Conventional Drugs Research Articles

Investigating the Influence of Patient Eligibility Characteristics on the Number of Deferrable Rheumatologist Visits: Planning for a Patient-Initiated Follow-Up Strategy.

Patient-initiated follow-up (PIFU) for rheumatoid arthritis (RA) is a model of care delivery wherein patients contact the clinic when needed instead of having regularly scheduled follow-up. Our objective was to investigate the influence of different patient eligibility characteristics on the number of potentially deferred visits to inform future implementation of a PIFU strategy. We conducted a retrospective chart review of 7 rheumatologists' practices at 2 university-based clinics between March 1, 2021, and February 28, 2022. Data extracted included the type and frequency of visits, disease management, comorbidities, and care complexities. Stable disease was defined as remission or low disease activity with no medication changes at all visits. The influence of patient characteristics on the number of deferrable visits in patients with stable disease was explored in 4 criteria sets that were based on early disease duration, medication prescribed, presence of care complexity elements, and comorbidity burden. Records from 770 visits were reviewed from 365 patients with RA (71.5% female, 70% seropositive). Among all criteria sets, the proportion of visits that could be redirected varied between 2.5% and 20.9%. The highest proportion of deferrable visits was achieved when eligibility criteria included only stable disease activity and patients with RA on conventional synthetic disease-modifying antirheumatic drugs or no medications (n = 161, 20.9%). PIFU may result in a more efficient use of specialist healthcare resources. However, the applicability of such models of care and the number of deferred visits is highly dependent on patient characteristics used to establish eligibility criteria for that model. These findings should be considered when planning implementation trials.

JAK-Inhibitors - A Story of Success and Adverse Events.

Rheumatoid arthritis (RA) is a systemic, chronic, immune-mediated inflammatory condition. Treatments options encompass conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), biologic disease-modifying antirheumatic drugs (bDMARDs) like tumor necrosis factor (TNF) inhibitors (TNFis) and targeted synthetic disease-modifying antirheumatic drugs (tsDMARDs) including Janus Kinase inhibitors (JAKinibs). Orally administered JAKinibs have demonstrated comparable or, in specific cases, superior efficacy compared to bDMARDs in inflammatory conditions. However, the escalating clinical utilization has been accompanied by the emergence of serious adverse effects, including major adverse cardiac events (MACE), malignancies and venous thrombotic episodes (VTE), leading to regulatory restrictions imposed by health authorities in both the US Food and Drug Administration (FDA) and the European Medicines Agency (EMA).

Tofacitinib citrate delivery through pharmaceutical formulations for divergent therapeutic treatments

The aim of article is to provide prompt and brief information on all available types of formulations of Tofacitinib citrate. Tofacitinib in the form of Tofacitinib citrate belongs to a new class of therapies called Janus kinase (JAK) inhibitors. Tofacitinib citrate is a medication used to treat rheumatoid arthritis, psoriatic arthritis and ulcerative colitis. Tofacitinib is available in the form of a tablet, an extended-release tablet and as an oral solution. Janus kinase inhibitors (JAKi) belong to a new class of oral targeted disease-modifying drugs which have recently revolutionized the therapeutic panorama of rheumatoid arthritis (RA) and other immune-mediated diseases, placing alongside or even replacing conventional and biological drugs. This article elaborates on the information related to patents of Tofacitinib citrate for its formulation. A survey data for the marketed formulations of Tofacitinib citrate is tabulated. Based on this it is estimated that very less type of formulations pertaining to conventional formulations as tablet or gel is only available in the market. Hence, there is an immediate demand for different type of tofacitinib formulations needed for treatment of extensive cases of arthritis or vitiligo. An extensive literature survey is done on pharmaceutical formulations of Tofacitinib citrate. Based on obtained data it was found these researched and developed formulations can be focused and further initiations can be done to make these formulations marketable. Wholesome, this article assists the reader to quickly grab information on marketed formulations and researched formulations of Tofacitinib citrate.

Increased risk of malignancy in HLA-B27-positive patients with ankylosing spondylitis requiring biologics for sustained inflammation: A long-term, single-center retrospective study.

