Correct Dose Research Articles

Study on Drug Usage, Storage and Wastage among Households in Chengalpattu, Tamil Nadu, India - A Cross-Sectional Study

Background: Improper drug storage is immensely prevalent in households. A significant number of families do not follow prescribed practices for maintaining the safety and efficacy of medications. Increased rates of unintentional poisoning, decreased drug efficacy, and the emergence of antibiotic resistance are just a few adverse consequences that might result from such negligence. Methodology: A total of 213 households were selected using multi-stage random sampling techniques. A pretested structured questionnaire on drug storage, usage, wastage in the households was used and detailed interview was conducted with the participants. Results: Majority of the participants 56.3% (120) belonged to the age group of 30- 40 years, most of the participants are graduates 39.4% (83). The prevalence of self-medication was 30.5%. Safe storage conditions with appropriate packing were used by 81.5% (167) of people. About 69.9% (149) has good knowledge on correct dosage of medications.91.2% (187) of households discard unused medications in the garbage. Commonly stored medicine was analgesics and antipyretics 21.6% (86). In this study Increasing age, Education and Family with senior citizens above 60 years have a strong association with storage condition of medicines at home. Conclusions: This study shows 96.3% prevalence of in-home storage medication practices. Ensuring the efficacy, safety, and cost-effectiveness of medications requires proper management from storage to use and waste prevention.

Clinical impact of inappropriate DOAC dosing in atrial fibrillation: Insights from a real-world registry.

A significant number of patients with atrial fibrillation (AF) on direct oral anticoagulants (DOACs) receives off-label or inappropriate doses. This study examines the prevalence, dosages, and clinical outcomes in AF-patients on DOAC therapy admitted to an emergency department (ED). This retrospective single-center observational study utilized data from the Heidelberg Registry of Atrial Fibrillation (HERA-FIB), consecutively including patients with AF presenting to the ED of the University Hospital of Heidelberg from June 2009 to March 2020. Rates of DOAC dosages at discharge from the ED were correlated with outcomes, focusing on a composite endpoint that included all-cause mortality, stroke, major bleeding, and myocardial infarction (MI). Among 10,222 patients included in the HERA-FIB registry, 4,239 (41.5%) were prescribed DOACs, and 3,031were eligible for the analysis. Of these, 2,199 (72.6%) received appropriate dosages, 627 (20.7%) were under-dosed, and 205 (6.8%) were over-dosed. Under-dosed AF-patients demonstrated a significantly increased risk of the composite endpoint compared to those receiving appropriate dosages (HR 1.84, 95%CI:1.55-2.18, p<0.0001). Over-dosage had no significant effect on the HR for the composite endpoint, all-cause mortality, stroke, MI, or major bleeding compared to correct dosing but was associated with higher risks of the composite endpoint (HR 1.43, 95%CI:1.04-1.96, p=0.029) relative to under-dosage. This study underscores the critical importance of accurate DOAC dosing in patients with AF presenting to an ED. Both under-dosing and over-dosing are linked to significant clinical risks, highlighting the urgent need for improved dosing protocols and careful monitoring to enhance patient outcomes.

P-1634. Prescribing Patterns of Antibiotics in an Academic Medical Center Internal Medicine Clinic

