Common Medications Research Articles

High prevalence of cough and common cold medication intoxications in the Czech paediatric population.

There has been much debate about the appropriateness of over-the-counter (OTC) cough and common cold medications (CCM). The aim of this nationwide study was to analyse the incidence of CCM intoxications in the Czech paediatric population from 2014 to 2023.We performed a retrospective study on the incidence of CCM intoxications in the Czech paediatric population (ages 0-18 years) from 2014 to 2023.There were 7,056 cases of CCM intoxication in children, of which 6,406 resulted from unintentional intoxication. No lethal doses were reported, but there were 1,769 documented toxic doses. Unintentional CCM intoxications represented 15.60% of all unintentional medication intoxication cases across all ages and medication types. Of the 6,406 unintentional intoxication cases, 5,465 (85.31%) were in children aged 0 to 6 years, including 1,564 (24.41%) in children aged 0 to 2 years. Children aged 0 to 6 years had a significantly higher risk of CCM intoxication compared to those aged 7 to 18 years (RR 9.5, p<0.00001). The annual incidence of unintentional CCM intoxication was 69.26 per 100,000 children aged 0 to 6 years and 7.29 per 100,000 children aged 7 to 18 years.Based on our data, we believe there is low awareness among parents and Czech paediatricians regarding the potential risks of CCM and the lack of proven efficacy of these medications.Our data may contribute to political discussions regarding the general prohibition of CCM use in children younger than six years.

Incident prescriptions for common cardiovascular medications: comparison of recent versus pre-2020 medication adherence and discontinuation in three universal health care systems

BackgroundHealth system disruptions since onset of the COVID-19 pandemic may have adversely impacted adherence to medications for common cardiovascular risk factors.MethodsWe examined adherence to and discontinuation of incident prescriptions for medications treating hypertension, dyslipidemia, diabetes, and atrial fibrillation in Ontario, Alberta, and Nova Scotia, Canada. We compared the recent period (April 1, 2020 through most recently available follow-up: September 30, 2021 for Ontario; March 31, 2021 for Alberta; and March 31, 2022 for Nova Scotia) to the baseline, pre-pandemic period (April 1, 2014 through March 31, 2019). In each province, people aged ≥66 years with a valid health number and corresponding incident prescription were included. For each medication class, adherence in the recent period, defined as ≥ 0.80 proportion-of-days-covered (PDC), was compared to the pre-pandemic period using modified Poisson regression with robust error variance, adjusted for patient characteristics. Similarly adjusted Cox proportional hazards models compared hazard of discontinuation over one year of follow-up between the two time periods.ResultsIn the recent period, PDC ranged from 48.9% for dyslipidemia medications in Alberta to 82.2% for anticoagulants in Nova Scotia. Adherence was not different between periods, with the following exceptions: higher adherence in the recent period for antihypertensives (adjusted risk ratios [aRR] 1.08, 95% CI 1.06–1.10) and dyslipidemics (aRR 1.07, 95% CI 1.04–1.09) in Nova Scotia, and for antihyperglycemics (aRR 1.10, 95% CI 1.08–1.14) and anticoagulants (1.15, 95% CI 1.12, 1.18) in Alberta. Adherence was lower in the recent period only for antihypertensives in Alberta (aRR 0.95, 95% CI 0.93, 0.97). One-year rates of discontinuation ranged from 20.9% for anticoagulants in the Alberta recent period to 56.7% for antihypertensives in the Ontario baseline period. The adjusted hazard of discontinuation was lower or unchanged in the recent period for all medication classes.ConclusionsDespite significant health system disruptions since 2020, recent adherence to incident cardiovascular prescriptions was similar or better than before and rates of medication discontinuation were lower. However, interventions are still needed to improve existing, suboptimal adherence.

Assessment and Evaluation of Consumer Awareness and Self-Medication Use Practices Towards Over the Counter (OTC) Analgesics. A Cross-Sectional Study in Abha-Saudi Arabia.

