Adverse Effects Of Medications Research Articles

The utility of the necessity-concerns framework (NCF) in explaining adherence and parental beliefs about controller medication in Saudi Arabian children with asthma

Objective This study aims to assess beliefs about asthma controller medications among parents of Saudi Arabian children with asthma and the association between these beliefs and medication adherence using the Necessity-Concerns Framework. Methods A cross-sectional survey was provided to parents of children with asthma when they brought their children to routine appointments at local public clinics between May 16 and July 10, 2018. Participants electronically filled out validated Arabic versions of the Medication Adherence Reported Scale (MARS) and Beliefs About Medications Questionnaire (BMQ). Descriptive statistics were used to characterize the study participants, while hierarchical linear regression analysis assessed associations between parental beliefs about controller medications and medication adherence. Results A total of 381 parents of children with asthma completed the study survey. The vast majority (89%) of study participants were non-adherent to their children’s prescribed medications while only 11% were adherent. Additionally, our study revealed a significantly positive association between adherence and parents’ beliefs in the necessity of the medication (p < .001), with concerns about the adverse effects of medication being negatively associated with parental adherence. A higher mean score for medication adherence was reported among the ambivalent groups compared to the accepting, indifferent, and skeptical groups. Conclusions Medication adherence among parents of children with asthma was relatively low. In addition, necessity beliefs were significantly associated with parental adherence to controller medications for their children with asthma. Further studies are warranted to investigate potential factors contributing to poor parental adherence and develop tailored interventions that support parental medication adherence for their asthmatic children.

A Comprehensive Review of Gastroesophageal Reflux Disease (GERD) Treatment and its Clinical Perspectives

Gastroesophageal reflux disease (GERD) occurs by regurgitation of food in the stomach. Aggressive factors increase GERD whereas defensive factors decrease GERD progression. GERD if mild can be put under control by lifestyle modification and giving non-pharmacological treatment methods to patients however if the disease progresses non-pharmacological methods are ineffective. Drugs reduce GERD progression and also maintain the pH of the stomach to a normal level and prevent abnormal acid exposure to the oesophagus. Antacids and alginate protect oesophagus by reducing acidity and increasing viscosity. Proton pump inhibitors and histamine 2 receptor antagonists reduce acid secretion by inhibiting its secretion. Prokinetic agents increase the motility of the stomach and reduce obesity. Metabotropic glutamate receptors, gamma-aminobutyric acid receptor agonists, and cannabinoid receptors are receptor-specific drugs that act on receptors underlying the gastrointestinal tract and alter the function of receptors which increases reflux disease. Combination of antacid and alginate, domperidone and omeprazole, omeprazole and baclofen, aluminum hydroxide, magnesium, and simethicone are frequently given in GERD to expedite the healing rate and reduce acid secretion. Combinations of suitable medications reduce the adverse effects of a single medication and also make it therapeutically more effective than using monotherapy drugs. The pharmacological method is safe and effective and treats GERD completely.

Caregivers’ Perception and Attitude towards Child Mental Health in Beni Suef Governorate, Egypt

Background: The World Health Organization recognizes the lack of public information about children and adolescents’ mental health (CAMH) disorders as a barrier to seeking help. This study assessed the current knowledge and attitudes of caregivers about CAMH problems in Egypt. Methods: A total of 1937 caregivers attending primary health care centers in Beni Suef, Egypt, were surveyed using the Arabic version of the University of Chicago Behavior Health Questionnaire (UCBHQ). Results: We found a statistical significance of positive attitude towards CAMH in parents’/caregivers’ who were females, relatively young, or had a higher educational degree. Due to the influence of media and negative publicity, caregivers were wary of the adverse effects of psychoactive medications and MH treatment. We also identified participants who had previously attended MH workshops or had a family member with mental illness were skeptical about existing MH services. Cultural background and spirituality were not a barrier to seeking MH care in this study. Conclusion: Findings highlight the need to utilize social media, television ad campaigns, and print fora to raise awareness about stigma, etiology of MH problems, and evidence-based treatments targeting gender and age-specific population.

