Daily Medication Research Articles

Long-acting Antiretroviral Agents in the Prevention and Treatment of HIV/AIDS: A Review of Recent Advances in Sub-Saharan Africa

Long-acting antiretroviral (LAARV) agents have the potential to enhance treatment and prevention by eliminating the need for daily oral medications and increasing available options. This paper reviewed recent evidence on LAARVs and explores the opportunities and challenges of implementing these innovative prevention and treatment strategies in Sub-Saharan Africa (SSA). Several clinical trials and studies on the effectiveness, drug-drug interactions, and resistance of LAARVs in key populations in SSA are ongoing or recently completed. While the effectiveness, efficacy, and cost-effectiveness of LAARVs compared to existing oral therapies have been established, these products are not yet widely used in SSA. Significant logistical challenges in integrating LAARVs into clinic workflows under the poor health systems that are common in SSA necessitate a multi-sectoral, patient-centered approach, including the use of non-traditional healthcare delivery models.

Chronic enteropathy in dogs affects the quality of life in both dogs and their owners-are veterinarians proficient in handling the caregiver burden?

Chronic disease is generally known to affect dogs' quality of life (QoL) as well as being associated with increased strain on their owners. Gastrointestinal (GI) disease is a common problem in companion animal practice, yet little is known about the QoL of dogs with chronic enteropathy (CE) and how their owners and veterinarians assess it. The aim of this study was to explore: (i) how dog owners and veterinarians observed and evaluated QoL for dogs with chronic GI disease, (ii) how having a dog with CE affected the owner's QoL, and (iii) characteristics of the communication and relationship between the dog owner and veterinarian. Twenty owners of dogs with CE and 20 companion animal veterinarians were included in this qualitative, interview-based, exploratory study. Owners evaluated QoL based on their dog's apparent emotional state, the presence of clinical signs, or restrictions in their daily life. In their assessments, veterinarians looked at the presence or absence of normal behavior, but also at disease severity and the emotional state of the dog. The majority of owners experienced many concerns and burdens that impacted their own QoL, including daily logistical challenges, implementing therapeutic regimens such as diet restriction, administering multiple daily medications, and the strain of nursing responsibilities on the owner-dog relationship. Dog owners generally felt that communication with their veterinarians was good, while veterinarians found the communication laborious and time-consuming. In general, owners and veterinarians were aligned in their QoL assessments, and the majority of veterinarians relied heavily on the owners' input and observations. However, assessments were not done in a standardized fashion among either group. Logistical challenges of having a dog with a chronic GI disease often lead to lifestyle changes for the owners, including altering working hours and cancelling holidays or other social arrangements. Having a dog with CE therefore affected the owners' QoL even when the dogs were clinically stable. Providing owners with written material about the condition in addition to medical and feeding regimen instructions may help the owner, improve compliance, and decrease the non-billable hours the veterinarian must spend communicating with the owner about their dog's CE.

Factors driving decisions in the use of HIV pre-exposure prophylaxis: a real-world study in the United States

Background: Uptake of pre-exposure prophylaxis (PrEP) in the United States (US) remains below target, despite reported high efficacy in prevention of HIV infection and being considered as a strategy for ending new HIV transmissions. Here, we sought to investigate drivers for PrEP use and barriers to increased uptake using real-world data. Methods: Data were drawn from the Adelphi PrEP Disease Specific Programme™, a cross-sectional survey of PrEP users and PrEP non-users at risk for HIV and their physicians in the US between August 2021 and March 2022. Physicians reported demographic data, clinical characteristics, and motivations for prescribing PrEP. PrEP users and non-users reported reasons for or against PrEP use, respectively. Bivariate analyses were performed to compare characteristics of users and non-users. Results: In total, 61 physicians reported data on 480 PrEP users and 121 non-users. Mean ± standard deviation of age of users and non-users was 35.3 ± 10.8 and 32.5 ± 10.8 years, respectively. Majority were male and men who have sex with men. Overall, 90.0% of users were taking PrEP daily and reported fear of contracting HIV (79.0%) and having at-risk behaviors as the main drivers of PrEP usage. About half of non-users (49.0%) were reported by physicians as choosing not to start PrEP due to not wanting long-term medication. PrEP stigma was a concern for both users (50.0%) and non-users (65.0%). More than half felt that remembering to take PrEP (57.0%) and the required level of monitoring (63.0%) were burdensome. Conclusions: Almost half of people at risk for HIV were not taking PrEP due to not wanting long-term daily medication and about half of current PrEP users were not completely adherent. The most common reason for suboptimal adherence was forgetting to take medication. This study highlighted drivers for PrEP uptake from physician, PrEP user, and non-user perspectives as well as the attributes needed in PrEP products to aid increased PrEP uptake.

