The 7th conference of the American College of Chest Physicians (ACCP7) provides recommendations on the type, dose, and duration of thromboprophylaxis in hospitalized patients at risk of venous thromboembolism (VTE), but the extent to which hospitals follow these criteria has not been well studied. Discharge and billing records for patients admitted to any of 16 acute-care hospitals from January 2005 to December 2006 were obtained. Patients 18 years or older who had an inpatient stay ≥2 days and no apparent contraindications for thromboprophylaxis were grouped into the categories of critical care, surgery and medically ill before being assessed for additional VTE risk factors based on the diagnostic criteria outlined in ACCP7. For patients at risk, the recommended type (mechanical or pharmacologic), dose, and duration of thromboprophylaxis was identified based on the guidelines and compared to the regimen actually received, if any. Among the 258,556 hospitalized patients, 68,278 (26.4%) were determined to be at risk of VTE without apparent contraindications for thromboprophylaxis. The proportions of patients who received the appropriate type, dose, and duration of thromboprophylaxis were 10.5, 9.8, and 17.9% for critical care, medical, and surgical patients, respectively. Of those at risk, 36.8% received no thromboprophylaxis and an additional 50.2% received thromboprophylaxis deemed inappropriate for one or more reasons. The implementation of ACCP7 guidelines for type, dosage, and duration of thromboprophylaxis is low in patients at risk of VTE. There is a need for physicians and health systems to improve awareness and implementation of recommended thromboprophylaxis.

US national performance measures may reduce the burden of venous thromboembolism (VTE) in surgical patients. To characterize the VTE rate in US surgical patients, and identify real-world independent VTE risk-factors, a national managed-care database was analyzed. 172,320 eligible surgical discharges (23.9% orthopedic, 76.1% abdominal surgery) from the PharMetrics database (January 2001-December 2005) were evaluated. The rate of thromboprophylaxis was low in orthopedic (40.5%) and abdominal (1.8%) surgery discharges, with the event rates of symptomatic VTE in these groups being 4.7% and 3.1%, respectively. The median time to VTE was 51 days: the majority of VTE events occurred post-discharge. Independent predictors of VTE included prior VTE (odds ratio [OR] 10.2; 95% CI: 9.2-11.4), and orthopedic versus abdominal surgery (OR 1.4; 95% CI: 1.4-1.6). Patients undergoing orthopedic or abdominal surgery remain at-risk for VTE. Implementation of national performance measures may help reduce the burden of VTE.

Access Free Rad. Antiox. www.antiox.org of deteriorative changes in the biological systems leading to cell inactivation. [1] Many antioxidant enzymes and compounds present in the cell, mitigate the oxidative stress due to free radicals, by dismutating these free radicals species or by converting these radicals into a less effective forms. [2] Antioxidant supplements or antioxidant-rich food are used to help the human body reduce oxidative damage from free radicals and active oxygen species. [3] Other synthetic antioxidants such as butylated hydroxytoluene (BHT), butylated hydroxyanisole (BHA) and trolox are widely used as antioxidants in the pharmaceutical and food industry. However, they have been shown to have toxic and/or mutagenic effects. [2] Because of their toxicity, the development and isolation of natural antioxidants IntroductIon The exogenous chemicals and endogenous metabolites in the body produce reactive oxygen species (ROS), which are capable of oxidizing various biomolecules resulting in tissue damage and cell death. Free radicals have been implicated in the cause of several diseases such as liver cirrhosis, atherosclerosis, cancer and diabetes and play an important role in ageing. Oxidative stress can also contribute to the development of neuro-degenerative disorders, such as Alzheimer's and Parkinson's as well as other diseases. These free radicals attack unsaturated fatty acids of biomembranes, resulting in lipid peroxidation and desaturation of proteins and DNA, causing a series

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Estrogens, and particularly glucuronides such as ethinylestradiol (EE), have been shown to cause cholestasis in animal studies, by reducing bile acid uptake by hepatocytes. The aim of the present article is to investigate anticholestatic activity of the ethanolic extract of the aerial parts of Jasonia montana against liver cholestasis induced by EE in adult female rats in an attempt to understand its mechanism of action, which may pave the way for possible therapeutic applications. Subcutaneous administration of 100 μg/kg b.w. ethinylestradiol to rats induced hepatocellular cholestasis with a significant decrease in serum cholesterol, bile acids and bilirubin levels as well as in hepatic superoxide dismutase (SOD), glutathione peroxidase (GPx), glutathione reductase (GR) activities and hepatic total, protein-bound and non-protein sulfhydryl groups. Also, treatment with EE produced significant increase in serum Pi-glutathione-s-transferase (Pi-GST), gamma glutamyl transpeptidase (γ-GT) and alpha-glutathione-s-transferase (α-GST) activities as well as serum nitric oxide (NO) and tumor necrosis factor alpha (TNF-α) level and hepatic malondialdehyde (MDA) level as compare to control group. Oral administration of the aerial parts of ethanolic extract at a concentration of 150 mg/kg b.w. daily to rats treated with EE for 15 days showed a significant protection against-induced decrease in serum cholesterol, bile acids and bilirubin levels. The treatment also resulted in a significant increase in hepatic SOD, GPx and GR activities as well as hepatic total, protein-bound and non-protein sulfhydryl groups. In addition, the extract could inhibit serum Pi-GST, γ-GT and α-GST activities as well as reduce serum TNF-α, NO and hepatic MDA as compare to ethinylestradiol treated rats. High content of flavonoids and phenolic compounds was found in ethanolic extract, which may be responsible for free radical activity. The results clearly suggest that the aerial parts of J. montana extract may effectively normalize the impaired antioxidant status in ethinylestradiol (EE)-cholestatic model. Thus the extract may have a therapeutic value in drug-induced biliary cholestasis as well as in hormonal therapy.