The First-Line Approach in Children with Obstructive Sleep Apnea Syndrome (OSA).

Obstructive sleep apnea syndrome (OSA) is the main manifestation of sleep-disordered breathing in children. Untreated OSA can lead to a variety of complications and adverse consequences mainly due to intermittent hypoxemia. The pathogenesis of OSA is multifactorial. In children aged 2 years or older, adenoid and/or tonsil hypertrophy are the most common causes of upper airway lumen reduction; obesity becomes a major risk factor in older children and adolescents since the presence of fat in the pharyngeal soft tissue reduces the caliber of the lumen. Treatment includes surgical and non-surgical options. This narrative review summarizes the evidence available on the first-line approach in children with OSA, including clinical indications for medical therapy, its effectiveness, and possible adverse effects. Literature analysis showed that AT is the first-line treatment in most patients with adenotonsillar hypertrophy associated with OSA but medical therapy in children over 2 years old with mild OSA is a valid option. In mild OSA, a 1- to 6-month trial with intranasal steroids (INS) alone or in combination with montelukast with an appropriate follow-up can be considered. Further studies are needed to develop an algorithm that permits the selection of children with OSA who would benefit from alternatives to surgery, to define the optimal bridge therapy before surgery, to evaluate the long-term effects of INS +/- montelukast, and to compare the impact of standardized approaches for weight loss.

ChatRx: ChatGPT’s potential to educate patients on medication adverse effects

ChatRx: ChatGPT’s potential to educate patients on medication adverse effects

Psychometric evaluation of the Serbian version of the Stigma Scale of Epilepsy (SSE)

ObjectiveTo evaluate the psychometric properties of the Serbian-language version of the Stigma Scale of Epilepsy (SSE). MethodsThe sample consisted of 108 patients with epilepsy (PWE) (60.2 % were female, age range: 19–67 years) and 102 students (86.3 % were female, age range: 18–47 years). The study encompassed two phases: (1) translation of the SSE into Serbian using the back-translation technique, and (2) evaluation of reliability and construct validity of the Serbian-language version of SSE. In addition to the SSE, the PWE filled out a Neurological Disorders Depression Inventory for Epilepsy (NDDI-E), Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder-7 (GAD-7). The socio-demographic and clinical variables were noted for each patient by the semistructured interview. Besides completing the SSE, the students were asked if they knew anyone with epilepsy. The reliability of the questionnaire was tested by assessing the internal consistency of the scale (Cronbach’s α), while construct validity was assessed by factor analysis, method of known-groups validation, and correlation analysis. ResultsSSE demonstrates a satisfactory level of reliability in both samples, with Cronbach's α of 0.86 in the PWE sample and 0.90 in the student sample. Using exploratory factor analysis, four factors were identified in both samples, corresponding relatively well with the scale domains originally produced, with a few exceptions described. Adverse effects (AEs) of antiseizure medications (ASMs) and driving ability significantly influenced SSE scores, but there were no significant effects of other socio-demographic and clinical variables on epilepsy-related stigma in the PWE sample. In addition, depression severity significantly influenced SSE scores (based on NDDI-E cut-off score), with the SSE showing a positive association with PHQ-9 (r = 0.42, p < .001) and GAD-7 (r = 0.35, p < .001) as well. Regarding the student sample, the effects of personal knowledge of someone with epilepsy on SSE scores were found to be significant. Besides, students (M = 46.28, SD = 16.43) reported higher epilepsy-related stigma than patients (M = 40.66, SD = 17.01), t(208) = 2.43, p < .05, d = 0.34. ConclusionThe Serbian version of the SSE has good psychometric properties and represents a useful tool for assessing epilepsy-related stigma in both patients and the general population.

