History Of Medication Use Research Articles

REAÇÕES CUTÂNEAS GRAVES: UMA VISÃO ABRANGENTE SOBRE A SÍNDROME DE STEVENS-JOHNSON, SUA ETIOLOGIA, FISIOPATOLOGIA E ABORDAGENS TERAPÊUTICAS

Stevens-Johnson Syndrome (SJS) is a rare and severe condition characterized by epidermal detachment and mucosal lesions, primarily affecting the mouth, eyes, and genitals. Often triggered by adverse drug reactions, such as antibiotics and anticonvulsants, SJS can also be caused by viral infections and, rarely, neoplasms. SJS forms a spectrum with Toxic Epidermal Necrolysis (TEN), differing in the extent of skin involvement: in SJS, less than 10% of the body surface is affected, while in TEN, the involvement exceeds 30%. Although rare, with an incidence of 1.2 to 6 cases per million people, SJS carries high morbidity and mortality, leading to complications such as severe infections and permanent damage to the skin and mucous membranes. Early diagnosis is crucial, based on characteristic lesions and a recent history of medication use. In some cases, a biopsy is necessary to confirm the diagnosis. Treatment involves a multidisciplinary approach, including intensive care, immediate discontinuation of the causative drug, and immune modulation with corticosteroids or intravenous immunoglobulin. While new therapies, such as cyclosporine and special wound dressings, are being explored, there is still a need for consensus on the ideal treatment protocol, as well as advances in personalized diagnosis and treatment.

Use of electronic health record data to examine administrations of pro re nata analgesics during hip fracture post-acute care.

Medications prescribed to older adults in US skilled nursing facilities (SNF) and administrations of pro re nata (PRN) "as needed" medications are unobservable in Medicare insurance claims. There is an ongoing deficit in our understanding of medication use during post-acute care. Using SNF electronic health record (EHR) datasets, including medication orders and barcode medication administration records, we described patterns of PRN analgesic prescribing and administrations among SNF residents with hip fracture. Eligible participants resided in SNFs owned by 11 chains, had a diagnosis of hip fracture between January 1, 2018 to August 2, 2021, and received at least one administration of an analgesic medication in the 100 days after the hip fracture. We described the scheduling of analgesics, the proportion of available PRN doses administered, and the proportion of days with at least one PRN analgesic administration. Among 24 038 residents, 57.3% had orders for PRN acetaminophen, 67.4% PRN opioids, 4.2% PRN non-steroidal anti-inflammatory drugs, and 18.6% PRN combination products. The median proportion of available PRN doses administered per drug was 3%-50% and the median proportion of days where one or more doses of an ordered PRN analgesic was administered was 25%-75%. Results differed by analgesic class and the number of administrations ordered per day. EHRs can be leveraged to ascertain precise analgesic exposures during SNF stays. Future pharmacoepidemiology studies should consider linking SNF EHRs to insurance claims to construct a longitudinal history of medication use and healthcare utilization prior to and during episodes of SNF care.

The Epidemiology of Hospital-Treated Alopecia Areata in Denmark, 1995-2016.

Alopecia areata (AA) is an autoimmune skin disease presenting as nonscarring hair loss. Information on the epidemiology of AA, especially the occurrence of AA and its subtypes within the general population, is scarce. The study aimed to estimate the incidence rates and prevalence of hospital-treated AA and its subtypes in Denmark and to examine the demographic and clinical characteristics of patients with AA, including comorbidities and use of prescription medications. This was a cohort study based on data from administrative and health registers in Denmark in 1995-2016. The study included individuals who were (1) registered with a hospital inpatient or hospital-based outpatient clinic diagnosis of AA between 1995 and 2016 in the Danish National Patient Registry covering encounters at all Danish hospitals, (2) alive and resided in Denmark anytime between 1995 and 2016, (3) aged ≥ 12years, and (4) resided uninterrupted in Denmark during the 12months before the first AA diagnosis during the study period. During the study period, 2778 individuals with an incident hospital-based diagnosis of AA were identified; 63.1% were female and 28.7% of the patients were aged ≥ 50years. Over the study period, the overall incidence rate for any hospital-treated AA per 100,000 person-years was 2.62 (95% confidence interval [CI], 2.53-2.72), and the overall prevalence in 2016 was 71.7 (95%CI 69.4-74.1) per 100,000 persons. Both incidence rate and prevalence increased over time. Prevalence of most hospital-treated comorbidities or history of medication use was below 10% and was similar in the alopecia totalis (AT)/alopecia universalis (AU) and non-AT/AU subtypes of AA. This cohort study reported incidence rates and prevalence over time and characteristics of individuals with hospital-treated AA in Denmark, which are in agreement with those previously reported in this population.