To assess the link between the administration of biologic disease-modifying antirheumatic drugs (bDMARDs) and the risk of malignancy in human leukocyte antigen B27 (HLA-B27)-positive patients with ankylosing spondylitis (AS) experiencing sustained inflammation. Between 2006 and 2021, 1445 HLA-B27-positive patients with AS were retrospectively evaluated. Among them, 112 patients required bDMARD therapy. The study compared conventional therapy with bDMARDs and investigated the risk factors for developing malignancies. During 8253 patient-years of follow-up, 38 (2.6%) patients developed various malignancies, including lung, liver, breast, and colon cancer. The risk of malignancy was significantly higher in the bDMARD-treated group compared to PS-matched groups receiving conventional synthetic DMARDs (csDMARD) and non-steroidal anti-inflammatory drugs. The cumulative risk of malignancies increased significantly after 6 years of follow-up. All patients who developed malignancy after bDMARD therapy received tumor necrosis factor-α inhibitors. Requiring bDMARD therapy, requiring bDMARDs in combination with csDMARD therapy, and being diagnosed with AS after 30 years of age were independent risk factors for developing malignancy. HLA-B27-positive AS patients with sustained inflammation requiring biologic therapy, particularly if diagnosed after age 30, may have an increased risk of malignancy. Regular cancer screenings are advisable for these patients while undergoing biologic treatment.

Different medicinal herbs for madhumegam (diabetes mellitus) prescribed in selected classical siddha literature: A review

Siddha system of medicine, one of the ancient medical systems has the great potential of medicinal resources as repository since ages. Diabetes is a major lifestyle disorder, the prevalence of which is increasing globally. Diabetes mellitus is compared with Madhumegam in Siddha literature. Most of the contemporary drugs work on insulin metabolism and several metabolic pathways to reduce hyperglycaemic conditions. The conventional Siddha drugs works on the same platform through its basic principles. Siddha medicinal plants which are having hypoglycaemic activity by involving various metabolic pathways are taken in to account and considered for a review. This process will create some new ideas in the avenue of research.

Alternative approaches for treating canine otitis externa caused by Malassezia pachydermatis

Malassezia pachydermatis is a fungal pathogen that often leads to dog dermatitis and ear infections. The current treatment for otitis externa, which involves antifungal, antibiotic, and glucocorticoid drugs, faces challenges due to drug resistance and pet owners' compliance with prolonged treatment. This review delves into alternative treatment methods beyond conventional antifungal drugs and provides recommendations for their practical use. These methods include phytotherapies, chemical substances, drug repositioning, ear cleaners, alternative administration methods, and therapeutic diets. Further research, clinical trials, and comparative studies are needed to validate the efficacy of these alternative treatments and incorporate them into clinical practice. By implementing these methods, traditional treatment protocols can be optimized, drug resistance can be minimized, and the management of M. pachydermatis otitis externa in dogs can be improved, following the One Health approach that promotes prudent antimicrobial use.

Cell-Specific mRNA Therapeutics for Cardiovascular Diseases and Regeneration.

Cardiovascular diseases (CVDs) represent a significant global health burden, demanding innovative therapeutic approaches. In recent years, mRNA therapeutics have emerged as a promising strategy to combat CVDs effectively. Unlike conventional small-molecule drugs, mRNA therapeutics enable the direct modulation of cellular functions by delivering specific mRNA molecules to target cells. This approach offers unprecedented advantages, including the ability to harness endogenous cellular machinery for protein synthesis, thus allowing precise control over gene expression without insertion into the genome. This review summarizes the current status of the potential of cell-specific mRNA therapeutics in the context of cardiovascular diseases. First, it outlines the challenges associated with traditional CVD treatments and emphasizes the need for targeted therapies. Subsequently, it elucidates the underlying principles of mRNA therapeutics and the development of advanced delivery systems to ensure cell-specificity and enhanced efficacy. Notably, innovative delivery methods such as lipid nanoparticles and exosomes have shown promise in improving the targeted delivery of mRNA to cardiac cells, activated fibroblasts, and other relevant cell types. Furthermore, the review highlights the diverse applications of cell-specific mRNA therapeutics in addressing various aspects of cardiovascular diseases, including atherosclerosis, myocardial infarction, heart failure, and arrhythmias. By modulating key regulatory genes involved in cardiomyocyte proliferation, inflammation, angiogenesis, tissue repair, and cell survival, mRNA therapeutics hold the potential to intervene at multiple stages of CVD pathogenesis. Despite its immense potential, this abstract acknowledges the challenges in translating cell-specific mRNA therapeutics from preclinical studies to clinical applications like off-target effects and delivery. In conclusion, cell-specific mRNA therapeutics have emerged as a revolutionary gene therapy approach for CVD, offering targeted interventions with the potential to significantly improve patient outcomes.