Willingness to Switch to Long-Acting Injectable Cabotegravir and Rilpivirine Every 2 Months for People Living with HIV in Nanjing, China.

Daily oral medication is currently the most common antiretroviral therapy (ART) for people living with human immunodeficiency virus (PLWH). As the first complete long-acting (LA) ART regimen, cabotegravir (CAB) and rilpivirine (RPV), offer a novel treatment approach with less frequent administration, via bimonthly infusion. Due to the upcoming availability of this regimen in China, the study aimed to analyze the willingness and reasons of PLWH to switch to CAB+RPV therapy. A questionnaire survey among PLWH receiving oral ART was carried out between March 25 and April 8, 2023, in the Second Hospital of Nanjing, China. Participants were asked about their willingness to switch to the CAB+RPV LA regimen and provided reasons for their decision. We analyzed the reasons for switching, and the factors affecting their willingness were analyzed by multinomial logistic regression. Among 693 participants, 56.7% expressed willingness to switch to the CAB+RPV regimen, 32.6% were uncertain, and 10.7% were unwilling. The primary reason for switching to CAB+RPV therapy was not being concerned about daily adherence to ART (22.6%). Uncertainty about switching was mainly associated with participants' concerns in terms of price (31.6%) and safety (31.1%) of the novel drugs. Unwillingness was mainly due to participants' satisfaction with their current treatment regimen (20.3%). In multivariate analysis, higher education (odds ratio [OR]: 2.990; 95% confidence interval [CI]: 1.171-7.636) was positively associated with willingness to switch, whereas the age of ≥60 (OR: 0.142; 95% CI: 0.036-0.554) was negatively associated. Our survey demonstrated that the majority of PLWH were willing to switch to CAB+RPV therapy, mainly due to its improved convenience and reduced risk of disease exposure. However, their concerns regarding price, efficacy, and safety could be the key challenges for the clinical implementation of the CAB+RPV LA regimen in the future.

Randomized controlled trial of a pilot PrEP linkage intervention for individuals leaving incarceration in a southern state: Design and baseline characteristics.

We report baseline characteristics of a pilot intervention, PrEP-Link, which uses a community health worker (CHW) model to provide navigation to PrEP, the daily HIV preventative medication, and other medical and social services upon release from incarceration. This pilot study uses a randomized controlled trial design. The control group receives enhanced standard of care, and the intervention receives enhanced standard of care plus personalized navigation services from the CHW for up to one year. PrEP-Link is modeled after the Transitions Clinic Program, where a CHW who has lived experience of incarceration builds close relationships with individuals and community partners. After COVID-19 restrictions prevented recruitment within local jails, recruitment for this study took place in local reentry centers which house individuals as they near completion of their jail or prison sentence. Data are collected at baseline, 6 months, and 12 months. Planning and reporting was guided by the CONSORT 2010 checklist. We enrolled 80 participants between September 2021 and April 2023. Thirty-nine participants were assigned to the control group and forty-one to the intervention group. Data collected at baseline included measures of PrEP usage, HIV risk, drug and alcohol use, healthcare usage, and history of incarceration. Analysis of baseline characteristics show comparability of both demographic and HIV-related risk factors between the two arms. At baseline, participants had high clinical indication for potential PrEP benefit, particularly with respect to self-reported intravenous drug use and condomless sex. Participants responded with high PrEP acceptability within both study arms. Participants reported low preventative healthcare utilization at baseline. Barriers to accessing PrEP among the study population are significant. Results of this pilot RTC will help inform CHW lead PrEP-linkage interventions for people leaving incarceration.

SPOON: an observational, cross-sectional study of perceptions and expectations of adults with generalised myasthenia gravis in France

ObjectivesTo capture patient perceptions about living with myasthenia gravis (MG) with respect to aspirations and ways to improve treatment.DesignOnline patient survey.SettingPatients recruited by MG patient associations or at MG reference...