Racial Differences in Bleeding Risk: An Ecological Epidemiological Study Comparing Korea and United Kingdom Subjects.

This study aimed to evaluate racial differences in bleeding incidence by conducting an ecological epidemiological study using data from Korea and the United Kingdom. We included healthy participants from the Korean National Health Insurance Service-Health Screening and the UK Biobank who underwent health examinations between 2006 and 2010 and had no comorbidities or history of medication use. Finally, 112,750 East Asians (50.7% men, mean age 52.6 years) and 210,995 Caucasians (44.7% men, mean age 55.0 years) were analyzed. The primary outcome was composed of intracranial hemorrhage (ICH) and bleeding from the gastrointestinal, respiratory, and genitourinary systems. During the follow-up, primary outcome events occurred in 2,110 East Asians and in 6,515 Caucasians. East Asians had a 38% lower 5-year incidence rate compared with Caucasians (3.88 vs. 6.29 per 1,000 person-years; incidence rate ratio [IRR]: 0.62, 95% confidence interval [CI]: 0.59-0.65). East Asians showed a lower incidence of major bleeding (IRR: 0.86, 95% CI: 0.81-0.91), bleeding from the gastrointestinal (IRR: 0.53, 95% CI: 0.49-0.56), and genitourinary systems (IRR: 0.49, 95% CI: 0.44-0.53) compared with Caucasians. The incidence rates of ICH (IRR: 3.20, 95% CI: 2.67-3.84) and bleeding from the respiratory system (IRR: 1.28, 95% CI: 1.11-1.47) were higher in East Asians. Notably, East Asians consuming alcohol ≥3 times/week showed a higher incidence of the primary outcome than Caucasians (IRR: 1.12, 95% CI: 1.01-1.25). This ecological study revealed significant racial differences in bleeding incidence, influenced by anatomical sites and lifestyle habits, underscoring the need for tailored approaches in bleeding management based on race.

Medication use and risk of amyotrophic lateral sclerosis: using machine learning for an exposome-wide screen of a large clinical database

Background Accumulating evidence suggests that non-genetic factors have important etiologic roles in amyotrophic lateral sclerosis (ALS), yet identification of specific culprit factors has been challenging. Many medications target biological pathways implicated in ALS pathogenesis, and screening large pharmacologic datasets for signals could greatly accelerate the identification of risk-modulating pharmacologic factors for ALS. Method We conducted a high-dimensional screening of patients’ history of medication use and ALS risk using an advanced machine learning approach based on gradient-boosted decision trees coupled with Bayesian model optimization and repeated data sampling. Clinical and medication dispensing data were obtained from a large Israeli health fund for 501 ALS cases and 4,998 matched controls using a lag period of 3 or 5 years prior to ALS diagnosis for ascertaining medication exposure. Results Of over 1,000 different medication classes, we identified 8 classes that were consistently associated with increased ALS risk across independently trained models, where most are indicated for control of symptoms implicated in ALS. Some suggestive protective effects were also observed, notably for vitamin E. Discussion Our results indicate that use of certain medications well before the typically recognized prodromal period was associated with ALS risk. This could result because these medications increase ALS risk or could indicate that ALS symptoms can manifest well before suggested prodromal periods. The results also provide further evidence that vitamin E may be a protective factor for ALS. Targeted studies should be performed to elucidate the possible pathophysiological mechanisms while providing insights for therapeutics design.

Safety evaluation of a buffer used in the lyophilization of canine platelets: type I hypersensitivity reaction in dogs caused by bovine serum albumin.