Assessment of corneal parameters in patients with rheumatoid arthritis.

To assess the corneal parameters in rheumatoid arthritis (RA) patients. We enrolled 64 patients with RA (32 receiving biologic and 32 receiving conventional drugs) and 32 healthy subjects. Keratometric values (anterior flat [K1], steep [K2], and mean keratometry [Km]), corneal thickness from the pupil center (CCT), apex (ACT), and the thinnest point (TCT), and corneal volume (CV) were measured and compared between the groups. K1, K2, and Km values were significantly higher in the RA group (P = 0.013, P = 0.048, P = 0.027, respectively). The means of CCT, ACT, TCT, and CV were significantly lower in RA patients (P < 0.001, P < 0.001, P < 0.001, P = 0.011, respectively). When we divided RA patients into two groups according to the treatment and compared them to controls, the differences in K1, CCT, ACT, TCT and CV were significant (P = 0.030, P = 0.005, P = 0.001, P = 0.001, P = 0.034, respectively). K1 and CV values of RA-biologic group were similar to the control group (P = 0.205 and P = 0.127, respectively). Biologic agents contribute to the improvement of K1 and CV values in patients with RA.

P1140 Complementary and alterantive medicicne in patients with Inflammatory Bowel Disease in Poland

Abstract Background There is an increasing interest in complementary and alternative medicine (CAM) in patients with chronic diseases, including inflammatory bowel disease (IBD). We decided to investigate this problem because there is still not much data on this interesting and underestimated topic. Methods This single-center, cross-sectional study was conducted between October 2021 and June 2022 among patients of the Department of Gastroenterology of the National Institute of Medicine of the Ministry of Internal Affairs and Administration, both hospitalized and outpatients. Patients with IBD were asked to complete an anonymous survey that included questions about the use of CAM, their type and reason for use. The questionnaire also included data on the course of the disease, treatment and socio-demographic information. The results of qualitative variables were expressed as frequencies and percentages. We used the chi-square and Mann-Whitney U tests. Results 435 patients were included in the study: 203 women (46.9%) and 230 men (53.1%). In this group, there were 250 (58.5%) with Crohn's disease (CD) and 177 (41.5%) with ulcerative colitis (UC). The average duration of the disease is 10.9 years. A little more than a half of patients received immunosuppressive and biological treatment. Among respondents, 66.9% (291) had ever used CAM. CAM was statistically more frequently used by people treated with immunosuppressive 60.26% (p=0.002) and biological drugs 72.51% (p=0.004), as well as people with higher education 71.75% (p=0.006) and secondary education 58.97 % (p=0.009), living in large cities 73.63% (p=0.006) and earning the highest income 85.51% (p&amp;lt;0.001). Age, gender, disease duration, use of other drugs (5-ASA, steroids) and disease diagnosis (UC vs. CD) did not influence the use of CAM. As many as 74.1% of CAM users use various types of dietary supplements. 61.5% of respondents follow special diets, 56.9% take probiotics, and 53.4% take herbs. Patients most often gain knowledge about CAM from other patients, family members (76.3%) and from the Internet (76.3%). The treatment is carried out independently, without medical supervision, and only 62.1% of patients inform the gastroenterologist about the use of CAM. Conclusion Our research shows that CAM is very often used by IBD patients in Poland, especially among patients with severe disease treated with immunosuppressive and biological therapy. This is particularly important for patient safety, taking into account the possible risk of interactions with conventional drugs and the usually lack of medical supervision.