Biomarker MSC-C5b-9-Guided Master Therapies for Resistant/Recurrent ITP: A Prospective, Randomized, Open-Label, Multicenter Trial

Introduction: Immune thrombocytopenia (ITP) is an acquired organ-specific autoimmune disorder and a common bleeding disorder that poses a considerable risk to human health. Steroids, as the first-line treatment, do not provide long-term relief. Our previous clinical trials have confirmed the efficacy and safety of all-trans retinoic acid (ATRA) in the treatment of ITP and identified that the biomarker MSC-C5b-9 may be a stratification marker for evaluating the efficacy of ATRA (Haematologica, 2019; Lancet Haematol. 2017; 2021). This research aims to develop a new treatment approach for steroid-resistant/recurrent ITP based on the marker MSC-C5b-9. Method: We conducted a prospective, randomized, open-label, multicenter trial to evaluate the efficacy and safety of ATRA combined with eltrombopag based on MSC-C5b-9 as a novel treatment for steroid-resistant/recurrent ITP. Following enrollment, all patients underwent bone marrow aspiration to assess MSC-C5b-9 levels. Subsequently, patients were randomly assigned in a 1:1 ratio to either the eltrombopag group or the eltrombopag + ATRA group. In both treatment groups, the initial dose of eltrombopag was 50 mg daily, with dose adjustments based on platelet levels. For patients assigned to the ATRA group, ATRA was given at a dose of 10 mg twice daily. Peripheral blood cell counts and adverse drug reactions were regularly monitored. The primary endpoint was the sustained response rate at 18 months after randomization, and secondary endpoints include Complete Remission, Partial Remission, Relapse rate, Early Response, Initial Response, Adverse Events, and Adverse Events graded using the National Cancer Institute Common Terminology Criteria (NCI CTCAE) v5.0 criteria. The study has been registered at clinicaltrials.gov. NCT05438875. Result: From March 2023 to July 2023, a total of 30 patients with steroid-resistant/recurrent ITP were enrolled in the study and randomized 1:1 to receive eltrombopag combined with ATRA (ATRA group, n=15, MSC-C5b-9 +6, -9) or eltrombopag alone (control group, n=15, MSC-C5b-9 +6, -9) in 5 centers, and all enrolled patients were included in the intention-to-treat (ITT) analysis. In the ATRA group, the median age was 38 years (range, 29-64), consisting of 8 male patients. In the control group, the median age was 44 years (range, 23-75), consisting of 9 male patients. There were no statistically significant differences observed in the baseline clinical characteristics between the two groups. There was no difference in the bleeding score and ECOG score between the two groups (P=0.717; P=1.000). The median platelet count was comparable between the ATRA group and the control group (17 (1-28) vs. 16 (2-26), P=0.850). Comorbidities at random, such as hypertension, were comparable between the two groups (26.7% (4/15) vs. 33.3% (5/15), P=1.000). Combined autoantibody abnormalities were compared between the two groups (6.7% (1/15) vs. 6.7% (1/15), P=1.000). The rate of Early Response in the ATRA group was higher than that in the control group, but the difference was not significant (73.3% (11/15) vs. 53.5% (8/15), P=0.256). As of July 29, 2023, a total of 24 patients had been enrolled for a duration exceeding 4 weeks. Similarly, the Initial Response rate was higher in the ATRA group, but no significant difference was observed between the two groups (84.6% (11/13) vs. 63.6% (7/11), P=0.357). Nevertheless, it is noteworthy that the 4-week CR rate in the ATRA group was higher than that in the control group (76.9% (10/13) vs. 36.4% (4/11), P=0.045). What's more, the overall efficacy of the ATRA group was better than that of the control group. The mean platelet count at weeks 1, 2, 3, and 4 posttreatment, along with the mean maximum platelet count posttreatment, exhibited higher values in the ATRA group than in the control group; however, these disparities did not reach statistical significance (P=0.310; P=0.568; P=0.779; P=0.618; P=0.355). ATRA was well tolerated, and only one patient developed grade I dry mouth and headache, which improved after dose reduction. There was no difference between the ATRA and control groups in terms of medication adverse effects (13.3% (2/15) vs. 13.3% (2/15), P=1.000). Conclusions: Eltrombopag plus ATRA is an effective and well-tolerated approach for treating steroid-resistant/recurrent ITP. Eltrombopag plus ATRA can enhance patients' complete remission and is well tolerated.