The present study was designed to evaluate the safety of substances generally used in the preparation of lyophilized platelet products (LPPs) because the possibility of an immune response to bovine serum albumin (BSA) was considered high when using previously described technology. An intradermal skin test, followed by a drug provocation test, was conducted to observe adverse events and identify the substances responsible for an immune response. Five male beagles (2 years old) weighing 12-14 kg were used. The dogs were clinically healthy and had no history of medication use. An intradermal skin test was conducted with each substance [i.e., 4-(2-hydroxyethyl)-1-piperazine ethanesulfonic acid, sodium chloride, potassium chloride, sodium bicarbonate, theophylline, trehalose, and BSA] used in the conventional freeze-dry method. In the intradermal skin test, three dogs tested positive at the BSA injection site and showed clinical signs after the intradermal injection, including nausea and vomiting. For the drug provocation test, all dogs received two intravenous injections of an LPP buffer solution. The initial injection was devoid of BSA, whereas the subsequent injection contained BSA. The three dogs that had reacted to BSA in the intradermal skin test exhibited adverse events such as lethargy, vomiting, and nausea immediately after intravenous injection of the LPP buffer containing BSA. All dogs recovered uneventfully after symptomatic treatment in both tests. The high incidence and severity of type I hypersensitivity reactions observed in this study suggested that BSA is unsuitable as a component of canine LPP.

Medication Deferrals in Blood Donors

Medication use is extremely common in blood donors. Blood centers use various methods to obtain a history of medication use, all of which have strengths and weaknesses. Some data are available to develop policies for medications that impact product quality, transmissible disease testing, and infectious risks. Many blood centers defer donors for use of a small number of highly teratogenic medications, as a precautionary measure. Others also defer for possible harms related to the pharmacologic effects of medications. However, a single exposure to a blood component containing medication, with immediate dilution in the recipient's blood stream, is a very different situation from ongoing use of medication in a patient, with steady state concentrations achieved over time. It is therefore highly unlikely that these effects are relevant for recipient safety.

Epidemiological parameters of multiple sclerosis in Chaharmahal and Bakhtiari Province, Iran.

Background: Multiple sclerosis (MS) is a neurological disease with a high burden and disability. There are reports of various medications' side effects on patients with MS. The aim of the study is to determine the characteristics and medicine usage distribution among patients with MS in Chaharmahal and Bakhtiari Province in Iran. Methods: This registry-based cross-sectional study was performed among MS cases in Chaharmahal and Bakhtiari Province. The epidemiological data were collected from the nationwide MS registry of Iran (NMSRI) from 2019 to 2022. The information collected included age, sex, family history, type of MS, age at MS onset and diagnosis, MS symptoms, physical condition, and history of medication use. All tests were performed at a significance level of 0.05 using SPSS software. Results: A total of 416 patients included in this study. Among them, 325 individuals (78%) were women with mean ± standard deviation (SD) of age of 37.35 ± 8.51 years. No significant difference was observed between men and women in terms of age, type of MS disease, family history of MS, and physical condition (P > 0.05). The results showed that the Expanded Disability Status Scale (EDSS) score in female patients (1.41) was different from the EDSS score in male patients (1.77) (P < 0.05). Most of the patients often used interferon beta (IFN-β). Conclusion: The results provided new insight into the epidemiology and medicine patterns of patients with MS in Chaharmahal and Bakhtiari Province. The epidemiological situation of MS in this province is similar to other parts of Iran. Planning according to national programs is suggested for the management and control of MS.

Radiographic Evaluation of Medication-Related Osteonecrosis of the Jaw (MRONJ) With Different Primary Cancers and Medication Therapies.