Abstract Background Antimicrobial stewardship is critical in the prevention of antibiotic resistance. The CDC estimates nearly 90% of antibiotic use occurs in outpatient settings, with up to half of the prescriptions not carrying appropriate indications. Public health efforts like the National Action Plan for Combating Antibiotic Resistant Bacteria aim to reduce/improve outpatient antibiotic use following the Department of Health and Human Services guidance. Inclusion/Exclusion 350 prescriptions were assessed for inclusion within the study. Prescriptions were excluded if antibiotics were prescribed for prophylaxis, indications outside of preferred list (notably: COPD Exacerbations, prostatitis, pyelonephritis, clearly documented “asymptomatic bacteriuria”), prescriptions continued from inpatient admission, pregnancy, under the age of 18, and infectious disease consults Methods A retrospective descriptive assessment of antimicrobial prescribing practice within one internal medicine clinic was conducted through chart review. Outpatient antibiotic prescriptions from a prespecified list of agents written between March to June of 2023 for cystitis, community-acquired pneumonia, and acute sinusitis were compared to current Infectious Disease Society of America recommendations for treatment. The primary outcome was appropriateness based on indication, drug choice, dose, and duration of therapy. A key secondary outcome assessed was ED or clinic return visits for the same primary problem within 30 days. Prescription Appropriateness Each prescription was assessed for correct indication, drug, dose, and duration based on current IDSA guidelines. Results This study included 166 antibiotic prescriptions written for 147 patients. Of these prescriptions, 67% were inappropriately prescribed. Duration and indication were inappropriate most frequently on prescriptions while drug and dose were appropriately selected by providers. Of the patients with prescription errors, 23.1% (25/108) led to a return visit versus 17.2% (10/58) for patients with antibiotics prescribed correctly (p =0.429). Prescription Inappropriateness by Type of Error This study included 166 antibiotic prescriptions written for 147 patients. Of these prescriptions, 67% were inappropriately prescribed. Duration (33%) and indication (34%) were inappropriate most frequently on prescriptions while drug (16%) and dose (7%) were appropriately selected by providers. Conclusion In conclusion, antibiotics are inappropriately prescribed in the outpatient setting which necessitates the need for increased stewardship efforts. A trend towards increased return visits was observed for patients who received an inappropriate antibiotic prescription. As a secondary outcome, this study was unable to meet statistical significance, but further evaluation should be done to explore this trend. Implementation of institutional prescribing guidelines for common infections such as acute sinusitis or cystitis paired with targeted education for outpatient clinics could help improve antimicrobial prescribing habits. Antibiotic Prescription by Appropriateness The most common antibiotics prescribed included amoxicillin-clavulanate, cephalexin, and nitrofurantoin accounting for 70% of the prescriptions reviewed. Fluroquinolones when prescribed were inappropriate in this study based on indication, dose, duration, or drug. Amoxicillin-clavulanate when prescribed was correct in all four categories for only 50% of prescriptions while nitrofurantoin was appropriate only 29% of the time. Disclosures All Authors: No reported disclosures

P-30 ROLE OF PLASMAPHERESIS IN TREATING A RARE CASE OF EXOGENOUS INSULIN ANTIBODY SYNDROME (EIAS) IN A YOUNG PATIENT WITH TYPE 1 DIABETES MELLITUS IN BABYLON GOVERNORATE: A CASE REPORT

Abstract Clinical Case A 17-year old female patient who was diagnosed with type 1 diabetes mellitus (DM) seven years ago, and she had continuously very high blood glucose readings with recurrent admissions to the emergency unit due to attacks of DKA. In addition to a planned diet, she was on more than 250 units of insulin per day (while her weight was 75 kilograms). She was initially on human insulin in the form of twice NPH insulin injections, and pre-meal regular insulin injections, in addition to repeated regular insulin correction doses without any reduction of her blood glucose. Then she was shifted to insulin analogues (to eliminate the possibility of insulin immunogenicity which have been encountered with the use of human insulin), in form of basal insulin Glargine OD, plus pre-meal rapid acting insulin Glulisine without any noticeable response. Continuous switching of her injection sites, with an in-hospital observed insulin injections (to avoid noncompliance), even the use of intravenous route did not help to achieve a glycemic control. Later on, metformin 1000 mg XR BID was added to her daily treatment without any benefit. A screen of anti-insulin antibodies was done and found to be elevated (which should be negative after all these years after her initial diabetes diagnosis). A presumptive diagnosis of EIAS (Exogenous Insulin Antibody Syndrome) was put. A small dose of steroids was administered with close observation (to avoid exacerbation ketosis) without any improvement. Then Cellcept (Mycophenolate mofetil), an immune modulator was added at a dose of 500 mg BID and increased 48 hrs. later to 1000 mg BID and resulted in a minimal reduction of her blood glucose levels. Finally the decision of plasmapheresis was made and an informed consent was obtained from the family after explaining the condition. A good response was recorded after the 1st session, with a minimal decrease of her total daily insulin doses. Later on, an additional excellent response was received during the next 2 sessions with a rapid decline of her glucose readings and her total daily insulin doses. She had recurrent attacks of hypoglycemia during her third and last plasmapheresis session. Her total daily dose of insulin was successfully reduced by more than 50%, and her general condition was improved noticeably without any recorded adverse reactions, as shown in the blood glucose logbook photos attached below.Figure 1:Glucose logbook after the 3rd and last session of Plasmapheresis Table 1:Response parameters to three sessions plasampheresis therapy

Analysis of "Dose Accuracy and Reliability of a Connected Insulin Pen System".

