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Poor glycemic control in diabetic chronic kidney disease (CKD) patients on maintenance hemodialysis is of great challenge, resulting in increased risk of morbidity and mortality. This study aimed to determine the prevalence and determinants of poor glycemic control among diabetic CKD patients on maintenance hemodialysis. A cross-sectional study was conducted in 12 dialysis centers located in four regions of Tanzania from March to June 2023. The study population was diabetic CKD patients above 18 years on maintenance hemodialysis for three months or more. A consecutive sampling technique was used for patient recruitment, and a semi-structured questionnaire was used to collect data. The primary outcome was poor glycemic control were considered when glycated hemoglobin (HbA1c) levels were <  6% or > 8%. Statistical Package for Social Sciences (SPSS) version 23 was used for data analysis. Univariate and multivariable regression models were used to evaluate the determinants of poor glycemic control. A p-value < 0.05 was considered statistically significant. Out of 233 enrolled patients, the overall prevalence of poor glycemic control was 55.4%, whereby 27.0% had HbA1c < 6% and 28.33% had HbA1c > 8%. A high risk of HbA1c > 8% was observed among patients who were on antidiabetic medication (2.16 (95% CI: 1.06-4.41) p =  0.035) and those attending dialysis sessions less than 3 times a week (1.59 (95% CI: 1.02-2.48) p =  0.040). The lower risk of HbA1c < 6% was observed in patients dialyzed using glucose-containing dialysates than those dialyzed with glucose-free dialysate (0.57 (95% CI 0.36-0.87) p =  0.020). The high prevalence of poor glycemic control among diabetic CKD patients, as revealed by this study, has significant implications. Patients on antidiabetic medication and those with less than three dialysis sessions per week are at a high risk of HbA1c > 8%. Conversely, patients dialyzed using glucose-free dialysates are at a high risk of HbA1c < 6%. Glycemic control in diabetic chronic kidney disease (CKD) patients is a great challenge due to altered glucose homeostasis, gluconeogenesis, tubular glucose reabsorption and inaccuracy of glycemic regulation metrics [1]. Furthermore, changed renal pharmacokinetics of antihyperglycemic agents (AHA), uremic milieu, and dialysis therapy also contribute to this challenge [2]. Based on the severe risk of hyperglycemia and hypoglycemia in patients with diabetic end-stage renal disease (ESRD), glycemic control is of paramount importance.

The aim of this study was to develop and validate a High-Performance Thin Layer Chromatographic (HPTLC) method for simultaneous determination of ceftriaxone and ceftriaxone e-isomer in powder for injection formulation. Ceftriaxone sodium injection is an antibiotic that used globally. It has Z/E geometrical conformation, in which ceftriaxone sodium and 3 ene-isomer have Z- conformation while (E)-isomer has E- conformation and the potential toxicity of ceftriaxone (E)-isomer has been reported. Thus, to safeguard the public health, a simple and easy to use, rapid and reliable method was developed for qualitative and quantitative determination of ceftriaxone sodium and its (E)–isomer. Samples were applied on HPTLC glass plates precoated with silica gel 60F254 by using Linomat semi-auto sampler. Separation was carried out using acetone, triethyl amine, water, chloroform and ethyl acetate as a mobile phase in different ratios. The R f values of separated compounds were 0.51 ± 0.01 and 0.62 ± 0.01 for ceftriaxone sodium and ceftriaxone (E)-isomer respectively. The method was validated by studying Specificity, Linearity, Accuracy, Precision, Robustness, Limit of Detection (LOD) and Limit of Quantification (LOQ) and Solution stability. The developed method was successfully, sensitive, simple, precise, accurate, robust and applicable for the simultaneous determination of ceftriaxone sodium and ceftriaxone (E)-isomer in powder for injection formulation.

