Drugs For Peptic Ulcer Research Articles

Pharmacological Prescription at the End of Life: Quality Assessment in the Transition of Care to a Community Palliative Care Support Team.

Appropriate pharmacological management is a cornerstone of quality in palliative care (PC), focusing on comfort and quality of life. Therapeutic review is crucial in PC, aiming to optimize symptom relief, reduce adverse effects, and manage drug interactions. This study aims to delve into the real-world pharmacological prescription practices within a Community Palliative Care Support Team (CPCST) in the northern region of Portugal, comparing practices at admission and at the last consultation before death. It is an observational, cross-sectional, retrospective study without intervention involving patients admitted to a CPCST in 2021. Data were obtained from clinical records, and the statistical analysis included descriptive and inferential measures. Sixty-four patients were included, with an average age of 77.34 years, referred mainly by a specialized Hospital Palliative Care Support Team (65.63%). Polypharmacy was present, with a significant increase in opioids, antipsychotics, prokinetics, antiemetics, antispasmodics, and local corticosteroids, and a reduction in drugs for peptic ulcer and gastroesophageal reflux treatment, antithrombotics, hypolipidemics, antihypertensives, and antidiabetics, among others. The oral route was preferred, decreasing between the two analyzed moments (85.5% versus 49.1%). Pro re nata (PRN) medications increased significantly (p ≤ 0.001). The prescription profile reflects a focus on symptom relief. The deprescription of drugs for chronic comorbidities suggests adaptation to care goals. At the end of life, PRN medications increase significantly (1.34 versus 3.26, p ≤ 0.001), administered as needed to soothe fluctuating symptoms. The pharmacological classes that have significantly increased are relevant in alleviating common symptoms in PC. The use of alternative routes for medication administration increases as instability of the oral route occurs, leading to a reduction in orally administered medications. Among these alternatives, the subcutaneous route shows the largest increase. The findings underscore the importance of flexible and responsive medication strategies in end-of-life care.

Dynamical Analysis of Peptic Ulcer Disease Model in Nigeria with the Effect of Vaccination and Treatment Program

The study developed a non-linear deterministic mathematical model to investigate the transmission dynamics of peptic ulcer disease in human population by considering both direct and indirect contact transmission with vaccine and treatment as control. In developing the model, the population was compartmentalized into susceptible-vaccinated-exposed-infected-treated-helicobacter pylori concentration in the environment recovered. The model developed is a system of differential equations. The rate of change of the system, existence and uniqueness of solution, region of absolute stability and positivity of the solution was established. Existence of disease-free equilibrium state and basic reproduction number was also established. Mathematical analysis was determined by the basic reproduction number if , the disease-free equilibrium is locally asymptotically stable whereas if then the equilibrium is unstable whereas the numerical analysis for the estimated basic reproduction number of the model is greater than unity in perspective of Nigeria, for which the Herd Immunity Threshold indicated that vaccinating 99.47% of Nigeria population can control spreading of Peptic ulcer disease in the country. The paper recommended amongst other things that if significant changes concerning the issue of threshold target are observed to improve the rate at which peptic ulcer can be minimized from the population where Government and non-governmental organization should encourage the use of peptic ulcer drugs and vaccines among individuals.

Gastric acid-responsive deformable sodium alginate/Bletilla striata polysaccharide in situ gel for the protection and treatment of alcohol-induced peptic ulcers

First-line drugs for peptic ulcer (PU) treatment are typically limited by poor targeting and adverse effects associated with long-term use. Despite recent advancements in novel therapeutic approaches for PU, the development of sustained-release delivery systems tailored to specific pathological characteristics remains challenging. Persistent inflammation, particularly gastric inflammatory microenvironment imbalance, characterizes the PU. In this study, we prepared an in situ gel composed of sodium alginate, deacetylated gellan gum, calcium citrate, and Bletilla striata polysaccharide (BSP) to achieve sustained release of BSP. The BSP in situ gel demonstrated favorable fluidity in vitro and completed self-assembly in vivo in response to the acidic milieu at a pH of 1.5. Furthermore, the shear, extrusion, and deformation properties increased by 26.4 %, 103.7 %, and 46.3 %, respectively, with long-term gastric retention (4 h) and mucosal adaptation. Animal experiments confirmed that the BSP in situ gel could attenuate necrotic injury and inflammatory cell infiltration, maintain mucosal barrier integrity, regulate cytokine imbalance and inflammation-associated hyperapoptosis, thus effectively alleviate the inflammatory microenvironmental imbalance in PU without significant side effects. Overall, our findings demonstrated that the BSP in situ gel is a promising therapeutic strategy for PU and opens avenues for developing self-assembled formulations targeting the pathological features of PUs.