To assess and evaluate consumer awareness and common medication use practices towards OTC analgesics, with a focus on the impact of irrational drug use and its implications for public health and safety. This includes identifying gaps in knowledge, evaluating the potential consequences of misuse, and discussing how these findings can inform future educational initiatives and policy development to promote safer medication practices. This was a cross-sectional, semi-quantitative survey of 750 Saudi volunteers both males and females aged between 18 and 65 years. A validated self-administered questionnaire was used among randomly selected volunteers with a history of OTC analgesic use. A total of 750 questionnaires were administered and the response rate was measured to be 75.6%. More than 50% of the study population used OTC analgesics without a prescription and reported using analgesics as soon as they start experiencing any pain. Paracetamol was found to be the most predominantly used analgesic. The most common indication of OTC analgesic use was reported for headache and toothache whereas irrational use of analgesics in terms of dose, frequency and indication was found to be to the extent of 50%. Primary source of information related to OTC analgesic use was obtained from pharmacy personnel (31.7%), and Patient Insert Leaflets (PIL) (28.7%). Majority of the respondents (64.3%) didn't know the safe maximum dose of Paracetamol, whereas 73.3% used to stop medicine only after experiencing some side effects. 52.4% of the respondents were not aware about the most common side effects, and potential interactions of analgesic medications. Our study highlights the menace of self-medication practices and irrational use of OTC analgesic by the study participants. Immediate remedial measure need to be taken to discourage self-medication and improve rational use of OTC drugs which can be achieved by focusing on improving the consumers' awareness of self-medication and the rational use of medications.

Evaluation of Standard Market Preparation Tablet (Tentex Forte) and Vrishya Gutika in the Management of Klaibya (Erectile Dysfunction): Research Protocol for a Randomised Controlled Tria

Introduction: Klaibya is a sexual dysfunction characterised by various symptoms, including Ling Shaithilya (penis shrinkage) and Mlan Shishna (penis weakening). It refers to a man’s inability to engage in sexual acts satisfactorily, leaving the female partner either partially or completely unsatisfied. The Charak Samhita mentions Vajikaran (aphrodisiac) Yoga as a remedy for Klaibya. Need of the Study: Common modern medications used to treat Klaibya include Cialis, Viagra, Levitra and Stendra. However, these drugs can lead to several side-effects, such as headaches, body aches, gastrointestinal disturbances, dizziness, vision changes, flushing, nasal congestion and in some cases, priapism (an erection lasting longer than four hours) and sudden changes in hearing. On the other hand, Vrishya Gutika, an herbal formulation mentioned in the Charak Samhita, includes ingredients like Vidarikand Swaras, Tugaksheeri Churna, Sharkara Churna, Ikshurak Churna (Kokilaksha), Pippali Churna, and Kappikacchu Beej Churna, along with cow ghee, cow milk, and honey-all known for their aphrodisiac properties. Aim: To conduct a comparative evaluation of the efficacy of Vrishya Gutika and Tablet Tentex Forte in the management of Klaibya (Erectile Dysfunction). Materials and Methods: A single-blinded, randomised controlled trial will be conducted at the Kayachikitsa outpatient and inpatient departments of Mahatma Gandhi Ayurved College, Hospital, and Research Centre in Salod (H), Wardha, Maharashtra, India from March 2023 to February 2025. Two groups will be formed, each consisting of 30 subjects. Group A will serve as the control group and will receive a standard market preparation (Tentex Forte)-two tablets twice daily. Group B, the trial group, will receive Vrishya Gutika-four tablets twice daily, both for 30 days. The effectiveness of the interventions will be evaluated using a validated questionnaire. The paired t-test will be employed to assess subjective parameters within the same group, while the unpaired t-test will be used for intergroup comparisons, establishing a significance level of &lt;0.05.

P-1196. Drug-Drug Interactions (DDIs) With Letermovir (LET) for Cytomegalovirus (CMV) Prophylaxis in Pediatric (Birth to &amp;lt; 18 years of age) Hematopoietic Cell Transplant (HCT) Recipients