Molecular docking, molecular dynamics, MM/PBSA approaches and bioactivity studies of nepetanudoside B isolated from endemic Nepeta aristata

Nepetanudoside B (NNB) was isolated from aerial parts of endemic Nepeta aristata crude extract (CH3OH-CHCl3) using silica gel (n-hexane, methanol, ethyl acetate, and dichlorometane, respectively) and sephadex LH-20 (65% Methanol-35% Chloroform) column chromatographies. Preparative-HPLC was used to purify NNB after activity-guided isolation of methanol sub-fractions with enzyme inhibitory and DNA protective properties. The NNB was determined using 1H,13C, COSY, HSQC, HMBC, and LC-MS/MS. The study compared the effects of NNB with conventional drugs in terms of its ability to inhibit enzymes such as urease, α-amylase, carbonic anhydrase (CA), lipase, α-glucosidase, and tyrosinase, as well as its ability to protect DNA. Enzyme kinetic and molecular docking were also used to evaluate this. NNB exhibited the best inhibitory activity on urease (1.28 ± 0.00 µg/mL), lipase (5.83 ± 0.10 µg/mL), BChE (3.73 ± 0.46 µg/mL), tyrosinase (7.39 ± 0.00 µg/mL), α-glucosidase (10.95 ± 0.00 µg/mL), α-amylase (22.11 ± 1.03 µg/mL) and AChE (25.68 ± 3.32 µg/mL), respectively. NNB has higher MolDock scores with binding energy in α-glucosidase (-233) and BChE (-8.90 kcal/mol). In enzyme kinetics studies, it was determined that urease, AChE, α-glucosidase, lipase, and CA were non-competitive , while BChE and tyrosinase were competitive inhibition mechanisms. Their Ki values were calculated as 0.09, 0.24, 0.09, 0.10, 0.08, 0.05, and 0.07 mM, respectively. Molecular dynamics simulation studies were performed for the interactions of NNB-BChE with MM/PBSA binding free energey RMSD, RMSF, Rg, SASA, and also the number of hydrogen bonds was calculated. The suitability and effectiveness of NNB have been proven in the food and pharmaceutical industries. The NNB molecule may lead to development studies as a BChE inhibitor. Communicated by Ramaswamy H. Sarma

Evaluation of antibacterial and antifungal activities of Pistacia atlantica and Pistacia khinjuk

Medicinal plants are renowned for their various therapeutic properties, including antibacterial and antifungal activities. This study aimed to investigate the antibacterial and antifungal activities of P. atlantica and P. khinjuk. Hydroalcoholic extracts of P. atlantica and P. khinjuk were prepared to assess their antibacterial and antifungal activities. Standard strains of Bacillus cereus, Pseudomonas aeruginosa, Escherichia coli, Staphylococcus aureus, Klebsiella pneumonia, Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, and Aspergillus flavus were utilized for the evaluation of antibacterial and antifungal activities. The inhibitory effects of the extracts on the growth of bacterial and fungal strains were evaluated using minimum inhibitory concentration (MIC) and minimal bactericidal concentration (MBC) through a 96-well microplate analysis following CLSI guidelines. Our findings revealed that the MICs and MBCs of P. atlantica and P. khinjuk for bacterial strains ranged from 0 to 64 mg/mL. Additionally, the MIC and MFC values for fungal strains ranged from 16 to 64 mg/mL. The results indicated that Pseudomonas aeruginosa and Klebsiella pneumonia were the most sensitive bacterial strains to P. atlantica. Furthermore, Aspergillus flavus was identified as the most sensitive fungal strain to P. atlantica. In conclusion, these findings suggest that P. atlantica and P. khinjuk possess antibacterial and antifungal effects. The paper argues that these plant extracts could be used as a supplementary treatment alongside conventional antibacterial and antifungal drugs.

Association of serum IL12 with clinical and biochemical parameters in a cohort of diagnosed rheumatoid arthritis patients on oral conventional synthetic disease modifying anti-rheumatic drugs.