Encapsulation of Dicranopteris linearis extract using cellulose microparticles for antiulcer medication

Dicranopteris linearis (DL) is a fern in the Gleicheniaceae family, locally known as resam by the Malay community. It has numerous pharmacological benefits, with antiulcer and gastroprotective properties. Peptic ulcer is a chronic and recurring disease that significantly impacts morbidity and mortality, affecting nearly 20 % of the world's population. Despite the effectiveness of peptic ulcer drugs, there is no perfect treatment for the ailment. Encapsulation is an advanced technique that can treat peptic ulcers by incorporating natural sources. This work aims to encapsulate DL extract using different types of cellulose particles by the solvent displacement technique for peptic ulcer medication. The extract was encapsulated using methyl cellulose (MC), ethyl cellulose (EC), and a blend of ethyl methyl cellulose through a dialysis cellulose membrane tube and freeze-dried to yield a suspension of the encapsulated DL extracts. The microencapsulated methyl cellulose chloroform extract (MCCH) has a considerably greater level of total phenolic (84.53 ± 6.44 mg GAE/g), total flavonoid (84.53 ± 0.54 mg GAE/g), and antioxidant activity (86.40 ± 0.63 %). MCCH has the highest percentage of antimicrobial activity against Escherichia coli (2.42 ± 107 × 0.70 CFU/mL), Bacillus subtilis (5.21 ± 107 × 0.90 CFU/mL), and Shigella flexneri (1.25 ± 107 × 0.66 CFU/mL), as well as the highest urease inhibitory activity (50.0 ± 0.21 %). The MCCH particle size was estimated to be 3.347 ± 0.078 μm in diameter. It has been proven that DL elements were successfully encapsulated in the methyl cellulose polymer in the presence of calcium (Ca). Fourier transform infrared (FTIR) analysis indicated significant results, where the peak belonging to the CO stretch of the carbonyl groups of methyl cellulose (MC) shifted from 1638.46 cm−1 in the spectrum of pure MC to 1639.10 cm−1 in the spectrum of the MCCH extract. The shift in the wavenumbers was due to the interactions between the phytochemicals in the chloroform extract and the MC matrix in the microcapsules. Dissolution studies in simulated gastric fluid (SGF) and model fitting of encapsulated chloroform extracts showed that MCCH has the highest EC50 of 6.73 ± 0.27 mg/mL with R2 = 0.971 fitted by the Korsmeyer-Peppas model, indicating diffusion as the mechanism of release.

Prevalence, severity, and correlates of erectile dysfunction among male adult patients of a primary care clinic in North-West Nigeria.

Erectile dysfunction (ED) is a common sexual problem that profoundly affects intimate relationships. It is poorly studied in North-western Nigeria. To assess the prevalence, severity and predictors of ED among adult males attending a primary care clinic in Northwest Nigeria. A cross-section of 392 males (aged ≥25 years) were randomly selected from attendees of a family medicine clinic in Kano, Nigeria. Information regarding their biodata, lifestyle factors, and clinical characteristics was obtained using a structured questionnaire. The International Index of Erectile Function Questionnaire (version 5) and Patient Health Questionnaire-2 assessed ED and depression, respectively. The participants' mean age was 45±14.1 years (range: 26-86 years). Most participants were married (88.8%), had one sexual partner (71.7%), had tertiary education (44.4%) and were traders (49.7%). The prevalence of ED was 52.3% (205/392) [comprising mild (36.0%), mild-to-moderate (14.3%), moderate (1.5%) and severe (0.5%)]. Age, body mass index (BMI), marital status, number of sexual partners, monthly income, type of exercise, hypertension history, blood pressure reading, antihypertensive and peptic ulcer drug use were associated with ED (P<0.05). However, age (≥50years) (OR= 1.91, 95%CI [1.28-2.85], P=0.001) and overweight/obesity (OR =1.81, 95%CI [1.18-2.77], P=0.007) were the predictors of ED in this population. ED prevalence was high, although mainly of the mild form. Age (≥50years) and overweight/obesity predicted ED. Hence, the need for early screening, objective grading of ED, identification of modifiable risk factors (e.g., overweight/obesity) and commencing proper treatment and prevention in this setting.