Medication-related osteonecrosis of the jaw (MRONJ) is a condition that affects the jaws and is characterized by exposed bone in the oral cavity that persists for more than eight weeks despite treatment. Additional criteria include that the patient should have a current or past history of antiresorptive drugsand/or in combination with antiangiogenic drugs, absence of metastasis, and no previous radiotherapy to the affected area. The radiographic features of MRONJ in most instances do not have any specific radiographic features. This is because standard radiographs usually show no stark abnormalities in the early stages of the disease. The study aimed to evaluate if any specific radiographic patterns are associated with primary cancers and between medications. The study is an observational case series. A total of 50 cases of possible osteonecrosisfrom June 2010 to June 2013 archives of the Department of Oral and Maxillofacial Radiology were assessed. Based on the history, 12 cases that had a history of medication use that could lead to medication-related osteonecrosis of the jaw (MRONJ) were selected. Cone beam computed tomography (CBCT) scans of these 12 cases were evaluated using the CBCT reconstruction program InVivo Dental version 6 (Anatomage Inc., San Jose, CA, USA). The number of areas showing sequestration, the pattern of osteonecrosis, and the extent were assessed. Primary cancer and the type of medication were also assessed to identify if certain cancers or drugs showed any distinctive pattern of osteonecrosis. Reconstructed panoramic images and true three-dimensional (3D) multi-planar images were assessed to study the condition. An oral and maxillofacial radiology resident in training and a board-certified oral and maxillofacial radiologist assessed the images. Radiographic findings varied among the 12 cases and included generalized sclerosis, osteosclerosis with widened periodontal ligament (PDL) space, bony sequestra, and bony necrosis. However, no specific or distinctive radiographic patterns were observed in any of the cases, regardless of the type of primary cancer or medication used. It is challenging to radiographically distinguish between MRONJ cases with different primary cancer and/or medication. Future studies should include evaluating larger samples with varying primary cancers and medications and combination drug therapies. Cases in an advanced stage of MRONJ do not have distinctive features due to extensive destruction and superimposed infection;it may be valuable to evaluate patients in the early stages of MRONJ to better understand distinguishing radiographic patterns specific to certain primary cancers or medications.

Use of spatial panel-data models to investigate factors related to incidence of end-stage renal disease: a nationwide longitudinal study in Taiwan

BackgroundThe assumptions of conventional spatial models cannot estimate the responses across space and over time. Here we propose new spatial panel data models to investigate the association between the risk factors and incidence of end-stage renal disease (ESRD).MethodsA longitudinal (panel data) study was conducted using data from the National Health Insurance Database in Taiwan. We developed an algorithm to identify the patient’s residence and estimate the ESRD rate in each township. Corresponding covariates, including patient comorbidities, history of medication use, and socio-environmental factors, were collected. Local Indicators of Spatial Association were used to describe local spatial clustering around an individual location. Moreover, a spatial panel data model was proposed to investigate the association between ESRD incidence and risk factors.ResultsIn total, 73,995 patients with ESRD were included in this study. The western region had a higher proportion of high incidence rates than the eastern region. The proportion of high incidence rates in the eastern areas increased over the years. We found that most “social environmental factors,” except average income and air pollution (PM 2.5 and PM10), had a significant influence on the incidence rate of ESRD when considering spatial dependences of response and explanatory variables. Receiving non-steroidal anti-inflammatory drugs and aminoglycosides within 90 days prior to ESRD had a significant positive effect on the ESRD incidence rate.ConclusionFuture comprehensive studies on townships located in higher-risk clusters of ESRD will help in designing healthcare policies for suitable action.

Glaucoma Characteristics and Influencing Factors during the COVID-19 Pandemic in the Huizhou Region.

