31 Jan 2023
31 Jan 2023
Developing countries have the majority of the world’s population and bear the greatest disease burden. The vast majority of those countries want to participate in the clinical research arena with their own data representing their population. The limited resources available in these countries necessitate the design and availability of evidence-based interventions that are efficient and cost-effective. Paradoxically, the lack of appropriately trained researchers, funding sources, and technical facilities limit the conduct of large-scale clinical trials in these countries that can serve as the basis of these interventional strategies. The identification of suitable measures that need minimal resources in terms of cost as well as skilled personnel is therefore an important requirement for these countries to meet the ever-increasing demands and burden put over the healthcare systems of these developing countries. Evidence extrapolated from randomized clinical trials is considered to be at the top of the evidence pyramid. Cluster randomization can offer logistical when delivered to the entire population rather than at the individual level. A cluster-randomized clinical trial allows both the direct as well as the indirect effects of an intervention to be captured and is well-suited for developing countries. In this review, the difference between the clinical trial studies conducted in the developing and the developed countries are delineated by looking at the clinical trial records of the Kingdom Saudi Arabia (KSA) and Egypt as developing countries, and Canada and Germany as developed ones. The pros and cons of conducting clustered clinical trials in the developing countries are then weighed, followed by ethical and methodological considerations that must be taken into account before conducting clustered clinical trials in the developing world. The benefits of using cluster randomization for the design of randomized clinical trials are then analyzed based on the previous observations.
Abdominal obesity, hypertriglyceridemia, low HDL, hypertension and hyperglycemia indicate condition of metabolic syndrome. Metabolic abnormalities can increase cardiovascular disease risk (Soegondo dan Purnamasari, 2010). The aim of study determine cardiovascular disease risk in the Rejang Clan. Research design used descriptive analytic with cross sectional in which independent variables (BMI, abdominal circumference, blood pressure, uric acid, blood sugar, cholesterol) and dependent variable (cardiovascular disease risk) were measured at the same time. Sample is the Rejang Clan, used purposive sampling with inclusion and exclusion criteria totaling 88 people. Data analysis used univariate and bivariate such as chi square, t independent and correlation test. Gender shows almost all of them are female, age describes most of them aged 45 years, education shows that most of them are highly educated, and occupations describe most of them not working. Mean of BMI is 26.17 kg/m2, abdominal circumference is 87.95 cm, blood pressure is 123.89 mmHg, uric acid is 5.54 mg/dl, sugar is 131.98 mg/dl, and cholesterol is 192.35 mg/dl. There is different proportions on the characteristics of age (p value 0.006), while on the characteristics of gender (p value 0.835), education (p value 0.107) and occupation (p value 0.124) have no difference in proportion. Furthermore, there was no difference in BMI, abdominal circumference, blood pressure, uric acid, blood sugar, cholesterol based on cardiovascular disease risk (p value > 0.05). Rejang Clan do not have a risk of cardiovascular disease.
The relationship between the risk of cardiovascular disease with BMI and HDL levels with Rank Spearman (ordinal data scale). Obesity is one of the modifiable risk factors and is an important key in increasing the incidence of cardiovascular disease, which is the measurement of Body Mass Index (BMI). Decreased levels of HDL (high density lipoprotein) in plasma is associated with an increased risk of cardiovascular disease. The most commonly used is the Framingham risk score (Framingham Risk Score), was is a calculation of the risk of atherosclerotic cardiovascular disease in the next 10 years. The objective was determine relationship between BMI and HDL lipid profile as cardiovascular disease risk factor. The research design was cross sectional, in a hospital in Sidoarjo, East Java, Indonesia. The relationship between the risk of cardiovascular disease with BMI and HDL levels with Rank Spearman (ordinal data scale). There were no relationship between HDL profile and BMI with cardiovascular risk factors in metabolic syndrome patients (p=0.682). Therefore, further research was needed to identify the relationship.
Helium (He), the most stable of all elements, was first discovered in 1868. Since then, it has had wide applications. In medicine, helium, in combination with oxygen (Heliox), has proved clinically valuable in respiratory care applications, helping in reducing the work of breathing by, among other things, (1) improving ventilation distribution and overall alveolar ventilation, (2) reducing airway resistance and minute volume requirement, and (3) improving aerosol delivery. As such, it has been indicated for managing patients with a wide range of respiratory conditions, including the tracheal, larynx, or lower airway obstruction. Despite its potential benefits and a huge body of research and clinical case reports advocating its usage, Heliox has only been used sporadically. Its role also remains largely undefined, owing to a dearth of data supporting its use. The present review searches and presents the available evidence for the effective clinical use of Heliox. The findings describe general beneficial effects in treating patients with a range of respiratory conditions by helping to improve breathing and oxygenation. Further studies are, however, warranted in this regard.
Hand washing is an important key factor to prevent transmission of infectious agents to patients. Antiseptics like triclosan and chlorhexidine gluconate are frequently used for both skin antisepsis. Natural products like betel leaf (Piper Betle Linn) have emerged with fewer side effects so that they can be considered safer, which has antiseptic properties. All Parts have antiseptic properties, including the essential oil whose main component consists of bethel phenol and several of its derivatives including cavibetol, alkaloids, flavonoids, tripenoids or steroids, saponins, terpenes, phenylpropane, terpinene, diastase, tannins, etc. The purpose of this research is to examine the effectiveness of betel leaf extract soap as an alternative to natural hand soap with chlorhexidine and triclosan. This research was conducted on oral and maxillofacial surgery residents who will become operators at the oral surgery clinic of Faculty of Dental Medicine of Airlangga University Surabaya. The operator's hands is swabbed before and after handwashing using three different kind of soap. Based on the Kruskal wallis overall there was no significant difference in the status of the number of bacteria between the chlorhexidine, triclosan, and betel leaf groups (p-0.368 or p>0.05). The significance value of the difference in the Mann Whitney test which was bigger than 0.05 (p>0.05) which is no difference colony count bacteria in every compared group of research. Conclusion of this research is betel leaf extract in the form of hand soap is as effective as the other two soaps which are chlorhexidine and triclosan which are exist already in market.