Abstract Background HCT recipients receive multiple medications post-transplant, increasing the potential for DDIs. LET, a CMV terminase complex inhibitor approved for CMV prophylaxis in adult CMV-seropositive allogeneic HCT recipients, has the potential for DDIs with multiple medications commonly used in the HCT setting. As LET-associated DDIs have been well characterized in adults, the objective of this analysis was to evaluate known LET-associated DDIs in pediatric HCT recipients, including impact on patient safety, in a recently completed Phase 2 nonrandomized, multicenter, open-label study (NCT03940586) which evaluated LET prophylaxis in pediatric allo-HCT recipients. Methods Participants from birth to &amp;lt; 18 years of age were enrolled within 28 days post-HCT to receive LET through 14 weeks (∼100 days) post-HCT and followed through Week 48 post-HCT. Medications with potentially significant drug interactions (per the LET US label) administered concomitantly with LET were assessed in all study participants. Results A total of 63 enrolled participants received at least one dose of LET. Sixty-two (98.4%) participants received one or more concomitant medications with a potentially significant LET-associated DDI, and 50 (79.4%) participants received two or more LET-associated DDI medications. The most common concomitant medications with a LET-associated DDI were cyclosporin A (60.3% [38/63]), tacrolimus (41.3%), and voriconazole (39.7%). DDIs were reported as an adverse event (AE) in five (7.9%) participants: cyclosporin A increased (n=2), voriconazole decreased (n=2), and tacrolimus interaction (n=1). LET was discontinued in one participant due to decreased voriconazole levels. No AEs or deaths were reported due to these DDI events. Conclusion Concomitant administration of LET with medications with known potentially significant LET-associated DDIs was generally safe and well tolerated in pediatric HCT recipients. Disclosures Lara A. Danziger-Isakov, MD, MPH, Aicuris: clinical research contract, paid to institutio|Ansun BioPharma: clinical research contract, paid to institution|Astellas: Advisor/Consultant|Astellas: clinical research contract, paid to institutio|Merck: clinical research contract, paid to institutio|Pfizer: Grant/Research Support|Takeda: clinical research contract, paid to institutio Andreas H. Groll, MD, Amplyx: Advisor/Consultant|Astellas: Advisor/Consultant|Astellas: Speaker bureau|Basilea: Advisor/Consultant|Basilea: Speaker bureau|F2G: Advisor/Consultant|F2G: Speaker bureau|Gilead Sciences: Advisor/Consultant|Gilead Sciences: Grant/Research Support|Gilead Sciences: Speaker bureau|Merck Sharp &amp; Dohme LLC: Advisor/Consultant|Merck Sharp &amp; Dohme LLC: Grant/Research Support|Merck Sharp &amp; Dohme LLC: Speaker bureau|Mundipharma: Grant/Research Support|Pfizer: Advisor/Consultant|Pfizer: Grant/Research Support|Pfizer: Speaker bureau|Subsidiary of Merck &amp; Co: Advisor/Consultant|Subsidiary of Merck &amp; Co: Grant/Research Support|Subsidiary of Merck &amp; Co: Speaker bureau Natasha Broyde, MS, Merck Sharp &amp; Dohme LLC,: Current employee|Merck Sharp &amp; Dohme LLC,: Stocks/Bonds (Public Company) Barbara A. Haber, MD, Merck &amp; Co., Inc: Employee of Merck &amp; Co., Inc Christopher L. Gilbert, n/a, Merck Sharp &amp; Dohme LLC: Current employee|Merck Sharp &amp; Dohme LLC: Stocks/Bonds (Public Company) Cyrus Badshah, MD, PhD, Merck Sharp &amp; Dohme LLC: Current employee|Merck Sharp &amp; Dohme LLC: Stocks/Bonds (Public Company)

Pharmacy Subscription Program and Medication Refills, Days’ Supply, and Out-of-Pocket Costs

Medication nonadherence imposes high morbidity, mortality, and costs but is challenging to address given its multiple causes. Subscription models are increasingly used in health care to encourage healthy behaviors; in January 2023, Amazon Pharmacy launched RxPass, a subscription program offering Amazon Prime members (hereafter, company members) in 45 states access to 60 common generic medications for a flat $5 monthly fee. To evaluate the associations of program enrollment with medication refills, days' supply, and out-of-pocket costs. In this retrospective, population-based cohort study, a difference-in-differences approach with doubly robust estimation was used to assess outcomes 6 months before and after program enrollment, compared with a contemporaneous control group (study period included July 24, 2022, to January 24, 2024). Participants were younger than 65 years, company members, and not enrolled in Medicare or Medicaid. Exposure individuals were enrolled in the program in the first 6 months of program launch. Control individuals resided in the 5 states where the program was not available but who clicked on the enrollment webpage in the first 6 months of program launch. Subscription program enrollment. The primary outcome was the number of days' supply of medications on the subscription program list per person per month (PPPM). Secondary outcomes were the number of prescription refills and out-of-pocket costs of medications on the program list, including program subscription costs, PPPM. After propensity score weighting, there were 5003 enrollees (mean [SD] age, 45.9 [11.1] years; 2076 female [41.5%]) and 5137 controls (mean [SD] age, 45.8 [11.1] years; 2116 female [41.2%]). The program was associated with an increase in days' supply of 10.39 days PPPM (95% CI, 10.29-10.48 days PPPM), a 27% increase, an increase in prescription refills of 0.19 PPPM (95% CI, 0.19-0.19 refills PPPM), a 29% increase, and a decrease in out-of-pocket spending by $2.35 PPPM (95% CI, $2.37-$2.33 PPPM), a 30% decrease. In this cohort study, program enrollment was associated with increased medication refills and total days' supply and reduced out-of-pocket costs. Future research should investigate the potential cognitive and/or behavioral mechanisms by which subscription programs encourage healthy behaviors and whether the results could be replicated among other pharmacies or cohorts.