To determine the association of serum interleukin-12 levels with disease progression in active rheumatoid arthritis patients on oral conventional synthetic disease-modifying anti-rheumatic drugs. The case-control study was conducted at the Army Medical College, Rawalpindi, in collaboration with the Pak Emirates Military Hospital, Rawalpindi, Pakistan, from January to December 2022, and comprised rheumatoid arthritis patients or either gender aged 18-75 years who were placed in group I, while group II comprised healthy controls. Demographic and clinical data was noted, and 2ml blood samples were drawn from each subject. The serum was separated and analysed using sandwich enzyme-linked immunosorbent assay to quantify serum interleukin-12 levels. Data was analysed using SPSS 22. Of the 150 subjects, 75(50%) were in group I; 27(36%) males and 48(64%) females with overall mean age 45.70±11.70 years. There were 75(50%) subjects in group II; 37(49.3%) males and 38(50.7%) females with overall mean age 31.70±7.70 years. Serum interleukin-12, erythrocyte sedimentation rate and C-reactive proteinquantitative levels were significantly higher in group I compared to group II (p<0.05). Smoking, positive family history of rheumatoid arthritis in a first-degree relative and history of consanguinity were identified as risk factors though they were not statistically significant (p>0.05). In group I (n=75), out of total study subjects, only 55(73.3%) cases belonged to the predominant castes, namely Awan, Rajput, Pathan, Araeen, Bhatti, Malik, Mughal, Sudhan, Chaudary, and Jutt. These individuals showed significantly higher mean serum interleukin-12 levels compared to patients of other castes in the same group. Mean serum interleukin-12 levels were higher in rheumatoid arthritis patients despite being on oral conventional synthetic disease-modifying anti-rheumatic drugs.

Molecular subtypes of disulfidptosis-regulated genes and prognosis models for predicting prognosis, tumor microenvironment infiltration, and therapeutic response in hepatocellular carcinoma

Disulfidptosis, a recently identified mode of cellular demise marked by excess SLC7A11-reliant cystine, has been proved to affect the development and resilience of tumor cells through the production of glutathione from cystine. Glutathione synthesis plays a crucial role in chemotherapy resistance and the survival of liver cancer cells. Thus, understanding the relationship between disulfidptosis and hepatocellular carcinoma (HCC) is imperative. A molecular typing approach was employed to classify patients with HCC into two distinct subtypes, namely disulfidptosis and disulfide-homeostasis, based on the expression of genes associated with disulfidptosis. Patients with disulfidptosis exhibited a longer survival time, improved immune status, and heightened sensitivity to conventional chemotherapeutic drugs and immunotherapy. Patients with disulfide-homeostasis demonstrated an immunosuppressive microenvironment, drug resistance, and unfavorable prognosis. A prognostic model was constructed utilizing the significant prognostic variables of the disulfidptosis-regulated genes. A real-world cohort was subjected to multiplex immunofluorescence to validate the clinical outcomes and immune context. Ultimately, our study delved into the prognostic relevance of disulfidptosis in HCC and provides insights into potential avenues for future research.

Efficacy and safety of Lianhua Qingwen as an adjuvant treatment for influenza in Chinese patients: A meta-analysis.

Lianhua Qingwen (LHQW) is a proprietary traditional Chinese medicine for the treatment of influenza (FLu). It is composed of 2 prescriptions, Maxing Shigan and Yinqiao, which has antiviral, antibacterial, and immunomodulatory effects. However its clinical suitability has not yet been investigated. This study aimed to evaluate the efficacy and safety of LHQW in the treatment of FLu. We searched several databases, including PubMed and China Biomedical Database for literature research, from inception to July 1, 2023. This meta-analysis included RCTs that compared the safety and efficacy of the combination of LHQW and conventional drugs (CD) with CD alone for IFU. The extracted data were analyzed using Revman5.4 software with risk ratio (RR), 95% confidence intervals (CI), and standardized mean difference. Our meta-analysis included 32 articles with 3592 patients. The results showed that the effects of LHQW adjuvant therapy were superior to those of CD (clinical effective rate: RR = 1.22, 95% CI: 1.18-1.26, P < .00001; cure rate: RR = 1.54, 95% CI: 1.35-1.75, P < .00001), and adverse reactions after treatment were significantly lower than those before treatment (RR = 0.70, 95% CI: 0.50-0.98, P = .04). This meta-analysis indicates that LHQW combined with CD may be more effective than CD alone for the treatment of FLu.

