Chronic Medication Use Research Articles

Potential risk factors and consequences of chronic pain among Hungarian adolescents

Introduction: Based on international data, the prevalence of chronic pain is 25% among adolescents which is associated with poor quality of life, extensive use of healthcare, and overuse of pain medication. Little is known about the medication use and chronic pain in Hungary. Aim: To assess the prevalence and potential socio-demographic risk factors of chronic pain and medication use among Hungarian adolescents. Method: We conducted a cross-sectional epidemiological study at primary and secondary schools with 354 school-children. Adolescents responded to questionnaires about demographic variables, characteristics of chronic pain, use of health-care system and medication. Results: 110 adolescents (31.1%) suffered from chronic pain in our sample. Pain in extremities was the most prevalent pain type. 4.6% (n = 5) of children suffered from continuous pain. The prevalence was lower among boys (χ2 = 9.4; p = 0.002) and younger subjects (Mann-Whitney U = 10906.5; p = 0.004). Sleep disorder was more frequent among adolescents with chronic pain (χ2 = 8.9; p = 0.03). Time from onset, intensity, prevalence and duration of pain were associated with the prevalence of visits to physicians. 78% (n = 276) of the sample took medication in the previous 6 months, however, regular medication use was as high as 48.3% (n = 171). We found a significant association between medication use and older age, female sex, and the presence of chronic pain. Medication use against pain among adolescents with chronic pain was significantly higher (n = 83.0, 75.5%). Conclusion: The prevalence of chronic pain, medication use and visits to physicians is considerable among Hungarian adolescents. It is an important healthcare challenge with long-term consequences until adulthood. Orv Hetil. 2020; 161(13): 502-509.

Insomnia, hypnotic use, and road collisions: a population-based, 5-year cohort study.

The study objectives were to examine accidental risks associated with insomnia or hypnotic medications, and how these risk factors interact with sex and age. A population-based sample of 3,413 adults (Mage = 49.0 years old; 61.5% female), with or without insomnia, were surveyed annually for five consecutive years about their sleep patterns, sleep medication usage, and road collisions. There was a significant risk of reporting road collisions associated with insomnia (hazard ratio [HR] = 1.20; 95% confidence interval [CI] = 1.00-1.45) and daytime fatigue (HR = 1.21; 95% CI = 1.01-1.47). Insomnia and its daytime consequences were perceived to have played some contributory role in 40% of the reported collisions. Both chronic (HR = 1.50; 95% CI = 1.17-1.91) and regular use of sleep medications (HR = 1.58; 95% CI = 1.16-2.14) were associated with higher accidental risks, as well as being young female with insomnia and reporting excessive daytime sleepiness. Both insomnia and use of sleep medications are associated with significant risks of road collisions, possibly because of or in association with some of their residual daytime consequences (i.e. fatigue and poor concentration). The findings also highlight a new group of at-risk patients, i.e. young women reporting insomnia and excessive daytime sleepiness.

Cost-Effectiveness of Pharmacist-Led Deprescribing of NSAIDs in Community-Dwelling Older Adults.

Older adults are often prescribed potentially inappropriate medications associated with adverse health outcomes and increased health services utilization. Developing Pharmacist-led Research to Educate and Sensitize Community Residents to the Inappropriate Prescriptions Burden in the Elderly (D-PRESCRIBE), a pragmatic randomized clinical trial, demonstrated how a community pharmacist-led evidence-based educational intervention successfully empowered community-dwelling older adults and their physicians to reduce chronic use of inappropriate medications. The objective of this study was to evaluate the cost-effectiveness of the D-PRESCRIBE intervention for discontinuing nonsteroidal anti-inflammatory drugs (NSAIDs). Cost-effectiveness analysis. Canada. Community-dwelling adults aged 65 years and older. Decision analysis combining decision tree and Markov state transition modeling was developed to estimate the cost-effectiveness of D-PRESCRIBE (NSAIDs) compared with usual care from a Canadian healthcare system perspective with a time horizon of 1 year. Data from the D-PRESCRIBE trial and published literature were used to calculate effectiveness, utilities, and costs. Reference case and scenario analyses were conducted using probabilistic modeling. Sensitivity analyses assessed the robustness of the reference case model. D-PRESCRIBE (NSAIDs) was less costly (-$1008.61) and more effective (.11 quality-adjusted life-years [QALYs]) than usual care and was the dominant strategy. At willingness-to-pay thresholds of $50 000 per QALY and $100 000 per QALY, D-PRESCRIBE (NSAIDs) incurred a positive incremental net benefit compared with usual care, suggesting it is cost-effective. Compared with the reference case, scenario analyses gave comparable QALYs with modest variation in cost estimates. For community-dwelling older adults, D-PRESCRIBE (NSAIDs) provides greater benefits at lower system costs, making it a compelling strategy to reduce the use and harms associated with chronic NSAID consumption. Our findings support reimbursing community pharmacists' clinical professional services for deprescribing inappropriate NSAIDs in community-dwelling older adults. J Am Geriatr Soc 68:1090-1097, 2020.