Improving the impact of pharmacy interventions in hospitals

The clinical and pharmaceutical interventions of pharmacy professionals are considered impactful inputs towards optimised patient care and safety, by rationalising prescriptions, enhancing therapeutic choices and reducing and preventing medication errors...

Is A Therapeutic Approach Required To Treat Insomnia In Pakistan?

Insomnia, defined as difficulty falling or staying asleep, is prevalent among one-third of the general population. (1) It can give rise to various physical and mental problems, such as obesity, diabetes, anxiety, and depression. (2) While there are many effective medications for insomnia, a therapeutic approach for treating it is more likely to be dependable over time. A meta-analysis exploring the benefits of cognitive behavioural therapy (CBT) for chronic insomnia revealed an improvement of sleep onset latency by 19.03 minutes, a gain of total sleep time by 7.61 minutes, and improved sleep efficiency by 9.91%. (3)CBT has been recognized as a first-line treatment for insomnia by NIH Consensus and State of the Science Statements (4)as it is equally effective as medication for a brief treatment and is more reliable over time. One in every three persons in Pakistan is reported to have sleep problems and, a third of those take sleeping pills. (5)In developing countries like Pakistan, where people don't have resources, a therapeutic approach is likely to reduce the cost and risk of adverse effects of medications. Pakistan is a pill-oriented society, and people prefer pills over therapy. The awareness among the population to adopt treatments or shift to therapeutic interventions is close to none. The cultural stigma associated with therapy is a significant hurdle as well. Unlike medicines, therapy reduces the risk of relapse after its discontinuation. Introducing therapy in the public sector can result in more jobs for therapists and counsellors and provide a cheaper alternative to pills. The best way to introduce CBT among the population is through awareness campaigns, media, and discussions on public platforms. In addition, counsellors can provide outreach in places where additional resources are required to combat the stigma associated with psychotherapy and inform people regarding its benefits. Counsellors collaborating with other health care professionals and gaining a valuable referral source from primary care physicians can also be a meaningful strategy. It would be worth mentioning here that more studies comparing the pills to CBT should be conducted to address the issue.

Compliance status and influencing factors of anticoagulation therapy in outpatient undergoing major orthopedic surgery.

This study was designed to investigate influencing factors of out-of-hospital anticoagulation therapy compliance among patients undergoing major orthopaedic surgeries. A cross-sectional, descriptive study was conducted from July 2022 to February 2023 among outpatients who underwent major orthopedic surgery in our hospital. Patients (n = 200) were surveyed using the General Information Questionnaire, the General Self-Efficacy Scale, the Specificity of Medication-Taking Beliefs Scale, and the Morisky Medication Adherence Scale. Factors that influenced patient compliance were also determined using univariate and multivariate regression analyses. One hundred eighty-three valid questionnaires were returned, the compliance with outpatient anticoagulation therapy among patients undergoing major orthopaedic surgeries was good in 56.3% (103/183) of all cases and poor in 43.7% (80/183). Multivariate logistic regression analysis showed that medication duration, adverse effects, self-efficacy and medication beliefs influenced adherence to out-of-hospital anticoagulation therapy in patients undergoing major orthopedic surgery (P < 0.05). Poor compliance with out-of-hospital anticoagulation therapy in patients undergoing major orthopedic surgery is mainly associated with a long course of medication, adverse reactions, low self-efficacy and low medication beliefs. Healthcare staff should strengthen post-discharge anticoagulation management based on relevant influencing factors to enhance patient compliance.

