THE USE OF SILDENAFIL AMONG MALES IN BENIN CITY

CHAPTER ONE

INTRODUCTION

1.1       BACKGROUND OF STUDY

Sildenafil citrate is a potent, competitive phosphodiesterase type 5 isoenzyme inhibitor, it was the first in a class of effective oral treatment for erectile dysfunction(ED) of varying etiologies including erectile dysfunction associated with drugs, diabetes, other general medical conditions and spinal cord injury (Giulinao et al). Sildenafil citrate was initially studied for use in hypertension and angina pectoris but since it induced penile erection to patients who took the drug in clinical trials (ABM), Pfizer decided to market it for erectile dysfunction rather than Angina, and was approved for use for erectile dysfunction by the FDA on March 27th 1998.  Sildenafil popularity with young adults has increased over the years (Peterson, 2001). The availability of sildenafil has changed the view of ED management, as well as increased patient access to disease management resources.(Boyce et.al 2001). A significant portion of the literature describing the use of sildenafil in recreational settings comes from Great Britain. The authors of one British review in 2000 reported that the PDE5 inhibitor was supplied via the Internet, as well as from street sources.(Downie et.al 2000) Opioid abusers were seeking the drug to improve sexual performance that might be adversely affected by long-term opiate use. Healthy menwere also seeking the drug in the belief that it would improve their sexual performance. The perceived risks of obtaining sildenafil via such online sources were assessed in 1999. Ten virtual pharmacies that sold sildenafil pursuant to an online prescription issued by an affiliated physician were assessed for their extent of dispensing the drug despite evident patient contraindications.(Eysenbach et.al1999)  Investigators posed as a 69-year-old obese woman with coronary artery disease and hypertension who complained of having “no orgasm.” Concomitant medications that were listed on the patient’s request form were captopril, pravastatin, atenolol, and erythromycin. One pharmacy offered to supply cimetidine tablets to be used in conjunction with sildenafil, with the explanation that concomitant use would lead to a “56% increase in plasma sildenafil concentrations…increased effectiveness would be noted with the same dose of Viagra taken with 800 mg of cimetidine.”(Eysenbachet al 1999) Three companies provided the requested drug, one of which sent an e-mail message advising the patient to discontinue the use of her other medications when taking sildenafil. Of those that failed to ship the product, two cited importation restrictions, three unknown benefits of the drug in women, and one cardiovascular concerns. The mean purchase cost per tablet was approximately twice that of prescription sildenafil obtained from a U.S. community pharmacy.

Erectile dysfunction is defined as the inability to achieve and sustain an erection of adequate rigidity for satisfactory sexual intercourse during sexual activity of humans. Penile erection is the hydraulic effect of blood entering and being retained in sponge-like bodies within the penis. The process is most often initiated as a result of sexual arousal,when signals are transmitted from the brain to nerves in the penis. The most important organic causes are cardiovascular disease,diabetes , neurological problems(for example,trauma from prostatectomy surgery), hormonal insufficiency (hypogonadism) and the drug side effects.

Psychological impotence is where erection or penetration fails due to thoughts or feeling (psychological reasons) rather than physical impossibility;this is somewhat less frequent but can often be helped. Notably in psychological impotence there is a strong response to placebo treatment. Erectile dysfunction can have severe psychological consequences as it can be tied to relationship difficulties and masculine self-image.

Besides treating the underlying causes such as potassium deficiency or arsenic contamination of drinking water, the first line treatment of erectile dysfunction consist of a trial of PDE5 inhibitors drugs(the first of which was sildenafil ) .In some cases treatment involves prostaglandin tablets in the urethra ,injections into the penis ,a penile prosthesis ,a penis pump or vascular  reconstructive surgery.

Erectile dysfunction affects approximately 10% of men and higher percentages of men of advanced age.(Krenzelok et al 2000). In 1998, the Food and Drug Administration (FDA) approved sildenafil (Viagra®—Pfizer), the first drug in the  phosphodiesterase (PDE) 5 inhibitor class, for the treatment of male erectile dysfunction (ED). As of 2002, the drug was marketed in more than 110 countries, and more than 100 million prescriptions had been issued for the agent.( Padma-Nathan  et al,2002) The availability of sildenafil has changed the view of ED management, as well as increased patient access to disease management resources.( Boyce  et al 2001) Along with the more recently marketed tadalafil (Cialis®—Lilly ICOS) and vardenafil Levitra®—Bayer HealthCare/ GlaxoSmithKline), sildenafil is now considered a first-line agent for treatment of ED, surpassing the use of intracavernosal or intraurethral prostaglandins, oral androgens, and vacuum devices. When used so widely, safety of medications is a particular concern, as even rare adverse effects affect substantial numbers of patients.