Association of medication storage with diabetes control: A cross-sectional study from Saudi Arabia

BackgroundIn addition to diet restriction and physical activity, diabetes mellitus is managed by the chronic use of medications that require appropriate storage conditions to maintain their stability and effectiveness. However, there is a lack of information regarding patients’ knowledge of medication storage and practices in Saudi Arabia. Therefore, the objective of this study was to determine the diabetics’ knowledge about medication storage requirements and to evaluate the impact of antidiabetic medications storage on the blood glucose levels. MethodsThis study was a cross-sectional in the form of an interviewer-guided interview using a close-ended questions. The study was conducted among patients diagnosed with diabetes at diabetic clinics of public hospitals and other diabetic specialized clinics in Hail region of Saudi Arabia, over a period of four months between January to April 2019. ResultsA total of 501 completed questionnaires were returned. Of the respondents, 51.5% were males and 48.5% were females. Of the total participants 52.7% never achieved normal blood glucose range, which was associated with health literacy and medication storage knowledge. Almost half of the participants stored the medication correctly and others have poor knowledge and practice of medication storage, of whom 7.8% always store their medicines in their cars. ConclusionAlmost half of the participants lack the knowledge of appropriate storage conditions of diabetes medications, which was shown to have a significant association with blood glucose levels.

Chronic Constipation in the Elderly Patient: Updates in Evaluation and Management.

Chronic constipation (CC) is a common disorder in the elderly population globally and is associated with comorbidities and negative implications on the quality of life. Constipation prevalence varies in different studies, primarily owing to the nonuniformity of the diagnostic criteria. However, 15%–30% of individuals aged >60 years are diagnosed with CC. Primary care physicians are the main healthcare providers that manage constipation in elderly patients in parallel with increased population aging and increased prevalence of constipation. Physical inactivity, polypharmacy, chronic medical conditions, rectal hyposensitivity, and defecatory disorders all play a role in the pathogenesis of CC in elderly patients. Detailed anamnesis, particularly history related to chronic medication use, with digital rectal examination may assist in identifying constipation causes. Additionally, blood tests and colonoscopy may identify organic causes of CC. Physiologic tests (i.e., anorectal manometry, colonic transit time with radiopaque markers, and defecography) can evaluate the physiologic function of the colon, rectum, and anus. However, generally, there are several causes of constipation in older patients, and an individualized approach is recommended. Treatment of chronic idiopathic constipation is empiric, based on the stepwise approach. Lifestyle advice, adjustment of chronic medications, and prescription of laxatives are the first steps of management. Several laxatives are available, and the treatment is evolving in the last decade. Biofeedback is an effective therapy especially for defecatory disorders. This review aimed to summarize the most updated knowledge for primary care physicians in the approach and management of CC in elderly patients.

