BACKGROUND Secondary prevention medications are recommended for older adults after acute myocardial infarction (AMI), but little is known about whether nursing home (NH) residents receive these medications. OBJECTIVES To evaluate new use of secondary prevention medications after AMI in NH residents who were previously non-users, and to evaluate which factors were associated with use. DESIGN Retrospective cohort using linked national Minimum Data Set assessments; Online Survey, Certification and Reporting (OSCAR) records; and Medicare claims. SETTING U.S. NHs. PARTICIPANTS National cohort of 11,192 residents aged ≥65 years who were hospitalized for an AMI May 2007-March 2010, had no beta-blocker or statin usage for ≥4 months prior, and survived ≥14 days after NH readmission. MEASUREMENTS The outcome was the number of secondary prevention medications initiated within 30 days of NH readmission. RESULTS Thirty-seven percent of residents initiated no secondary prevention medications after AMI, 41% initiated one, and 22% two. After covariate adjustment, use of more secondary prevention medications declined with advancing age (down to proportional odds ratio (POR)=0.48, 95% confidence interval (CI)=0.40–0.57 for ≥95 versus 65–74 years), female sex (POR=0.88, 95% CI=0.80–0.96), do not resuscitate (DNR) order presence (POR=0.90, 95% CI=0.83–0.98), functional impairment (dependent or totally dependent versus independent to limited assistance, POR=0.77, 95% CI=0.69–0.86) and cognitive impairment (moderate to severe dementia versus cognitively intact, POR=0.79, 95% CI=0.70–0.89). CONCLUSION More than one-third of older NH residents in the U.S. do not initiate any secondary prevention medications after AMI, with fewer medications initiated among residents with older age, female sex, DNR orders, poor physical functioning, and cognitive impairment. A lack of evidence for the NH population and unmeasured patient-centered goals of care are both plausible explanations for these findings.

Snakebites can present local or systemic envenomation, while neurotoxicity and respiratory paralysis are the main cause of death. The mainstay of management is anti-snake venom (ASV), which is highly effective, but liable to cause severe adverse reactions including anaphylaxis. The types of adverse reaction to polyvalent anti-snake venom have not been previously studied in Bangladesh. In this prospective observational study carried out between 1999 and 2001, in the Snake Bite Study Clinic of Chittagong Medical College Hospital, 35 neurotoxic-snake-bite patients who had received polyvalent anti-snake venom were included while the ones sensitized to different antitoxins and suffering from atopy were excluded. The common neurotoxic features were ptosis (100%), external ophthalmoplegia (94.2%), dysphagia (77.1%), dysphonia (68.5%) and broken neck sign (80%). The percentage of anti-snake venom reaction cases was 88.57%; pyrogenic reaction was 80.64%; and anaphylaxis was 64.51%. The common features of anaphylaxis were urticaria (80%); vomiting and wheezing (40%); and angioedema (10%). The anti-snake venom reaction was treated mainly with adrenaline for anaphylaxis and paracetamol suppository in pyrogenic reactions. The average recovery time was 4.5 hours. Due to the danger of reactions the anti-snake venom should not be withheld from a snakebite victim when indicated and appropriate guidelines should be followed for its administration.

Abstract:Malathion is an organophosphorous insecticide widely used in the agricultural field in Bangladesh and reach in the aquatic environment through rain wash. In the present study, we examined the effects of Malathion on hematological parameters and gills morphology in common carp exposed to two sub-lethal concentrations (1.5 and 3.0 mg/L) for a period of 192h (8 days). For hematological parameters fish were sacrificed at 24, 48, 72, and 96h after start of exposure. Gills were collected at 192h after start of exposure. The blood glucose level was significantly elevated with increasing the concentration of Malathion. Red blood cells (RBCs), hemoglobin (Hb) and hematocrit (Hct) values were significantly decreased after the exposure of Malathion. Significant increments were observed in case of the mean corpuscular volume (MCV) and mean corpuscular hemoglobin concentration (MCHC), while no distinct changes were noted for mean corpuscular hemoglobin (MCH). Interestingly, white blood cells (WBCs) count was significantly increased with toxicity of Malathion. Several morphological changes, such as telangiectasia, blood lamellar congestion, hypertrophy of filaments, lamellar fusion were observed in the gills of fish exposed to Malathion. The present study revealed that the insecticide had adverse effects on various blood parameters and gills morphology in common carp. Thus, the use of insecticide in the agriculture field may be a threat to fauna and flora of the aquatic environment.

In older NH residents with T2D, T2D-friendly β-blocker use was associated with a lower rate of hospitalization for hyperglycaemia, but a higher rate of all-cause re-hospitalization.