Higher Risk Of Adverse Effects Research Articles

Necrosis and Changes in Pigmentation Following Silver Nitrate Application: A Case Report.

Silver nitrate has useful antimicrobial and anti-inflammatory effects. However, there are currently no guidelines in place for its use in cauterization and the management of hemostasis. This lack of guidelines has resulted in different approaches being taken in outpatient and healthcare settings, which can lead to a higher risk of adverse effects. The authors present a case that illustrates a classic but exaggerated adverse effect following silver nitrate application.

Mesh-like External Suture Splint: A Way to Improve Results and Reduce Postoperative Complications after High-definition Liposculpture.

High-definition liposculpture with variable degrees of muscular definition allows both patients and surgeons to broaden the procedure to fit almost any individual preferences; however, skin laxity and those secondary cases still represent a big challenge for the surgeon to achieve optimal outcomes. We are reporting our experience with a new suture-splint procedure to reduce edema, avoid skin laxity, and increase muscular definition after liposculpture. We enrolled patients undergoing HDL with any risk factor that could compromise aesthetic outcomes. Tumescent technique with VASER fat emulsification and power-assisted liposuction were used to complete HDL. We performed a continuous suture over the midline and other areas of muscular definition right before patients awakened from anesthesia. Real-time ultrasound imaging was performed to ensure the safety of the procedure. A total of 52 consecutive patients were treated with MesHD in our study. Only two patients voluntarily dropped off from postoperative analysis due to geographical limitations. Postoperative edema was referred by only one patient after surgery. No major complications were reported. Three patients complained of stabbing pain over one of the stitches, which resolved completely after suture removal. All patients were satisfied with postoperative results. Mesh suture-splint at body areas with high risk of adverse effects after body contouring surgery may be an effective procedure to improve recovery by decreasing edema formation, enhancingmuscular definition, decreasing risk of fibrosis, and avoiding skin laxity postoperative appearance.

Allergic bronchopulmonary aspergillosis in a lung transplant recipient treated with mepolizumab

Allergic bronchopulmonary aspergillosis (ABPA) is a complex hypersensitivity reaction to Aspergillus spp. ABPA diagnosis may be challenging due to its non-specific presentation. Standard ABPA treatment consists of systemic corticosteroids and antifungal agents. Mepolizumab, a monoclonal antibody against interleukin-5 seems to be a promising treatment for ABPA. Data about ABPA following lung transplantation (LuTx) are scarce. LuTx recipients are at higher risk for adverse effects of ABPA treatment compared to the general population.Here we present a case of a LuTx recipient who was successfully treated with mepolizumab for ABPA following LuTx. Prolonged administration of high dose prednisone was thus avoided. To our knowledge, this is the first case describing mepolizumab administration following LuTx. Mepolizumab seems particularly attractive as a corticosteroid-sparing agent or as an alternative option to antifungal treatments, because of its excellent safety profile and low risk of drug interactions.

The red listed eagle owl (Bubo bubo) population in Norway is exposed to POP levels exceeding threshold values for adverse health effects

The eagle owl (Bubo bubo) population in Norway is today classified as critically endangered on the red list of endangered species. Because previous studies have detected high concentrations of Persistent Organic Pollutants (POPs) in birds of prey, concerns have been raised whether POPs exposure are a significant factor to the substantial decline of the eagle owl population.The aims of this study were to measure the levels of POPs in eagle owls and to assess whether POPs may represent a potential health risk. POPs were analysed in liver samples from 100 eagle owls collected between 1994 and 2014.The concentrations of POPs were generally very high and individual birds had levels among the highest measured worldwide. The contaminant groups analysed were highly correlated (p < 0.0001). The concentrations of sum of Polychlorinated Biphenyls (∑PCB) exceeded the threshold value from moderate to severe health risk in 90% of the birds. The birds with cachectic or lean body condition had significantly higher levels of contaminants than those with higher body condition scores. No significant temporal or spatial trends were noted.The lack of temporal trends, suggest that the downward trend of POPs, appear to be levelling off. The lack of differences between inland and coastal regions suggest that the risk of exposure may be comparable between predatory birds feeding in marine or terrestrial food webs. The significantly higher POPs levels detected in individuals with poor body condition may be due to reduced fat stores and thereby higher concentration in the remaining fat and/or the weight loss could be induced by toxic effects. The high proportion of birds exceeding the threshold values for severe and high risk of adverse effects, suggest that the high contamination load may reduce the eagle owl’s fitness and survival and, thus, contribute to decline of the eagle owl population.