Surgeries of the lacrimal drainage system – A review

Nasolacrimal system serves as a conduit for tear flow from eye to the nasal cavity. Periodic blinking initiates a pump mechanism, helping in the even distribution of tears over the ocular surface, which then flows into the lacrimal sac and finally to the nasal cavity via the nasolacrimal duct (NLD). Obstruction in this system leads to inadequate tear drainage, which clinically presents as epiphora. Lacrimal outflow system disorders are very annoying to the patients, and sometimes vision threatening. Surgery is a definitive solution for most outflow obstructions, and patients should be counseled accordingly. Chronic use of topical medications for NLD problems is neither cost-effective nor efficacious, but only prolongs agony. This article aims to provide a comprehensive insight into the commonly performed lacrimal drainage surgeries. Literature search using PubMed, Cochrane, and Google Scholar with a combination of various words appropriate to this article was done and relevant articles were reviewed.

Associations between midlife chronic conditions and medication use with anxiety and depression: A cross-sectional analysis of the PREVENT Dementia study.

Background:Multimorbidity including physical and mental illness is increasing in prevalence. We aimed to investigate the associations between physical conditions and medication use with anxiety and depression in midlife.Methods:We conducted an observational cross-sectional study of volunteers in the PREVENT Dementia study. Using logistic and linear regression, we investigated the association between increasing numbers of self-reported chronic physical conditions and medications with self-reported depression and anxiety disorder, and scores on the Center for Epidemiologic Studies Depression (CES-D) scale and Spielberger State-Trait Anxiety Inventory (STAI) state subtest.Results:Of the 210 participants, 148 (71%) were women and 188 (90%) Caucasian. The mean age was 52 (standard deviation (SD) = 5.5) years. The mean number of physical conditions was 2.2 (SD = 1.9) and medications 1.7 (SD = 2.2). Each additional physical condition was associated with increased odds of self-reported depression (odds ratio (OR) 1.41, 95% confidence interval (CI) 1.11–1.80; p = 0.004, adjusted for age and gender) and anxiety disorder (OR 1.70, 95% CI 1.30–2.37; p < 0.001). Increasing medication use was associated with self-reported depression (adjusted OR per additional medication 1.35, 95% CI 1.08–1.71; p = 0.008) but not anxiety disorder. For each additional condition, CES-D scores increased by 0.72 (95% CI 0.11–1.33; p = 0.020) and for each extra medication, by 0.88 (95% CI 0.32–1.44; p = 0.002). There was no significant association between increasing conditions and medications with STAI scores. In models accounting for antidepressant use, all associations were attenuated.Conclusions:Having more physical conditions is associated with anxiety and depression in midlife, and taking more medications is associated with depression but not anxiety.

MULTIPLE MEDICATION USE AND RISK OF TREATED FALL INJURY: THE HEALTH ABC STUDY

Multiple medication use within one year is associated with increased fall injury risk in older adults. However, chronically using multiple medications and treated fall injury have rarely been explored, particularly in cohort studies linked with claims data. We examined using >5 medications in 2 or more consecutive years (chronic medication use) as a risk factor for treated fall injury in 1,898 community-dwelling adults (age 73.6±2.9 years; 53% women; 37% black) with linked Medicare Fee-For-Service (FFS) claims from the Health, Aging and Body Composition Study since 1997/98 clinic visit. Incident fall injury (N=546) was the first claim from 1998/99 clinic visit to 12/31/08 with an ICD-9 fall code and non-fracture injury code, or fracture code with/without a fall code. Stepwise Cox models with a time-varying predictor of chronic medication use before fall injury or censoring (N=414) vs. not using >5 medications at the same time (N=1008) were adjusted for baseline demographics, lifestyle factors, fall history, quadriceps strength, cardiovascular disease (CVD), diabetes, sensory nerve impairment, and kidney function. Fall injury risk increased for chronic medication users (37%) vs. non-users (29%) (HR=1.25[1.00-1.57]), though was attenuated after adjustment for CVD and diabetes (HR=1.18[0.93-1.51]). Sensitivity analyses excluding fall-risk-increasing drugs (FRIDs) from medication counts (HR=1.32[0.54-3.20]), or including those using >5 medications non-chronically (N=365) in referent groups (HR=1.22[0.96-1.55]) had consistent findings. Unmeasured comorbidity differences may confound associations of chronic medication use and treated fall injury risk in older adults with Medicare FFS. Considering both chronic diseases and medication use in fall risk assessments is needed.

