Objectives:To assess knowledge and practice levels in asymptomatic hyperuricemia (AH) and investigate predictors of urate-lowering therapy (ULT) misprescribing among primary health care (PHC) physicians.Methods:A cross-sectional study was conducted among 201 PHC physicians from December 2017 to May 2018. A based clinical guidelines for hyperuricemia management from American Professional Organizations, a semi-structured questionnaire was administered to collect demographic and professional data; knowledge and practice levels in management of AH; and barriers to the management of hyperuricemia and gout, with focus of the misprescribing of ULT in AH. A 2-stage stratified sampling technique was used to select 4 PHC centers were from each of the 5 advisory sectors in Jeddah, Kingdom of Saudi Arabia; and to recruit a minimum of 10 eligible participants per primary health care center (PHCC). Binary logistic regression was used to analyze predictors of ULT misuse in AH.Results:Only 32.8% participating physicians had adequate knowledge about AH. Regarding practice, while majority (88.1%) correctly recommended a low-purine diet and lifestyle changes to patients, almost half misprescribed ULT and 10.9% misprescribed non-steroid anti-inflammatory drugs. Lack of knowledge and awareness about guidelines were the most frequently self-reported barriers to adequate practice. Predictors of ULT misuse included the percentage of patients having gout (1-10%: OR=5.40, p=0.047) or receiving ULT (>10-20%: OR=20.02, p=0.001)among patients seen in clinic, attendance of rheumatology conferences (OR=2.55, p=0.017), and having a close relative with hyperuricemia or gout (OR=2.45, p=0.026).Conclusion:There are inadequate levels of knowledge regarding AH among Saudi PHC physicians increasing risk of malpractice including misprescription of ULT and anti-inflammatory medications.

Agricultural service providers (Agric. SPs) play an essential role in the adoption of promising agricultural technologies by small and medium-sized farms. Similarly, agricultural service provision also generates substantial income for them. The study highlights the role of Agric. SPs in promotion of moisture conservation; soil health and fertility improving technologies at specific sites in Pakistan for three years i.e. from 2015 to 2017. It is based on primary data collected in the year 2018-19 from eighty sampled farmers, which were purposively selected to cover a range of selected technologies. It is found that Agric. SPs-induced adoption of these technologies has increased over time. They achieved considerable success in the promotion of the use of gypsum for moisture conservation and fertilizer placement drill in Pothwar-Punjab, ridge planting of crops in irrigated province Punjab, laser land leveling in irrigated areas of Sindh province, and use of biozote for improving soil fertility in both irrigated and rain-fed areas of Punjab province. These technologies have good income generation potential for Agric. SPs. The article also highlights factors hindering the large-scale adoption of the technologies in the country. Technical and entrepreneurship capacity building of the Agric. SPs in the provision of services to farmers in multiple technologies, and technical feasibility assessment of few technologies to use these for more than one crop are suggested for large-scale adoption of these technologies.

Background: Bladder cancer, particularly urothelial carcinoma, is prevalent in male and ≥55 years old population. Grade of the bladder tumor affects clinical characteristics, management, and prognosis of the patient. This study aimed to analyze the association between age and histopathological grade of bladder urothelial carcinoma. Methods: This cross-sectional analytical study was approved by the Ethical Clearance Committee of Dr. Hasan Sadikin General Hospital, involving 241 medical records of bladder urothelial carcinoma patients in the Department of Anatomical Pathology at Dr. Hasan Sadikin General Hospital during 2009-2013. Chisquare test was applied to 45 patients with complete record of histopathological grade. Results: Most of the subjects were 65 years old. Male patients were the most frequent. The proportion of low-grade carcinoma in <65 years old age group was only 39.1%, while in ≥65 years old age group was 72.7%. The proportion of high-grade carcinoma in <65 years old age group reached 60.9%, which was 27.3% higher than in ≥65 years old age group. Chi-square test result showed a statistically significant difference between histopathological grade of urothelial carcinoma in <65 years and ≥65 years age groups (p=0.023). Conclusions: Proportion of high-grade and low-grade urothelial carcinoma between <65 years and ≥65 years age groups are statistically different; therefore, an association between age and histopathological grade of bladder urothelial carcinoma is shown.

AbstrakKeganasan terbanyak ketiga di dunia pada organ kolorektal adalah karsinoma yang berasal dari lapisan epitel mukosa. Modalitas yang digunakan untuk terapi karsinoma kolorektal stadium lanjut selain operasi adalah kemoterapi dan saat ini dikembangkan terapi target sebagai alternatif terapi, yaitu metabolit aktif vitamin D, calcitriol. Calcitriol bekerja sinergis dengan agen kemoterapi yang aktivitasnya dimediasi oleh vitamin D reseptor (VDR). Penelitian ini bertujuan mengetahui korelasi imunoekspresi VDR dengan stadium dan derajat diferensiasi Colorectal carcinoma (CRC) is a malignancy from mucosal epithelium of the colon/rectum. The treatment modalities used for advance stage colorectal carcinoma therapy is chemotherapy, in addition to surgery. Targeted therapy is currently being developed as an alternative therapy. One of the agents used in this therapy is calcitriol. Calcitriol is an active metabolite of vitamin D. Calcitriol works synergistically with chemotherapeutic agents and its activity is mediated by the vitamin D receptor (VDR). VDR plays a role in the inhibition of tumor progression via induction of cellular differentiation and proliferation inhibition. In this study, imunoexpression of vitamin D receptor was examined in conjunction with the staging and degree of differentiation (grading) of colorectal adenocarcinoma. The study objects include 35 colorectal adenocarcinoma paraffin blocks created from colectomy which were collected at the Department of Patology Anatomic of Dr. Hasan Sadikin General Hospital Bandung from January 2009-June 2014. The blocks were divided into three groups of staging (I, II, and III) and three groups of grading: well, moderately, and poorly differentiated. Immunostaining was used to evaluate the VDR immunoexspression by histo-score. The data were tested using rank spearman test. There was a weak negative correlation between VDR imunoexpression and staging(p=0.045, R=-0.341), and a moderate positive correlation between VDR imunoexpression and grading (p=0.000, R=0.558). It is concluded that a significant correlation of VDR imunoexpression with staging and grading of colorectal adenocarcinoma is found and this finding can be used as a reference for further studies in the development of targeted therapies. [MKB. 2016;48(2):123-8]