In an article in the Journal of Diabetes Science and Technology, Backfish and coauthors examined the dose accuracy and reliability of the Tempo Pen and Tempo Smart Button connected insulin pen system. This study sponsored by Eli Lilly and Company found that this system met the International Organization for Standardization 11608-1:2014 requirements for dose accuracy at a range of doses, as well as the data transfer requirements after all injections. While these results are very encouraging, they were based on simulated human factors data while data from a human factors validation study where individuals successfully dialed and administered correct doses was not reported. There is a need for further studies in a variety of populations that would greatly benefit from this enhanced insulin pen technology to facilitate optimization of dose adjustments based on accurate and reliable insulin dosing data.

Metal Oxide Nanocatalysts for the Electrochemical Detection of Propofol

Propofol is one of the most widely used intravenous drugs for anaesthesia and sedation and is one of the most commonly used drugs in intensive care units for the sedation of mechanically ventilated patients. The correct dosage of propofol is of high importance, but there is currently a lack of suitable point-of-care techniques for determining blood propofol concentrations. Here, we present a cytochrome P450 2B6/carbon nanotube/graphene oxide/metal oxide nanocomposite sensor for discrete measurement of propofol concentration. Propofol is converted into a quinol/quinone redox couple by the enzyme and the nanocomposite enables sensitive and rapid detection. The metal oxide nanoparticles are synthesised via green synthesis and a variety of metal oxides and mixed metal oxides are investigated to determine the optimal nanocatalyst. Converting propofol into the redox couple allows for the measurement to take place over different potential ranges, enabling interference from common sources such as paracetamol and uric acid to be avoided. It was found that nanocomposites containing copper titanium oxide nanoparticles offered the best overall performance and electrodes functionalised with such nanocomposites demonstrated a limit of detection in bovine serum of 0.5 µg/mL and demonstrated a linear response over the therapeutic range of propofol with a sensitivity of 4.58 nA/μg/mL/mm2.

P0775 The IBD Specialist Pharmacist actively contributes to the IBD clinical team, providing significant benefits and enhancements to patient care

Abstract Background The prevalence of IBD is rising globally, and in the UK has risen from 328/100,000 in the 90s to 970/100,000 in 2017 [1]. This, together with a rapidly expanding and more complicated range of therapeutic options has necessitated the need for proactive management, intervention and monitoring of patients. Through a combination of Physician, Nurse and Pharmacist clinics, we provide a comprehensive IBD outpatient service to meet these requirements in line with UK IBD standards [2]. Our pharmacist-led clinic prescribes initial treatments (JAK inhibitors, immunomodulators and ongoing prescribing of biologic therapy infliximab and vedolizumab) to ensure effective close monitoring, correct dose adjustments, therapeutic drug monitoring and early identification of possible side effects to the new treatments. Methods The study aims to identify all referrals and clinical outcomes to the pharmacist clinic during the period between January to August 2024. All patients are appointed from our weekly IBD Multidisciplinary team (MDT) meeting. The data is obtained from the IBD MDT log. Results During the period analysed of the pharmacist clinic activity, the drug distribution was as follows: JAK inhibitor 35.9% (14 patients), thiopurines monotherapy 25.6% (10 patients) and combination therapy anti-TNF + immunomodulators and allopurinol if shunting 38.5% (15 patients). The total number of patients reviewed during this period was 39, accumulating a total of 289 appointments which equates to an average 7.4 appointments per patient over this period. During the analysed period 234 cases were discussed at IBD MDT. 39 cases (16.7%) were referred to the pharmacist to conduct treatment initiation and drug monitoring. The pharmacist referred 21 cases (7.27%) to IBD MDT for new discussion resulting in 26 agreed-upon outcomes by the IBD team as detailed below. Some patient reviewed had more than one outcome. Conclusion Two specialist IBD pharmacists (Whole Time Equivalent (WTE) 0.6) are the essential part of the IBD multidisciplinary team, providing early identification of treatment failure or serious adverse effects, and closer monitoring of patients with monthly appointment on average. The 26 clinical outcomes demonstrated an effective model for more personalised medicine. Therefore, it integrates an additional pathway for patients' management. The model of care aligns with UK national recommendations and showcases the positive impact that specialist pharmacists as non-medical prescribers can assist in over-stretched conventional IBD services.

Interpreting IGF-1 in children treated with recombinant growth hormone: challenges during early puberty.