A curious case of bony streaks and stripes due to osteopathia striata

A 47-year-old woman presented with pain in her lower back, hip and lower limbs following a road traffic accident. Prior to this, there was no significant systemic illness, or chronic...

Anticholinergic burden of long-term medication is an independent risk factor for the development of postoperative delirium: A clinical trial.

Postoperative delirium (POD) is a common complication after surgery. We sought to determine the association between preoperative anticholinergic load calculated using the anticholinergic drug scale (ADS) and POD in cancer patients over 65 years of age. A retrospective sub-investigation of a randomised controlled interventional trial. Two tertiary university hospitals. Overall, patients aged 65 years and older scheduled for surgical treatment of gastrointestinary, genitourinary or gynaecological cancers. The primary outcome was the interaction between anticholinergic drug scale and occurrence of postoperative delirium. Patient clinical parameters and ADS scores were assessed preoperatively. POD screening was conducted for a total of 7 days following surgery using validated measures. Independent associations between ADS and POD were assessed using multivariate logistical regression analyses. A total of 651 patients (mean age, 71.8 years; 68.5% males) were included. Of those, 66 patients (10.1%) developed POD. The ADS score was independently associated with the occurrence of POD (higher ADS per point OR 1.496; 95% CI 1.09-2.05; p = 0.01). Additionally, age (per year OR 1.06; CI 95% CI 1.01-1.11; p = 0.03) and ASA state (OR 2.16; 95% CI 1.22-3.83; p = 0.01), as well as stay on ICU (yes vs. no OR 2.8; 95% CI 1.57-4.998; p < 0.01), were independently associated with POD. ADS assessment according to chronic medication use is a cost-effective, non-invasive method of identifying elderly cancer patients at risk for POD. www.clinicaltrials.gov. Identifier NCT01278537. Ethics: IRB of Charité University-Medicine Berlin, Germany; EA2/241/08.

Prevalence of and factors associated with female sexual dysfunction among women using hormonal and non-hormonal contraception at the AGA Khan University Hospital Nairobi.

BackgroundFemale sexual function (FSD) is a complex phenomenon. It integrates all body systems and is influenced by a variety of factors. Contraceptives have shown to have variable effects on FSD. In Kenya, the majority of women use hormonal contraception with high rates of discontinuation of use, attributed to related side effects such as weight loss and loss of libido.AimTo determine the prevalence of and the factors affecting FSD among women using contraception in our setting.SettingThe study was carried out at the Aga Khan University Hospital, Nairobi, at various clinical sites.MethodsA cross-sectional study was conducted. Consecutive sampling of women of reproductive age using either hormonal or non-hormonal contraception was conducted. Two questionnaires were completed after obtaining informed consent. Independent associations of factors with the outcome variables were assessed using the chi-square test of association, and variables with a p < 0.25 were used in the multivariate analysis. Factors associated with FSD were determined using binary logistic regression.ResultsA total of 566 participants were included. The prevalence of FSD among those using hormonal and those using non-hormonal contraception was 51.5% and 29.6%, respectively (p < 0.0001). We found that the factors associated with FSD were presence of chronic illness and use of chronic medication, being self-employed or unemployed, alcohol intake and history of miscarriage(s).ConclusionThere was a high prevalence of and a strong association between hormonal contraception and FSD. More studies on this topic in different settings are recommended to investigate the effect of each type of hormonal method on FSD.

Proton Pump Inhibitors and Infection-Related Hospitalizations Among Residents of Long-Term Care Facilities: A Case-Control Study.