SYSTEMIC CIVIL PROTECTION IN CONDITIONS OF LIMITED RESOURCES OF FIRE BRIGADE UNITS IN POLAND IN THE EVENT OF A PANDEMIC. EXAMPLE OF THE COVID-19 PANDEMIC IN POLAND

Ensuring an adequate level of security should be the responsibility of every civilised developedcountry. The overall functioning of the civil protection system depends on the efficiency of thedecision-making entities, which are entities of the public administration at various levels andthe executive entities such as fire protection units, the Police, the Armed Forces, the MedicalRescue System, etc. Each of the aforementioned institutions and organisations has at itsdisposal the resources that are necessary to maintain organisational capacity and to maintaincontinuity of operations. The COVID-19 pandemic had a significant impact on society, as wellas on administrative entities, organisations and institutions. Its impact created a very high riskof adverse effects that affected organisational resources. The aim of this article is to determinehow to systemically ensure the civil protection under conditions of limited institutional resourcesin the wake of the COVID-19 pandemic. Fire protection units, more specifically organisationalunits of the State Fire Service and volunteer fire services, were taken as an analytical basis. It wasinvestigated by means of empirical research, quantitative and qualitative research methods onhow the COVID-19 pandemic affected the resources of these fire protection units, in particular:human, financial, information and material resources. The results of the research were analysedand used to define guidelines and a system model of providing civil protection in conditions oflimited resources of fire protection units in Poland in the wake of the COVID-19 pandemic.

O04 Reintroducing pen and leaving quin-alone: examining the impact of a penicillin allergy de-labelling project on antibiotic prescribing in a hospital setting

Abstract Background The label of penicillin allergy is carried by between 8 and 25% of all patients (1). Alternative antibiotics may not be as efficacious, can be more expensive and lead to more adverse effects (2). Interrogation of a penicillin allergy is an important stewardship intervention considering only 1-10% of these patients are truly allergic to penicillin (1). The aim of this study was to investigate if a penicillin allergy de-labelling project altered antibiotics subsequently prescribed in a hospital setting. Methods A review was carried out of 75 patients identified as part of a penicillin allergy de-labelling project in Galway University Hospital over a 15 month period. Self-reported penicillin allergy by hospitalized patients was investigated and clarified by a collaboration from pharmacy, immunology and infectious diseases. Allergy labels were either reinforced, immediately de-labelled or further investigated with skin testing or oral challenge. Antibiotics prescribed prior to allergy de-labelling and following allergy clarification were noted. This information was obtained from the electronic hospital record. Results In total, 118 patients had penicillin allergy assessment. 75 patients had their penicillin allergy de-labelled. 44 patients were de-labelled from history, 22 were de-labelled after skin testing and oral challenge and 9 were de-labelled following an oral challenge only. 47 patients (63%) received penicillin post de-labelling. Out of these 47 patients, 27 had been previously treated with fluoroquinolones (57%), 4 had received teicoplanin surgical prophylaxis for surgical procedures (9%), 4 had received linezolid, 2 had received ceftazidime and 2 had been seemingly prescribed meropenem based on allergy. Conclusions These results demonstrate that appropriate de-labelling of penicillin allergy has a positive impact on future antibiotic prescription in a hospital setting. It results in reduced use of fluoroquinolones as well as other restricted antibiotics with higher risk of adverse effects and is a useful antimicrobial stewardship tool.