Erectile dysfunction is estimated to affect up to 30million men in the United States (Aytac et.al 1999). The disorder is age associated (Goldstein  et.al 1998) with estimated prevalence rates of 39 percent among men 40 years old and 67 percent among those 70 years old (Data on file  2005) .

 STATEMENT OF PROBLEM

Sildenafil citrate is widely used as an effective and safe oral treatment for erectile dysfunction of various etiologies (Goldstein et al., 1998; Cheitlin et al., 1999; Benchekroun et al., 2003). It is a potent and selective inhibitor of phosphodiesterase type 5 enzymes that acts to break down cyclic guanosine monophosphate (cGMP) (Boolell et al., 1996). The medication amplifies the effect of sexual stimulation by retarding the degradation of this enzyme. Sildenafil has been found effective in several subpopulations of men with erectile dysfunction, including sufferers from diabetes (Basu and Ryder, 2004), hypertension (Feldman et al., 1999), spinal cord injuries (Hultling et al., 2000; Deforge et al., 2006), multiple sclerosis (Fowler et al., 2005), depression (Seidman et al., 2001; Rosen et al., 2004; Tignol et al., 2004; Fava et al., 2006), PTSD (Orr et al., 2006), and schizophrenia (Aviv et al., 2004; Gopalakrishnan et al., 2006), men after resection of the prostate or radical prostatectomy (Nandipati et al., 2006), after renal transplant (Sharma et al., 2006), men on dialysis (Dachille et al., 2006), and men aged 65 years and older (Wagner et al., 2001; Carson, 2004). 

 Psychogenic erectile dysfunction (ED) patients are excellent candidates for sildenafil citrate therapy due to the intact neurovascular pathway. Nevertheless, the drug has been reported to be effective only in about 78% of patients with psychogenic ED (McMahon et al., 2000). It is likely that performance anxiety and sympathetic overtone are the cause of this unresponsiveness to sildenafil citrate during awakening, though data supporting this assumption are lacking (Rosen, 2001). The drug has been found to be effective and well tolerated in men with mild to moderate erectile dysfunction of no clinically identifiable organic cause (Eardley, 2001). 

With the presence of PDE5 in choroidal and retinal vessels sildenafil citrate increase choroidal blood flow and cause vasodilation of the retinal vasculature. The most common symptoms are a blue tinge to vision and an increased sensitivity to light (Kerr and Danesh Meyer, 2009). Adverse effects include headache, visual and retinal disturbances, dizziness and pupil-sparing third nerve palsy (Monastero et al., 2001). There have been reports of non-arteritic anterior ischaemic optic neuropathy and serous macular detachment in users of PDE5 inhibitors; although a causal relationship has not been conclusively shown. Despite the role of cGMP in the production and drainage of aqueous humor these medications do not appear to alter intraocular pressure and are safe in patients with glaucoma. All PDE5 inhibitors weakly inhibit PDE6 located in rod and cone photoreceptors resulting in mild and transient visual symptoms that correlate with plasma concentrations. Psychophysical tests reveal no effect on visual acuity, visual fields or contrast sensitivity; however, some studies show a mild and reversible impairment of blue-green colour discrimination. PDE5 inhibitors transiently alter retinal function on electroretinogram testing but do not appear to be retinotoxic. Despite the role of cyclic nucleotides in tear production there is no detrimental effect on tear film quality. Based on the available evidence PDE5 inhibitors have a good ocular safety profile (Kerr and Danesh-Meyer, 2009).

THE USE OF SILDENAFIL AMONG MALES IN BENIN CITY

IMPACT OF NON-TRADITIONAL VARIABLES IN HEALTH CARE RISK ADJUSTMENT: A CASE STUDY OF UTH, UYO, AKWA IBOM

IMPACT OF NON-TRADITIONAL VARIABLES IN HEALTH CARE RISK ADJUSTMENT: A CASE STUDY OF UTH, UYO, AKWA IBOM

 

