Inadvertent Use Research Articles

Secondary Bacterial Infections in Critically Ill COVID-19 Patients Admitted in the Intensive Care Unit of a Tertiary Hospital in Romania.

Background: The outbreak of the COVID-19 pandemic caught healthcare systems in many countries unprepared. Shortages of personnel, medicines, disinfectants, and intensive care unit (ICU) capacities, combined with inadvertent use of antibiotics and emergence of drug-resistant secondary infections, led to a surge in COVID-19-related mortality. Objective: We aimed to evaluate the prevalence of secondary bacterial infections and the associated antibiotic resistance in a temporary established ICU dedicated to COVID-19 patients. We also assessed the utility of clinical and routine laboratory data as predictors of secondary infections and mortality in these patients. Methods: We examined the medical records of 243 patients admitted to the COVID-19 Medical Support Unit of Târgu Mures, Romania, between 1 August 2020 and 31 January 2021. Results: Among the 243 patients admitted to the COVID-19 Medical Support Unit of Târgu Mures between 1 August 2020 and 31 January 2021, 59 (24.3%) presented secondary infections. Acinetobacter baumannii and Klebsiella pneumoniae were the most frequent isolates (31.1% and 18.9%, respectively), most of them multidrug resistant. Chronic obstructive pulmonary disease had a higher prevalence in patients who developed secondary infections (p = 0.012). Secondary infections were associated with longer stay in the ICU and with higher mortality (p = 0.006 and p = 0.038, respectively). Conclusions: Early identification of secondary infections and proper use of antibiotics are necessary to limit the spread of multidrug-resistant microorganisms in COVID-19 patients admitted in the ICU.

Insight into efficient photocatalytic degradation of norfloxacin over a simple, economical biochar-based magnetic photocatalyst under solar illumination: a statistical and experimental approach.

The transformation of residual agricultural solid waste into an efficient value-added carbon product has been an ongoing strategy for solid waste management and a sustainable economy. Meanwhile, the upsurgence of antibiotic contamination in water bodies due to their inadvertent use poses a serious threat to human health and leads to antimicrobial resistance. Hence, to neutralize two evils in one stroke simultaneously, a simple, easy, and cost-effective pea shell-based magnetic photocatalyst (PSMC) has been synthesized and characterized by XRD (X-ray diffraction), VSM (vibrating sample magnetometer), XPS (X-ray photoelectron spectroscopy), TGA (thermogravimetric analysis), and FTIR (Fourier-transform infrared) spectroscopy techniques. Batch experimental studies revealed that PSMC efficiently eliminates norfloxacin (91.3%) within 180min from wastewater and mineralizes it into innocuous products at optimum parameters of norfloxacin concentration of 20mg/L, catalyst dosage of 15mg, and pH 3.5. Additionally, statistical parameters for the photodegradation of NX obtained from ANOVA by applying the Box-Behnken design are in close agreement with batch experiment parameters. PSMC has surplus advantages of facile recovery for recycling up to seven consecutive cycles by an external magnet and efficacy in natural solar light, making it cost-effective and economical. Radical scavenging studies revealed that O2•- and OH• were the potent reactive species in the photocatalytic degradation process.

7336 Decades In The Dark: The Long Road To Diagnosing And Treating Hypophosphatasia

Abstract Disclosure: V.A. Mendpara: None. G. Madrigal Loria: None. L.Z. Khan: None. Background: Hypophosphatasia (HPP) is a rare bone disorder that results from deficient activity of the tissue non-specific isoenzyme alkaline phosphatase (ALP).[1] This case highlights a patient whose diagnosis of this treatable genetic condition was significantly delayed for almost two decades, despite receiving care at a prominent academic institution. The patient's persistently low ALP levels in routine lab tests were overlooked by multiple clinicians, leading to a delay in her care and eventual treatment. Case presentation: A 61-year-old Caucasian woman presented at the endocrinology clinic with complaints of severe fatigue, generalized pain, multiple childhood fractures, and ongoing dental issues. The rheumatology clinic to which she was referred for polyarthralgia diagnosed her with Hypophosphatasia (HPP) after noting chronically low alkaline phosphatase (ALP) levels from her previous charts ranging from 15 to 24 U/L (normal range: 34 to 123 U/L) over two decades. Her serum calcium, parathyroid hormone (PTH), and 25-hydroxy vitamin D levels were within normal ranges. A DEXA scan revealed normal bone density, effectively ruling out osteoporosis. Further investigation showed elevated Vitamin B6 levels at 219.6 nmol/L (normal range: 20.0 to 125.0 nmol/L), raising suspicion for HPP. The patient's family history provided additional insight, with her mother having a history of short stature and fractures and her son experiencing premature tooth loss at the age of 2. A genetic evaluation identified a heterozygous pathogenic variant in the ALPL gene (c.881A>C, p.Asp294Ala), confirming the diagnosis of autosomal dominant HPP. Initiating treatment with Asfotase alfa, a medication targeting HPP, resulted in a marked improvement in the patient's symptoms. Discussion: This case shows the diagnostic complexities of HPP, stressing the significance of actively screening for this condition via ALP levels in routine laboratory testing or during osteoporosis evaluations. The diagnostic process is critical to distinguish HPP from primary osteoporosis, as treatment and potential risks differ significantly. Inadvertent use of bisphosphonates can worsen hypomineralization and lead to atypical femoral fractures in HPP patients. Asfotase alfa enzyme replacement therapy, available since 2015, offers a targeted approach by replacing the enzyme defect, thereby mitigating symptoms. Heightened awareness among healthcare providers of HPP in adults holds the potential to enhance diagnosis rates and facilitate improved treatment outcomes for this highly treatable condition.[1] Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism, Eighth Edition. ASBMR. Presentation: 6/2/2024