Efficacy and safety of steroids for chronic subdural hematoma: A systematic review and meta-analysis

Background: Chronic subdural hematoma (CSDH) is a condition characterized by the accumulation of fluid, blood, and blood breakdown products between the brain’s arachnoid and dura mater coverings. While steroids have been explored as a potential treatment option, their efficacy and safety remain uncertain. This meta-analysis and systematic review aimed to assess the impact of steroids on CSDH management, including mortality, recurrence, complications, and functional outcomes. Methods: We conducted a comprehensive literature search in major electronic databases up to June 2023, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and Cochrane Handbook for Systematic Reviews and Interventions. Inclusion criteria encompassed adult patients with CSDH, the use of steroids as monotherapy or adjuvant therapy, and clearly defined outcomes. Randomized controlled trials and cohort studies meeting these criteria were included in the study. Results: The initial search yielded 4315 articles, with 12 studies meeting the inclusion criteria. Our findings indicate a non-significant trend toward reduced mortality with steroids in combination with standard care (Odds ratios [OR] = 0.66, 95% confidence interval [CI] 0.20–2.18). However, substantial heterogeneity was observed (I2 = 70%). Sensitivity analysis, excluding influential studies, suggested a potential increased mortality risk associated with steroids (OR = 1.47, 95% CI 0.87–2.48). Steroids showed a possible benefit in reducing the recurrence of CSDH (OR = 0.58, 95% CI 0.20–1.67), but with significant heterogeneity (I2 = 89%). No clear advantage of steroids was observed in terms of functional outcomes at three months (modified Rankin scale scores). Furthermore, steroids were associated with a significantly higher incidence of adverse effects and complications (OR = 2.17, 95% CI 1.48–3.17). Conclusion: Steroids may have a potential role in reducing CSDH recurrence but do not appear to confer significant advantages in terms of mortality or functional outcomes. However, their use is associated with a higher risk of adverse effects and complications. Given the limitations of existing studies, further research is needed to refine the role of steroids in CSDH management, considering patient-specific factors and treatment protocols.

Differences between physician and patient preferences for cancer treatments: a systematic review

BackgroundShared decision-making is useful to facilitate cancer treatment decisions. However, it is difficult to make treatment decisions when physician and patient preferences are different. This review aimed to summarize and compare the preferences for cancer treatments between physicians and patients.MethodsA systematic literature search was conducted on PubMed, Embase, PsycINFO, CINAHL and Scopus. Studies elicited and compared preferences for cancer treatments between physicians and patients were included. Information about the study design and preference measuring attributes or questions were extracted. The available relative rank of every attribute in discrete choice experiment (DCE) studies and answers to preference measuring questions in non-DCE studies were summarized followed by a narrative synthesis to reflect the preference differences.ResultsOf 12,959 studies identified, 8290 were included in the title and abstract screening and 48 were included in the full text screening. Included 37 studies measured the preferences from six treatment-related aspects: health benefit, adverse effects, treatment process, cost, impact on quality of life, and provider qualification. The trade-off between health benefit and adverse effects was the main focus of the included studies. DCE studies showed patients gave a higher rank on health benefit and treatment process, while physicians gave a higher rank on adverse effects. Non-DCE studies suggested that patients were willing to take a higher risk of adverse effects or lower health benefit than physicians when accepting a treatment.ConclusionsPhysicians and patients had important preference differences for cancer treatment. More sufficient communication is needed in cancer treatment decision-making.

Efficacy and safety of baricitinib in patients with alopecia areata: evidence to date.

Alopecia areata (AA) is a chronic, tissue-specific autoimmune disorder, characterized by non-scaring hair loss, with a global prevalence of approximately 2%. Typically, it affects a young population, with initial onset frequently occurring before the age of 30 years. Even though the exact pathogenesis of AA remains unclear, the predominant hypothesis is the breakdown of immune privilege of the hair follicle, resulting in increased self-antigen and major histocompatibility complex expression in the follicular epithelium. The relapsing nature of the disease negatively impacts patients' quality of life and makes them more susceptible to developing psychiatric comorbidities. Although many treatment modalities have been proposed, there are no currently available treatments able to induce and sustain disease remission. Traditional treatment modalities, despite being widely used, present limited results and a high risk of adverse effects. Hence, there exists an unfulfilled requirement for treatments that are both more efficient and safer. The latest understanding of the pathophysiology of AA and its connection to the JAK-STAT pathway has prompted the advancement of JAK inhibitors. These small-molecule agents function by obstructing the JAK-STAT intracellular signalling pathway. Baricitinib an orally administered, selective JAK1 and JAK2 inhibitor is a promising alternative to the available treatments, and is already approved for the treatment of AA.