Glaucoma in individuals who tested positive for the coronavirus disease 2019 (COVID-19) during the pandemic outbreak has not been comprehensively studied. Therefore, this study aimed to analyze the characteristics and risk factors of glaucoma during the COVID-19 pandemic in Huizhou. Retrospective data from outpatients with glaucoma at the Huizhou Hospital Affiliated with Guangzhou Medical University and Longmen County People's Hospital were collected during two periods: the COVID-19 pandemic period (Phase A: December 1, 2022, to January 19, 2023) and the prevention and control period (Phase B: December 1, 2021, to January 19, 2022). The demographic characteristics of the outpatients during both phases were compared. The characteristics of glaucoma in patients with COVID-19 during Phase A were examined. Multivariate logistic regression analysis was used to identify factors influencing the development of acute angle-closure glaucoma (AACG) in Phase A patients. The proportion of patients with glaucoma was significantly higher during Phase A than during Phase B at both hospitals. No statistically significant differences were observed between patients with glaucoma during Phases A and B for age, sex, and region. A high COVID-19-positive rate was associated with old age, females, AACG, newly diagnosed glaucoma, and binocular involvement during phase A. Females testing positive for COVID-19, glaucoma that started after testing positive for COVID-19, and a history of medication use were associated with a higher proportion of AACG in phase A. Multivariable logistic regression analysis identified testing positive for COVID-19 as an independent potential risk factor for developing AACG. In summary, during the COVID-19 pandemic in Huizhou, patients with COVID-19 were primarily affected by AACG, especially females, older individuals, and those with binocular involvement. Testing positive for COVID-19 increases the risk of developing AACG.

A cross-sectional study on demography, clinical presentation, knowledge, attitude, practice, and treatment seeking behavior among uncomplicated Plasmodium falciparum malaria patients at a tertiary care hospital in Eastern India

Background: Malaria continues to be a public health problem in India including Kolkata, West Bengal. Timely recognition of the symptoms of malaria, attending health-care facilities, prompt diagnosis and appropriate treatment can only prevent fatal outcome. Aims and Objectives: The aim of the study was to explore the knowledge, attitude, practice, and treatment seeking behavior of uncomplicated Plasmodium falciparum malaria patients attending a tertiary care hospital in Kolkata. Materials and Methods: This cross-sectional and observational study was conducted at a tertiary care hospital in Kolkata after receiving ethics committee approval. Each consecutive consented uncomplicated P. falciparum malaria patients of all age group and gender excluding sick patients, pregnant women, and infants were interviewed with a predesigned and pretested semi-structured questionnaire to elicit personal history, clinical complaints, knowledge, and awareness about malaria, preventive measures, and treatment seeking behavior along with history of medication use. Results: Out of total 112 study participants, majority were young (mean age 37.5 ± 13.41 years), 50.89% had no formal education, mostly engaged in small business (33.03%) or in manual labor. Majority (74.10%) used antipyretic and analgesics for fever and 51.78% consulted a local private physician first before attending government hospital which they usually prefer. Many (58.92%) knew mosquito as vector but only 7.14% regularly used mosquito bed nets. Use of antibiotics (barring antimalarials) was 11.60%. Conclusion: The study participants showed a good knowledge about malaria, its transmission, and clinical symptomatology but a mismatch with attitude and practice in disease prevention and treatment seeking behavior was noted. More awareness campaign should be conducted among general public to improve the same.

Use of gradient boosting machine for exposome-wide analyses: application for pharmaceutical risk factors for amyotrophic lateral sclerosis

Background Accumulating evidence suggests that human health is affected by a complex set of exposures, including to environmental toxicants, dietary constituents, psychosocial stressors, and physical factors. Capturing the complexity of the whole exposome is pivotal for advancing etiological knowledge, yet standard statistical methods, as well as recent developments for mixtures analysis, are limited to considering only a modest number of exposures and interactions while often also making the implicit assumption that the exposures are continuous. Machine learning approaches could offer benefits in these very high-dimensional settings. Method Using gradient boosted decision trees coupled with Bayesian model optimization and a nested cross-validation design, we describe an approach for outcome prediction based on a mixture of exposures, and for identification of specific culprit factors within the mixture that consistently drive the association while allowing for synergistic or antagonistic interactions between the predictors. While this flexible approach is applicable to many settings, we used it to evaluate the association between patients’ history of medication use and risk of amyotrophic lateral sclerosis (ALS), as a steppingstone for integrating additional exposures and in a setting that largely avoids exposure measurement errors that further complicate many toxicant mixtures. Results Of nearly 800 binary predictors, we identified 7 medication classes that were consistently associated with ALS risk across independently trained models. Interactions between medication groups did not substantially affect the risk. Prediction accuracy was consistent, but low due to the lack of information on other etiological risk factors for ALS. Summary The described methodology allows to predict the overall effect of a mixture and to identify specific culprit factors in very high dimensional settings and when both continuous and categorical exposures are of interest. While causal interpretation of purely predictive models should generally be avoided, the repeated sampling of the dataset has interesting causal inference implications.