Comparison of 3 methods of quantification of phenobarbital in canine plasma: high-performance liquid chromatography, a point-of-care immunoassay, and the FDA-approved immunoassay analyzer.

Phenobarbital is a common antiseizure medication that has a relatively narrow therapeutic window. Therapeutic drug monitoring (TDM) is a helpful tool to guide dose adjustments for phenobarbital and avoid its toxicity. We investigated the agreement among 3 methods of quantifying phenobarbital in canine plasma: high-performance liquid chromatography (HPLC), point-of-care (POC) testing, and the FDA-approved immunoassay analyzer. We randomly selected 45 plasma samples obtained by the TDM service (College of Veterinary Medicine, Auburn University, Auburn, AL, USA). Passing-Bablok regression and Lin concordance correlation coefficients (CCCs) were used to determine the agreement of the results obtained for the 3 methods; Bland-Altman plots were used for bias analysis using the results from the HPLC method as a reference. The FDA-approved immunoassay analyzer and POC immunoassay method results agreed with the HPLC. The results from the FDA-approved immunoassay analyzer were better correlated than those from the POC method, with Lin CCCs of 0.96 (95% CI: 0.93-0.98) and 0.94 (95% CI: 0.90-0.97), respectively. The average biases of the FDA-approved and the POC immunoassay analyzers were 0.80 and -0.64 µg/mL, respectively. Based on the CIs of Lin CCCs, the commercial POC phenobarbital test is a good screening tool and agrees with the HPLC method. However, the FDA-approved immunoassay analyzer method allows for more accurate quantification of phenobarbital concentrations, which is required for appropriate dose adjustment of phenobarbital.

Design of S-Scheme CuInS2/CeO2 Heterojunction for Enhanced Photocatalytic Degradation of Pharmaceuticals in Wastewater.

The release of common medications and illegal drugs into the environment could be potentially harmful to the ecosystem and hamper the behavior and growth of plants and animals. These pollutants gain access to water through sewage and factory discharges and have been found to exceed safety limits in water bodies. Therefore, there is an urgent need for improved wastewater purification systems. In this study, semiconductor-based heterojunction photocatalyst CuInS2/CeO2, synthesized through a facile solvothermal process, was explored for the photocatalytic degradation of ciprofloxacin, commonly used antibiotics. Studies on the electronic properties of the heterojunction revealed interfacial characteristics that were suitable for enhanced charge carrier separation and transport and a potential S-scheme charge transfer mechanism. The heterojunction achieved ∼90% efficiency for the degradation of CIP compared to 60% and 12% reported for CeO2 and CuInS2, respectively. This shows an improvement in the activity, which results from the improved charge carrier properties of the heterojunction. Further investigation of the charge transfer mechanism through radical scavenging experiments identified •OH, O2•-, and h+ as active species contributing to the catalyst's efficacy. Based on X-ray photoelectron spectroscopy analysis, a proposed S-scheme charge transfer mechanism was suggested for the CuInS2/CeO2 heterojunction. The findings indicate the potential of the CuInS2/CeO2 heterojunction as a promising photocatalyst for treating waste effluents from the pharmaceutical industry.

GLP-1RA Use and Thyroid Cancer Risk

The increasing use of glucagon-like peptide-1 receptor agonists (GLP-1RA) demands a better understanding of their association with thyroid cancer. To estimate the risk of incident thyroid cancer among adults with type 2 diabetes being treated with GLP-1RA vs other common glucose-lowering medications. This was a prespecified secondary analysis of a target trial emulation of a comparative effectiveness study using claims data for enrollees in commercial, Medicare Advantage, and Medicare fee-for-service plans across the US. Eligible participants were adults with type 2 diabetes at moderate risk for cardiovascular disease and without history of thyroid cancer who had newly filled prescriptions for GLP-1RA, sodium-glucose cotransporter 2 inhibitor (SGLT2i), dipeptidyl peptidase-4 inhibitor (DPP4i), or sulfonylurea from January 1, 2014, to December 31, 2021. Data were analyzed February 1 to October 31, 2024. Overall and piecewise (<1, 1-2, and ≥2 years since treatment initiation) hazard ratios (HRs) for thyroid cancer with use of GLP-1RA vs the other 3 drug classes were estimated using inverse propensity score weighted Cox proportional hazards models. Modified intention-to-treat (mITT) (primary) and as-treated (sensitivity) analyses were performed. Of 351 913 patients (mean [SD] age, 65.3 [8.5] years; 173 391 [49.3%] females and 178 522 [50.7%] males), 41 112 started treatment with GLP-1RA; 76 093, with DPP4i; 43 499, with SGLT2i; and 191 209, with sulfonylurea therapy. The numbers of patients diagnosed with thyroid cancer were 69 (0.17%) in the GLP-1RA group, 172 (0.23%) in the DPP4i group, 72 (0.17%) in the SGLT2i group, and 381 (0.20%) in the sulfonylurea group. In the mITT analysis, GLP-1RA initiation was not significantly associated with increased overall risk for thyroid cancer compared to the other 3 diabetes drugs (HR, 1.24; 95% CI, 0.88-1.76). However, the risk for thyroid cancer was significantly higher within the first year after GLP-1RA initiation (HR, 1.85; 95% CI, 1.11-3.08) and was amplified in the overall as-treated analysis that censored patients when therapy was discontinued or another medication was added (HR, 2.07; 95% CI, 1.10-3.95). This secondary analysis of a target trial emulation of a comparative effectiveness study found that despite the low absolute risk of thyroid cancer among patients receiving GLP-1RA therapy, there was an increased risk of new thyroid cancer diagnoses within the first year of GLP-1RA initiation compared to 3 other diabetes drugs. This finding may have been due to enhanced early detection; therefore, further research is necessary to understand the underlying causes of this association.