It can be challenging to determine the correct dosage of recombinant growth hormone (GH) in children with GH deficiency, leading to highly variable treatment responses. Insulin-like growth factor-1 (IGF-1) is a tool for monitoring GH treatment and dosing. However, IGF-1 levels depend on sex, age, and pubertal stage, amongst other factors, making its interpretation somewhat difficult. This study aimed to evaluate descriptively a group of 93 children treated per protocol with GH to assess the influence of pubertal signs and sex steroid levels on the interpretation of IGF-1. 93 (67 boys and 26 girls) prepubertal children who participated in a previous GH treatment trial were included. Age, pubertal stage, weight, height, GH dose, and IGF-1 plasma concentrations were collected at least yearly from 2 years before pubertal start and 3 years after pubertal start. Levels of estradiol in girls and testosterone in boys were analyzed from previously collected frozen samples. Nine of 58 (15.5%) estradiol samples in girls with Tanner breast stage 1 had pubertal levels of estradiol ≥25 pmol/L. For boys with testes size <4 mL, 24 out of the 153 (15.7%) testosterone samples were above the pubertal cut-off, ≥0.47 nmol/L. All the IGF-1 samples were divided into two groups based on an IGF-1 standard deviation score (SDS) of ≥2 or <2 SDS. The IGF-1 ≥2 SDS samples had a higher median (range) GH dose, 0.042 (0.02-0.10) mg/kg/day, compared with the IGF-1 <2 SDS samples, 0.038 (0.01-0.10) mg/kg/day, p<0.001. In the IGF-1 ≥2 SDS samples vs the IGF <2 SDS samples, estradiol levels were lower among girls, 13 (3-214) vs 102 (1-1070) pmol/L p<0.001, and testosterone levels were lower among boys, 0.35 (0.11-27.2) vs 6.9 (0.04-31.2) nmol/L p<0.001. Interpretation of IGF-1 near puberty is challenging due to the influence of sex steroids. Variations in sex steroid levels and pubertal status can lead to misleading interpretations and an overestimation of IGF-1 SDS. Establishing an IGF-1 reference range that includes sex steroid levels can improve its clinical use to monitor GH treatment.

The Use of PediSTAT Application by Paramedics Working in Saudi Arabia to Reduce the Risk of Medication Error for Pediatric Patients.

This study aimed to assess and compare the rates of medication error (ME) using the PediSTAT application compared to the conventional method of calculating the correct dose and determining the appropriate route of medication administration for common pediatric emergencies. A prospective cross-sectional study design was used for the study. Data were collected using a questionnaire that was distributed to certified paramedics holding a bachelor's degrees or higher and working in Riyadh City, Saudi Arabia. Alternate simple random sampling was used to recruit the participants into two groups using the same questionnaire: the PediSTAT group and the conventional method group. The questionnaire contained four pediatric emergency vignettes: cardiac arrest, asthma exacerbation, seizures, and hypoglycemia. A total of 63 participants agreed to the study. Almost 80% of them were males, 81% held bachelor's degrees, and 87% were certified in pediatric resuscitation courses. The findings of the study showed that the use of the PediSTAT application increased accuracy and reduced the risk of ME for common pediatric emergencies. This was shown to be statistically significant for asthma medication dose (p-value < 0.001, 95% CI 0.034-0.352), midazolam dose (p-value = 0.012, 95% CI 0.030-0.764), and hypoglycemia medication dose (p-value < 0.001, 95% CI 0.046, 0.452). The study findings supported the use of standardized precalculated applications such as PediSTAT, which was shown to reduce the risk of ME in prehospital care for pediatric emergencies.

Psychotropic medications: a descriptive study of prescription trends in Tabriz, Iran, 2021–2022