Pediatric multi-drug-resistant tuberculosis in Germany – diagnostic and therapeutic challenges of an “orphan disease”

Delay in diagnosing multidrug-resistant tuberculosis (MDR-pTB) in children prolongs time to effective treatment. Data on risk factors for pediatric MDR from low-incidence countries are scarce. Retrospective nationwide case–control study to analyze MDR-pTB cases in Germany between 2010 and 2020 in comparison to a drug-susceptible (DS)-pTB group. We included 52 MDR cases (24 tuberculosis (TB), 28 TB infection (TBI); mean age 7.3 years) and 56 DS cases (31 TB, 26 TBI; mean age 7.9 years). Groups were similar for sex, household size, and migration background. Compared to the DS group, more children with MDR were born in the Commonwealth of Independent States (CIS) (22% MDR-pTB vs. 13% DS-pTB, n.s.) and had more MDR index cases (94% MDR-pTB, 5% DS-pTB, p < 0.001). The interval between first healthcare contact and initiation of effective therapy was significantly longer in MDR-pTB (47 days) than in DS-pTB (11 days, p < 0.001), correlating with disease progression. Treatment for MDR-pTB was successful in 74%, but 22% experienced long-term adverse effects (e.g., hepatopathy, hearing loss).Conclusions: Close contact to MDR cases or birth in MDR-TB-high-incidence countries are risk factors for MDR-pTB. Early identification of potential MDR index cases by contact investigation, and susceptibility testing in children from high-burden MDR-TB countries are essential for timely diagnosis and treatment, reducing the severity of disease and treatment side effects.Trial Registration: Deutsches Register Klinischer Studien (https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00023817), DRKS00023817, 2020–09-08.What is Known:•Management of children with MDR-TB remains challenging due to difficulties in diagnosing MDR-TB (lack of information on MDR index case, lack of microbiological confirmation in paucibacillary disease).•Choice of treatment regimen and monitoring of side effects.What is New:•Children with an MDR-TB index or born in a MDR-TB-high-incidence country are at higher risk of developing MDR-TB in a low incidence country.•The time lag to initiate treatment in MDR-TB is longer than in DS-TB and MDR-TB treatment involves a higher risk of adverse effects in longer treatment regimens especially with injectables.

Genome-wide association study of treatment-related toxicity two years following radiotherapy for breast cancer

Background and purposeUp to a quarter of breast cancer patients treated by surgery and radiotherapy experience clinically significant toxicity. If patients at high risk of adverse effects could be identified at diagnosis, their treatment could be tailored accordingly. This study was designed to identify common single nucleotide polymorphisms (SNPs) associated with toxicity two years following whole breast radiotherapy. Materials and MethodsA genome-wide association study (GWAS) was performed in 1,640 breast cancer patients with complete SNP, clinical, treatment and toxicity data, recruited across 18 European and US centres into the prospective REQUITE cohort study. Toxicity data (CTCAE v4.0) were collected at baseline, end of radiotherapy, and annual follow-up. A total of 7,097,340 SNPs were tested for association with the residuals of toxicity endpoints, adjusted for clinical, treatment co-variates and population substructure. ResultsQuantile-quantile plots showed more associations with toxicity above the p < 5 × 10-5 level than expected by chance. Eight SNPs reached genome-wide significance. Nipple retraction grade ≥ 2 was associated with the rs188287402 variant (p = 2.80 × 10-8), breast oedema grade ≥ 2 with rs12657177 (p = 1.12 × 10-10), rs75912034 (p = 1.12 × 10-10), rs145328458 (p = 1.06 × 10-9) and rs61966612 (p = 1.23 × 10-9), induration grade ≥ 2 with rs77311050 (p = 2.54 × 10-8) and rs34063419 (p = 1.21 × 10-8), and arm lymphoedema grade ≥ 1 with rs643644 (p = 3.54 × 10-8). Heritability estimates across significant endpoints ranged from 25% to 39%. Our study did not replicate previously reported SNPs associated with breast radiation toxicity at the pre-specified significance level. ConclusionsThis GWAS for long-term breast radiation toxicity provides further evidence for significant association of common SNPs with distinct toxicity endpoints.