Usage Pattern of Fixed-dose Combinations at ICMR Network of Rational Use of Medicine Centres across India: Recommendations for Policymakers and Prescribers.

Irrational use of medicines is a global problem. In India, one contributing factor is the availability of a large number of fixed-dose combinations (FDCs). To improve rational use and to strengthen policies, it is important to assess the usage patterns and rationality of FDCs. This study was conducted as part of a 1-year prospective cross-sectional analysis of prescriptions in the outpatient clinics of broad specialities from 13 tertiary care hospitals across India. Five most commonly prescribed FDCs in each center were analyzed. In addition, all the prescribed FDCs were classified as per the Kokate Committee classification and it was noted whether any of the FDCs were irrational or banned as per the reference lists released by regulatory authorities. A total of 4,838 prescriptions were analyzed. Of these, 2,093 (43.3%) prescriptions had at least one FDC. These 2,093 prescriptions had 366 different FDCs. Of the 366 FDCs, 241 were rational; 10 were irrational; 14 required further data generation; and the remaining 96 FDCs could not be categorized into any of the above. Vitamins and minerals/supplements, antibacterial for systemic use, and drugs for gastroesophageal reflux disease (GERD) and peptic ulcer were the most used FDCs. Based on the finding that some prescriptions contained irrational FDCs, it is recommended that a rigorous, regular, and uniform method of evaluation be implemented to approve/ban FDCs and that prescribers be periodically notified about the status of the bans.

Polypharmacy and multiple sclerosis: A population-based study

Background: Little is known about polypharmacy and multiple sclerosis (MS). Objectives: To estimate polypharmacy prevalence in a population-based MS cohort and compare persons with/without polypharmacy. Methods: Using administrative and pharmacy data from Canada, we estimated polypharmacy prevalence (⩾5 concurrent medications for >30 consecutive days) in MS individuals in 2017. We compared the characteristics of persons with/without polypharmacy and described the number of polypharmacy days, the most common medication classes contributing to polypharmacy and hyper-polypharmacy prevalence (⩾10 medications). Results: Of 14,227 included individuals (75% women), mean age = 55.4 (standard deviation (SD): 13.2) years; 28% (n = 3995) met criteria for polypharmacy (median polypharmacy days = 273 (interquartile range (IQR): 120–345)). Odds of polypharmacy were higher for women (adjusted odds ratio (aOR) = 1.14; 95% confidence intervals (CI):1.04–1.25), older individuals (aORs 50–64 years = 2.04; 95% CI:1.84–2.26; ⩾65 years = 3.26; 95% CI: 2.92–3.63 vs. <50 years), those with more comorbidities (e.g. ⩾3 vs. none, aOR = 6.03; 95% CI: 5.05–7.22) and lower socioeconomic status (SES) (e.g. most (SES-Q1) vs. least deprived (SES-Q5) aOR = 1.64; 95% CI: 1.44–1.86). Medication classes most commonly contributing to polypharmacy were as follows: antidepressants (66% of polypharmacy days), antiepileptics (47%), and peptic ulcer drugs (41%). Antidepressants were most frequently co-prescribed with antiepileptics (34% of polypharmacy days) and peptic ulcer drugs (27%). Five percent of persons (716/14,227) experienced hyper-polypharmacy. Conclusion: More than one in four MS persons met criteria for polypharmacy. The odds of polypharmacy were higher for women, older persons, and those with more comorbidities, but lower SES.

Frequently reported adverse events of rebamipide compared to other drugs for peptic ulcer and gastroesophageal reflux disease

This study aimed to detect safety signals of rebamipide and search for adverse events (AEs) of rebamipide that are more common than those of other drugs for peptic ulcer disease (PUD) and gastroesophageal reflux disease (GERD) in the elderly population. A total of 101,735 AE reports for drugs used to treat PUD and GERD between 2009 and 2018 from the KIDS-KAERS database (KIDS-KD) were used. Disproportionality analysis was performed to calculate the proportional reporting ratio (PRR), reporting odds ratio (ROR), and information component (IC). Drug labels in Korea, Japan, and China were reviewed to identify signals that have been listed. AEs frequently reported in the elderly population were also analyzed. Seriousness and median time to AEs were evaluated for statistically significant AEs. A total of 14 signals were detected, and 4 signals (dry mouth, dermatitis, purpura/petechia, and fluid overload) were not listed on drug labels; however, they may be included as part of other listed AEs. In the elderly population, 11 AEs such as dyspepsia/indigestion/gastrointestinal distress, somnolence, dry mouth, and edema were common. These AEs were not serious and occurred within 2–9 days. This study identified possible AEs of rebamipide, a relatively safe drug.