Therapeutic Delivery Potential of Covalent Organic Framework (COF): Intuition from Theoretical Calculations

AbstractRegardless of the benefits, pharmaceutical companies are reticent to engage further in covalent organic framework‐based drug development and drug delivery systems, preferring rather to explore preexisting chemical compound libraries for drug delivery. As such, this study aims to account for the efficacy of covalent organic frameworks (COFs) in the delivery of seven conventional drugs: Acetaminophen, Clodronic Acid, Hydroxyurea, Mercaptoporine, Thiotepa, Tioguanine, and Arsenic trioxide. Herein, Gaussian 16 software package is employed for the purpose of optimizing the systems at the DFT/ωB97XD/def2svp level of theory. Substantially, the nature of the inter‐ and intra‐ molecular interactions between the COF and each of the drugs utilized resulted in the re‐adjustment of the molecular orbitals and yielded a distinct set of results for the most reactive and least stable and vice versa as deducible from the magnitudes of the highest occupied molecular orbital and lowest unoccupied molecular orbital (HOMO‐LUMO) gaps. Furthermore, the natural bond orbital (NBO) study indicates that the interacting molecules exhibit similar stability and reactivity, as evidenced by the proximity of their mean stabilization energies. Additionally, the topological analysis revealed that the most positive interaction occurred in Acetaminophen_COF, Clodronic acid_COF, Hydroxyurea_COF, and Tioguanine_COF. Also, the adsorption studies demonstrate that the above‐mentioned drugs have weak interaction kinetics when they interact with the investigated COF. Strong adsorbing contacts were detected in the interactions of Arsenic trioxide, Hydroxyurea, and Tioguanine with the COF in the order Arsenic trioxide_COF &lt; Hydroxyurea_COF &lt; Tiog_COF, with corresponding values of −9.413 kcal/mol, −12.550 kcal/mol, and −17.570 kcal/mol, respectively. Overall, the study hypothesizes that when delivering the various drugs studied through the COF to biological systems, Acetaminophen, Hydroxyurea, Tioguanine, and Mercaptopurine have high reactivity with the COF and would be better adsorbed on it, as well as a longer recovery time of desorption due to their high adsorption on the COF surface.

Multicenter evaluation of tofacitinib retention and safety in rheumatoid arthritis - why cardiovascular risk factors do not equate to overt risk.

This multicenter, real-world, retrospective cohort study aimed to assess the effectiveness and safety of tofacitinib (TOFA) in rheumatoid arthritis (RA). Two hundred nine patients with active RA treated with TOFA, unresponsive to at least 2 conventional synthetic disease-modifying drugs, were recruited. Clinical characteristics were extracted from an electronic registry and supplemented with manual chart review and data linkage with ambulatory care. Drug retention and reasons for discontinuation were evaluated. Median (interquartile range) follow-up in the whole sample was 16.9 (5.93-31.7) months. Mean (standard deviation) age was 51.44 (±11.84) years, with female predominance (n = 168, 80.4%). Only 30 patients (14.4%) had no pre-existing traditional cardiovascular (CV) risk factor at TOFA initiation. Tofacitinib retention rates were high, with median survival estimated at 89.3% at 6 months, 82.4% at 12 months, and 60.4% at 24 months. Ineffectiveness was the primary cause of discontinuation (n = 50). The rate of adverse events (AEs) was relatively low, with lipid abnormalities, blood count alterations, and infectious events among the most common. No major adverse CV event was reported. The incidence rate of AEs necessitating treatment switch was 60.34 (95% CI: 37-92) per 1,000 person-years of follow-up. Presence of multiple (> 3) CV risk factors was associated with lower odds of TOFA retention and treatment effectiveness. Tofacitinib demonstrated high retention rates and a favorable safety profile in RA patients, including those with traditional CV risk factors. Tofacitinib may be a valuable treatment option for RA patients when combined with individualized CV risk management. Further studies are warranted to explore the long-term effects of TOFA and its CV impact in larger populations.