Our objective was to investigate associations between proton pump inhibitor (PPIs) use and infection-related hospitalizations among residents of long-term care facilities (LTCFs). This was a case-control study of residents aged ≥ 65years admitted to hospital between July 2013 and June 2015. Residents admitted for infections (cases) and falls or fall-related injuries (controls) were matched for age (± 2years), sex, and index date of admission (± 6months). Conditional logistic regression was used to estimate crude and adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for associations between PPI use and infection-related hospitalizations. Analyses were adjusted for age, sex, polypharmacy, diabetes, heart failure, chronic obstructive pulmonary disease, myocardial infarction, cerebrovascular accident, and concomitant use of cancer and immunosuppressant medications. Subgroup analyses were performed for high- and low/moderate-intensity PPIs and for respiratory and non-respiratory infections. Logistic regression was used to compare the odds of infection-related hospitalizations among users of high- and low/moderate-intensity PPIs. Overall, 181 cases were matched to 354 controls. Preadmission PPI use was associated with infection-related hospitalizations (aOR 1.66; 95% CI 1.11-2.48). In subgroup analyses, the association was apparent only for respiratory infections (aOR 2.26; 95% CI 1.37-3.73) and high-intensity PPIs (aOR 1.93; 95% CI 1.23-3.04). However, the risk of infection-related hospitalization was not significantly higher among users of high- versus low/moderate-intensity PPIs (aOR 1.25; 95% CI 0.74-2.13). Residents who use PPIs may be at increased risk of infection-related hospitalizations, particularly respiratory infections. Study findings provide further support for initiatives to minimize unnecessary PPI use in the LTCF setting.

Role of Vesicular Monoamine Transporter 2 Inhibitors in Tardive Dyskinesia Management.

Tardive dyskinesia (TD) is a distressing and disabling movement disorder that occurs with the use of chronic neuroleptic medications. TD is defined as involuntary athetoid or choreiform movements of head, trunk or limbs. Tongue, lower face, jaw, and extremities are commonly involved but pharyngeal, diaphragmatic, or truncal muscles are also sometimes involved affecting breathing, swallowing, speech, posture, gait, and mobility of an individual.TD is a debilitating movement disorder that requires timely intervention. Subtle tongue movements, tic-like facial movements or increased blink frequency could be some of the initial manifestations of TD. Our article is focused on the new advents in treating TD, their efficacy, and tolerability with emphasizing their side effect profile. The implication of a genetic marker vesicular monoamine transporter 2 (VMAT2), helped in investigating VMAT2 inhibitors for alleviating TD. Among the modalities tested, only VMAT2 inhibitors reported efficacy. However, the outcome of long-term use and its side effect profile can only be determined with longer studies utilizing large set data. More clinical trials are required to explore individual drug efficacy and their long-term adverse effects.We aim to provide an overview of TD management, illustrating the priority of VMAT2 inhibitors and to determine the importance of selecting an optimal medication. A search through PubMed with terms "Tardive dyskinesia" and "VMAT2 inhibitors" was carried out. Several treatment modalities were tested to control the symptoms of TD with limited benefit. However, VMAT2 inhibitors showed improvement in the Abnormal Involuntary Movement Scale (AIMS) rating scale for TD. Valbenazine and deutetrabenazine (d-TBZ) were recently approved by the Food and Drug Administration (FDA) for treating TD in adults.

Are the Benefits of Value-Based Insurance Design Conclusive?

Questions about the clinical significance of improvements to medication adherence resulting from value-based insurance design (VBID) policies persist in the literature. Given the lack of conclusive evidence about effectiveness, in addition to concerns about the cost of implementing VBID programs, it is perhaps not surprising that VBID is not more widely used by managed care plans. Although VBID holds promise for improving chronic medication use, additional evidence is needed if VBID is to become universally adopted. DISCLOSURES: No funding contributed to the writing of this article. The author currently receives funding from Blue-Cross Blue-Shield of Minnesota for unrelated research.

Chronic inflammatory diseases, anti-inflammatory medications and risk of prostate cancer: a population-based case-control study