Prescription Appropriateness of Drugs for Peptic Ulcer and Gastro-Esophageal Reflux Disease: Baseline Assessment in the LAPTOP-PPI Cluster Randomized Trial.

Background: Drugs for peptic ulcer and gastro-esophageal reflux disease (GERD) are among the most widely prescribed, frequently without appropriate indications. This represents an important issue, as it leads to risk of adverse events for patients and unnecessary costs for National Health Service. Aim: To assess the prescription appropriateness of drugs for GERD, in the frame of the “Evaluation of the effectiveness of a Low-cost informative intervention to improve the Appropriate PrescripTiOn of Proton PumP Inhibitors in older people in primary care: a cluster-randomized controlled study” (LAPTOP-PPI) (Clinicaltrial.gov: NCT04637750). Methods: The appropriateness of drug prescription was assessed on data collected in administrative databases, by integrating information on concomitant medications, outpatient medical and laboratory procedures and hospital discharge diagnoses, according to the reimbursement criteria provided by the Italian Medicine Agency. We analyzed data of community-dwelling people aged 65 years and over, living in the areas of Bergamo (Northern Italy) and Caserta (Southern Italy), from July 1 to 31 December 2019. Results: Among 380,218 patients, 175,342 (46.1%) received at least one prescription of drugs for GERD. All in all, we found that only 41.2% of patients received appropriate prescriptions. Conclusion: Given the potential risk of adverse drug reactions, especially in older people, educational interventions should be prompted for physicians, in order to improve the quality of prescription of drugs for GERD and, in turn, avoid unfavorable health outcomes and unnecessary costs.

Evaluation Conformity Rejimen Peptic Ulcer Drug Therapy In Inpatient Care Facility At West Nusa Tenggara Regional Public Hospital

Evaluation Conformity Rejimen Peptic Ulcer Drug Therapy In Inpatient Care Facility At West Nusa Tenggara Regional Public Hospital