Abnormal Movements Resembling Tic Disorder in a Patient with Schizophrenia: A Case Report

Introduction: Since many movement disorders are associated with schizophrenia, it is important to distinguish various motor manifestations of the disease itself from associated abnormal movements. Case Presentation: We present a 35-year-old single man with schizophrenia who was admitted for seizure-like tics. The disease started 7 years earlier with psychotic manifestations, including persecutory delusion, negative symptoms, and impaired function. About a year ago, movements in the limbs, abdomen, and spine (similar to those seen in tonic-clonic seizures) were added to the patient’s symptoms, lasting for a few seconds to a few minutes. After some time, these movements were accompanied by expressing words and phrases that had sexual content. Due to the exacerbation of these attacks, the patient was admitted to the hospital. He was unable to explain the cause of these movements, and differential diagnoses included stereotype, extrapyramidal effects of antipsychotic drugs (particularly tardive dyskinesia), and temporal lobe epilepsy. However, the patient had no history of epilepsy. Urine screening for illegal substances, electroencephalography (EEG), brain magnetic resonance imaging (MRI), and neurological counseling were all normal. The adverse effects of medications were ruled out because the patient had taken antipsychotics very irregularly and in low doses. A short time after starting 4 mg of oral risperidone (as the main treatment), the patient showed better cooperation and was able to describe his symptoms in more detail. He explained that a stranger or a copy of himself occasionally compelled him to do the movements, and if he refused to do it, he would be punished by them. Ten days after continuing treatment and starting weekly flupentixol decanoate, the motor symptoms improved significantly, and the patient was discharged after 3 weeks. Conclusions: This case presentation emphasizes the importance of accurate clarification of the nature of signs and symptoms in patients with mental disorders, which seems to be crucial in making a diagnosis and appropriate treatment.

Cognitive Dysfunction and Affective Mood Disorder Screening in Patients With Chronic Inflammatory Bowel Disease: Protocol for a Prospective Case-Control Study.

Mild cognitive impairment (MCI) and Alzheimer's disease (AD) might be more frequent in patients with inflammatory bowel disease (IBD), but the relationship between these 2 entities is yet to be entirely established. Certain blood biomarkers (eg, serum amyloid A [SAA] and serum homocysteine [Hcy], which increase in IBD and MCI; brain-derived neurotrophic factor [BDNF], which decreases in MCI and AD but is not clearly modified in IBD; and S100 calcium-binding protein B [S100B], which increases in the blood-brain barrier and neuronal lesions) might predict the stage of MCI or dementia or progression to a further state. The gut-brain axis (GBA) might be the key to the development of MCI in patients with IBD, along with systemic inflammation and the possible and unknown adverse effects of disease-modifying medication. The aim of this study is to investigate whether GBA interactions play a role in MCI development in patients with IBD. A case-control study will be conducted on at least 100 patients diagnosed with IBD, matched with 100 healthy individual controls. The matching will include sex, age, and education. Patients will be fully examined, and a full interview and a neurological and cognitive examination will be performed. The primary clinical outcomes will be cognitive test scores (Montreal Cognitive Assessment, Trail Making Test, Digit Symbol Substitution Test, forward and backward digit span testing). Depression, stress, and anxiety screening will also be performed. Blood samples from all participants will be collected, and aliquots will be immediately stored in a biobank. Primary laboratory outcomes will include serum levels of presumed cognitive dysfunction blood biomarkers SAA, Hcy, S100B, and BDNF. Follow-up will be performed at 12, 24, 36, and 48 months. Data collection started in December 2021 and is ongoing. So far, 53 patients with IBD have been recruited and 50 HC matched. Data collection should end in January 2030. Intermediary analysis will be performed in April 2024. We expect patients with IBD to have lower scores on cognitive testing and a positive correlation between disease length and cognitive impairment level. In addition, the levels of stress, anxiety, and depression should be higher in the IBD group. The serum levels of the 4 biomarkers could correlate or anticorrelate with cognitive scores and serve as predictive factors for MCI or dementia development. A higher level of education, a younger age, the absence of malabsorption, and good disease control might serve as protectors against MCI. GBA interactions, along with systemic inflammation and the adverse effects of medication, might be a cause of MCI and AD development in patients with IBD. Serum biomarkers could prove cheap and useful predictors of MCI development. ClinicalTrials.gov NCT05760729; https://clinicaltrials.gov/study/NCT05760729. DERR1-10.2196/50546.

