Utilization patterns of antihypertensive drugs in the management of hypertension among patients with chronic kidney disease at a tertiary hospital

Background: Objective of the current investigation was to identify the utilization patterns of antihypertensive drugs among hypertensive patients with chronic kidney disease at Sultan Qaboos university hospital.Methods: This is a retrospective study of the utilization patterns of antihypertensive drugs that were prescribed to 181 hypertensive patients with CKD. Patients’ data and drugs’ data were collected from the hospital track care system and analysed.Results: The results show that diuretics were prescribed for 63.53% of the patients followed by β-blockers (61.3%). Drugs were prescribed orally to 90% of the patients. Furosemide was prescribed to 55.8% of patients followed by amlodipine (55.2%). The majority of the patients were on multiple antihypertensive medications (84%). There was no significant difference between drug utilization in patients with albuminuria and those without albuminuria. Among patients with CKD stages two and three, β-blockers were the most common antihypertensive drugs being utilized. Among patients with stage 4 and stage 5, calcium channel blockers and diuretics were the most common antihypertensive drugs being utilized. The prescription of angiotensin II receptor blockers and direct vasodilators showed a significant difference among different stages of CKD.Conclusions: This study showed that diuretics were the most commonly prescribed antihypertensive drugs among the study cohort. The majority of the patients were on multiple antihypertensive medications

Quantum rotation gates with controlled nonadiabatic evolutions

Quantum gates can be implemented adiabatically and nonadiabatically. Many schemes used at least two sequentially implemented gates to obtain an arbitrary one-qubit gate. Recently, it has been shown that nonadiabatic gates can be realized by single-shot implementation. It has also been shown that quantum gates can be implemented with controlled adiabatic evolutions. In this paper, we combine the advantage of single-shot implementation with controlled adiabatic evolutions to obtain controlled nonadiabatic evolutions. We also investigate the robustness to different types of errors. We find that the fidelity is close to unity for realistic decoherence rate

Prevalence and Antibiogram of Escherichia coli isolates recovered from bovine milk

Antimicrobial resistance is considered a major threat facing humanity. It doesn’t only affect public health, but also causes great losses in the dairy industry. Mastitis is a major threat to the dairy industry. The aim of this study was to monitor the antimicrobial resistance of Escherichia coli (E. coli) collected from raw milk of both healthy and mastitis cows and buffaloes in Egypt. In total, 450 milk samples were collected and examined in the period from 2018 to 2021. The samples were collected from healthy cows and buffaloes (30, 58), suffering from clinical mastitis (139, 223) respectively. E. coli was isolated from 33 mastitis milk samples (9.1%) and from 3 (3.4%) normal milk samples. The antibiotic susceptibility testing was performed using the disc diffusion method (Kirby-Bauer method). E. coli isolated from mastitis milk samples showed resistance to amoxicillin-clavulanic acid (75.8%), ceftazidime (75.8%), colistin (69.8%), ampicillin (39.4%), imipenem (24.2%), trimethoprim-sulfamethoxazole (24.2%), aztreonam (15.2%), cefotaxime (15.2%), tetracycline (15.2%), ciprofloxacin (12.2%), chloramphenicol (6%), and gentamicin (3%). E. coli isolated from normal milk samples showed resistance to ampicillin, and imipenem (66.7%), each, and amoxicillin-clavulanic acid, tetracycline, and trimethoprim-sulfamethoxazole (33.3%), each. The Extended Spectrum -Lactamases test (ESBL) performed on the E. coli isolates showed positive results in 9% of mastitis milk samples, but no results in normal milk samples. Out of 36 E. coli isolates, 34 possessed the ampC gene, but blaTEM and blaSHV were detected in 5 isolates with percentages of 94%, 1.4%, and 1.4%, respectively, while BlaIPM and Sul1 were found in one isolate (2.7%), for each

The Impact of Water Price on the Financial Sustainability of the Palestinian Water Service Providers

The impactof water sales price on the performance of water service providers is typically something of a mystery. High prices mean more revenue and profit; but it may lead to less bills collection and encourage the illegal connections. Yet, this argument has not been fully addressed in the Palestinian water sector; this research evaluates the effect of average water prices on the financial sustainability key indicators as collection efficiency, profit or loss percentage, non-revenue water, staff productivity, daily consumption, operating, and maintenance cost. The average price of cubic meter sold is segmented into low, medium, and high categories. Multivariate analysis shows that there are significant differences in profit or working ratio, daily consumption, and operating cost based on the different price categories. Further significant differences have been found in non-revenue water, collection efficiency, and water production based on low and high price categories. On the other hand, no significant difference has been found in staff productivity. The results show high price set by Palestinian water providers, leads to an increase in the bill collection rate and profit margin. However, negative relationship has been found between the price on one hand, and non-revenue water, average daily consumption, and water production on the other hand. The implication of these findings reveal that the Palestinian water providers should increase water prices gradually to cover operating and maintenance cost for better financial performance and sustainability.This research paper has been made possible through the support from MEDRC Water Research at the Sultanate of Oman. We would like to express our deepest appreciation to MEDRC for publishing this paper. The deepest gratitude also to Palestinian Water Authority (PWA) for valuable, effective supervision, coordination of the scientific researches, and directing them toward finding creative solutions for current water problems

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Utilization patterns of antihypertensive drugs in the management of hypertension among patients with chronic kidney disease at a tertiary hospital

Background: Objective of the current investigation was to identify the utilization patterns of antihypertensive drugs among hypertensive patients with chronic kidney disease at Sultan Qaboos university hospital.Methods: This is a retrospective study of the utilization patterns of antihypertensive drugs that were prescribed to 181 hypertensive patients with CKD. Patients’ data and drugs’ data were collected from the hospital track care system and analysed.Results: The results show that diuretics were prescribed for 63.53% of the patients followed by β-blockers (61.3%). Drugs were prescribed orally to 90% of the patients. Furosemide was prescribed to 55.8% of patients followed by amlodipine (55.2%). The majority of the patients were on multiple antihypertensive medications (84%). There was no significant difference between drug utilization in patients with albuminuria and those without albuminuria. Among patients with CKD stages two and three, β-blockers were the most common antihypertensive drugs being utilized. Among patients with stage 4 and stage 5, calcium channel blockers and diuretics were the most common antihypertensive drugs being utilized. The prescription of angiotensin II receptor blockers and direct vasodilators showed a significant difference among different stages of CKD.Conclusions: This study showed that diuretics were the most commonly prescribed antihypertensive drugs among the study cohort. The majority of the patients were on multiple antihypertensive medications.</jats:p

Implementation of quantum rotation gates using controlled non-adiabatic evolutions

Quantum gates are the basic building blocks in the quantum circuits model. These gates can be implemented using adiabatic or non adiabatic processes. Adiabatic models can be controlled using auxiliary qubits, whereas non adiabatic models can be simplified by using one single-shot implementation. In this paper, the controlled adiabatic evolutions is combined with the single-shot implementation to obtain quantum gates with controlled non adiabatic evolutions. This is an important improvement which can speed the implementation of quantum gates and reduce the errors due to the long run in the adiabatic model. The robustness of our scheme to different types of errors is also investigated. Keywords—Adiabatic evolutions, non adiabatic evolutions, controlled adiabatic evolutions, quantum rotation gates, dephasing rates, master equation