IntroductionMental disorders, such as anxiety and depression, significantly impacted global populations in 2019 and 2020, with COVID-19 causing a surge in prevalence. They affect 13.4% of the people worldwide, and 21% of Iranians have experienced them. Prescription analysis is critical for evaluating and improving medical care in a cost-effective manner. This study examined prescription patterns for psychotropic drugs in outpatient settings to improve the understanding of medication utilization in a variety of patients. It aimed to assist healthcare professionals in making well-informed decisions about drug prescriptions, a topic not much addressed in Iran.MethodA descriptive study was conducted using data extracted from the Social Security Organization in Iran. We analyzed prescriptions in Tabriz from March 2021 to March 2022. Prescription data were categorized by medication category, physician specialty, age group, and sex. Then statistical analysis was performed using SPSS 2022.ResultsWe analyzed the number of psychotropic medication prescriptions issued by 7246 doctors to a group of 413,466 individuals over a year representing 44.9% of our target population. The average age of individuals receiving psychotropic drugs was 45.57 years. Gabapentin had the highest prescription rate, followed by sertraline. Antidepressants accounted for 38.1% of all prescriptions, with anxiolytics accounting for 18.6%. Other psychotropic drugs included alprazolam, chlordiazepoxide, and valproate. Adults in all age groups had the highest frequency of prescriptions for psychotropic medications. The majority of patients were female (63.5%). General practitioners had the highest number of instances of prescribing psychotropic drugs, with psychiatrists contributing 54.7% of the total prescriptions.ConclusionApproximately 45% of the target population received psychotropic medication, which highlights the significant prevalence of mental health issues in Iran. Antidepressants were the most commonly administered class, highlighting the need for training programs that specifically address their possible negative effects and the correct dosage. The goal is to provide healthcare practitioners with a comprehensive understanding of prescription trends, enabling them to administer the most appropriate treatments.

Evaluation of the consumption pattern and efficacy of Linezolid in COVID-19 hospitalized patients in a hospital in Tehran-Iran.

The inappropriate use of antibiotics increases the costs of treatment, antibiotic resistance, increased disease length and duration of hospital stay. The aim of this study was investigating the pattern of use and effectiveness of the Linezolid in COVID-19 hospitalized patients. In this retrospective cross-sectional analytical study was carried out from February 2020 (from the beginning of the pandemic in Iran) to the end of September 2020, 32 COVID-19 patients that used Linezolid were included. The data retrieved from medical document's unit and analysis was performed by SPSS statistical software version 20. According to the three elements of the 1- culture of resistant bacteria 2-the correct daily dose and 3-adequate duration of the drug, consumption pattern of Linezolid was irrational in 24 (75%) COVID-19 patients and it was rational only in 8 (25%) patients. Twenty-three (71.9%) patients received sufficient doses of the drug and 9 (28.1%) patients did not receive the required minimum dose. Four (50%) patients who rationally received Linezolid improved and the remaining 4 died. Leukopenia occurred in 1 patient (3.1%), anemia appeared in 24 individuals (75%), and 15 patients (46.9%) developed thrombocytopenia. We suggest that the prescription of Linezolid is in accordance with the standard instructions and the stewardship antibiotic program to reduce the medication costs, drug side effects, and the prevalence of antibiotic resistance.

Phenotypes of Patients with Direct Oral Anticoagulant (DOAC) Underdosing in Atrial Fibrillation: Results from the ARENA Registry.

Oral anticoagulation in patients with atrial fibrillation is crucial to prevent thrombus formation in the heart, a major cause of ischemic stroke. The appropriate dose of direct oral anticoagulants (DOAC) - either standard or reduced dose - must be chosen individually in accordance with defined patient characteristics. However, a significant proportion of patients receive inappropriately low DOAC doses (underdosing). With a novel medication-based approach, this study aims to facilitate the identification of patients at risk of DOAC underdosing. The prospective ARENA registry is a multi-centre study on patients with atrial fibrillation in Germany. Patients gave detailed information on medication, including over-the-counter preparations. Medication data were grouped according to the Anatomical Therapeutic Chemical (ATC) classification. In a bivariate analysis, the characteristics of patients on an appropriate versus inappropriate dose were compared (n = 866). To further evaluate variables for their association with underdosing, a model based on ATC third level medication data complemented with dose-adjustment criteria and validated clinical scores in all patients with complete information was built (n = 504). In 15% of patients, an inappropriately low dose was found. The number of DOAC drug interactions, concomitant antiplatelet therapy and the total drug count were the most important predictors of DOAC underdosing. Mineral supplements and better health-related quality of life (HrQoL) were predictive of correct DOAC dosing, among others. Medication-related data showed to be predictive of DOAC underdosing. Clinicians should check for inappropriately reduced DOAC doses, especially in patients undergoing antiplatelet therapy, polypharmacy and reduced HrQoL. NCT02978248; date of registration: 30 November 2016.