CHAPTER ONE
INTRODUCTION
1.1 Background of the study
The business of risk adjustment has come a long way since the publication of the Academy’s “Monograph Number One” with the title, “Health Risk Assessment and Health Risk Adjustment—Crucial Elements in Eective Health Care Reform” in May 1993. Less than ten years later, we had hospital inpatient
diagnosis-based approaches, such as the model used by the Market Stabilization Pool for small group and individual coverage in NYS in conjunction with mandated community rating. The PIP-DCG approach for Medicare + Choice, also inpatient only, soon followed.
Risk adjustment models have included variables such as demographic (i.e. age and gender) and clinical markers based either on ICD-9 diagnosis codes and/or pharmacy codes such as the National Drug Codes (NDCs). Literature points to other variables such as geography, Body Mass Index (BMI), education,
and income that also explain the variation in health care cost – but have hitherto not been included in risk adjustment programs mainly because such variables are not typically found in claim data. If these nontraditional variables explain meaningful variation in cost beyond traditional risk adjustment models – then this may provide incentives for issuers to select certain members. If such incentives lead to selection that aects the financial performance of issuers – then the policy goals of the risk adjustment program will be undermined. Recognizing the importance of fortifying risk adjustment programs against
selection based on nontraditional variables, the Society of Actuaries’ Health Section sponsored an in-depth study into the relationship of nontraditional variables with health costs. This report presents the results of this study. We used the Medical Expenditure Panel Survey (MEPS) data in this research. Specific details concerning the data and preparation can be found in Section 3.2. This data is unique in that it includes a large number of individual characteristics (from BMI to whether a person has diiculty enjoying hobbies) together with healthcare claim data. There are limitations to the use of MEPS data, and these limitations are discussed further in Section 4. The results of this research demonstrate that it is important to adjust the traditional risk adjustment model in order to recognize nontraditional variables. The report develops a new measure (Loss Ratio Advantage or LRA) to help quantify the potential of a nontraditional variable to aect
a risk adjustment program. With the help of this measure, the report compares the importance of over thirty variables that were systematically narrowed down from a list of over fieen hundred variables describing various characteristics of the general population (i.e. the purchasers of healthcare insurance coverage). The nontraditional variables were broadly categorized into

(1) demographic

(2) economic,

(3) lifestyle,

(4)psychological self-assessment (i.e. how a person feels about their mental health)

(5) physical self-assessment.

 

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IMPACT OF NON-TRADITIONAL VARIABLES IN HEALTH CARE RISK ADJUSTMENT: A CASE STUDY OF UTH, UYO, AKWA IBOM

TIME SERIES ANALYSIS ON THE TOTAL NUMBER OF PATIENTS TREATED FOR MALARIA FEVER (BETWEEN 2001 AND 2010) (A CASE STUDY OF COMPREHENSIVE HEALTH CENTRE OTAN AYEGBAJU OSUN STATE)

TIME SERIES ANALYSIS ON THE TOTAL NUMBER OF PATIENTS TREATED FOR MALARIA FEVER (BETWEEN 2001 AND 2010) (A CASE STUDY OF COMPREHENSIVE HEALTH CENTRE OTAN AYEGBAJU OSUN STATE)

 

ABSTRACT
This project work reveled the rate at which people are infected with malaria the least square method used for analysis showed that people are infected with malaria irrespective of the time and seasons of a successive year,There is no noticeable direction as regarding the number of patient treated for malaria over time. Also, the analysis from autoregressive moving average report shows that both autoregressive and moving average of order four were both appropriate while the report from autocorrelation and countenance does not
indicate any noticeable trend in the number of patients treated for malaria.

CHAPTER ONE
INTRODUCTION
The term time series refers to one the quantitative method used in determination pattern in data collected over time e.g weekly monthly, quarterly or yearly. Time service is the statistic tool or methodology that can be used to transform past experience to predict future event which would enable the researcher or organization to plan.
It gives information about how the particular case of study has been behaving in the past and present and such information can be used in prediction The number of people treated for malaria fever at the otan Ayegbaju management hospital. Comprehensive health centre otan. We are going to seen how change
occur over mouths in each year in the occurrence of the disease in the hospital.As a result of this, we will be able to know certain factor responsible for increase or decrease in the rate of infection of the disease over the period of time. Record of time series data can be made in the following ways:-
1. THROUGH CUMULATIVE FIGURES:- these represent value of input through the quarter. We must always bear in mind the dierent when handling time series data and as certain which particular type we are dealing with in every case.
2. CUMULATIVE TYPE ADDED COMPILATION:- some cases when an added compilation introduced for the cumulative type of data the figure which are related to month of the year and not the total for month. further more the characteristic movement, seasonal variation Irregular variation in the analysis of time series, we have two types of model are generally accepted as good approximation of the true data association among the component of observed data, they are the most commonly assumed relationship between time series and its components. These are additive model and Multiplicative mode. All time series contain at least on of four of its components. These components are:-