An Automated Medicine Dispenser using IOT

Abstract—An Automated Medicine Dispenser using IoT is a part of IoT technology that takes on the challenge of medication non-adherence for daily medication schedules especially for aging population. Non-adherence to medication results in negative health outcomes, higher rates of hospitalizations, and consid- erable costs to healthcare. To ensure that medicine is delivered on time and accurately, the project integrates different hardware components such as a motor-driven dispensing mechanism. The project uses both audio and visual alerts to inform users when they should take their medication. This enables patients and caregivers, as well as clinicians care providers to instantly monitor medication adherence which is supported by the devices IoT connectivity. The dispenser is also designed to be easy-to-use and user friendly and aims at elderly patients who have a hard time managing the complexities of multi-medication schedules. The Dispenser offers a reliable solution for improving medication management. Index Terms—Automated Medicine Dispenser, IoT, medication adherence, elderly care, healthcare technology, real-time moni- toring.

Association Between an Enhanced Clinical Pharmacy Service and Patient Experience in Hospitalized Adults: A Cohort Study.

Purpose. To determine if implementation of an enhanced clinical pharmacy service (ECPS) at a community hospital could improve patient experience as measured by medication-related Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores. Methods. A cohort study of 260 patients at a community hospital was conducted. Patients in the intervention group received additional pharmacy services from the standard of care (SOC) group, including daily medication counseling, pharmacist-driven medication administration, discharge medication reconciliation and education, consistent offers to enroll in a bedside medication delivery program (BMDP), and a telephone call following discharge. The primary outcome of patient experience was assessed through patients' responses to a care transitions HCAHPS survey question regarding understanding of the purpose of taking medications following discharge. Results. Among patients in the ECPS cohort, 75.8% had a top-box response to the care transitions HCAHPS question, compared to 63.3% of patients in the SOC cohort (OR = 1.81; 95% CI [0.61-5.37]). Top-box responses increased for all assessed HCAHPS questions but were not statistically significant. The HCAHPS survey response rate was 29.3% in the SOC cohort and 29.9% in the ECPS cohort. Conclusion. Following an ECPS intervention, patient experience as determined by HCAHPS scores increased, but the results did not reach statistical significance. Further, larger studies are needed on this topic.

The SQ tree sublingual immunotherapy tablet is effective and well tolerated in children-A pivotal phase III trial.

Allergic rhinitis and/or conjunctivitis (AR/C) induced by tree pollen is common and negatively impacts quality of life in children and adolescents. This phase III trial investigated the efficacy and safety of the SQ tree SLIT-tablet in a paediatric population (5-17 years) with moderate-to-severe AR/C induced by pollen from birch and trees in the birch homologous group. Nine hundred and fifty-two subjects were randomized (1:1) to daily treatment with SQ tree SLIT-tablet or placebo for up to 52 weeks and had free access to AR/C symptom-relieving medications. The primary endpoint was the average total combined score (TCS); sum of average daily symptom score (DSS) and average daily medication score (DMS) during the birch pollen season (BPS). Key secondary endpoints included average DSS and DMS during BPS and average TCS, DSS and DMS during tree pollen season (TPS). SQ tree SLIT-tablet demonstrated a statistically significant and clinically relevant treatment effect compared with placebo for the TCS during BPS with an absolute treatment difference of 1.29 (95% CI: 0.58, 2.00; p = .0004) and a relative reduction of 21.9% (95% CI: 10.6, 31.9). Results were substantiated by reductions in both DSS and DMS versus placebo during the BPS and in DSS, DMS and TCS during the TPS. Treatment was generally well tolerated. Most treatment-related adverse events were mild or moderate local administration site reactions. This is the first paediatric trial to provide robust evidence of efficacy and safety of the SQ tree SLIT-tablet in tree pollen-induced AR/C in a paediatric population (5-17 years).

Quantifying Pill Disutility Associated With Starting Versus Continuing Cardioprotective Medication: A Randomized Experiment.