Effectiveness of lifestyle interventions for improving the physical health of children and adolescents taking antipsychotic medications: protocol for a systematic review and meta-analysis

IntroductionChildren and adolescents are increasingly prescribed antipsychotic medications off-label in the treatment of behavioural disorders. While antipsychotic medications are effective in managing behavioural issues, they carry a significant risk of...

Improvement in Nasal Symptoms of Chronic Rhinitis after Cryoablation of the Posterior Nasal Nerve.

To determine the efficacy of posterior nasal nerve (PNN) cryoablation for improving the symptoms of chronic rhinitis. Retrospective cohort study. A private practice. This study evaluated medication usage and adverse effects of in-office PNN cryoablation with a handheld device in patients > 18 years with chronic (>6 months) allergic or nonallergic rhinitis for whom medical management failed. The total nasal symptom score (TNSS) and mini rhinoconjunctivitis quality of life questionnaire (mRQLQ) scores were compared before and after treatment. This study included 127 patients with a mean age of 52.4 ± 16.9 years; 60.6% of patients were female and 49.6% had allergic rhinitis. Mean symptom scores decreased from 5.94 (95% confidence interval [CI], 5.51-6.43) to 3.44 (95% CI, 2.97-3.81, P < .001) after the procedure, with clinically important decreases in 75 (59.1%) patients. For patients with baseline TNSS values of ≥4, 63.5% (66/104) had a clinically important decrease, whereas only 39.1% (9/23) of those with the lower baseline did (P = .04). Mean mRQLQ scores also decreased from 2.51 (95% CI, 2.29-2.72) to 1.28 (95% CI, 1.20-1.47, P < .001) after the procedure. Seventy-eight of 273 (28.6%) medications were discontinued after the procedure. Adverse effects occurred in 18.1% (23/127) of patients with headache as the most common. PNNcryoablation improves nasal symptoms and quality of life in patients with chronic rhinitis. Patients with a higher baseline TNSS are more likely to experience significant symptomatic improvement.

Recent Studies on the Mechanisms and Adverse Effects of Medications Used in COVID-19 Patients

To increase the success in Covid-19 treatment, many drug suggestions are presented, and some clinical studies are shared in the literature. There have been some attempts to use some of these drugs in combination. However, using more than one drug together may cause serious side effects on patients. Therefore, detecting drug-drug interactions of the drugs used will be of great importance in the treatment of Covid-19. In this study, some vital drugs and supplements used for Covid-19 treatment with their mechanism of actions and possible adverse/side effects shed a light about their safety and efficacy level. Moreover, some of these drugs are used together in Covid-19 treatment for better outcome of treatment, thus the side effects caused by using these drugs together are shared. In this review, it is aimed to facilitate the selection of proper drugs by the physicians and increase the success rate of Covid-19 treatment according to the targeted patient.