#6930 TOO ELDERLY FOR A KIDNEY BIOPSY?

Abstract Background and Aims As we age, we lose kidney function and accumulate risk factors and comorbidities that predispose to kidney damage. However, kidney disease can develop at any time. Life expectancy continues to improve worldwide. For that reason, more elderly patients are undergoing diagnostic kidney biopsies (KB). There is a general reluctance in performing KB in those patients. It is important to know if a diagnosis KB in elderly patients can have a positive therapeutic impact. Method In this retrospective cohort study, we analyzed the medical charts of all patients aged ≥ 80years who underwent a native kidney biopsy (KB) between January and December 2021, in a central hospital in Portugal. Results Between January and December 2021, 59 patients underwent a native KB, 6 of them over 80 years of age (10% of all patients). Between those elderly patients, the median age was 82 years. The indications for KB were chronic kidney disease with a nephrotic range proteinuria in 3 patients, nephrotic syndrome, acute glomerulonephritis and acute kidney injury in 1 patient each. Median serum creatinine was 2.27 mg/dL (minimum 0.8 and maximum 5.4 mg/dL) and median protein-to-creatinine ratio was 5.7g/g (minimum 3.3 and maximum 13g/g). The pathological diagnoses found were focal and segmental glomerulosclerosis (FSGS) (n=2), pauci-immune crescentic glomerulonephritis (n=1), membranous nephropathy in a patient with a follicular lymphoma (n=1), acute interstitial nephritis (AIN) (n=1), and diabetic glomerulosclerosis in a patient with a monoclonal gammopathy of undetermined significance (n=1). 3 patients have received a kidney-specific treatment – the patient with AIN started corticosteroids, one patient with FSGS was submitted to corticosteroids plus tacrolimus, and the patient with pauci-imune crescentic glomerulonephritis to corticosteroids plus rituximab. The patient with membranous nephropathy and follicular lymphoma received a specific chemotherapy regimen according with lymphoproliferative disease. An improvement in kidney function occurred only in one patient and the other three developed adverse effects (particularly corticosteroids induced diabetes and infections). One year later, one of patients who received treatment was dead, another one was on hemodialysis, and the other two patients had a glomerular filtration rate lower than 15mL/min/1.73 m2. Conclusion Elderly patients have a higher risk of adverse effects from the kidney-specific treatment. It is important to assess the therapeutic risk/benefit when considering performing a renal biopsy in these patients.

Are antidepressants effective in the treatment of depression in the elderly? A critical umbrella review on reviews, methods, and future perspectives

AbstractThe elderly are currently the most frequent users of antidepressants across ages, despite having a high risk of adverse effects (AEs). This literature review critically reviews the current evidence of the effectiveness of antidepressants and AEs in the elderly and discusses methodological limitations and future directions. Elements of Preferred Reporting Items for Systematic reviews and Meta‐Analyses and Population, Intervention, Control, and Outcomes guidelines were applied. Search in Scopus, PubMed, PsycInfo/Ovid, Cochrane Library, and Google Scholar for relevant systematic‐ and meta‐reviews on effectiveness and AEs studies. Ten reviews were identified and summarized within the last decade. Studies showed only modest superiorities to placebo in response rates if any, and only a few studies reached significant remission. Moreover, there was evidence of lower efficacy for patients over 65. AEs were common and problematic among the elderly in the studies reporting them. The evidence of the benefits of antidepressants in the elderly was weak and alternative treatments are advised. Despite the lack of clear evidence for the efficacy, UK National Institute for Health and Care Excellence guidelines have not incorporated separate recommendations for the elderly.