Antiviral properties of Essential Oils: What do we know?

This narrative review delves into the antiviral properties of essential oils and aromatherapy, a field gaining prominence recently. Essential oils are noted for their pharmacological effects, particularly their antiviral capabilities. The review pays special attention to essential oils' effectiveness against influenza and coronaviruses. A comprehensive review in this context underscores the diverse chemical compounds in essential oils that offer broad-spectrum antiviral mechanisms. This is crucial given the growing resistance to conventional antiviral drugs, positioning plant-derived essential oils as potential novel antiviral agents. The hypothesis posited in this review is that essential oils could be effective natural antiviral agents, potentially useful as complementary or alternative therapies in viral infections. The review underscores the significance of essential oils' antiviral properties in enhancing human health, advocating for more focused research in this area.

Using Electronic Health Records and Linked Claims Data to Assess New Medication Use and Primary Nonadherence in Rheumatology Patients.

The objective of this study was to determine the proportion of new medication prescriptions observed in electronic health records (EHR) that represent true incident medication use, accounting for undocumented previous prescriptions (prevalent medication use) and failure to initiate treatment (primary nonadherence) with linked administrative claims data as the reference standard. Using single-specialty rheumatology EHR data from more than 700 community practices in the United States linked to administrative claims data, we identified first (index) EHR prescriptions and assessed the positive predictive value (PPV) of different EHR-derived new user definitions to identify true incident use (no prior claims). We then assessed how often index EHR prescriptions that met a definition of new use resulted in primary nonadherence (no subsequent claims). Overall, 12,405 index EHR prescriptions were identified with PPVs of 0.59 to 0.67 for true incident use. PPVs increased to 0.76 to 0.85 by excluding medications listed during the EHR medication reconciliation process and further increased to 0.87 to 0.93 by requiring ≥12 elapsed months since the first rheumatology office visit. Primary nonadherence at three months was observed in 33% to 38% overall and varied substantially by medication class, ranging from 15% to 23% for conventional synthetic disease-modifying antirheumatic drugs (DMARDs) to 54% to 64% for targeted synthetic DMARDs. New DMARD use was accurately distinguished from prevalent use with EHR prescriptions and simple new user definitions that include current medications collected during medication reconciliation. Primary nonadherence was frequent and varied by DMARD class. This has important implications for epidemiologic studies using EHR data and for optimal delivery of clinical care.

Resistance profile of pathogenic strains isolated from community acquired infection at the Protestant Hospital of Ngaoundere (Cameroon)

Worldwide data show that there is increasing resistance among infection bacteria to conventional drugs. The present study aimed at determining data on susceptibility of bacteria isolated from patient for community acquired infection in Protestant Hospital of Ngaoundere against prescribed antibiotics in case of infections by these bacteria. Bacteriological profile of collected samples (stool, urine, cervico-vaginal and urethral secretion, blood) was carry out by standard method. Antibiotic susceptibility was done by the agar disk diffusion method. A total of 120 samples were collected. Among 46 samples was positive for bacterial infections germs (38% of prevalence). Stomach pain represents the most frequent complaint of patients (33.1%). Enterobacteriaceae were the most isolated (70%) followed by Neisseria gonorrhoeae (15%). About 73.0% of Enterobacteriaceae identified were resistant to ticarcillin while 80% of N. gonorrhoeae to ampicillin. Some of the isolates were resistant to ticarpen (73%), oxacillin (71%) and tobramycin (57%) which are more frequently prescribed and indicates that increased consumption of a particular antibiotic leads to acquisition of resistance. Enterobacteriaceae were predominant bacterial isolated and it is necessary to continue monitoring the consumption of antibiotics to ensure good management of infections.

Pragmatic targets for moderate/severe SLE and their implications for clinical care and trial design: sustained DORIS or LLDAS for at least 6 months is sufficient while their attainment for at least 24 months ensures high specificity for damage-free progression

ObjectivesTreatment targets in systemic lupus erythematosus (SLE) have been validated in unselected—in terms of severity—cohorts, which limits their generalisability. We assessed remission (Definition of Remission in SLE (DORIS)) and Lupus...