Quantifying patient-reported pill disutility is important for understanding the risk-benefit tradeoffs of taking medications. The objective of this study was to quantify and compare the pill disutility associated with starting a new medication and continuing an existing medication for cardiometabolic disease prevention in a sample of older adults in the United States. We enrolled adults aged ≥60 years from an online panel. Respondents completed a survey that included a 2-armed experiment that randomized them to either a starting or a continuing scenario in which they were instructed that their doctor recommended they start or continue, respectively, a daily medication that prevents heart attacks and strokes. Pill disutility was calculated using a time-tradeoff method with time willing to trade obtained via alternating dichotomous choice contingent valuation design. Pill disutility was described within each scenario overall and by subgroups and then compared across scenarios using the Kruskal-Wallis test and multivariable fractional logistic regression. A total of 621 respondents with a mean age of 69 years were included in the final analysis. A majority were taking medications (n=84.5%, n=525) and had at least 1 chronic cardiometabolic disease (78.7%, n=489). Pill disutility associated with starting a new medication was 0.0662 (SD, 0.13), while pill disutility associated with continuing an existing medication was 0.0378 (SD, 0.10; P<0.001). Participants randomized to the starting scenario had higher odds of higher pill disutility versus participants randomized to the continuing scenario in both multivariable testing (odds ratio, 1.66 [95% CI, 1.15-2.40]) and across subgroups. Pill disutility for a daily cardioprotective medication, when obtained from a sample of older adults utilizing rigorous ascertainment methods, is higher than previously reported, especially with regard to starting the medication. These represent the first estimates that can be used in cost-effectiveness modeling involving both prescribing and deprescribing.

Potential of Aluminum Drug Packages with Press-Through Packaging Considering Usability for a Wide Range of Users.

Press-through packages (PTPs) are frequently used for the packaging of prescription drugs in Japan. However, tablets or capsules packaged in PTPs may become unstable and difficult to store. Therefore, aluminum pouches (pillow packages) are applied as an additional packaging option. Especially for 10-sheet tablet (capsule) PTPs, there are many opportunities for health-care professionals (mainly pharmacists) to open pillow packages during the dispensing process. However, aluminum pouches (pillow packages) that are easy to open and store appropriately by not only pharmacists, but also patients, are needed. A 100-unit PTP (pillow package) with conventional specifications ① and two other products (②: open vertically by a wavy processed half-cut and ③: pinch the backlining open) were developed with the aim of improving the ease of opening. The study participants, consisting of pharmacists and patients, performed tasks such as opening and taking drugs out of the PTP for each sample, and evaluated the differences in usability. The results of a sensory test revealed that pharmacists rated products ② and ③ higher than product ①. On the other hand, patients, including those with weak grip and pinching strengths, rated ③ highly, confirming the superiority of usability in the order of ③, ②, and ①. In addition, item ③ was successfully opened by all patients. The present results indicated the superiority of the developed pillow packaging, which enables pharmacists to save time in the dispensing process. In addition, product ③ was evaluated highly by patients, especially those with disabilities, for its ease of use not only in terms of opening, but also storage. Sensory testing by actual users applying ergonomic methods enabled a multifaceted evaluation of the products and provided insights into the actual status of pharmacists' dispensing work (product issues) and patients' daily medication use.

Medication Self-Management for Home Care Users Receiving Multidose Drug Dispensing: Qualitative Interview Study.

Multidose drug dispensing (MDD) is an adherence aid where medicines are machine-dispensed in disposable unit bags, usually for a 14-day period. MDD replaces manually filled dosettes in many home care services in Norway. While evidence suggests that MDD can improve medication adherence and reduce errors, there are few studies on how patients manage MDD at home and how this affects their daily routines. The aim of the study is to identify factors influencing medication self-management behavior among MDD users living at home and explore how MDD affects medication self-management. We conducted semistructured interviews with 19 MDD users in Oslo between August 2019 and February 2020. The interviews were held at the participants' homes, and the interview transcripts were analyzed thematically. All participants in the study received some form of assistance with medication management from home care services. This assistance ranged from MDD delivery every other week to actual assistance with medication administration multiple times daily. However, regardless of the level of assistance received, participants primarily managed their MDD medications themselves. Daily medication routines and knowledge about medicines varied among the participants, with some taking an active role in their medication management, while others relied on others to take responsibility. The degree of involvement seemed determined by motivation rather than capability. MDD can support medication self-management, but its effectiveness varies among patients. The level of medication management by MDD users is not solely determined by their actual capabilities. Factors such as interest in self-care and independence, available support, information, and cognitive capacity all play a role in determining the degree of autonomy.