ACCURACY OF THE USE OF ANTITUBERCULOSIS DRUGS IN PATIENTS WITH PULMONARY TUBERCULOSIS COMORBID WITH TYPE 2 DIABETES MELITUS IN HOSPITAL X BEKASI CITY FOR THE PERIOD 2019-2022

Introduction: Pulmonary tuberculosis is a chronic infection caused by the bacterium Mycobacterium tuberculosis. The disease can lead to severe complications, including diabetes, which increases the risk of death. In addition, the prevalence of TB-DM in Indonesia reaches 14.8%. Objective: This study was to evaluate the use of antituberculosis drugs in patients with pulmonary TB comorbid with diabetes mellitus using the right indication, right dose, and right drug indicators. Methods: The research design used was observational with a retrospective approach. This study used independent variables including age, gender, treatment profile, stage of treatment, correct drug, correct dose and correct indication. The sampling technique used was consecutive sampling. The sample of this study consisted of 62 outpatients who were analyzeddescriptively quantitatively using Microsoft Excel. Results: This study shows that the number of male (65%) and female (35%) patients with the majority age 46-55 years (45%). Lung TB drug use therapy is dominant OAT Kombipak (69.4%) and KDT (30.6%). Evaluation of drug use showed the level of indication accuracy of 100%, the right dose of 83.9%, and the right drug of 93.5%. Conclusion: Based on compliance with the "National Guidelines for TB Control" issued by the Ministry of Health of the Republic of Indonesia in 2016, the treatment provided to outpatient TB patients with DM comorbidity at Hospital X in Bekasi Cityfrom 2019 to 2022 showed a 100% accuracy rate for indications (62 patients), 83.9% accuracy rate for dosages (52 patients), and 93.5% accuracy rate for drug selection (58 patients).

ANALISIS PENGGUNAAN OBAT PADA PASIEN PENYAKIT JANTUNG ISKEMIK DI RUMAH SAKIT Z KOTA JAMBI TAHUN 2023

Ischemic Heart Disease is a condition that mainly occurs due to narrowing of the coronary arteries due to atherosclerosis, spasm, or a combination of both. The aim of this research is to determine the use of drugs which includes the right drug, the right indication, the right patient, the right dose and the right time interval for administering the drug in patients with Ischemic Heart Disease at Z Hospital, Jambi City in 2023. This research is a descriptive study with retrospective data collection. which searches the medical record data of patients in 2023 who meet the inclusion criteria. The results of this study found 115 patient medical record data that met the inclusion criteria with a percentage of drug accuracy of 99,13%, 100% correct indication, 87,83% correct patient, 100% correct dose, and only 33,91% correct time interval for drug.

Detection of the Gene Encoding Resistance to Ampicillin from Staphylococcus aureus Causing Subclinical Mastitis in Dairy Cows at Bandung District

An examination of 48 samples of cow's milk was conducted, taken from three farms in the Districts of Warnasari, Babakan Kiara, and Citawa in Bandung District. This study aimed to determine subclinical mastitis's causes and detect genes encoding bacterial resistance to ampicillin in these farms. Based on isolation and identification, PCR examinations, and phylogenetic tree examinations, the bacteria causing subclinical mastitis were identified as Staphylococcus aureus that genetically belongs to Staphylococcus aureus strains MVF-7 and DMB17 with genetic similarities of 84% and 65%, respectively, and Staphylococcus aureus strains SPH062R, SPH038L, and SPH029L (genetic similarity with the mecA gene of Staphylococcus aureus at 99.6%). Resistance to Staphylococcus aureus can be transmitted from livestock to farmers and the environment. The increase in antimicrobial resistance depends on the sensitivity of the compartments in humans, animals, and the environment. The level of resistance in humans is the most sensitive level when related to the parameters of the human compartment to the environment. Small-scale farmers with small livestock and land area can be a predisposing factor in increasing the spread of bacterial contamination and resistance. To stop resistance and prevent its spread, it is recommended to replace beta-lactam antibiotics such as ampicillin with other antibiotic groups that are still sensitive, such as gentamicin, oxacillin, bacitracin, and cephalosporin. Additionally, it is advised for veterinary health technicians to accurately diagnose diseases, administer correct antibiotic dosages, and select appropriate antibiotic groups that align with the cause of the disease.