Addressing challenges in pediatric thrombosis: a comprehensive guideline development

BackgroundPediatric thrombosis is a relatively rare but severe condition in the field of pediatrics, with far-reaching consequences. Recent studies have indicated a rising incidence of this disease in children over the years. Additionally, the pharmacological treatment of thrombotic diseases in children faces numerous challenges. Due to significant physiological differences between children and adults, guidelines for the prevention and treatment of thrombotic diseases in adults cannot be directly applied to pediatric patients.PurposeA systematic review of the existing evidence-based medical literature should be conducted to propose pharmacological prevention and treatment recommendations for pediatric thrombotic diseases. Developing a comprehensive and practical pharmacotherapy guideline for the prevention and treatment of pediatric thrombotic diseases is essential to enhancing the rational use of medications in managing these conditions in children.MethodsThe guideline development followed the World Health Organization's (WHO) Handbook for Guideline Development. This involves systematically searching and extensively collecting data on common medication issues in the prevention and treatment of pediatric thrombosis nationwide. The Delphi method was used to survey experts and identify the clinical issues to be included. Subsequently, a systematic literature review was conducted to evaluate existing primary studies, systematic reviews, and guidelines or consensus statements from professional organizations. The quality of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. The Delphi method was employed again to reach a consensus on the recommendations and evidence levels. This process was culminated in the development of the Guideline for Pharmacological Management of Thrombotic Diseases in Children.ResultsDuring the guideline development process, a total of 29 clinical issues were collected and evaluated by 78 experts in clinical pharmacy and clinical medicine. Through two rounds of surveys, 13 clinical issues were selected. Under the supervision of two methodologists, 13 clinical pharmacotherapy recommendations were formulated.ConclusionBy conducting a comprehensive assessment of the feasibility and safety of clinical practices, the guideline provides specific anticoagulant medication recommendations for pediatric healthcare professionals. This will help enhance the prevention and treatment of pediatric thrombosis, promoting more standardized and effective medical practices.

How Should Clinicians Discuss Deprescribing with Caregivers of Older Adults Living with Dementia? A Qualitative Study.

Preventive medications are potential targets for deprescribing in older adults with dementia as goals of care change from preventive to palliative. Yet, prescribers lack communication guidance to address deprescribing. Using bisphosphonates as a case example, we sought to characterize and compare communication preferences of prescribers and family/informal caregivers regarding deprescribing. We conducted 23 semi-structured interviews with prescribers (12) and caregivers (11) of older adults with Alzheimer's disease or related dementias (ADRD). Prescribers and caregivers were asked to provide their impressions of seven conversation starters for discussing deprescribing, focusing on a case example using bisphosphonates. These phrases focused on topics including life expectancy, treatment burden, adverse effects, and costs. We used a qualitative framework analysis to identify relevant themes as prescribers and caregivers discussed their general perceptions of the potential benefits and harms of bisphosphonates and experiences with deprescribing. Among prescribers, there were ten physicians and two nurse practitioners; most (nine) female and white. Among caregivers, eight were female, seven were white, and five were Latino/a. For both prescribers and caregivers, preferred conversation starters initiated a risk versus benefit discussion, emphasizing medication adverse effects and patient-specific factors, such as functional status and indication for treatment. While prescribers emphasized discussing common medication adverse effects, caregivers noted the importance of knowing a medication's potential impact on ADRD. The least preferred conversation starter for deprescribing among both groups focused on the extra effort and cost of continuing bisphosphonates. Discordance between caregivers and prescribers were identified in several phrases; notably, caregivers disliked statements that introduced discussions of prognosis and life expectancy. Deprescribing conversations may be best perceived by caregivers when introduced with a discussion of a medication's adverse effects and potential impact on cognition. In addition, deprescribing conversations should be tailored to patient-specific factors, including functional status, goals of care, and the role of their caregiver in medical decision-making. Avoiding discussions of medication cost, pill burden, and life expectancy may help reassure the caregiver that deprescribing is a form of medication optimization and not a withdrawal of care.

