and 272 immediate deaths, 259 of which were occupational accidents, thus being considered the largest expanded occupational accident in Latin America. In this context, the public health workers involved in the care of affected populations presented risks of developing mental illness. The team in the Workeŕs Health Reference Centre (Cerest) observed signs of mental suffering in multiple Primary Health Care workers of Brumadinho. Cerest professionals proposed the realization of therapeutic groups, which did not occur due to the high level of demand generated by the accident. As such, individual consultations were provided by 3 psychologists on duty, on the workplaces that had more complaints. 20 workers with symptoms like insomnia, fatigue and body aches were assisted.Among the 20 patients, 2 were referred to specialized treatment and 3 left the municipality. As such, despite having shown positive effects, the results from this therapeutic approach are not final. The consultations and formal identification of this demand based the creation of a care project centered in therapeutic groups for workers of the health system and other public sectors, like social assistance. This experience shows that the mental health of the response and repair workers was severely neglected. Said professionals, once inserted in a context of high demands and urgency, were not only subjected to more distress, but also had limited opportunities to seek or receive care. As an expanded occupational accident, the unique perspective from teams specialized in occupational health played a key role in this practice, which facilitated the proper assistance required for such a scenario. Key messages This experience reaffirms the need to include health care measures, including mental health, for workers responsible for assisting populations affected by disasters. Worker’s Health Reference Centres of the Brazilian public healthcare system have a prominent role in health vigilance and assistance for all workers affected by expanded occupational accidents.

Selected Pharmaceuticals in Different Aquatic Compartments: Part II—Toxicity and Environmental Risk Assessment

Potential risks associated with releases of human pharmaceuticals into the environment have become an increasingly important issue in environmental health. This concern has been driven by the widespread detection of pharmaceuticals in all aquatic compartments. Therefore, 22 pharmaceuticals, 6 metabolites and transformation products, belonging to 7 therapeutic groups, were selected to perform a review on their toxicity and environmental risk assessment (ERA) in different aquatic compartments, important issues to tackle the water framework directive (WFD). The toxicity data collected reported, with the exception of anxiolytics, at least one toxicity value for concentrations below 1 µg L−1. The results obtained for the ERA revealed risk quotients (RQs) higher than 1 in all the aquatic bodies and for the three trophic levels, algae, invertebrates and fish, posing ecotoxicological pressure in all of these compartments. The therapeutic groups with higher RQs were hormones, antiepileptics, anti-inflammatories and antibiotics. Unsurprisingly, RQs values were highest in wastewaters, however, less contaminated water bodies such as groundwaters still presented maximum values up to 91,150 regarding 17α-ethinylestradiol in fish. Overall, these results present an important input for setting prioritizing measures and sustainable strategies, minimizing their impact in the aquatic environment.

Affordability Assessment from a Static to Dynamic Concept: A Scenario-Based Assessment of Cardiovascular Medicines

The out-of-pocket payments for prescription medications can impose a financial burden on patients from low- and middle- incomes and who suffer from chronic diseases. The present study aims at evaluating the affordability of cardiovascular disease (CVD) medication in Iran. This includes measuring affordability through World Health Organization/Health Action International (WHO/HAI) methodology. In this method, affordability is characterized as the number of days’ wages of the lowest-paid unskilled government worker. The different medication therapy scenarios are defined in mono-and combination therapy approaches. This method adds on to WHO/HAI methodology to discover new approaches to affordability assessments. The results show the differences in the medicines affordability when different approaches are used in mono-and combination therapy between 6 main sub-therapeutic groups of CVD. It indicates the medicine affordability is not a static concept and it changes dynamically between CVD therapeutic subgroups when it used alone or in combination with other medicines regarding patients’ characteristics and medical conditions. Hypertension and anti-arrhythmia therapeutic groups had the most non-affordability and hyperlipidemia had the most affordable medicines. Therefore, affordability can be considered as a dynamic concept, which not only affected by the medicine price but significantly affected by a patient’s characteristics, the number of medical conditions, and insurance coverage.