Impact of age, race, and medication use on efficacy endpoints in a randomized controlled trial of topical sildenafil cream for the treatment of female sexual arousal disorder.

A study of topical Sildenafil Cream 3.6% was completed among healthy premenopausal women with female sexual arousal disorder. To compare efficacy endpoints based on product use in pre-planned and post-hoc subsets of age, race, and medication use. Phase 2b, exploratory, randomized, placebo-controlled, double-blind study of Sildenafil Cream, 3.6% among healthy premenopausal women with female sexual arousal disorder (FSAD). Eligible participants were randomized 1:1 to Sildenafil versus Placebo Cream and used investigational product for 12weeks. The co-primary efficacy endpoints were the change from baseline, at week 12, in the Arousal Sensation (AS) domain of the Sexual Function Questionnaire (SFQ28) and Question 14 (Q14) of the Female Sexual Distress Scale - Desire, Arousal, Orgasm (FSDS-DAO). The secondary efficacy endpoint was the change from baseline at week 12 in the mean number of satisfactory sexual events (SSEs) reported in a daily diary. Exploratory efficacy endpoints included the Desire and Orgasm domains of the SFQ28. Age group (≥18years and ≤ 45years versus >45years), race group (White versus non-White), and baseline use/non-use of hormonal contraception did not significantly affect the co-primary endpoints of the SFQ28 AS domain and FSDS-DAO Q14 (P values >0.11). Non-White Sildenafil Cream users had an increase in SSEs at week 12 (0.7 ± 0.63) while non-white Placebo Cream users reported a decrease (-1.5 ± 0.58) (P = .02). Daily psychiatric medication use among women assigned to either Placebo or Sildenafil Cream resulted in lower SFQ28 Desire domain scores compared to non-users of these medications. Women who used study product only in un-partnered events had a larger improvement in their SFQ28 Orgasm domain scores at week 12 (2.39 ± 0.95) with Sildenafil Cream use compared to Placebo (-0.19 ± 0.75) (P = .06). Non-White women represented a higher proportion of un-partnered women and women who used IP only during un-partnered sexual events compared to White women (P < .01). These pre-planned subset analyses will help refine target populations in future studies of Sildenafil Cream, 3.6% for the treatment of FSAD. Subset analyses focused on variables pertinent to future target populations. The current study population was primarily educated non-Hispanic White women. Age and hormonal contraceptive use did not impact the efficacy of topical Sildenafil Cream. Daily psychiatric medication use decreased sexual desire in active and placebo users.

Optimising Emergency Care for Older Adults: A Case Study of the EDITH Service Following a Proximal Humerus Fracture

Abstract Background The Emergency Department in the Home (EDITH) service offers emergency Occupational Therapy and medical assessments to older adults at home, thus negating the need for hospital attendances. Mr X, an 86-year-old with vascular dementia and hypertension, sustained a left proximal humerus fracture from a fall. Following assessment in the ED, Mr X was deemed fit for discharge and was referred to EDITH for an acute functional assessment and clinical review. Methods Within 72 hours of discharge, Mr X was visited at home by an Occupational Therapist (OT) and an Advanced Nurse Practitioner (ANP). The OT conducted a home environment assessment, falls-risk screening, delirium screening, reviewed social supports, and performed a functional assessment. Education on one-handed dressing techniques and falls prevention was provided. The ANP conducted a clinical review, and reviewed Mr X’s medication and analgesia. Mr X had the support of his wife to assist with Activities of Daily Living (ADLs), functional mobility and medication management. Mr X’s son purchased assistive equipment recommended by the OT, to enhance home safety. Referrals were made to the local memory support service, a Physiotherapist, and his Public Health Nurse to organise formal care supports. Results Mr X remained at home with support from his wife, primary care services, and virtual EDITH follow-up. Mr X had a scheduled review at the fracture clinic following his ED attendance. Conclusion Emergency care practitioners play a crucial role in addressing acute functional and clinical changes in older adults attending the ED. Supported ED discharges and service integration during the acute phase can prevent hospital admissions. Collaboration between emergency medicine and primary care is essential for addressing acute medical needs and long-term functional outcomes. With adequate social support and timely services, older adults can recover successfully at home.