Improving tremor response to focused ultrasound thalamotomy.

MRI-guided high-intensity focused ultrasound thalamotomy is an incisionless therapy for essential tremor. To reduce adverse effects, the field has migrated to treating at 2 mm above the anterior commissure-posterior commissure plane. We perform MRI-guided high-intensity focused ultrasound with an advanced imaging targeting technique, four-tract tractography. Four-tract tractography uses diffusion tensor imaging to identify the critical white matter targets for tremor control, the decussating and non-decussating dentatorubrothalamic tracts, while the corticospinal tract and medial lemniscus are identified to be avoided. In some patients, four-tract tractography identified a risk of damaging the medial lemniscus or corticospinal tract if treated at 2 mm superior to the anterior commissure-posterior commissure plane. In these patients, we chose to target 1.2-1.5 mm superior to the anterior commissure-posterior commissure plane. In these patients, post-operative imaging revealed that the focused ultrasound lesion extended into the posterior subthalamic area. This study sought to determine if patients with focused ultrasound lesions that extend into the posterior subthalamic area have a differnce in tremor improvement than those without. Twenty essential tremor patients underwent MRI-guided high-intensity focused ultrasound and were retrospectively classified into two groups. Group 1 included patients with an extension of the thalamic-focused ultrasound lesion into the posterior subthalamic area. Group 2 included patients without extension of the thalamic-focused ultrasound lesion into the posterior subthalamic area. For each patient, the percent change in postural tremor, kinetic tremor and Archimedes spiral scores were calculated between baseline and a 3-month follow-up. Two-tailed Wilcoxon rank-sum tests were used to compare the improvement in tremor scores, the total number of sonications, thermal dose to achieve initial tremor response, and skull density ratio between groups. Group 1 had significantly greater postural, kinetic, and Archimedes spiral score percent improvement than Group 2 (P values: 5.41 × 10-5, 4.87 × 10-4, and 5.41 × 10-5, respectively). Group 1 also required significantly fewer total sonications to control the tremor and a significantly lower thermal dose to achieve tremor response (P values: 6.60 × 10-4 and 1.08 × 10-5, respectively). No significant group differences in skull density ratio were observed (P = 1.0). We do not advocate directly targeting the posterior subthalamic area with MRI-guided high-intensity focused ultrasound because the shape of the focused ultrasound lesion can result in a high risk of adverse effects. However, when focused ultrasound lesions naturally extend from the thalamus into the posterior subthalamic area, they provide greater tremor control than those that only involve the thalamus.

Nutritional behaviours and lifestyle before and during covid-19 pandemic: based on data from Polish and Turkish surveys.

Students are a group particularly high risk of adverse effects from such restrictions introduced within counter transmission the SARS-CoV-2 pandemic. Fear felt of contracting the disease and social isolation can lead to consuming excessive amounts of energy with food, resulting in weight gain and eating disorders. The aim of the study was analysed selected lifestyle aspects of Polish and Turkish students before and during the COVID-19 pandemic and to determine the existence of differences between the lifestyles of these individuals during the two periods. The study was conducted at the turn of 2020-2021 among 435 students, including 331 Polish and 104 Turkish students. The research instrument was an original questionnaire created in a Google Forms, consisting of metric and a proper part regarding lifestyle before and during the pandemic. Prior to the actual study, in order to verify whether the research tool is understandable, a pilot study was conducted, which included 40 individuals. The Wilcoxon test was used to examine the differences between the lifestyle of students before and during the pandemic. A value of p<0.05 was considered statistically significant. Both before and during the pandemic, most Polish students ate 4-5 meals daily (52.9% and 47.7%, respectively), while most Turkish students ate 3 meals (47.1% and 38.5%, respectively). There were statistically significant differences in: duration of sleep (p=0.001), way of spending one's leisure time (p=0.001) and type of physical activity (p=0.001) among the Polish and Turkish students before and during the pandemic. The results of this study showed changes in the lifestyle of both Polish and Turkish students during the pandemic compared to the pre-pandemic period. This indicates the need to develop interventions to prevent harmful behaviour and their health consequences in the future.

