Institute review to evaluate...

From page 9 which suggested that prolonged use of PPI causes oxidative stress which is associated with renal interstitial tubular injury, resulting in the decline of the renal function. Hence for users of PPIs, kidney health must be reviewed annually since continuous use at unrevised dosage may increase the risk of chronic kidney disease. Evidence based research to establish this hypothesis has not been done.

Generally, side effects from short term use are mild and rare but there is a growing concern of other infrequent associated effects from observational studies such as dementia, pneumonia, bone fractures and hypomagnesemia.

For enhanced bioavailability, you are advised to take PPIs on an empty stomach one hour before meals. If taken just prior meals, then the time for the drug to dissolve and absorb would have been longer when compared to the time acid production commences after chewed food reaches the stomach. Hence, food decreases its bioavailability resulting in a lower blood concentration of the PPI.

In Asians and the elderly populations, PPI tend to have an increased bioavailability. When patient charts were reviewed, some persons including elderly patients, who are high risk at diminished renal function, were not taken off PPIs or their dose was not reduced. The American Geriatric Society in 2015 cited concerns about such incidents which were included their review of inappropriate use of PPIs in the elderly.

In the American Gastroenterology Association publication, volume 162 of Clinical Practice Update dated April 2022, an expert reviewed study considered the de-prescribing of Proton Pump Inhibitors. Specialists’ consensus endorsed by the American Gastroenterological Association, reiterated that an annual review is required to evaluate the continuous indicated use is of PPI.

Several best practice advice for primary care physicians followed:

• Patients without a definitive indication for chronic use of PPI should be de-prescribed

• Twice daily dose for chronic PPI use should step down to once daily

• Do not discontinue PPI in the following patients: complicated GERD or peptic stricture

• De-prescription should not be considered for certain conditions (Barrett’s esophagus, eosinophilic esophagitis, idiopathic pulmonary fibrosis)

• Evidence based protocol instituted before de-prescribing patients with upper GI bleed

• Transient rebound effect can occur after discontinuing long term use of PI

• Consider downward dose readjustment or abrupt discontinuation when de-prescribing

• Only use lack of indication as a consideration for de-prescribing and not PPI associated adverse effect

Pharmacists are entrusted to educate patients and make de-prescribing recommendations to the primary care physicians as stated in the December 2019 issue of U.S. Pharmacist so as to ensure appropriate use and stewardship of PPIs. The Canadian Association of Gastroenterology has alerted both physicians and patients to question the need for PPI and to choose wisely.

Endorsed and implemented protocols will target optimum treatment of various indicated conditions in a structured manner.

For further discussion, contact the pharmacist of Medicine

Express PHARMACY located at 223 Camp Street, between Lamaha and New Market Streets. If you have any queries, comments or further information on the above topic kindly forward them to medicine.express@gmail. com or send them to 223 Camp Street, N/burg. Tel #225-5142.

ON Thursday, Opposition Leader Aubrey Norton repeated what seems to be his mantra that the People’s Progressive Party Civic (PPP/C) Administration was allegedly racist, discriminatory and denying half of Guyana’s population real development.

Apart from his usual murky and puerile politics, Norton sought to drag the Guyana Police Force (GPF) into the fray of public criticism, stating that the wanted bulletins that were issued earlier in the week, for several persons who were part of the violent protest, were politically motivated.

Norton used the sordid affairs surrounding the death of Quindon Bacchus again, to covertly appeal to his supporters’ race, telling them that the Police “charge people with terrorism is clearly an abuse of power”.

He said that the “people” are “innocent” and this is why “we’ll support them”. In fact, the Leader of the Opposition is on record, stating “it is clearly another attempt to harass people, it is a clear case of trumped-up charges.”

Norton vowed to “do everything to deal with it”.

Firstly, these are serious and dangerous statements that should not be taken lightly by law enforcement bodies, and those manning the system of justice in Guyana and elsewhere.

The GPF should be up in arms over those statements which seek to bring every single officer conducting the investigations into disrepute during the lawful execution of their duties.

It matters not if the men were yellow, brown, white, green, or black, the Police have reasons to believe they were involved in a crime either directly or indirectly and acted in accordance with the Police Act by the issuance of the wanted bulletins.

Surely, Norton should be prepared to take full responsibility if anything happens to any of the Police Officers who are conducting those specific investigations.

The Police Commissioner and other senior officers should take note of what Norton said as it is being interpreted by the public as a veiled and indirect threat.

Secondly, Norton exposed himself because he appears not to be concerned about crimes committed, losses suffered, and the livelihoods interrupted by the unprovoked episodes.

Norton cannot bother himself with the facts and case in point because perhaps all he can see is the race of the men in question, and the geographic location, all from the PNC/APNU strongholds, presumably.

How did a presumably intelligent man, who has his eyes locked on the presidency of Guyana, make the kind of deductions or inductions that Norton made about the innocence of the men and that charges are trumped-up?

The public only hopes that they are innocent and that the Police will conduct themselves professionally in the course of the investigations.

Was Norton just saying this to people to make his presentation emotive or was he deliberate in his will to spread misinformation and lies, particularly aimed at weakening the Police Force in the public’s eyes?

Thirdly, Norton should tread cautiously, because the party he represents and APNU+AFC are known for their role as the sympathizers of criminals who wreak havoc on innocent Guyanese.

Moreso, the ‘Blackie’ and ‘Fineman’ episode has not escaped the public’s mind and their deliberate links to the criminal enterprise in Buxton, Agricola, Sophia and Albouystown during the crime spree of the 2000s.

The PNC/R and the APNU can ill-afford to have a leader who talks about crime and security matters so loosely as if he perhaps does not have sense.

What was the motive behind the statements coming from the Opposition Leader?

Will the PNCR/APNU really be footing the expenses of these individuals who are wanted for questioning by the Police?

What support will the APNU have to offer them?

These answers must be given at once because the public wants to know if the PNC/APNU is in bed with the would-be criminals, and is anti-police.

Former President David Granger may be turning in his bed right now to see and hear Norton’s irresponsible and damning political statements made just before Guyana goes into the polls again, this time for the local government elections.

Also, Joseph Harmon, Winston Felix and Gary Best must be appalled and shocked at what is seen as Norton’s public endearment or endorsement of criminals and suspects. If the blank cheque scenario was not enough, and the diatribe against Norton was not enough, then this surely is enough to cause pause politically.

Finally, Norton hopefully knows what he is doing to some of the Afro-Guyanese supporters because they left the North Ruimveldt rally fuelled up with lies, misinformation and hate from the stories he told them.

He did not arm some of them with the truth or narrative to make them sound intelligent or ask for answers from the PPP/C Government. He continued to use his academic and practical knowledge to twist the story, telling a different narrative and a different story.

He did not empower his supporters about their rights and the electoral fight ahead. Seemingly, Norton wants to keep some of the Afro-Guyanese population in darkness, perpetual ignorance and dumbfounded so he can use them each time they vote.

Enlightenment, truth and facts are the only way to break the chains of discrimination, racism and political inferiority, not clandestinely supporting the criminals by appealing to race so as to cause mayhem, confusion and distrust. Crime and criminality must not be politicised, at least not in this way!