A-027 The Clinical Indications of Low or Non-reportable HbA1c Results

Abstract Background Hemoglobin A1c (HbA1c) is the major non-enzymatic glycation product of hemoglobin A (HbA) and usually measured as a percentage of total hemoglobin. It is widely used in the screening, diagnosis, and monitoring of diabetes because HbA1c correlates with the average blood glucose level over the past 8–12 weeks in patients with a normal RBC lifespan. However, many factors can cause inaccurate HbA1c measurements or invalidate this correlation. While a high HbA1c raises the concern of inadequate glycemic control, a low or non-reportable HbA1c may also indicate diverse clinical conditions or technical issues. This study analyzes the pathophysiological conditions and technical limits leading to a low or non-reportable HbA1c value and discusses the use of other lab values in HbA1c result interpretation. Methods HbA1c was measured by cation exchange HPLC (Tosoh G8, v5.24F). 37 cases with a low or non-reportable HbA1c (&amp;lt;4.0%) from January 1, 2022 to November 30, 2022 were reviewed. The relevant diagnoses, medical history, medications, and recent (±1 week from the HbA1c test) lab results (CBC, blood glucose, fructosamine, haptoglobin, LDH) were examined to identify the causes of low HbA1c values. The causes were grouped by pathological mechanisms or technical issues to calculate the frequency, and the association with other lab values was also explored. Results Low or non-reportable HbA1c cases accounted for 0.1% of total HbA1c tests (37/42 771), and about 30% (11/37) had been diagnosed with diabetes by the end of the review period. From the chart, 41% (15/37) cases had elevated blood glucose (&amp;gt;109 mg/dL), 73% (27/37) were anemic (Hb &amp;lt; 13.0 or 11.7 g/dL for male or female), and 46% (17/37) showed a high MCV (&amp;gt;96 fL). Among those cases, a minor portion was caused by method-specific technical issues (8%, 3/37) or unknown reasons (5%, 2/37). The majority (86%, 32/37) was attributed to the following mechanisms: intravascular hemolysis (51%, 19/37), hepatosplenic RBC destruction (27%, 10/37), and increased erythropoiesis (8%, 3/37). For those cases with intravascular hemolysis (51%), the causes were categorized as inherited RBC disorders (19%, 7/37, including hemoglobinopathy and G6PD deficiency), acquired hemolytic diseases (19%, 7/37, including autoimmune hemolytic anemia), and adverse effects of medications (13%, 5/37, including dapsone and hydroxychloroquine). For those cases with hepatosplenic RBC destruction (27%), most of them were caused by cirrhosis (19%, 7/37). In addition, increased erythropoiesis (8%) was observed in patients with recent hemorrhage or EPO treatment. Some hemoglobin variants like homozygous HbE resulted in non-reportable HbA1c (8%), which represented a technical limit of the HPLC method. Conclusion Although low or non-reportable HbA1c cases are rare (0.1%), a significant portion (30%) of them are diabetic patients, and their HbA1c results can be misleading. The majority of low HbA1c cases (86%) are associated with clinical conditions causing a shortened RBC lifespan, and the most common causes include inherited RBC diseases (19%), cirrhosis (19%), medication adverse effects (14%), and autoimmune diseases (11%). Because increased RBC destruction and compensatory erythropoiesis are the underlying mechanisms, hemoglobin, MCV, and markers assessing hemolytic anemia (haptoglobin, LDH, reticulocyte%) can aid in HbA1c interpretation.

A-160 Factor VIII Chromogenic Low Activity Sample Analysis in a Low Calibration Curve Model

Abstract Background Adequate laboratorial diagnostics of hemophilia is essential and could be done by chromogenic and one-stage assays based on APTT methodologies. Adverse effects of medications became less severe recently, but it remains important to be aware of to ensure that treatment is effective and ensure the best possible conditions for affected individuals. Classification of hemophilia according to FVIII activity: mild 25%–5%; moderate, 5%–1% and severe &amp;lt;1%. For new therapies such as emicizumab and some drugs with an extended half-life, the World Federation of Hemophilia recommends the use of a chromogenic assay of FVIII containing bovine FX for monitoring factor FVIII activity. Objetive: evaluate the applicability of a low calibration curve (LCC) in the chromogenic factor VIII (FVIII-Chr) assay by standardizing the dilution of the standard (calibrator) and thus ensuring the accuracy of the analyses in the lower values like severe hemophilia range. Methods The samples were obtained from H&amp;H LAB SAS, which guarantees all requirements. Sysmex® CS 2100i Siemens Healthineers. Calibration was performed with Standard Human Plasma (SHP), together with FVIII-Chr. Quality Control (QC); the accuracy of the LCC was checked. Results Preparation of the LCC: SHP reconstitution, followed by 1:10 dilution between the SHP and the plasma deficient in FVIII. The curve was named FVIII-Chr Low. QC was performed through pathological control (PC) with 2 dilutions: 1) identical to the formation of the low curve, i.e., dilution 1:10 (2.3%–3.9%). 2) dilution 1:30 (0.2%–2%) to accommodate the range of activity comprising severe hemophilia. The values found confirms the curve’s quality. Discussion This study sought to develop a way to detect FVIII activities &amp;lt;1.5% in a reproductive manner, even with a reduced “N” number of samples for severe state. The chromogenic test presents a limit of detection for the optical density of D.O. 0.0080 reporting &amp;lt;0,3% FVIII-Chr activity, which is very close to the most diluted point of the LCC. Conclusion QC performance with PC 1/10 and 1/30 showed excellent reproducibility. With the protocol FVIII Low and LCC (SHP + PDF) it is possible to obtain results of FVIII-Chr &amp;lt;1.0% compatible patients with severe hemophilia clinical condition.