Dermoscopic Distinction of Tinea Incognito on the Face and Topical Steroid Damaged Face: A Cross-Sectional Study in Skin of Color

Abstract Background: Dermatophytosis is widespread in India due to recalcitrant and resistant infection. Tinea incognito (TI) is modified dermatophytosis due to the inadvertent use of topical steroids (TS). Similarly, topical steroid-damaged face (TSDF) is caused by prolonged use of TS. Distinction of TI and TSDF is difficult when the face is affected. Dermoscopy can assist in the differentiation of both by revealing characteristic features. We evaluated the dermoscopic features in TI affecting the face and TSDF. Aims and Objectives: To evaluate the clinical and dermoscopic features of TI affecting the face and TSDF. To observe the involvement of eyelids in TI as opposed to TSDF. Materials and Methods: The study was conducted in a tertiary hospital after obtaining ethical clearance and informed consent. Patients with signs of TI or TSDF were enrolled and demographic data were collected. Patients who had applied TS/combination creams were included. A handheld dermoscope with 10x magnification was used. A potassium hydroxide mount was used to confirm the diagnosis of TI. Results: Out of 80 patients, 27 males and 53 females were present. The mean duration of application was 8.25 ± 7 months. Clinical features were pruritus, erythema, scaling, and burning sensation. Eyelid involvement was noted in TI while it was spared in TSDF. On dermoscopy, morphological features were predominant in TI whereas vascular structures were found in TSDF in addition to white rosettes. Conclusion: Dermoscopy distinguishes TI from TSDF comprehensively by demonstrating definitive features. In addition, the involvement of the eyelid is an excellent clinical sign of TI.

The Public Health Risks of β-Hemolytic Bacillus pumilus Bacteria Resistant to Gastrointestinal Conditions from Medicinal Plant.

In numerous countries, the utilization of plants for both nutritional and therapeutic purposes is a common practice. However, the inadvertent use of these plants can pose risks due to their active molecules or microbiota. The traditional use of Herniaria glabra L. (H. glabra) plant in treating various diseases is well-known; however, its application in yogurt production raises concerns. In this study, Bacillus pumilus isolated from H. glabra was identified through 16s rRNA sequencing and MALDI-TOF MS (Matriks Assisted Lazer Desorption Ionization Time of Flight Massspectrometry). The bacterium's resistance under simulated gastrointestinal tract (GIT) conditions was assessed, followed by investigations into its aggregation ability, antibiotic resistance, hemolytic activity, and antagonistic potential through in vitro tests. The study revealed that B. pumilus exhibited 100% resistance to GIT conditions. Notably, the bacterium demonstrated strong autoaggregation (34.48%) and coaggregation abilities (49.82% for Escherichia coli, 49.13% for Listeria monocytogenes), signifying a potent aggregative potential. Sensitivity to most tested antibiotics was observed, while no antagonistic activity against tested bacteria was evident. Furthermore, the bacterium exhibited β-hemolytic activity, indicative of potential virulence. The findings suggest that this resistant yet virulent bacterium, with its hemolytic activity, could disrupt the GIT balance, posing serious health risks. The study underscores the need for caution and awareness regarding the potential dangers posed by bacteria in plant microbiota in herbal therapies.