Polypharmacy, certain medication classes seem to worsen COVID-19 outcomes

Pharmacists are well aware that polypharmacy is a major issue among patients, especially older adults. Recent studies have estimated that approximately 36% of older adults take at least 5 prescription medications, and 67% take 5 or more medications or supplements, including OTCs. But what do clinicians know about polypharmacy and clinical outcomes for COVID-19? Researchers conducted a study, published in JAPhA, to find out. “The key message is that polypharmacy, as well as certain medication classes, has a negative impact on COVID-19 outcomes,” said lead author Sorochi Iloanusi, BPharm, a doctoral candidate in the Department of Pharmaceutical Health Outcomes and Policy at the University of Houston. Examining the available literature from all over the world through an electronic database search, the research team found that 5 out of 7 included studies published between November 2019 and September 2020 connected polypharmacy and negative clinical outcomes among COVID-19 patients. From the sample size, 10,519 patients were COVID-19–positive and 4,818 COVID-19–positive patients were labeled as having experienced polypharmacy. Antipsychotics, non-tricyclic antidepressants, opioid analgesics, and drugs for peptic ulcer and gastroesophageal reflux disease were among the drug classes associated with adverse clinical outcomes for patients with COVID-19. In addition to polypharmacy being associated with an increased risk of contracting COVID-19, polypharmacy was linked with death among male COVID-19 patients, an increased rate of acute kidney injury, and adverse drug reactions, according to the findings. “I would say that the most surprising finding for me during this systematic review was that men and women’s risk profile for adverse COVID-19 outcomes associated with certain drug classes were slightly different,” said Iloanusi. Although non-cardiovascular polypharmacy was associated with adverse COVID-19 outcomes, Iloanusi said cardiovascular polypharmacy showed no such association. She said readers should interpret the findings cautiously, since the studies included in the review were observational in nature and did not control for comorbidities, which is a strong cofounder for polypharmacy. The adverse impact of polypharmacy on various diseases such as pneumonia and influenza is well-documented. “Our findings are consistent with already existing evidence on other diseases,” said Iloanusi. In the research paper, the study authors also point to the high prevalence of polypharmacy in long-term care facilities, noting one systematic review that reported polypharmacy in roughly 91% of patients. “In addition, vulnerable groups, especially older persons, are disproportionately affected by severe COVID-19 infection, as evidenced in the ravaging effect of the disease in [long-term care] facilities and among community-dwelling of older adults worldwide,” the authors write. Iloanusi said their study findings support deprescribing and medication optimization for COVID-19 patients to improve their health outcomes. Pharmacists are taught deprescribing skills as part of comprehensive medication management and review. According to a 2015 JAMA Internal Medicine article, deprescribing is the process of tapering or stopping drugs, aimed at minimizing polypharmacy and improving patient outcomes. A proposed deprescribing protocol is comprised of 5 steps: 1.Ascertain all drugs the patient is currently taking and the reasons for each one,2.Consider overall risk of drug-induced harm in individual patients in determining the required intensity of deprescribing intervention,3.Assess each drug in regard to its current or future benefit potential compared with current or future harm or burden potential,4.Prioritize drugs for discontinuation that have the lowest benefit-harm ratio and lowest likelihood of adverse withdrawal reactions or disease rebound syndromes, and5.Implement a discontinuation regimen and monitor patients closely for improvement in outcomes or onset of adverse effects. Deprescribing should be a shared decision-making process between patient and provider, and it needs to be communicated with other providers caring for the patient. The authors note in the review that it might be wise to incorporate deprescribing early on in the management of patients with COVID-19 to prevent further exacerbation of the disease. “Because increasing level of polypharmacy has been found to increase the risk of getting infected with COVID-19, prophylactically optimizing medication regimens for older adults and individuals with multimorbid conditions might help to lower their risk of getting infected with COVID-19,” study authors write.

Drug-related problems in older patients with advanced chronic kidney disease identified during pretransplant comprehensive geriatric assessment

BackgroundOlder patients with advanced chronic kidney disease may be exposed to a higher risk of adverse drug events due to chronic kidney disease and aging. The integration of clinical pharmacist into pretransplant comprehensive geriatric assessment is an opportunity to perform medication optimization. ObjectiveThe aim was to describe drug-related problems in older patients with advanced chronic kidney disease. MethodsObservational study was conducted with retrospective data from July 2017 to April 2019. Patients≥65 years with advanced chronic kidney disease, referred by nephrologists for pretransplant comprehensive geriatric assessment were included. During medication optimization, the pharmacist evaluated the appropriateness of each medication prescribed and identified drug-related problems. Any drug-related problem identified lead to a pharmaceutical intervention. ResultsIn total, 103 patients were included (74.5±2.9 years, 26.2% female, 47.6% on dialysis). Overall, 394 drug-related problems were identified in 93.2% of patients (3.8±2.4 drug-related problems per patient) during the medication optimization. Cardiovascular medications (25.1%), antithrombotics (13.5%) and drugs for peptic ulcer and reflux disease (10.2%) were the most involved drugs in drug-related problems. Drug-related problems mainly concerned drugs without indication (27.1%), inappropriate method of administration (24.4%) and non-conformity to guidelines (20.1%). ConclusionA high prevalence of drug-related problems in older patients with advanced chronic kidney disease was identified during medication optimization. The systematic integration of a clinical pharmacist in the multidisciplinary team performing pretransplant comprehensive geriatric assessment may be relevant to detect inappropriate prescriptions and to prevent from adverse drug events.

Medication use and dry eye symptoms: A large, hypothesis-free, population-based study in the Netherlands