Design of an Intelligent medication box system

In the context of today's intelligent development, in order to help improve the living experience of the elderly, convenient and intelligent "smart medicine boxes" have begun to enter their lives. The intelligent medication box system designed in this article aims to assist elderly people in taking medication, while monitoring and providing feedback on daily medication usage information. Using microcontroller technology and Bluetooth wireless communication technology, when Bluetooth is in contact with a mobile phone, the indicator light of the smart medicine box will light up, the LCD1602 display screen will prompt medication, and the buzzer will sound an alarm, thereby reminding the elderly to take medication at the appropriate time. When the switch of the smart medicine box fluctuates, the mobile app will provide feedback on the switch status of the medicine box, thereby providing specific information on the medication taking of the elderly. The future application prospects of this system are extremely broad.

The efficacy of curcumin/Qing Dai combination in children with active ulcerative colitis: a multicenter retrospective cohort study.

Curcumin and Qing Dai (QD) are herbal extracts that recently showed efficacy in treating inflammatory bowel disease (IBD). Since 2016, a combination of curcumin with QD (CurQD) has been employed in our center for management of active ulcerative colitis (UC). We report the effectiveness and safety of CurQD therapy in children with mild-moderate UC or IBD-unclassified (IBD-U). A multicenter retrospective study. Children aged ≤OP18 years who were treated with CurQD during 2017-2021 were included. Disease activity measures were Pediatric UC Activity Index (PUCAI), and fecal calprotectin (FC). The primary outcome was a decrease in PUCAI by ≥10 points, FC normalization (≤100 µg/gr when baseline ≥300 µg/gr) or a ≥ 50% decrease in FC. Of 30 patients (60% males, mean age 14 ± 3.9 years), 15 (50%), 13 (43%), and 2 (7%) had pancolitis, left-sided colitis and proctitis, respectively. The daily medication dose was 0.5-3 gm QD with 1-4 gm curcumin. Concomitant treatment at induction was corticosteroids (19%), biologics (28%) and 5-aminosalicylic acid (40%). The mean duration of induction was 11.6 weeks [95% confidence interval (CI) 10.2-13.1, range 8-16]. PUCAI decreased from a mean of 31.3 (95% CI 26.6-36.0, range 5-60) to 10.9 (95% CI 7.6-14.4, range 5-35) (n = 26, p < 0.001). FC response and normalization occurred in 11/12 and 7/12 patients, respectively. The median decline in FC was from 749 µg/gm [interquartile range (IQR) 566-1000] to 39 µg/gm (IQR 12-132) (n = 15, p = 0.04). During follow-up (median 8 months, IQR 6-10), 10 patients (33%) flared; five of them regained remission or responded to a treatment change. Of 18 patients treated beyond induction, 12 (67%) achieved clinical response and 10 achieved clinical remission by the end of follow up. CurQD may be effective and safe as an add-on option to conventional management, for induction and maintenance in children with mild-moderate UC/IBD-U.

Trajectories of daily antipsychotic use and weight gain in people hospitalized for the first episode of psychosis.

We need to better understand the risk factors and predictors of medication-related weight gain to improve metabolic health of individuals with schizophrenia. This study explores how trajectories of antipsychotic medication (AP) use impact body weight early in the course of schizophrenia. We recruited 92 participants with first-episode psychosis (FEP, n=92) during their first psychiatric hospitalization. We prospectively collected weight, body mass index (BMI), metabolic markers, and exact daily medication exposure during 6-week hospitalization. We quantified the trajectory of AP medication changes and AP polypharmacy using a novel approach based on meta-analytical ranking of medications and tested it as a predictor of weight gain together with traditional risk factors. Most people started treatment with risperidone (n=57), followed by olanzapine (n=29). Then, 48% of individuals remained on their first prescribed medication, while 33% of people remained on monotherapy. Almost half of the individuals (39/92) experienced escalation of medications, mostly switch to AP polypharmacy (90%). Only baseline BMI was a predictor of BMI change. Individuals in the top tercile of weight gain, compared to those in the bottom tercile, showed lower follow-up symptoms, a trend for longer prehospitalization antipsychotic treatment, and greater exposure to metabolically problematic medications. Early in the course of illness, during inpatient treatment, baseline BMI is the strongest and earliest predictor of weight gain on APs and is a better predictor than type of medication, polypharmacy, or medication switches. Baseline BMI predicted weight change over a period of weeks, when other traditional predictors demonstrated a much smaller effect.