Inadvertent use of topical clobetasol leads to skin hypopigmentation: A clinical image

An 18-year-old male presented to our outpatient department with a complaint of hypopigmented skin lesions with well-defined margins and peripheral inflammatory skin at the volar surface of the bilateral wrist and fingers symmetrically without peripheral skin inflammation for one month

Association between sleep quality and habits of electronic media use among young adults with different circadian typology

Background: Circadian preference refers to individual differences for mental and physical activity in the morning and evening. We hypothesized, that inadvertent use of electronic media can cause circadian misalignment that influences sleeping habits and sleep quality of young adults. Aims and Objectives: The aim of the study was to investigate the effect of circadian preferences on sleeping habits and the association of electronic media use with sleep quality and sleep disturbances. Materials and Methods: A total of 188 subjects were enrolled and divided into three groups: Evening, intermediate, and morning chronotype based on the Morningness-Eveningness score. Electronic media use at bedtime and duration of use were assessed subjectively. Sleep quality and subjective sleep disturbances, daytime sleepiness, and chronotype were assessed by the Pittsburgh Sleep Quality Index, Epworth Sleepiness Score, and Morningness-Eveningness Questionnaire Self-assessment version, respectively. Results: The majority of subjects with the evening chronotypes suffered from poor sleep quality compared to other chronotypes and the difference was statistically significant. In evening-type subjects, electronic media use at bedtime, long sleep latency, short sleep duration, and daytime sleepiness were significantly associated with poor sleep quality with odds ratios of 2.34 (1.08–5.08), 11.42 (4.98–26.19), 8.54 (1.01–68.24), and 1.68 (1.03–2.73), respectively. Conclusion: The majority of evening-type subjects had poor sleep quality, altered sleeping habits, and electronic media use at bedtime is significantly associated with poor sleep quality. Hence, history regarding sleep habits and lifestyle, especially electronic media use, should be taken from young adults, who are coming to the outpatient department for other than sleep disorders, to prevent the development of health-related problems.

Multiple Cutaneous Infections Secondary to Inadvertent Use of Systemic Steroids

Introduction: Steroids have a major role in the treatment of many dermatological disorders. This class of drugs is also one of the most frequently abused drugs, both by patients and doctors. Inadvertent use of steroids can cause a plethora of side effects. Methods: A 43-year-old male who presented to the dermatology outpatient department with complaints of generalized itching and hyperpigmented lesions on his glans was examined clinically. The patient was found to be a known case of pemphigus vulgaris who developed multiple cutaneous infections secondary to the inadvertent use of systemic steroids. Results: The case being presented shows multiple cutaneous infections, a side effect caused by systemic corticosteroids because of the immunosuppression they cause. Conclusion: The present case underscores the need to regulate the dispensing practices of not only corticosteroids but also all the drugs that are sold without the prescription of a registered medical practitioner.

Riddling Substitution of "hsa" to "has" in the Enigmatic MicroRNA Nomenclature.

This concise review and analysis offers an initial unpacking of a previously under-recognized issue within the microRNA research and communications field regarding the inadvertent use of "has" instead of "hsa" in article titles in the microRNA nomenclature. This subtle change, often the result of grammar auto correction tools, introduces considerable ambiguity and confusion among readers and researchers in reporting of microRNA-related discoveries. The impact of this issue cannot be underestimated, as precise and consistent nomenclature is vital for science communication and computational retrieval of relevant scientific literature and to advance science and innovation. We suggest that the recognition and correction of these often inadvertent "hsa" to "has" substitution errors are timely and important so as to ensure a higher level of accuracy throughout the writing and publication process in the microRNA field in particular. Doing so will also contribute to clarity and consistency in the field of microRNA research, ultimately improving scientific veracity, communication, and progress.

Antibiotic Prescribing Practices for Upper Respiratory Tract Infection Among Clinical Officers at Kiambu County