PurposeTo date, population-based studies reporting associations between dry eye disease and medications were hypothesis-driven, did not take into account underlying comorbidities, and did not investigate individual drugs. The purpose of this study was to clarify the association of dry eye symptoms with medication classes and individual drugs, using a hypothesis-free approach. Methods79,606 participants (age 20–97 years, 59.2% female) from the population-based Lifelines cohort in the Netherlands were cross-sectionally assessed for dry eye symptoms using the Womens’ Health Study dry eye questionnaire. All medications used were coded with the ATC classification system. Logistic regression was used to assess the risk of the 59 most-used therapeutic/pharmacological subgroups and the 99 most-used individual drugs (all n > 200) on dry eye symptoms, correcting for age, sex, body mass index, and 48 comorbidities associated with dry eye. ResultsThirty-eight (64%) medication subgroups and fifty-two (53%) individual drugs were associated with dry eye symptoms (P < 0.05), after correction for age and sex only. A multivariable model correcting for comorbidities revealed highly significant associations between dry eye symptoms and drugs for peptic ulcer (particularly proton pump inhibitors (PPIs)), antiglaucoma and anticholinergic medications. ConclusionsThis study underlines that medication use is highly informative of risk of dry eye symptoms. Correction for underlying comorbidities is critical to avoid confounding effects. This study confirms suggested associations between medications and dry eye symptoms at a population level and shows several new associations. The novel link between PPIs and dry eye symptoms deserves particular attention given how commonly they are prescribed.

Genetic correlations between COVID-19 and a variety of traits and diseases

Genetic correlations between COVID-19 and a variety of traits and diseases

Management of primary immune thrombocytopenia in a real-world setting in Japan: eltrombopag versus corticosteroids.

This real-world study in Japan assessed the long-term safety of persistent use of eltrombopag compared to corticosteroids. Overall, 1887 patients with primary immune thrombocytopenia were included in the study cohort, based on hospital claims data. Eltrombopag was frequently used as a second- or third-line therapy (monotherapy: 13.1% and 25.7%; combination: 24.39% and 16.52%, respectively). The risk of bleeding was approximately 30% lower in the eltrombopag group (as monotherapy and in combination with other drugs including corticosteroids) than the corticosteroid group (hazard ratio, 0.66; 95% confidence interval, 0.45-0.96). Results from univariate and multivariate Cox models indicated that patients aged ≥ 60years, male patients and patients who received the drugs for peptic ulcer or gastroesophageal reflux disease have a higher risk of cerebral haemorrhage or gastrointestinal bleeding. Surgeries were more common among patients on corticosteroids compared to patients on eltrombopag (39.1% vs 34.6%, P = 0.004), while splenectomies were very rare. There was no significant difference in the costs of scheduled, emergency, or any type of hospitalisations between the exposure groups. The risk of infections, cataracts, and thrombosis did not differ between the exposure groups.

Use and prescription appropriateness of drugs for peptic ulcer and gastrooesophageal reflux disease in hospitalized older people.

The aims of this study were to assess the prevalence of use and prescription appropriateness of drugs for peptic ulcer and gastrooesophageal reflux disease (GERD) at hospital admission and discharge. Patients aged 65years or more hospitalized from 2010 to 2016 in 101 Italian internal medicine and geriatric wards in the context of the REPOSI register were scrutinized to assess if they were prescribed with drugs for peptic ulcer and GERD at hospital admission and discharge. Appropriateness of prescription was assessed considering the presence of specific conditions (i.e., history of peptic ulcer or gastrointestinal hemorrhages, advanced age, Helicobacter Pylori) or gastro-toxic drug combinations, according to the criteria provided by the reimbursement rules of the Agenzia Italiana del Farmaco (NOTA 1 and 48). Among 4715 enrolled patients, 3899 were discharged alive. At hospital discharge, 2412 (61.9%, 95%CI: 60.3-63.4%) patients were prescribed with drugs for peptic ulcer and GERD, a 12% of increase from hospital admission. Almost half of the patients (N = 1776, 45.6%, 95%CI: 44.0-47.1%) were inappropriately prescribed or not prescribed: among the drugs for peptic ulcer and GERD users, about 60% (1444/2412) were overprescribed, and among nonusers, 22% (332/1487) were underprescribed. Among patients newly prescribed at hospital discharge, 60% (392/668) were inappropriately prescribed. The appropriateness of drugs for peptic ulcer and GERD therapy decreased by 3% from hospital admission to discharge. Hospitalization missed the opportunity to improve the quality of prescription of this class of drug.

Schirmer test results: are they associated with topical or systemic medication?