Investigation of the use of gabapentinoid drugs in pain management

Objectives: This study aimed to investigate the kind of painful conditions and preferred drug doses for which gabapentinoids were used for pain management for the musculoskeletal and nervous systems. Materials and Methods: The study included 364 patients over the age of 18 who applied to the physical therapy and rehabilitation outpatient clinic with complaints of musculoskeletal and nervous system pain. Demographic characteristics of the patients including age, gender, body mass index, smoking, disease diagnoses, preferred gabapentinoid drug, and dosage were recorded. Moreover, the estimation of the severity of pain by the Visual Analog Scale (VAS) before and 6 months after the treatments was collected from medical records. Results: The mean age of the patients was 59.54 ± 11.59 years and 82.1% were female and 17.9% were male. The diseases preferred for drug use were lumbar disc herniation (39.3%), cervical disc herniation (13.7%), spondylolisthesis (11.3%), diabetic neuropathy (11%), frozen shoulder (10.7%), gonarthrosis (10.4%), psoriatic arthritis (8.5%), spondylosis (8%), fibromyalgia (4.9%), carpal tunnel syndrome (4.7%), complex regional pain syndrome (2.7%), restless leg syndrome (1.1%), coxarthrosis (0.8%), postherpetic neuralgia (0.8%), and hemiplegia (0.5%), respectively. There was significant female gender superiority in both pregabalin and gabapentin groups (P &lt; 0.001). In whole chronic pain conditions, the VAS scores before and after 6 months of treatment were significantly reduced in both groups, except for restless legs syndrome (P = 0.066). According to the results of the study, it was determined that the indication for gabapentinoid use was mainly related to neuropathic pain and gabapentinoid doses were below the recommended amounts. Conclusion: Originally developed as anticonvulsants, gabapentin, and pregabalin are increasingly used in the treatment of various types of pain, including neuropathic and musculoskeletal pain. Although they raise concerns about addiction, it should not be overlooked that gabapentinoids are useful in the treatment of chronic painful conditions when used in the correct indications and doses.

Prognostic factors and impact of management strategies for status epilepticus: The STEPPER study in the Emilia-Romagna region, Italy.

The STEPPER (Status Epilepticus in Emilia-Romagna) study aimed to investigate the clinical characteristics, prognostic factors, and treatment approaches of status epilepticus (SE) in adults of the Emilia-Romagna region (ERR), Northern Italy. STEPPER, an observational, prospective, multicentric cohort study, was conducted across neurology units, emergency departments, and intensive care units of the ERR over 24 months (October 2019-October 2021), encompassing incident cases of SE. Patients were followed up for 30 days. A total of 578 cases were recruited (56% female, mean age = 70 years, 32% with previous diagnosis of epilepsy, 43% with in-hospital onset, 35% stuporous/comatose, 46% with nonconvulsive SE). Etiology was known in 87% (acute 43%, remote 24%, progressive 17%, definite epileptic syndrome 3%). The mean pre-SE Rankin Scale score was 2, the Status Epilepticus Severity Score was ≥4 in 33%, the Epidemiology-Based Mortality Score in Status Epilepticus score was ≥64 in 61%, and 34% were refractory. The sequence of treatments followed current clinical practice guidelines in 63%. Benzodiazepines (BDZs) were underused as first-line therapy (71%), especially in in-hospital onset cases; 15% were treated with continuous intravenous anesthetic drugs. Mortality was 24%; 63% of survivors had functional worsening. At the two-step multivariable analysis, incorrect versus correct treatment sequence with correct BDZ dose was the strongest predictor of failure to resolve SE in the in-hospital group (odds ratio [OR] = 4.42, 95% confidence interval [CI] = 1.86-10.5), with a similar trend in the out-of-hospital group (OR = 2.22, 95% CI = .98-5.02). In turn, failure to resolve was the strongest predictor of 30-day mortality (OR = 11.3, 95% CI = 4.16-30.9, out-of-hospital SE; OR = 6.42, 95% CI = 2.79-14.8, in-hospital SE) and functional worsening (OR = 5.83, 95% CI = 2.05-16.6, out-of-hospital SE; OR = 9.30, 95% CI 2.22-32.3, in-hospital SE). The STEPPER study offers insights into real-world SE management, highlighting its significant morbidity and functional decline implications. Although nonmodifiable clinical factors contribute to SE severity, modifiable factors such as optimized first-line therapies and adherence to guidelines can potentially influence prognosis.