Background Induction of labor is a medical procedure used to stimulate uterine contractions and promote cervical ripening, facilitating spontaneous vaginal delivery (SVD). Various induction methods are used globally, but data on their safety and effectiveness, especially in developing countries, are limited. This study evaluated the safety and effectiveness of different labor induction methods among pregnant women delivering at referral hospitals in Dar es Salaam, Tanzania. Methods This cohort study enrolled pregnant women who underwent labor induction at referral hospitals in Dar es Salaam from April to May 2021. The induction methods assessed were oxytocin, dinoprostone, misoprostol, and balloon catheter. Data were collected on the proportion of women achieving SVD, median time to delivery, and maternal and neonatal outcomes. Data were analyzed using SPSS version 23, presenting findings as frequencies, percentages, and medians. Cox regression modelling assessed factors associated with SVD and delivery outcomes. Results Of the 322 women included, 198 (61.5%) were at term, and 210 (65.2%) had comorbidities. Overall, 80% of women achieved SVD following induction. Among women induced with oxytocin, 95% achieved SVD, compared to 69% for dinoprostone, 72% for misoprostol, and 77% for balloon catheter. The median time to SVD was 5.42 h (IQR: 4.50–6.00) for oxytocin, 13 h (IQR: 12.00–14.00) for dinoprostone, 8.5 h (IQR: 7.00–9.00) for misoprostol, and 9.0 h (IQR: 8.00–10.00) for the balloon catheter. Maternal blood loss was significantly lower for oxytocin-induced women ( p  < 0.001), compared to misoprostol, dinoprostone, and balloon catheter. Neonatal outcomes were better for oxytocin-induced women ( p  < 0.01) and poorer for those induced with misoprostol ( p  < 0.01). Factors associated with achieving SVD included multigravidity (AoR = 1.57, p  = 0.004), comorbidities (AoR = 1.47, p  = 0.007), and use of oxytocin (AoR = 3.13, p  < 0.001) or dinoprostone (AoR = 0.58, p  = 0.003). Conclusion Oxytocin was the most effective and safest method for labor induction within 24 h, resulting in favorable maternal and neonatal outcomes. Healthcare workers should prioritize oxytocin for timely deliveries, while considering alternatives like dinoprostone, misoprostol, and balloon catheter based on individual patient needs and clinical circumstances.

Background Postoperative antibiotic prophylaxis (PAP) involves using antibiotics after surgery to prevent surgical site infections (SSIs). However, studies have shown that PAP offers no additional benefits compared to discontinuation after surgical incision closure, prompting its de-implementation to prevent unnecessary antibiotic use that may contribute to antibiotic resistance. We conducted this review to synthesize evidence for guiding the design and implementation of effective strategies for discontinuing PAP practice and optimizing antibiotic use in surgical settings. Methods This umbrella review searched for articles from PubMed/MEDLINE and Scopus, focusing on reviews conducted on human subjects on PAP to prevent SSIs, published in English language from 2019 to 5th July 2024. This review followed guidelines from PRISMA-P and PRIOR. The risk of bias (methodological quality) was assessed using AMSTAR-2. The pooled risk ratio (RR) was estimated using a fixed-effects model (Mantel–Haenszel method), while I 2 was used to assess the heterogeneity between reviews. This review was registered with PROSPERO (CRD42024566124). Results In our umbrella review, we screened 1156 articles, with 28 review articles found eligible for final analysis, involving over 457 primary studies. About 80,483 patients were involved in 9 meta-analysis reviews, which were used to estimate the pooled RR. We found no significant benefits to patients from continuing PAP beyond 24-h post-surgery compared to immediate discontinuation, RR : 1.07 (95% CI : 0.97–1.17, I 2 : 25%, p -value: 0.22). Strategies such as regularly assessing and refining guidelines to fit specific surgical settings and patients’ characteristics, multidisciplinary collaboration, availability of resources needed for best practices, education and training healthcare workers on SSI prevention and antibiotic stewardship, and patient education in SSI prevention and proper antibiotic use were recommended to improve best practices in surgical settings. Conclusions Prolonging antibiotic prophylaxis beyond 24-h post-surgery did not show significant protective benefits against SSIs. Our findings support the 2018 WHO recommendation for the immediate discontinuation of PAP following surgical incision closure in clean and clean-contaminated procedures. Further de-implementation research studies are needed to guide the effective discontinuation of PAP practice.