PurposeTo test whether Schirmer test (ST) results are associated with topical or systemic medication and to evaluate the distribution of tear fluid quantity in a 3-min and 5-min ST. MethodsThe Gutenberg Health Study is a population-based, prospective, observational cohort study in Germany. ST was assessed in a sub-cohort of 1,999 participants. ST was performed under topical anesthesia for 5 min (ST-5) or of 3 min (ST-3). Anthropometric factors, systemic diseases, use of systemic and eye medications were recorded. We used multivariable quantile regression analysis to assess the influence on ST measurements. ResultsThe length of wetting of the Schirmer strips for ST-5 was 23.2 ± 9.31 mm for right and 22.9 ± 9.0 mm for left eyes. In ST-3, the measurements were 20.0 mm in right and 19.1 mm in left eyes. The clinical cut off of 10 mm for ST-5 corresponded with an 8 mm cut off for ST-3.There was an association of smaller ST-5 measures with male sex, higher age, socioeconomic status and season (all p < 0.001), but not with diabetes or smoking. The use of prostaglandin or beta-blocker eye drops or oral non-steroidal anti-inflammatory drugs, drugs for peptic ulcer and gastro-oesophageal reflux disease, thyroid hormones, progesterone and estrogen combination drugs, and hypnotics and sedatives showed an association with smaller ST-5. ConclusionsFor the first time we describe the distribution of tear fluid quantity by ST in a very large cohort of the general population. Furthermore, we found associations of ST measures with topical and systemic medication.

Drug utilisation study in surgery outpatient department at Ashwini Rural Medical College, Kumbhari, Solapur

Background: Drug utilization studies should be regularly conducted to increase therapeutic efficacy, decrease adverse effects and provide feedback to prescribers to promote the rational use of drugs. Systematic audit of prescriptions in Surgery Outpatient Department are very few in India. This study was conducted to study drug prescription pattern in Surgery Outpatient Department (OPD) in Ashwini Rural Medical College, Kumbhari.Methods: Six hundred prescriptions were screened and analyzed as per the study parameters at Surgery OPD of Ashwini Rural Medical College, Kumbhari. Study parameters like demographic profile of the patient like age, sex and diagnosis were recorded. Also groups of drugs commonly prescribed, number of drugs per patient, drug profile and drawbacks of prescription if any were recorded and analyzed. The percentage of the drugs prescribed by generic names and from the essential drug list was calculated.Results: Most common group of drugs prescribed by physicians were drugs for peptic ulcer (27.26%), followed by antimicrobials (20.89%). The average number of drugs prescribed per patient was 2.98. Drug prescription by generic name was low (8.82%). The incidence of polypharmacy was common occurrence and some prescriptions had small drawbacks like absence of diagnosis, absence of doctor’s signature, absence of patient age etc.Conclusions: Prescribing by generic name and from the essential drug lists should be encouraged. Training sessions on the correct method of writing prescriptions are needed.