Complications in pregnancies achieved by assisted reproduction.

Pregnancies resulting from assisted reproductive technologies (ART) have been documented to have a higher risk of adverse effects. To provide evidence on obstetric and perinatal complications associated with conceptions by ART versus spontaneous pregnancies. Comprehensive review of original articles published between 2010 and 2018 addressing the more common obstetric and perinatal complications in pregnancies resulting from in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI), in comparison with spontaneous conceptions. Thirty-seven original articles, which reported on 26 cohort studies and 11 case-control trials, were included. IVF and ICSI conceptions were associated with a larger number of obstetric and perinatal complications such as low birth weight, prematurity, low weight for gestational age, admission to the neonatal intensive care unit, congenital malformations, C-sectionand premature rupture of membranes, among others. Pregnancies by ART are associated with an increased risk of obstetric and perinatal complications in comparison with spontaneous conceptions. Further research is needed to determine which aspects result in higher risk.

Knowledge, attitude, and practice towards COVID-19, among an elderly population in Sri Lanka: A cross-sectional study

Background: Elderly people are at high risk for adverse effects from SARS-CoV-2 infection. Therefore, to prevent and lower the fatality rate of COVID-19 among elderly people, determining the knowledge, attitude and practice of the elderly population towards COVID-19 is needed. Objectives: This study aimed to investigate the knowledge, attitude and practice (KAP) towards COVID-19, among an elderly population in Western province, Sri Lanka. Results: A descriptive cross-sectional study was conducted among 414 elderly persons in the Western province, Sri Lanka. Data were collected using a pre-tested, self-administered/interview-based questionnaire. SPSS version 26 was used for the analysis of the study. Among the total participants (n=414), most respondents (80.68%) had good knowledge regarding COVID-19. Most of the participants (76.81%) were in good attitude category regarding COVID-19. Regarding practices towards COVID-19, the majority of participants (87.19%) had a good practice level. Total knowledge level was significantly associated with attitude level p&lt;0.001 and practice level p&lt;0.001 towards COVID-19. Conclusion: Imparting knowledge, increasing good behavioral change, and strengthening preventive practices towards COVID-19 prevention is the best solution for pandemic control.

Comparison of the factors that influence the pattern of procurement and usage of antithrombotic drugs

Antithrombotics are used for many indications in prophylaxis and therapeutic treatment. It is often associated with a higher risk of adverse effects; hence a drug utilization evaluation is essential. The main aim was to describe the utilization of antithrombotic drugs. The specific objectives are to compare the pattern of procurement and usage of antithrombotic drugs, estimate the Defined Daily Dose (DDD), and to compare the usage of antithrombotic drugs with the WHO recommended standard. This was a retrospective study evaluating the utilization of antithrombotics at a public tertiary care hospital in the urban city of Klang Valley, Malaysia. A defined daily dose (DDD) per 1000 inhabitants/day was calculated to estimate patients with thromboembolic disorders receiving standard treatment on a daily basis. Expenditures on all antithrombotic drugs were also assessed. The DDD was examined for correlation with gender, race, and age group. Malaysian Clinical Practice Guideline on the Prevention and Treatment of Venous Thromboembolism was used as a tool to evaluate the quality of prescribing. During the study period, among anticoagulants prescribed, warfarin was the most commonly utilized for treatment and prophylaxis in various disciplines, with 1.82 DDD. Enoxaparin was the second most utilized anticoagulant, with 1.05 DDD, followed by tinzaparin, with 0.39 DDD. For antiplatelet drugs, acetylsalicylic acid was the most utilized antiplatelet with 8.5 DDD followed by clopidogrel (1.42 DDD) and ticlopidine (0.16 DDD). The utilization pattern for all the antithrombotic drugs was in accordance with the WHO DDD guidelines. The pattern of antithrombotic drug procured was based on the demand for the drug supplies. Age, gender, and race weredeterminant factors that influenced the choice of antithrombotic drugs and further affected the antithrombotic drug utilization pattern. Still, additional information regarding patient’s status and concomitant disease condition is needed to establish the impact of utilization of antithrombotics fully. DDD analysis is an excellent practice to be conducted at planned intervals. It is a tool to update the changing or even new pattern of drug usage, which will assist in the justification of rational use of drugs. The mean difference in terms of DDDs of the studied antithrombotic drugs impacts patient demographic characteristics, smokinghistory, presence of atherosclerotic diseases and peripheral artery diseases, comorbidity, patient compliance, and bleeding history. It is useful to evaluate trends and expenditures, which will ultimately avoid untoward adverse effects and unnecessary costs.