Medications and cognitive decline in Alzheimer's disease: Cohort cluster analysis of 15,428 patients.

Medications for comorbid conditions may affect cognition in Alzheimer's disease (AD). To explore the association between common medications and cognition, measured with the Mini-Mental State Examination. Cohort study including persons with AD from the Swedish Registry for Cognitive/Dementia Disorders (SveDem). Medications were included if they were used by ≥5% of patients (26 individual drugs). Each follow-up was analyzed independently by performing 100 Monte-Carlo simulations of two steps each 1) k-means clustering of patients according to Mini-Mental State Examination at follow-up and its decline since previous measure, and 2) Identification of medications presenting statistically significant differences in the proportion of users in the different clusters. 15,428 patients (60.38% women) were studied. Four clusters were identified. Medications associated with the best cognition cluster (relative to the worse) were atorvastatin (point estimate 1.44 95% confidence interval [1.15-1.83] at first follow-up, simvastatin (1.41 [1.11-1.78] at second follow-up), warfarin (1.56 [1.22-2.01] first follow-up), zopiclone (1.35 [1.15-1.58], and metformin (2.08 [1.35-3.33] second follow-up. Oxazepam (0.60 [0.50-0.73] first follow-up), paracetamol (0.83 [0.73-0.95] first follow-up), cyanocobalamin, felodipine and furosemide were associated with the worst cluster. Cholinesterase inhibitors were associated with the best cognition clusters, whereas memantine appeared in the worse cognition clusters, consistent with its indication in moderate to severe dementia. We performed unsupervised clustering to classify patients based on their current cognition and cognitive decline from previous testing. Atorvastatin, simvastatin, warfarin, metformin, and zopiclone presented a positive and statistically significant associations with cognition, while oxazepam, cyanocobalamin, felodipine, furosemide and paracetamol, were associated with the worst cluster.

Childhood family income and medication use in youth

BackgroundLow family socioeconomic position is a well-established determinant of poor health in youth. Much less is known about the social patterning of youth medication use, and the current evidence is...

National assessment on the frequency of pain medication prescribed for intrauterine device insertion procedures within the Veterans Affairs Health Care System.

The intrauterine device (IUD) is a highly effective form of long-acting reversible contraception, widely recognized for its convenience and efficacy. Despite its benefits, many patients report moderate to severe pain during and after their IUD insertion procedure. Furthermore, reports suggest significant variability in pain control medications, including no adequate pain medication. The aim of this evaluation was to assess the pharmaceutical pain medication types, proportions, and trends related to IUD insertion procedures within the Veterans Health Administration (VHA). IUD insertion procedures documented in the VA electronic health record were assessed from 1/1/2018 to 10/13/2023. Descriptive statistics described patient and facility characteristics while annual trends were assessed using linear regression. Out of the 28,717 procedures captured, only 11.4% had any form of prescribed pain medication identified. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) were the most frequently prescribed pain medication category (8.3%), with ibuprofen being the most common pain medication overall (6.1%). Over the assessment period, there was an average annual increase of 0.52% (p = 0.038) of procedures with prescribed pain medication, increasing from 10.3% in 2018 to 13.3% in 2023. Although IUD insertion procedures have been seeing an increase in prescribed pain medication, the overall proportion remains disproportionality low relative to the pain experienced. Additionally, when pain interventions were initiated, they disproportionally utilized medication that have been shown to be ineffective. The intent of the work is that the information will help guide data driven pain medication strategies for patients undergoing IUD insertion procedures within the VHA.

Sex-related differences in heart failure patients: physiological mechanisms of cardiovascular ageing and evidence-based sex-specific medical therapies.

This review aims to describe the sex differences in heart failure (HF) patients, with a particular emphasis on the effect of cardiovascular ageing. Additionally, it takes into consideration the sex-related variation in cardiovascular health and physiology and the role ageing plays in HF and its implications in drug therapy. The pharmacokinetics and pharmacodynamics of the common HF medications, classified according to the established sub-types, are summarised with respect to sex-specific documented findings. Despite numerous studies confirming significant differences in HF outcomes according to sex, there are no current guidelines that consider patients' sex in medical therapy of HF. Moreover, females are significantly under-represented in research trials, as well as under-treated in clinical practice, which hinders our understanding of HF in this demographic. Most of the current knowledge on sex-specific HF therapies is driven by secondary analyses of studies not primarily undertaking sex-specific analyses. Therefore, we propose a multi-faceted approach, including increased awareness among healthcare providers and more inclusive research to create a personalised care plan accounting for sex differences in HF management. Given the highlighted knowledge gaps, it is paramount for new research efforts to account for the different sex phenotypes in HF.