Oromandibular dystonia induced by olanzapine and mirtazapine: A case report

AbstractBackgroundDystonia has been reported as an adverse effect of antipsychotic medications; however, dentists rarely detect the symptoms because of the complexity of complaints.Case PresentationA 74‐year‐old woman presented with an open bite and jaw pain. She reported a history of depression and was being treated with medication including olanzapine. We diagnosed the patient with oromandibular dystonia. Her psychiatrist withdrew olanzapine treatment following consultation, and the open bite and jaw pain were resolved.ConclusionDentists should consider oromandibular dystonia when a patient taking antipsychotic medication complains of an open bite. Irreversible procedures should be avoided in these patients.

A Qualitative Study Exploring the Perceived Barriers Among Patients After Percutaneous Coronary Intervention

Introduction: Cardiovascular diseases, particularly coronary heart disease (CHD), are the third biggest cause of mortality worldwide, and percutaneous coronary intervention (PCI) is one of the available treatments. The patient’s self-efficacy in performing self-care decreases as a result of several post-PCI hurdles, which has an effect on their quality of life. The purpose of this investigation was to explore the barriers that patients experience following PCI. Methods: The study design used was descriptive qualitative in 15 patients after PCI. Purposive sampling was used to conduct the participant recruitment process. Between June 2021 and January 2022, data were collected using a semi-structured interviewing method. The data were analysed through the use of thematic content analysis. Results: The thematic content analysis found four themes: 1) Perceived physical barriers; 2) Perceived psychological barriers; 3) Low adherence; 4) The adverse side effects of medications. Conclusion: The results of this study highlight the value of empowering patients to take care of themselves at home following PCI and assisting in the creation of holistic and continuity nurse intervention models.

A SYSTEMATIC REVIEW OF THE APPLICATION OF NATURAL POLYMERS IN THE FORMULATION OF ORO-DISPERSIBLE TABLET

Oral drug delivery is still the preferred method for administering many medications. Recent technological advancements have led to the development of orally disintegrating drugs, which offer improved patient compliance and convenience. Orodispersible(ODTs) drugs are a unique dosage form that dissolves in the mouth within 1-3 min without the need for chewing or water. Over the past three decades, orodispersible drugs have gained popularity as an alternative to traditional drugs due to their increased patient compliance, solubility, and stability. This new technology meets both the pharmaceutical and patient demands and provides a comfortable dosage method for pediatric, geriatric, and psychiatric patients with dysphagia. Natural substances are preferred over synthetic ones because they are more accessible, less expensive, non-toxic, and chemically inert. Natural polymers, such as locust bean gum, banana powder, mango peel pectin, and Mangifera indica gum, enhance drug characteristics and are used as binders, diluents, and super disintegrants to speed up disintegration, increase solubility, and provide supplements. Manufacturers are increasingly using natural polymers due to various issues with medication release and adverse effects. This review article views the development of ODTs, challenges in formulation, new ODT technologies, and our suspects.