BackgroundWhether chronic inflammation increases prostate cancer risk remains unclear. This study investigated whether chronic inflammatory diseases (CID) or anti-inflammatory medication use (AIM) were associated with prostate cancer risk.MethodsFifty-five thousand nine hundred thirty-seven cases (all prostate cancer, 2007–2012) and 279,618 age-matched controls were selected from the Prostate Cancer Database Sweden. CIDs and AIMs was determined from national patient and drug registers. Associations were investigated using conditional logistic regression, including for disease/drug subtypes and exposure length/dose.ResultsMen with a history of any CID had slightly increased risk of any prostate cancer diagnosis (OR: 1.08; 95%CI: 1.04–1.12) but not ‘unfavourable’ (high-risk or advanced) prostate cancer. Generally, risk of prostate cancer was highest for shorter exposure times. However, a positive association was observed for asthma > 5 years before prostate cancer diagnosis (OR: 1.21; 95%CI: 1.05–1.40). Risk of prostate cancer was increased with prior use of any AIMs (OR: 1.26; 95%CI: 1.24–1.29). A positive trend with increasing cumulative dose was only observed for inhaled glucocorticoids (p < 0.011).ConclusionDetection bias most likely explains the elevated risk of prostate cancer with prior history of CIDs or use of AIMs, given the higher risk immediately after first CID event and lack of dose response. However, findings for length of time with asthma and dose of inhaled glucocorticoids suggest that asthma may increase risk of prostate cancer through other pathways.

Clinical Results of Comprehensive Medication Management Services in Primary Care in Belo Horizonte.

The high prevalence of chronic diseases and use of multiple medications identified in Primary Health Care (PHC) suggest the need for the implementation of Comprehensive Medication Management (CMM) services. This study aimed to evaluate the clinical results of CMM services in a Brazilian PHC setting. A quasi-experimental study was performed with patients followed-up for two years (n = 90). Factors associated with the detection of four drug therapy problems (DTP) or more in the initial assessment were evaluated (univariate and multivariate analyses), as well as the clinical impact observed in laboratory parameters (HbA1c, Blood Pressure, LDL- and HDL-covariance analysis). A predominance of women (61.1%), a mean age of 65.5 years, and a prevalence of polypharmacy (87.8%)—use of five or more drugs—were observed. A total of 441 DTP was identified, 252 required interventions with the prescriber, 67.9% of which were accepted and 59.6% were solved. The main DTP were ‘non-adherence’ (28.1%), ‘need for additional drug therapy’ (21.8%), and ‘low dose’ (19.5%). Hypertension was positively associated with the identification of four DTP or more. A statistically significant reduction was detected in all assessed laboratory parameters (p < 0.05). CMM services contributed to the resolution of DTP and improved clinical outcomes.

Pre-Race Risk Screening and Stratification Predicts Adverse Events - SAFER Study In 76654 Distance Runners

PURPOSE: The purpose of this study was to determine if a pre-race medical screening and risk stratification program predicts adverse events (ability of a runner to finish the race, or develop a medical complication) during an endurance running event. METHODS: This prospective study, conducted during the Two Oceans marathon races (21.1km and 56km) in South Africa over 4 years, involved 76654 consenting race entrants. Race entrants completed a pre-race medical screening questionnaire at registration (3-4 months before the race), and were risk stratified into four groups: very high risk (VHR; existing cardiovascular disease - CVD), high risk (HR; risk factors for CVD), intermediate risk (IR; existing other chronic disease, medication use or injury), and low risk (LR). All runners in the VHR and HR categories were provided with educational information to decrease the risk of medical complications, and were also advised to undergo a pre-race medical assessment. Runners were tracked from registration to starting and finishing the race, and medical encounters (ME) were documented. Main outcome variables were the did-not-start rate (DNS; % runners registering but not starting) and the adverse event rate (AE) [defined as % starters that did-not-finish (DNF) or had an ME] in each risk category. RESULTS: The DNS rate (%: 95% CI) for runners was similar in all risk categories (VHR=19.5; 17.9-21.2, HR=18.8; 18.0-19.7, IR=18.4; 18.0-18.9, and LR=18.6; 18.2-19.1)(p=0.604). The DNF rates in the VHR (2.2; 1.6-3.0)(p=0.005), HR (1.8; 1.5-2.1)(p=0.017), and IR (1.9; 1.8-2.1)(p<0.001) were significantly higher compared to the LR (1.4; 1.2-1.5). The overall AE rates for runners in the VHR (2.3; 1.8-3.0)(p=0.0017), HR (1.8; 1.5-2.1)(p=0.0323), and IR (2.0; 1.9-2.2)(p<0.001) were significantly higher compared to the LR (1.5; 1.3-1.6). CONCLUSIONS: A pre-race medical screening, risk stratification and educational intervention program did not change the DNS in the risk categories. However, runners in the higher risk categories, that chose to start the race, were more likely to suffer an adverse event (not finish the race or present with a medical encounter) compared with runners in the lowest risk category.