Effective PPI Therapy: Ensuring Appropriate Dosage of PPI in Patients with Different Comorbidities in Medicine, Surgery and Gastroenterology Ward

Background: Proton pump inhibitors (PPIs) are widely prescribed medications used to treat conditions related to excessive stomach acid, such as gastroesophageal reflux disease (GERD), peptic ulcers, and Zollinger-Ellison syndrome. Despite their efficacy in managing acid-related disorders, the appropriate use of PPIs, particularly concerning the correct dosage remains a critical issue in clinical practice. Objective: This study aimed to assess the effectiveness of PPI therapy by ensuring appropriate dosage of PPI in patients with different comorbidities in medicine, surgery, and gastroenterology wards in Dhaka Medical College Hospital. Methods: This cross-sectional observational study was conducted at the Department of Pharmacology and Therapeutics, Dhaka Medical College, Dhaka, from July 2019 to June 2020. A total of 600 patients were selected as study subjects by purposive sampling technique. Data were collected and evaluated considering USFDA-approved indications, and the systematic review by Scarpignato et al. recommendations. Data were analyzed using descriptive statistics. Analysis of data was carried out by using Statistical Package for Social Science (SPSS) 22.0 for Windows. Results: Among 255 patients, who were prescribed PPIs for an appropriate indication, 129 (50.6%) patients were given PPIs in an appropriate dose, whereas the dose was inappropriate in 126 (49.4%) patients. The appropriate dose was followed mostly in the gastroenterology department (83.1%), followed by the medicine department (47.3%). Whereas in the surgery department, only 35% of patients were given PPIs with an appropriate dose and the difference in the usage of appropriate doses of PPIs among the three departments is significant with p-value &lt;0.001. The most common comorbid condition was diabetes (110; 18.3%), followed by hypertension (91; 15.2%) and stroke (24; 4.0%). Conclusion: This study estimates that only 50.6% of the 255 patients received the appropriate PPI dosage. The gastroenterology department had the highest adherence to appropriate dosing (83.1%). Diabetes was the most common comorbidity among patients (18.3%), followed by hypertension (15.2%) and stroke. These results highlight the need for improved adherence to PPI dosing guidelines across departments to enhance therapy effectiveness. J Rang Med Col. September 2024; Vol. 9, No. 2: 44-49

Important Guide for Natural Compounds Inclusion in Precision Medicine

Precision medicine describes the definition of disease at a higher resolution by genomic and other technologies to enable more precise targeting of disease subgroups with new therapies. Preventative or therapeutic interventions can be developed with the knowledge of how a compound acts safely in the body to target receptors and produce the desirable effect. With the completion of the Human Genome Project in 2003 and the rapid increase in sequencing and bioinformatics tools, obtaining information about a person's genome is becoming more accessible. To make use of genetic information in precision or personalised medicine, it is important to examine the roles of natural remedies in the individualization of treatment - to use as the right drug, at the correct dose, for the right person, at the right time. Integrating biomarkers, especially within clinical workflows, plays a crucial role in implementing precision medicine. Though the horizon in precision medicine looks promising, one major issue resides in the precise mapping into clearly defined medical conditions associated with biomarker identification and precedence ranking. This communication is met to provide guidelines that could improve biomarker discovery and enhance the participation and integration of novel natural compounds in the processes of implementing precision or personalized medicine.

Low dose Adenoviral Vammin gene transfer induces myocardial angiogenesis and increases left ventricular ejection fraction in ischemic porcine heart

This preliminary study investigated if VEGFR-2 selective adenoviral Vammin (AdVammin) gene therapy could induce angiogenesis and increase perfusion in the healthy porcine myocardium. Also, we determined using a clinically relevant large animal model if AdVammin gene therapy could improve the function of a chronically ischemic heart. Low doses of AdVammin (dose range 2 × 109–2 × 1010 vp) gene transfers were performed into the porcine myocardium using an endovascular injection catheter. AdCMV was used as a control. The porcine model of chronic myocardial ischemia was used in the ischemic studies. The AdVammin enlarged the mean capillary area and stimulated pericyte coverage in the target area 6 days after the gene transfers. Using positron emission tomography 15O-radiowater imaging, we demonstrated that AdVammin gene therapy increased perfusion in healthy myocardium at rest. AdVammin treatment also increased ejection fraction at stress in the ischemic heart, as detected using left ventricular cine angiography. In addition, we demonstrated successful in vivo imaging of enhanced angiogenesis using [68Ga]NODAGA-RGD peptide. However, AdVammin also increased tissue permeability and was associated with significant pericardial fluid accumulation, limiting AdVammin’s therapeutic potential and emphasizing the importance of correct dosage.