Background Antibiotics are the most prescribed medications worldwide. Global consumption rose by 65% in 76 low and middle-income countries between the years 2000 and 2015. According to the World Health Organization, improper administration of antibiotics occurs in over 60% of people with upper respiratory tract infections. Inadvertent antibiotic use has been identified as a contributor to antimicrobial resistance. Outpatient antibiotic use accounts for around 80-90% of all antibiotic use in patients. Clinical officers are non-physician healthcare workers who have received less training, have a more restricted scope of practice than physicians. Clinical officers are key service providers in this country especially at the primary healthcare level. Objective The study assessed the factors that influence antibiotic prescribing for upper respiratory tract infections by clinical officers. Method A prospective study was carried out at 20 public hospitals in Kiambu County, on 36 clinical officers and 600 patient prescriptions. The parameters measured were patient factors, prescriber factors, institutional factors and how they affected the antibiotic prescribing practices by either being rational or irrational. Rational prescribing was identified as prescribing the right drug, at the right frequency, in the right duration, right dose for the right indication. Prescriptions were considered irrational if they did not satisfy any of the rational indices. Data was collected via a questionnaire from the clinical officers while WHO prescription checklist was used to collect data from patient encounters. Data was analyzed using Statistical Package for Social Sciences version 22.0 (SPSS v22.0) with P-value, Confidence Interval and Odds Ratio. Results A total of 600 patient encounters were recorded and 79.8% of the 479 encounters had an antibiotic prescription for URTI, 91% of the antibiotics prescribed were the right dose, 98% had the right frequency, 75% had the right duration, and only 23% had the right indication. Patients above 65 years were more likely to receive an antibiotic prescription OR 3.98 CI 0.91,17.41 P=0.17 compared to children under 12 years old. Males were more likely to receive an antibiotic, but this was not significant OR 1.06 CI 0.70, 1.59 P=0.79. A total of 28 (4.6%) patients had fever, and all received antibiotics. A total of 36 clinical officers were sampled and only 5 (13.8%) were found to have rational prescriptions (P=0.63), prescriber age (P=0.92), prescriber level of education (P=0.99) and prescriber work experience (P=0.22) were not associated with antibiotic prescription. As per institutional factors, availability of antibiotics (P=0.026) and availability of prescription guidelines (P=0.012) were associated with rational prescription of antibiotics. Conclusion The study indicated that there was a high antibiotic prescription rate deviating from the WHO standard. It demonstrated that most antibiotic prescriptions were irrational.

COVID-19 Outbreak in a Neonatal Intensive Care Unit During Third Pandemic Wave: A Case Series

The case series aims to provide insights into the clinical presentation, diagnosis, management, and outcomes of neonates infected with COVID-19 during the third wave. We highlight the unusual clinical features, especially incessant cough even in extremely premature neonates, and the mode of horizontal transmission that led to this outbreak. A high index of suspicion and timely diagnosis of COVID-19 in neonates can help avoid the overdiagnosis of clinical sepsis and limit the inadvertent use of antibiotics. The report adds valuable information to the literature for clinicians caring for neonates during the ongoing COVID-19 pandemic.

Serotonin syndrome: An often-neglected medical emergency.

Optimum serotonin level in the serotonergic synapses of the central nervous system (CNS) is related to mood, behavior, and sleep. Serotonin syndrome (SS) is a rare yet very dangerous adverse effect resulting from increased serotonin in CNS. The diagnosis of SS is based on the presence of clinical symptoms, which can include agitation, confusion, rapid heart rate, high blood pressure, dilated pupils, muscle rigidity, tremors, sweating, and diarrhea. SS is invariably caused by inadvertent use of serotonergic medicines. There is an ever-growing list of medicines that are associated with the risk of SS. Some of the common classes of drugs that can contribute to the development of SS include selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, monoamine oxidase inhibitors, tricyclic antidepressants, stimulants (e.g., amphetamines and cocaine), lithium, opioids, drugs used for recreational purposes like ecstasy Methylenedioxymethamphetamine (MDMA), and some herbal supplements (e.g., St. John's Wort). SS can occur when these medications are taken alone or in combination, especially when a new medication is added, or the dose of an existing medication is changed. The management of SS typically involves discontinuing the use of the substance that caused the excess serotonin levels and providing supportive care, such as intravenous fluids and electrolytes. In severe cases, benzodiazepines may be used to control agitation and muscle rigidity, while serotonin antagonists, such as cyproheptadine, may be used to reduce serotonin levels. The literature review points to a general unawareness among physicians about the condition or drugs associated with it. Consequently, this potentially fatal condition is overlooked. There is a need for regular information updates and reminders to all those who prescribe medications to the patients.

Importance of the Internal Thoracic Artery as the Source of Collateral Circulation in CABG Patients with Leriche Syndrome.

In coronary artery bypass grafting (CABG) the use of the internal thoracic artery (ITA), is a Class I indication for the left anterior descending (LAD) artery. Atherosclerosis is a systemic disease, and peripheral arterial disease (PAD) is an important complicator of CABG, present in about one-third of the patients with coronary disease. In Leriche Syndrome, ITA can be the source of collateral circulation for arteries below the level of occlusion. Its inadvertent use can lead to serious ischemic complications in the dependent territories.

