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   Table of Contents - Current issue
Coverpage
January-March 2022
Volume 7 | Issue 1
Page Nos. 1-32

Online since Monday, March 28, 2022

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REVIEW ARTICLES  

Eplerenone–A novel Mineralocorticoid receptor antagonist for the clinical application p. 1
Nan-Nan Wu, Yuan-Yuan Zhang, Dong Zhao
DOI:10.4103/ed.ed_7_21  
Aldosterone is produced from the zona glomerulosa of the adrenal cortex in the adrenal gland, which is main mineralocorticoid hormone. Upon binding the mineralocorticoid receptor, it regulates sodium and potassium absorption, secretion, and retention, thereby maintaining stable blood pressure levels. However, abnormal aldosterone synthesis and metabolism could be pathogenic and contribute to multiple organ fibrosis and structural remodeling. For instance, hyperaldosteronemia is critically involved in the development of hypertension, heart failure (HF), and renal disease. Therefore, mineralocorticoid receptor antagonists (MRAs) that could fight against high concentrations of aldosterone play an important role in the treatment of diseases caused by hyperaldosteronism. Eplerenone, as a novel selective MRA, has better therapeutic efficiency and fewer side effects comparing to the classical drug spironolactone. In this review, first, we go through the biosynthesis and biologic properties of aldosterone and then introduce how hyperaldosteronemia facilitates certain diseases progression. Aldosterone is an important part of the renin-angiotensin-aldosterone system (RAAS), which plays a crucial role in essential hypertension, atrial tremor, and tissue fibrosis. Second, we summarize current evidence of clinical application of eplerenone in the control of primary aldosteronism, hypertension, HF, nephropathy, insulin resistance, and liver damage. It is exciting that many studies have shown that the use of eplerenone in these diseases yields good outcomes accompanied with fewer adverse effects such as hyperkalemia, metabolic acidosis, hypotension, and acute kidney failure, which indicates that eplerenone is a strong and safe MRA and inhibitor of RAAS system. This review focuses on therapeutic efficacy and disadvantages of eplerenone when treating a series of different diseases. Ultimately, we hope to shed light on future therapeutic strategies in diseases associated with hyperaldosteronemia.
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Augmenting the public health response to ensure effective containment of the Omicron variant p. 12
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/ed.ed_5_22  
The ongoing coronavirus disease–2019 (COVID-19) pandemic continues to disrupt human lives and almost all sectors and industries. The purpose of the current review was to explore the Omicron variant, the associated global risk, and the public health measures that need to be taken to contain the new variant. An extensive search of all materials related to the topic was carried out in the PubMed search engine and the World Health Organization website. A total of 13 articles were selected based upon their suitability with the current review objectives. Keywords used in the search include COVID-19 and Omicron in the title alone only. The World Health Organization identified a new variant of concern – Omicron on November 26, 2021, which has been reported in more than 170 nations. Depending on the evidence that has surfaced till now, the overall global risk associated with Omicron has been identified as very high. However, the variant has not been linked with serious forms of illness and complications; nevertheless, the large number of cases resulting due to high transmissibility has definitely accounted for a proportional rise in the number of hospital admissions and thus overwhelming the health-care delivery systems. To conclude, the Omicron variant of the causative virus has been associated with high transmissibility but low rates of development of serious infections. This call for the need to raise to the occasion, and all of us should adhere to the standard prevention and control measures and get immunized with the vaccine at the earliest.
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ORIGINAL ARTICLES Top