Psychosocial Characteristics and Reporting Patterns of Women's Experiences With SSRI-Linked Sexual and Non-Sexual Side Effects

ABSTRACT Introduction A majority of women who use Selective Serotonin Reuptake Inhibitors (SSRIs) experience iatrogenic sexual dysfunction – primarily decreased arousal and desire (Lorenz et al., 2016). Experiencing SSRI-linked sexual side effects predicts decreased medication satisfaction and adherence, but few psychosocial factors have been identified that may increase risk of experiencing SSRI-linked side effects. Objective To describe characteristics of young women who report experiencing sexual versus non-sexual side effects linked with SSRI use. Methods 818 emerging adult women (mean age = 19.7, SD = 2.5) in the Southeastern and Midwestern United States reported their lifetime history of medication use (including SSRIs), mental health, unwanted sexual activity, and age of sexual debut. Those who reported ever using an SSRI medication indicated if they had ever experienced any of 20 possible SSRI-related effects, including sexual effects (e.g., desire changes, problems becoming aroused, problems having an orgasm, and increased pain during sex) and 16 non-sexual effects (e.g., weight gain, insomnia, emotional dulling). Linear logistic regression examined psychosocial predictors of reporting sexual versus non-sexual SSRI-linked side effects. Results 187 women (22.9% of sample) reported ever using an SSRI to manage mental health. Among the women who reported lifetime SSRI use, 89 (47.6%) reported experiencing at least one non-sexual side effect, while 45 (24.1%) reported experiencing at least one sexual side effect. Of those who reported that they experienced non-sexual side effects, 45 (50.6%) also reported one or more sexual effect. Every respondent who reported experiencing sexual effects also reported nonsexual effects – that is, nobody reported sexual side effects in the absence of nonsexual side effects. Respondents were 3.8x more likely to report sexual side effects if they ever experienced unwanted sex, p = .005; while mental health disorder history did not significantly predict sexual side effect reporting, p = .226. On the other hand, unwanted sexual experiences did not contribute to models predicting non-sexual effect reporting, p = .236; whereas mental health disorder history was a significant factor, linked with 1.76x increased odds for each positive screening of three possible psychiatric diagnoses, p = .016. Respondents’ age of sexual debut did not significantly contribute to predictions of sexual or non-sexual effects, ps = .813 and .709. Conclusions Among this sample of young women who used SSRIs, sexual and nonsexual side effect reporting was not unilaterally distributed; while non-sexual effects sometimes occurred independently from sexual effects, sexual effects always occurred in the presence of non-sexual effects. This finding raises important questions about whether sexual side effects might be mediated by other secondary effects, like fatigue or emotional dulling. Further, women's unwanted sexual experiences uniquely predicted increased likelihood of reporting sexual effects, whereas their mental health disorder history uniquely predicted increased odds of reporting non-sexual effects. Future directions include testing how patient-provider communication influences patient perception of side effects and how various unwanted sexual experiences (forced and coerced) may differentially impact women's risk of experiencing SSRI-linked side effects. Disclosure No

Differences in cardiometabolic risk profiles between Chinese and Finnish older adults with glucose impairment and central obesity