Prevalence and management of hypertension in Turner syndrome: data from the International Turner Syndrome (I-TS) registry.

Cardiovascular disease is the most common cause of death in Turner syndrome (TS) for which arterial hypertension has a direct influence and is a key modifiable risk factor. To investigate the prevalence and patterns of hypertension diagnosis and management in adult patients with TS who are registered in a large international multicentre database (TS-HTN study). Retrospective multicentre observational study of patients aged ≥18 years included in the I-TS (International-TS) registry (2020-2022), using registry and participating centre-collected data. Twelve international centres participated, including 182 patients with a median age of 28 years (IQR 23-37.2). Arterial hypertension was recorded in 13.2% (n = 24). The median age at hypertension diagnosis was 27 years (range 10-56), with 92% aged less than 50 years at diagnosis. The majority (75%) were classified as primary hypertension (n = 18). In binomial regression analysis, higher body mass index was the only parameter significantly associated with the occurrence of hypertension (B = 1.487, P = 0.004). Among patients with aortic disease (n = 9), 50% had systolic BP ≥ 130 mmHg and 66.6% had diastolic BP ≥ 80 mmHg during the last clinic review. Angiotensin-converting enzyme inhibitors were the most common (n = 16) medication prescribed, followed by angiotensin receptor blockers (n = 6), beta-blockers (n = 6) and calcium channel blockers (n = 6). Arterial hypertension is common in TS and occurs at a young age. Overweight/obesity was a notable risk factor for hypertension. The frequency of suboptimal BP control among high-risk patients highlights the importance of increased awareness and TS-specific consensus guidance on management.

Unmasking the lipid landscape: carbamazepine induces alterations in Leydig cell lipidome.

Leydig cells rely on lipids and fatty acids (FA) for essential functions like maintaining structural integrity, energy metabolism, and steroid hormone synthesis, including testosterone production. Carbamazepine (CBZ), a common anticonvulsant medication, can influence lipid metabolism and profiles, potentially impacting Leydig cell function and testosterone levels. Understanding this interplay is crucial to optimize treatment strategies for individuals requiring CBZ therapy while mitigating any adverse effects on male reproductive health. This study focuses on evaluating the effects of selected CBZ concentrations on the lipid homeostasis of BLTK-1 murine Leydig cells. By employing liquid chromatography-mass spectrometry (LC-MS) and gas chromatography-mass spectrometry (GC-MS), we aimed to uncover the specific changes in lipid profiles induced by CBZ exposure (25 and 200 μM). FA analysis demonstrated a significant decrease in FA 22:6 n-3 with increasing CBZ concentration and an increase in the n-6/n-3 ratio. Furthermore, changes in the lipidome, particularly in lipid species belonging to phosphatidylethanolamine (PE), phosphatidylcholine (PC), phosphatidylglycerol (PG), and sphingomyelin (SM) classes were observed. PE and PC lipid species were significantly elevated in Leydig cells exposed to 200 μM CBZ, whereas PG and SM species were downregulated. CBZ treatment significantly altered the Leydig cell phospholipidome, suggesting specific phospholipids such as PG 40:4, PG 34:1, PC O-32:1, PC 32:2, and PE P-38:6, which exhibited the lowest p-values, as potential biomarkers for clinical assessment of CBZ's impact on Leydig cells. These findings underscore the intricate relationship between CBZ exposure and alterations in lipid profiles, offering potential insights for monitoring and mitigating the drug's effects on male reproductive health.

Role of Desmopressin in Bleeding Disorders: What Indian Physicians Need to Know?