Evaluation of a Pharmacist-Driven Ambulatory Aspirin Deprescribing Protocol.

Recent guidelines indicate that aspirin affords less cardiovascular protection and greater bleeding risks in adults aged > 70 years. Deprescribing potentially inappropriate medications is particularly important in older adults, as this population experiences a high risk of adverse effects and polypharmacy. Limited data are available regarding targeted aspirin deprescribing approaches by pharmacists. The objective of this study was to implement and evaluate the success and feasibility of a pharmacist-led aspirin deprescribing protocol for older adults in a primary care setting. This prospective feasibility study in a US Department of Veterans Affairs ambulatory care pharmacy setting included patients aged ≥ 70 years with documented aspirin use. We reviewed 459 patient records and determined that 110 were eligible for deprescribing. A pharmacistinitiated telephone call was attempted for each eligible patient to discuss the risks and benefits of deprescribing aspirin. The primary outcome was the proportion of patients reached for whom aspirin was discontinued. Secondary outcomes included patient rationale for declining deprescribing and the time to complete the intervention. Of 94 patients reached, 45 (48%) agreed to aspirin deprescribing, 3 (3%) agreed to dose reduction, and 29 (31%) declined the intervention. An additional 17 (18%) had previously stopped aspirin, which led to a medication reconciliation intervention. Pharmacists spent about 2 minutes per record review and 12 minutes on each encounter, including documentation. Implementing a pharmacist-driven aspirin deprescribing protocol in a primary care setting led to the discontinuation of inappropriate aspirin prescribing in nearly half of older adults contacted. The protocol was well accepted by collaborating physicians and feasible for pharmacists to implement, with potential for further dissemination across primary care settings.

Bilateral erector spinae plane block vs quadratus lumborum block for pediatric postoperative pain management after laparoscopic abdominal surgery: a double blinded randomized study

Background: Postoperative pain management in children can be effectively controlled using regional analgesic techniques. In general, neuraxial blocks pose a higher risk of adverse effects and complications in comparison to peripheral nerve blocks. Recently, both quadratus lumborum block (QLB) and erector spinae plan block (ESPB) have been used to achieve adequate postoperative analgesia in children. We compared the efficacy of both in postoperative pain management after laparoscopic abdominal surgery.&#x0D; Methodology: Eight five patients with laparoscopic abdominal surgery received either bilateral QLB or ESPB at the level of T8 transverse process with 0.5 ml/kg of 0.25% bupivacaine to achieve adequate postoperative analgesia. FLACC score was used to assess pain score after surgery and the need for rescue opioid analgesia.&#x0D; Results: The average dose of fentanyl was lower and the time to the first dose of rescue analgesic was longer in QLB group when compared to ESPB group. In addition, FLACC scores were significantly lower in QLB group in comparison to ESPB group at the 6th, 8th, 12th and 20th h after surgery.&#x0D; Conclusion: Quadratus lumborum block can provide longer and more effective postoperative analgesia in pediatric patients following laparoscopic abdominal surgery in comparison to erector spinae plan block.&#x0D; Citation: Taman HI, Saber HIES, Farid AM, Elawady MM. Bilateral erector spinae plane block vs quadratus lumborum block for pediatric postoperative pain management after laparoscopic abdominal surgery: a double blinded randomized study. Anaesth. pain intensive care 2022;26(5):602-607; DOI: 10.35975/apic.v26i5.2017&#x0D;