Awareness of health and environmental hazards of plastic bag use and available substitutes among health workers of two hospitals in a rural area of Northwest Nigeria p. 16
Adewale Olufemi Ashimi, Taiwo Gboluwaga Amole, Abdulkadir Yusuf, Godpower Chinedu Michael
DOI:10.4103/ed.ed_26_21  
Objective: This study assessed health-care workers' awareness of the health and environmental hazards associated with plastic bags and available substitutes. Methods: This cross-sectional questionnaire-based survey was carried out in two rural hospitals in Northwest Nigeria over a 4-week study period. It included permanently employed health workers who were residents in the study community. The data were analyzed using SPSS version-20; the association between respondents' sociodemographic characteristics and awareness of the harmful effects of plastic-bags was determined using the Chi-square test. Results: There were 200 respondents aged 20–55 years with a mean of 31.7 ± 8.6 years. Most, 45% (90/200), respondents were nurses/midwives; 21% (42/200) were doctors. Most respondents, 49% (98/200), would throw away the plastic bags after a single use; 23.5% (47/200) would keep and reuse, while 45.5% (91/200) use reusable bags for shopping. Most respondents, 91% (182/200), were aware of the harmful effect on the environment, while 74% (148/200) knew it could be harmful to health. Respondents' age (>30 years) was significantly associated with awareness of the harmful effects of used plastic bags (P = 0.03), while male gender, age >30 years, being married, and of non-Hausa/Fulani ethnicity were associated with awareness of plastic-bag substitutes. Conclusions: Most respondents were aware of the health and environmental hazards of plastic bags and the available substitutes. Promoting reuse of plastic bags and the use of available substitutes will help to control this growing hazard.
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The prevalence of thyroid nodules and risk factors of thyroid nodules with metabolic disorder in Beijing: A cross-sectional study p. 22
Yuanyuan Zhang, Alexandra Wehbe, Xuhong Wang, Rong Xin Sun, Zhao Hui Zheng, Dong Zhao
DOI:10.4103/ed.ed_14_21  
Background: In recent years, the prevalence of thyroid nodules (TNs) has been increasing, but the relationship between metabolic abnormalities and the incidence of TNs is not well defined, and there is scant data evaluating this relationship stratified by gender. This study aims to analyze the prevalence of TNs and possible risk factors for TNs across gender lines and various metabolic states in Beijing, China. Patients and Methods: A total of 6001 subjects who underwent thyroid ultrasounds as part of a routine medical checkup at Luhe Hospital between 2017 and 2018 were enrolled in this study. Multivariate adjustment logic was used to analyze possible demographic and clinical risk factors of TN stratified by gender. Results: The prevalence of TNs was 44.1%, of which 45.9% were female and 40% were male. In general, the prevalence of TNs increased in parallel with advancing age. These findings were even starker among females, with TN prevalences of 37.5%, 46.5%, 52.9%, and 54.1%, among participants in <55-, 55–65-, 65–75-, and >75-year-old age groups, respectively. The prevalence of TNs was significantly higher among patients with obesity (46.8% vs. 43%, P = 0.008), central obesity (45% vs. 40.4%, P = 0.005), hypertension (47.1% vs. 42.4%, P < 0.001), metabolic syndrome (MetS) (46.1% vs. 41%, P < 0.001), and low TSH levels (46.5% vs. 37.1%, P < 0.001). MetS and obesity were independent risk factors for the prevalence of TNs (odds ratio [OR] = 1.167, [1.002–1.277] and (OR = 0.038, [1.01–1.396]), respectively). TSH had a protective effect on the prevalence of TNs (OR = 0.664, [0.585–0.75]). Conclusions: The present study supports the existing research that contends a strong correlation between older age, MetS, and other clinical risk factors and the prevalence of TNs. This relationship only persisted among women when stratified by gender. These results set the precedent for further research on how gender influences the incidence of TNs, particularly in the setting of other clinical and demographic risk factors.
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SHORT COMMUNICATION Top

Coronavirus disease-19 pandemic and health-care waste: Strategies to ensure environmentally sustainable management p. 29
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/ed.ed_6_22  
In the global mission to prevent climate deterioration and ensure environmental sustainability, the appropriate management of health-care waste carries immense importance. The available global estimates suggest that 30% of the healthcare establishments do not have the desired systems and mechanisms required for the segregation of waste. The ongoing coronavirus disease-2019 (COVID-19) pandemic proved to be a double-edged sword in this case, wherein not only it accounts for a massive increase in the health-care waste that has been generated, but also significantly decreased the capacity of the workers to efficiently deal with the waste, owing to rising caseload and other consequences of the infection. Acknowledging the magnitude of the problem, it is the need of the hour to come out with potential solutions to reduce the impact of health-care waste on the environment. To conclude, the containment of the ongoing COVID-19 pandemic necessitated an unprecedented global response. There are no doubts that we have improved ourselves in that regard, but in the process, it has resulted in the generation of significant amounts of health-care waste. It is high time that all the stakeholders should join their hands together and take appropriate steps to ensure reduction and appropriate management of health-care waste.
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