BackgroundObesity and ethnicity play important roles in cardiovascular complications in patients with type 2 diabetes mellitus (T2DM). This study aimed to compare cardiometabolic risk profiles between Chinese and Finnish older adults of central obesity with prediabetes or T2DM.MethodsStudy subjects were 60–74 years old and originated from two population samples. The Finnish subjects came from the Kuopio Ischemic Heart Disease (KIHD) study (n = 1089), and the Chinese subjects came from the Shanghai High-risk Diabetic Screen (SHiDS) study (n = 818). The KIHD and SHiDS studies used similar questionnaires to determine participants’ baseline characteristics regarding the history of medication use and diseases and lifestyle factors. All study subjects participated in glucose tolerance tests and anthropometry assessments, including waist circumference measurements.ResultsAmong study subjects of central obesity with prediabetes (n = 298), fasting and 2-h glucose, and fasting insulin and insulin resistance were significantly higher in Chinese than in Finnish (p < 0.0001–0.016). In addition, triglyceride (TG) level was higher and the low-density lipoprotein cholesterol (LDL) and LDL to high-density lipoprotein cholesterol (HDL) ratio were lower in Chinese than in Finnish (p < 0.0001–0.003). Among subjects of central obesity with T2DM (n = 251), Chinese subjects had significantly less proportions of antihypertensive, glycaemic control medication, and statin users as well as lower level of physical activity (p < 0.0001 for all), while higher blood pressure (p = 0.002 for systolic blood pressure and p < 0.0001 for diastolic blood pressure), TG levels (p < 0.05) and HDL (p = 0.002) than the Finnish counterparts. There were no differences in β-cell function (HOMA-β) between Chinese and Finnish both in prediabetes and T2DM.ConclusionsOur results indicated that Chinese and Finnish older adults of central obesity with prediabetes and T2DM had similar β-cell function. However, Chinese individuals with prediabetes are prone to insulin resistance. Meanwhile, lipid metabolism dysfunction is also different between Chinese and Finnish. Chinese older adults of central obesity with prediabetes showed higher TG, but Finnish showed higher LDL and LDL/HDL. Strategic for T2DM prevention and treatment should be ethnically specific.

Cryptogenic multifocal ulcerating stenosing enteritis and other under-recognised small bowel inflammatory enteropathies.

Capsule endoscopy and more sensitive radiological techniques have resulted in more enteropathies being detected. A rare disease of unknown aetiology, 'cryptogenic multifocal ulcerating stenosing enteritis' or 'chronic nonspecific multiple ulcers of the small intestine' (CNSU), has long been recognised. This review aims to describe how disease can be better diagnosed and differentiated from other small bowel inflammatory disorders. Genetic studies have shown that some patients with CNSU (the term used in Japanese studies) express SLCO2A1 gene mutations, a gene which encodes a prostaglandin transporter expressed on vascular endothelium, allowing a more specific diagnosis of 'chronic enteropathy associated with SLCO2A1'. Mutations in the PLA2G4A gene result in cytosolic phospholipase A2α deficiency and reduced arachidonic acid for prostaglandin synthesis leading to a severe ulcerating, stenosing and fistulating small bowel disease. A 'prostaglandin-related enteropathy' should be considered in patients with atypical small bowel ulceration and stenosis. Genetic analysis will allow the detection of SLCO2A1 and PLA2G4A gene mutations. However, a careful history of medication use and a urinary metabolite screen may reveal the use of nonsteroidal anti-inflammatory drugs, a common cause of small bowel injury which is well recognised as being mediated by prostaglandin inhibition.

Fever, Rash, Cytopenia, and Disseminated Intravascular Coagulation in a 6-year-old.

Fever, Rash, Cytopenia, and Disseminated Intravascular Coagulation in a 6-year-old.

Potentially harmful medication use and the associated factors among pregnant women visiting antenatal care clinics in Mbarara regional referral hospital, southwestern Uganda

Pregnancy management using medications has been challenging for both healthcare providers and pregnant women, given the fear of teratogenicity effects and the potential for fetal harm. In the developing world, poor health-seeking behavior of patients, delayed initiation of antenatal care (ANC), and low level of educational status of mothers could contribute to the issue of drug safety in pregnancy. The aim of the study was to determine the prevalence and factors associated with potentially harmful medication use in pregnancy. A cross-sectional study was conducted from April 1 to June 6, 2021, including 209 pregnant women on ANC follow-up at a referral hospital in Southwestern Uganda. The simple random sampling technique was employed to select study participants. Interviewer-administered questionnaires were used to collect the history of medication use since conception and then the participant's ANC card was reviewed to determine prescribed drug regimens and their indications. Statistical Package for the Social Sciences version 23.0 was used for analysis. Out of the 1,422 medications used by 209 women, 665 (42.2%) were category C, and 182 (11.5%) were category A. A total of 92 (44.0%) pregnant women used at least one potentially harmful medication during the current pregnancy. Having more than average monthly income (adjusted odds ratio [aOR] = 2.32 [1.04, 5.14 at 95% confidence interval (CI)]), having a chronic disease (aOR = 3.24 [1.17, 8.97 at 95% C.I]), using 7 and more medications (aOR = 9.12 [4.11, 20.24 at 95% CI]), and use of herbal medicines (aOR = 4.50 [2.10, 9.87 at 95% CI]) were shown to be risk factors. The proportion of pregnant women that used at least one potentially harmful medication is higher than in previous studies. Having comorbidities and taking more medications increase the risk of receiving a potentially harmful medication during pregnancy. This study identified the gaps in the use of medicines during pregnancy which will enable the development and implementation of protocols for optimizing prescribing practices in pregnant women by focusing on the safety of the fetus.