Role of Natural Phenolics in Hepatoprotection: A Mechanistic Review and Analysis of Regulatory Network of Associated Genes.

The liver is not only involved in metabolism and detoxification, but also participate in innate immune function and thus exposed to frequent target Thus, they are the frequent target of physical injury. Interestingly, liver has the unique ability to regenerate and completely recoup from most acute, non-iterative situation. However, multiple conditions, including viral hepatitis, non-alcoholic fatty liver disease, long term alcohol abuse and chronic use of medications can cause persistent injury in which regenerative capacity eventually becomes dysfunctional resulting in hepatic scaring and cirrhosis. Despite the recent therapeutic advances and significant development of modern medicine, hepatic diseases remain a health problem worldwide. Thus, the search for the new therapeutic agents to treat liver disease is still in demand. Many synthetic drugs have been demonstrated to be strong radical scavengers, but they are also carcinogenic and cause liver damage. Present day various hepatic problems are encountered with number of synthetic and plant based drugs. Nexavar (sorafenib) is a chemotherapeutic medication used to treat advanced renal cell carcinoma associated with several side effects. There are a few effective varieties of herbal preparation like Liv-52, silymarin and Stronger neomin phages (SNMC) against hepatic complications. Plants are the huge repository of bioactive secondary metabolites viz; phenol, flavonoid, alkaloid etc. In this review we will try to present exclusive study on phenolics with its mode of action mitigating liver associated complications. And also its future prospects as new drug lead.

Associations of major depressive disorder with chronic physical conditions, obesity and medication use: Results from the PISMA-ep study

BackgroundLife expectancy of people with depression is on average 15 years less than that of the general population. This excess of mortality is largely attributed to a deteriorated physical health. Evidence about the association between major depressive disorder (MDD) and physical health is still lacking in some areas. The aim of this study was to explore the association between MDD and physical health-related variables in southern Spain. MethodsThe PISMA-ep is a cross-sectional study based on community-dwelling adult population. Our main outcome was current prevalence of MDD. Independent variables explored were: lifetime prevalence of twenty-one chronic physical conditions (CPCs), anthropometric measures (height, weight, body max index, and hip and waist circumferences), general health status, and medication use. ResultsMDD was significantly associated with any CPC (OR = 2.60; 95% CI: 2.01–3.35; p < 0.001). Increases in BMI were associated with MDD in women (OR=1.08; 95% CI: 1.05–1.11; p < 0.001), but not in men (OR=0.99; 95% CI: 0.95–1.05; p = 0.916). Variables associated with MDD in the multivariate model were: female gender, obesity, general health status, cancer, peptic ulcer, tinnitus and vertigo. 21.4% of participants with MDD received antidepressant treatment. ConclusionsMDD is associated with CPCs, obesity, and increased use of medication. The high rates of comorbidity between MDD and CPCs call for a more holistic management of patients in the clinical practice. The low rate of antidepressant use may be indicating underdiagnosis. Anthropometric variables were differently associated with MDD depending on gender, suggesting a strong influence of psychosocial factors.

Shared decision making in chronic medication use: Scenarios depicting exemplary care.

Patient-centred care includes patients and their values in the healthcare decision-making process. Shared decision-making is essential for patient satisfaction, medication adherence, and positive clinical outcomes. It also empowers patients to play an active role in managing their health condition by improving their sense of agency, allowing them to personalise their care. Long-term prescriptions are an unexplored area where shared decision-making could be impactful. This paper provides 5 common clinical prescription scenarios pertaining to route of administration, medication timing, side effects, and length of prescription. Minor tailoring of treatment plans could significantly improve clinical outcomes. These serve as exemplars as to how to personalise prescriptions through shared decision making in accordance with patient values.