Caution Ahead! Updated List Tracks Hazardous Drugs in Elderly

LOS ANGELES — The American Geriatrics Society (AGS) released a new version of the AGS Beers Criteria for Potentially Inappropriate Medication Use in Older Adults in early 2019, and care professionals immediately began poring over its updated recommendations — anything but an easy task. “The Beers list can be cumbersome and tedious to read. But we need to remember that [medication-related] adverse events are a serious situation,” especially in the geriatric population, said Vanessa J. Mandal, MD, MS, CMD, a geriatrician based near Sacramento, CA. Dr. Mandal updated colleagues about the new Beers Criteria (J Am Geriatr Soc 2019;67:674–694) at the annual meeting of the California Association of Long Term Care Medicine, which serves physicians, medical directors, nurses, pharmacists, administrators, and other professionals. Researchers estimated that tens of thousands of people in the United States die each year due to adverse medication-related events. The number could be as high as 106,000, making it the nation’s fourth-leading cause of death, the Food and Drug Administration has reported, and that number doesn’t take incidents at nursing homes into account (FDA, “Preventable Adverse Drug Reactions,” Mar. 6, 2018; http://bit.ly/307goCj). The newly updated Beers Criteria removes 25 medications for various reasons such as lack of current availability or adverse effects that are not unique to older adults (65 and older). Several drugs, however, have been added to the list. Dr. Mandal highlighted several drugs and medication classes that should be used with caution. Digoxin: Avoid this heart drug as a first-line treatment for atrial fibrillation or heart failure, and beware of multiple potential drug interactions. “If we see this is the only agent on board, it behooves us to contact the cardiologist to ask why this is the case,” Dr. Mandal said. “We also have to avoid doses greater than 0.125 mg. I don’t see it that much, but it still occurs and should be questioned. We need to be cautious not only because of its own effects but because of how it interacts with other medications.” Cilostazol: Avoid this vasodilator drug in any type of heart failure. “Generally, I don’t use this medication in older adults anymore,” Dr. Mandal said. “But we see it prescribed in patients from the hospital.” Aspirin: Note that the guidelines regarding aspirin’s use as primary protection against cardiovascular disease and colorectal cancer have changed. Now the Beers list says aspirin should be used for these purposes with “extra caution” starting at age 70, not 80. H2-receptor antagonists: The Beers list has updated recommendations regarding these drugs and no longer says they should be avoided in patients with dementia or cognitive impairment. But they should still be avoided in the context of delirium. Anticholinergics: The Beers Criteria include numerous drugs with anticholinergic properties that should be avoided. Two medications — the antihistamine pyrilamine (also known as mepyramine) and the peptic ulcer drug methscopolamine (Pamine) — are new to the list. Alpha blockers: Avoid doxazosin (Cardura), prazosin (Minipress), and terazosin (Hytrin) — all prostate enlargement/blood pressure medications — for hypertension due to risk of reduced blood flow to the brain. Antipsychotics: Do not use these drugs to control behavioral problems due to dementia or delirium. Instead, Dr. Mandal suggested, try alternative strategies that don’t involve drugs. Look for ideas, she said, by visiting the Nursing Home Toolkit (www.nursinghometoolkit.com), the Hospital Elder Life Program (www.hospitalelderlifeprogram.org), and Positive Approach to Care (www.teepasnow.com). Antidepressants: Avoid amitriptyline (Elavil), amoxapine, clomipramine (Anafranil), desipramine (Norpramin), doxepin (>6 mg/day), imipramine (Tofranil), nortriptyline (Pamelor), paroxetine (Paxil), protriptyline, and trimipramine (Surmontil), which are highly anticholinergic and sedating. Also according to new guidelines, avoid serotonin and norepinephrine reuptake inhibitors (SNRIs) such as duloxetine (Cymbalta) and venlafaxine (Effexor) in patients who have a history of falls or fractures. Benzodiazepines and Z drugs: Avoid these drugs except in certain situations because of their risk of dementia and cognitive impairment. On this front, “there’s a lot of awareness [of the risks] of anticholinergics and antipsychotics” Dr. Mandal said, but fewer people know about benzodiazepines and Z drugs such as several common types of sleeping pills. Sliding-scale insulin: Avoid the use of “insulin regimens that include only short- or rapid-acting insulin dosed according to current blood glucose levels without concurrent use of basal or long-acting insulin,” according to the new criteria. Opioids: Per the FDA’s black-box warning, avoid using opioids concurrently with benzodiazepines and gabapentinoids. Although the Beers list doesn’t provide rules, its guidelines are very helpful, Dr. Mandal said. “We can consider it a very useful tool for us to look at potentially avoidable adverse events.” Randy Dotinga is a San Diego-based freelance writer.

Drug utilisation study in medicine outpatient department at Ashwini Rural Medical College, Kumbhari, Solapur, India

Background: Drug utilization studies are used to analyze different aspects of the use of drugs and to implement methods of improving therapeutic quality. This study was conducted to study drug prescription pattern in Medicine Outpatient Department (OPD) in Ashwini Rural Medical College, Kumbhari. Methods: Six hundred prescriptions were screened &amp; analyzed as per the study parameters at Medicine OPD of Ashwini Rural Medical College, Kumbhari. Study parameters like demographic profile of the patient like age, sex and diagnosis were recorded. Doctor details and patient details like age, sex and address were analyzed. Also, groups of drugs commonly prescribed, number of drugs per patient, drug profile and drawbacks of prescription if any were recorded and analyzed.Results: Most common group of drugs prescribed by physicians were Analgesics (21.84%), followed by Drugs for Peptic ulcer (17.92%) and Multivitamins/multimineral (14.70%). The average number of drugs prescribed per patient was 2.38. The incidence of Polypharmacy was common occurrence and some prescriptions had small drawbacks like absence of diagnosis, absence of doctor’s signature, etc.Conclusions: Authors conclude that most of the prescriptions which were analyzed at Ashwini Rural Medical College Hospital, Kumbhari, were according to the standard norms of WHO prescriptions and also most of the drugs prescribed were from the list of essential drug list. But still there is scope for improvement in prescription pattern.