The Use of Over-the-Counter Sleep Aid Containing Diphenhydramine Hydrochloride Among Saudis.

BackgroundDiphenhydramine is a first-generation H1 receptor antihistamine that is usually used for the treatment of allergy, insect bites such as mosquitos, bee stings, and some types of skin rashes. However, it possesses antiparkinsonian, antitussive, antiemetic, and most importantly hypnotic properties. This study aimed to assess the prevalence, frequency of use, and dosage of over-the-counter (OTC) sleep aid containing diphenhydramine hydrochloride used among Saudis.Material and MethodsThe study used a descriptive cross-sectional design conducted among the Saudi population. An online self-administered questionnaire was distributed among the selected Saudi nationality using social media platforms. The subjects included were Saudis aged 15 years or older, literate in using social media. The questionnaire included basic demographic characteristics, previous and current history of medication use that contains diphenhydramine hydrochloride, its side effects, and other related behavior of using, such as frequency of use and dosage.ResultsA total of 414 respondents were recruited (51% males and 49% females). Previous and current use of medications that contain diphenhydramine hydrochloride constituted 87.2% and 31.9%, respectively. The most common reason for using sleep aid was insomnia (52.1%). Dizziness or imbalance was the most commonly reported side effect. The Chi-square test revealed that the age group of ≤25 years (p = 0.044), female gender (p = 0.040), being a student (p = 0.015), current use of sleeping aid medications (p < 0.001), and the use of other medications (p < 0.001) were significantly associated with increased use of sleep aid medications.ConclusionThe excessive use of over-the-counter (OTC) sleep aid medications containing diphenhydramine hydrochloride was widely prevalent among the Saudi population. Younger female students constitute the majority of OTC sleep aid medication users.

Cross-cultural adaptation to the Spanish version of the “Structured HIstory of Medication Use” questionnaire for medication reconciliation at admission

Background and objectiveThe “Structured HIstory of Medication Use” (SHIM) questionnaire is a tool developed to obtain an accurate pre-admission overview of medications, involving a structured interview with patients, and has demonstrated its potential to prevent reconciliation errors. The objective of this study was to cross-culturally adapt the SHIM questionnaire to Spanish. Patients and methodsForward and blind-back translations followed by a synthesis and adaptation, with the participation of an expert panel, to guarantee the equivalence between the original questionnaire and the Spanish version. Subsequently, pilot testing of the Spanish version was carried out through cognitive interviews in a sample of polymedicated patients under follow-up by the Department of Internal Medicine. ResultsThe Spanish version of the SHIM questionnaire (SHIM-e) was obtained. Scores for difficulty assigned by translators involved in forward and back translations were low. During the synthesis and adaptation phase, three discrepancies were resolved, and the expert panel decided to include some terms commonly used for clinical interviews in the Spanish version of the questionnaire. The pilot testing, which was performed in a sample of 10 polymedicated patients admitted to the Department of General and Digestive Surgery, showed 100% comprehensibility for all items, except for number 13, which was 90%. ConclusionsThis work presents the first cross-cultural adaptation to Spanish of the SHIM questionnaire. The forward and blind-back translations presented low difficulty and the results of the pilot testing showed a high level of comprehensibility for the Spanish version of this tool.