Desmopressin (1-deamino-8-D-arginine vasopressin), formerly introduced for the treatment of diabetes insipidus, is a well-known analog of vasopressin, that is, antidiuretic hormone (ADH). Subsequently, after the late 1970s, it has emerged as the medication of choice for type 1 von Willebrand's disease (vWD) and minor hemophilia A. Prothrombotic factors FVIII and von Willebrand factor (vWF) are released from storage sites when vasopressin receptors are targeted by desmopressin. It also facilitates platelet-vessel wall adhesion, resulting in a substantial hemostatic effect. Research studies have shown that desmopressin administration can lead to up to a fourfold increase in vWF levels, highlighting its hemostatic actions. Desmopressin is commonly used in conditions like nocturnal polyuria leading to nocturia or nocturnal enuresis, diabetes insipidus, von Willebrand disease, uremic bleeding, and hemophilia A. Desmopressin is also used to avoid rapid sodium correction along with hypertonic saline, management of intracranial bleed due to the use of antiplatelet agents, and trauma resuscitation with active hemorrhage. It is also used in bleeding disorders, dental extractions, epistaxis, and menstrual bleeding. Hence, it is imperative that clinicians become acquainted with the use of desmopressin, which has become a common medication for many patients with congenital bleeding disorders. Desmopressin is included in the treatment guidelines for vWD.

Evaluation of Practice and Awareness of the Safety Profile of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) among Dental Practitioners: A Cross-Sectional Study

Non-steroidal anti-inflammatory drugs (NSAIDs) are the common medications used by dental practitioners to relieve dental pain and control post-operative signs of inflammation. NSAIDs, irrespective of their benefits, have a lot of hazards because of misuse and faulty prescriptions by dentists. The aim of this study is to evaluate the current use of NSAIDs during dental practice and to evaluate the association of the level of education and years of experience of dental practitioners with the awareness of the safety profile of NSAIDs. This observational cross-sectional study was conducted in Benghazi city between August and October 2024. The sample size is composed of 341 dentists. Participants were selected randomly from approximately every dental clinic in Benghazi. The questionnaire is composed of sections including assessment of drug use and drug-precautionary awareness. It is structured with checklist answers and was formulated in English. It is filled by the dentists during a visit to their dental clinics on the basis of an interview. The Statistics Package for Social Science Version 21 (SPSS) software was used for transferring and analysis of data. The results showed that the females accounted for the majority (60.7%). General practitioners represented 67.7% of the participants. About 61.0% of the dentists had clinical experience of less than 10 years. Ibuprofen and Ketoprofen were the most prescribed NSAIDs, 67.2% and 51.6, respectively. More than fifty percent (55.4%) of the participants used to prescribe NSAIDs for less than three days. Postoperative pain and dental pain were the most common clinical indications that NSAIDs were prescribed, 71.3% and 59.5%, respectively. Pregnancy was the most cited to be contraindicated (58.9%). Awareness of avoiding NSAIDs in the case of peptic ulcer patient was associated with years of experience of the dentists (P=0.030). Participants agreed that nausea was the most side effects (45.2%). Awareness of the interaction between NSAIDs and warfarin was associated with the level of education (P=0.006). The outcomes of the study have revealed less comprehension regarding scientific background knowledge of NSAIDs. There was little effect of level of education and years of experience on the awareness of the safety profile of NSAIDs during dental practice. Therefore, a lot of efforts should be focused on improving the knowledge for making proper therapeutic decisions and minimizing the risk of serious adverse effects on the patients who attend dental clinics.

Effect of hormonal contraceptive exposure on hormonal receptor and proliferative index expression in meningioma patients

Background and objectives. Hormonal contraceptives remain one of the most common birth control medications among females in the general population. The use of hormonal contraceptives is believed to be one of the risk factors for meningioma. Research on meningioma has provided substantial evidence regarding the existence of hormone receptors. Our study was designed to clarify whether the expression of hormonal receptors and proliferative index is influenced by the exposure to hormonal contraceptives. Materials and methods. This cross-sectional study was conducted at Mohammad Hoesin General Hospital, Palembang, Indonesia, from 2018 to 2023. The inclusion criteria encompassed meningioma patients with a history of exposure to hormonal contraceptives. Patient data collection was obtained from medical records and detailed interviews (reproductive status and history of hormonal contraceptive use). Data regarding patients’ characteristics, histology type, and WHO grade tumors were extracted from the patients’ clinical files. Immunohistochemistry studies were performed to evaluate the progesterone receptor expression, estrogen receptor expression, and Ki-67 index. Results. A total of 51 patients were reviewed in our study, with a mean age of 46.88 ± 9.62 years. According to the histopathological classification, 84.3% had WHO grade I, 13.7% had grade II, and 2% had grade III. Ninety-eight percent (98%) of subjects had PR positive with strong staining. Only 3.9% of patients had strong staining in ER expression. For the proliferative index, most patients were in the range of ≤4%. There was no significant difference among the type, duration, and status of hormonal contraceptive use with the expression of hormonal receptors and the Ki-67 index. Conclusions. Our findings suggest that exposure to hormonal contraceptives did not influence the expression of PR, ER, and Ki-67. However, we discovered a trend of higher PR expression in patients with a history of progesterone-only hormonal contraceptives.