  • Long term trend
  • Seasonal variation
  • Cyclical variation
  • Irregular or random variation value

 

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TIME SERIES ANALYSIS ON THE TOTAL NUMBER OF PATIENTS TREATED FOR MALARIA FEVER (BETWEEN 2001 AND 2010) (A CASE STUDY OF COMPREHENSIVE HEALTH CENTRE OTAN AYEGBAJU OSUN STATE)

HALITOSIS AMONG STUDENT IN SHEHU IDRIS COLLEGE OF HEALTH SCIENCE AND TECHNOLOGY, MAKARFI, KADUNA STATE

HALITOSIS AMONG STUDENT IN SHEHU IDRIS COLLEGE OF HEALTH SCIENCE AND TECHNOLOGY, MAKARFI, KADUNA STATE

 

ABSTRACT
In fact, the aim of this study is to create awareness on the Halitosis among students in SICHST Makarfi Local Government Area, Kaduna State. Halitosis or most commonly bad breath are terms used to describe noticeably unpleasant odor exhaled in breathing. Halitosis is a condition acting both male and female in
all ages, Halitosis can cause by eating of certain foods, like cooked eggs, garlic, onions, smoking and drinking alcohol, which when absorbed into our blood stream, are transferred to the lungs and exhaled breath will be produced as bad breath, suering from some systemic disease such as liver, kidney, diabetic
mellitus, and digestive track infection whereby gases are blocked from passing the stomach or intestines.

CHAPTER ONE
INTRODUCTION
Background of the Study
Halitosis or most commonly bad breath are terms used to describe noticeably unpleasant odor exhaled in breathing (Gage, 2007). Halitosis can be important social problem in which the standard dental treatment and mouth wash that are  recommended provide only temporary relief. The smell is from an oral source due to bacterial activities (Rosemberg, 2002). Oral malodor is primarily the result of microbial metabolism, the mouth is a home of hundreds of bacterial species with various nutritional preferences. The most common location for mouth related halitosis is the tongue. Tongue bacterial produce malordor and fatty acid and count for about 80 to 90 percent of all cases of mouth related bad breath. Large quantities of naturally occurring bacteria are oen found on the dorsum of the tongue, where they are relatively undisturbed by normal activities. This part of the tongue is relatively dry and poorly cleansed and bacterial populations can thrive on remnants of food deposits, dead epithelial cells and post nasal drip. The convoluted microbial structure of the tongue dorsum provides an ideal habitat for anaerobic bacterial, which flourish under a continually – forming tongue coating of food debris, dead cells, post nasal drip and overlying bacteria living and dead when  on the tongue the anaerobic respiration of such bacterial can yield either the putrescent smell of indole, skatole, methyl mercapton, alloymethyl sulfide and dimethyl sulfide (Tonzentich, 1997).
The organism digest protein, and several fatid substance arise leading to bad breath. Oral malodor from the overgrowth of proteolytic, anerobic gram negative bacterial the creavices of the tongue dorsum can be successfully diagnosed and treated (Lochner et al, 2000).
There are several causes of halitosis although the main one is oral bacterial over 90 million people suer
from chronic halitosis which is medical term for bad breath in most cases halitosis originate from the gums and tongue, caused by bacterial from the decay of food particles, other debris in the mouth and poor
oral hygiene. In most cases (85-90%) bad breath originate in the mouth itself.
The intensity of bad breath during the day, due to eating of certain foods such as garlic, onions, meat, fish, egg, cheese, smoking and alcohol consumption, since the mouth is exposed to less oxygen and is in active during the night, the odor is usually worse upon awakening (morning breath). Bad breath may be transient of ten disappearing following brushing teeth, flushing or rinsing with special mouth wash (Tammy Devenport, 2007). Bad breath may also be persistent (chronic bad breath). Which is a more serious condition affecting some 25 percent of the population in varying degrees. It can negatively act
the individual’s personal, social and business relationship leading to poor self esteem and increased stress. Halitosis is a medical term for bad breath and this is quite serious as a social disorder. Halitosis can cause extremely embarrassing situation in social interaction and relationship at work

 

 

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HALITOSIS AMONG STUDENT IN SHEHU IDRIS COLLEGE OF HEALTH SCIENCE AND TECHNOLOGY, MAKARFI, KADUNA STATE