Hypertension Cure Research progress: The use of Zilebesiran in Hypertension

Chronic hypertension is a lifelong condition, and the patients need lifelong treatment with oral anti-hypertensive medications to say healthy and to prevent the development of serious complications. Demands for changing this situation of lifelong dependence on daily medications have been increasing. The aim of this paper is to highlight the recent breakthrough in hypertension research. Expert opinion: Zilebesiran, a small interfering RNA targeting angiotensinogen has the main advantage of long duration of action which allows meeting many hypertensions patients’ demand of avoiding the inconvenience of talking oral hypertensive medication on daily basis. It is worth mentioning that a more optimal blockade of renin-angiotensin-aldosterone system is not the only advantageous therapeutic approach for the treatment of hypertension. Impairment of endothelium-dependent vasodilation has been increasingly recognized as an important contributor for the development of essential hypertension’s-arginine is an amino acid that is considered the biological precursor of nitric oxide which is an important contributor to microvascular vasodilation and to the reduction atherosclerosis. Oral L-arginine has been emerging as a new effective approach of reducing blood through improving endothelial function in hypertensive patients.

Organic cation transporter 1 in the lacrimal gland facilitates the entry of systemic drugs causing ocular surface toxicity

Many of the daily systemic medications (parenteral and oral) used to treat various diseases are known to cause ocular toxicities - leading to vision loss. How these medications gain entry into the eye despite the ocular barriers is an important question to be addressed. Various reports show almost 30–40 % of systemic drugs causing ocular toxicity are organic cation in nature. We hypothesize these systemic drugs (cations) are non-specifically recognized as endogenous substrates by organic cation transporter (OCT1) in the lacrimal gland, thereby facilitating its entry into the anterior eye segment. Therefore, we studied the expression and localization of OCT1 in the lacrimal gland of rabbits. Further, to prove our hypothesis, OCT1 substrates (known as well as predicted from our previous Artificial Intelligence study) were administered intravenously in the presence and absence of topically administered OCT1 blockers. Our findings show, OCT1 gene and protein expression in the lacrimal gland, with its localization in the terminal acinar cells. The tear levels of intravenously administered substrates decreased in the presence of topical OCT1 blockers, indicating – a) the entry of systemic drugs into the eye via lacrimal secretion and b) OCT1 in the lacrimal gland is involved in the drug transport (substrates) from blood to the eye. Though the role of transporters in toxicity is well-known, the current study opens a new avenue for understanding the role of transporters in ocular toxicity.

Self-perceived oral health in hemato-oncological patients and the relation to quality of life

PurposeTo assess the self-reported oral health and oral health-related quality of life of patients diagnosed with hemato-oncological disease.Patients and methodsData was collected through a digital questionnaire in collaboration with the Dutch patient organization Hematon. The questionnaires EORTC-QLQ-C30, EORTC-QLQ-OH15, shortened Xerostomia Inventory (XI), and the OHIP-14 were used.ResultsSeven hundred five patients were included (52.5% female, mean age 63.2 ± 10.1). The majority was diagnosed more than 2 years ago (86%) and had received treatment (81%) for their disease. Lymphoma, leukemia, and multiple myeloma were the most frequent malignancies. Chemotherapy alone, chemotherapy in combination with targeted therapy or immunotherapy, and myeloablative chemotherapy followed by autologous stem cell transplantation were the most common treatment modalities. The XI identified that 40.5% met the criteria for xerostomia. Other complaints included mouth soreness and sensitivity, gingival pain and bleeding, problems with teeth or with an ill-fitting denture. Despite reporting oral complaints, most patients experienced a rather good OH-QoL. A high xerostomia score led to a significantly lower OH-QoL. Female gender, history of stem cell transplantation, radiation to head and neck, and multiple daily medication use were significant predictors of xerostomia.ConclusionPatients with hematologic malignancies frequently reported a dry mouth and other oral complaints including mouth soreness and sensitivity, gingival pain and bleeding, and problems with teeth. Despite these oral complaints, most patients experienced a relatively good OH-QoL. Future longitudinal studies are needed, and health professionals should have an active role in providing oral supportive care based on patients’ individual needs.