Heterotopias, Non-Places and Оther Chiasmi

This paper investigates the dichotomy between Dismaland, a dystopian inversion of Disneyland, and Disneyland as an enduring bastion of joyous illusion. Through the lenses of heterotopia, non-places, and chiasmus, it explores how their coexistence authentically grounds one while estranging the other. Banksy's inadvertent use of а chiastic structure in transforming Dismaland is analyzed for its reorganizational logic, and challenging norms. Drawing on Lefebvre, Foucault, Rancière, and Nikolchina, the paper examines cultural representations, spaces, and social relations. The analysis extends to non-places vs. heterotopias, emphasizing Dismaland's resistance to non-place classification. The paper advocates for heterotopias, like Dismaland, to challenge norms andfoster alternative cultural production, critiquing interpretations of Situationist theories and proposing Rancière's spatial occupation. The conclusion explores how chiastic structure and heterotopian thinking fuel Dismaland's revolutionary potential, challenging predetermined environments, and underscores art's transformative role in societal evolution towards a renewed existence.

The complete chloroplast genome of Aristolochia fangchi provided insights into the phylogeny and species identification of Aristolochia.

Aristolochia fangchi is an important species within the family Aristolochiaceae, most of which contain nephrotoxic aristolochic acid. The inadvertent use of Aristolochiaceae plants as raw ingredients in the manufacturing of patent medicine poses a significant risk warranting considerable attention. In this study, we assembled and analyzed the complete chloroplast genome of Aristolochia fangchi, which is a 159 867 bp long circular molecule. Functional annotation of the A. fangchi plastome unveiled a total of 113 genes, including 79 protein-coding genes, 30 tRNA genes, and 4 rRNA genes. Subsequently, a series of genome structure and characteristic evaluations were conducted against the A. fangchi plastome. Further phylogenetic analysis suggested that a plausible phylogenetic relationship among Aristolochiaceae derived from the concatenated sequences of shared conserved genes rather than from the entire chloroplast genome with one IR copy. Finally, a DNA polymorphism assessment against a dozen Aristolochia plastomes yielded multiple potential regions for biomarker designation. Six pairs of primers were generated and underwent both in silico and actual PCR validations. In conclusion, this study identified the unique characteristics of the A. fangchi plastome, providing invaluable insights for further investigations on species identification and the phylogeny evolution between A. fangchi and its related species.

Iatrogenic macular hole due to Nd:YAG-SLT laser: Case report and management: Nd:YAG-SLT laser iatrogenic macular hole.

To report a case of a patient who suffered a full thickness macular hole (FTMH) due to the accidental utilization of the selective laser trabeculoplasty (SLT) mode of a dual mode laser. Case report. A 69-year-old woman experienced vision loss in her left eye immediately after undergoing attempted Neodymium:yttrium-aluminum-garnet (Nd:YAG) capsulotomy using a Nd:YAG-SLT laser system. Post-injury visual acuity was 20/25 and 20/800 in the right and left eyes, respectively. Ophthalmic exam and multimodal imaging revealed multiple macular hemorrhages and an irregular FTMH. The patient required multiple surgeries including an autologous retinal transplant to achieve hole closure. Macular hole formation is a devastating consequence of inadvertent use of the SLT mode when performing a Nd:YAG laser capsulotomy with a Nd:YAG-SLT laser system. We emphasize the importance of ensuring the correct mode is selected for treatment to minimize the risk of retinal damage and permanent vision loss.

2230. Consumption of Quinolones, Macrolides, and Beta-Lactam Antibiotics at a Tertiary Care Veterans Affairs Medical Center (VAMC) during COVID-19 Pre-pandemic and Pandemic periods: A 4-year Analysis and Implications for Antimicrobial Stewardship

Abstract Background During the coronavirus disease 2019 (COVID-19) pandemic, antimicrobial use increased tremendously. Evidence suggests that the pandemic has resulted in an increased rate of AMR due to inadvertent antibiotic use. This likely reflects difficulties in distinguishing COVID-19 from community-acquired pneumonia when patients first arrive at a hospital. Strengthening antimicrobial stewardship (AMS) efforts by formulating policies for the use of antibiotics is crucial to prevent emergence of AMR. Methods A retrospective analysis to assess changes in antibiotic use during the pandemic and pre-pandemic patterns was done. Results : In the inpatient setting, there was an overall decrease in antibiotic use (all units that follow are in DOT/1000 BDOC) from an average of 380 to 300, vancomycin from 90 to 62, cefazolin from 30 to 17, Linezolid from 5 to 2, Zosyn from 57 to 30 from pre-pandemic period (Jan 2019) to pandemic period (Dec 2022). Antimicrobials that showed an increase during the pandemic included ceftriaxone from 70 to 82, Cefepime from 5 to 8, Levofloxacin from 2 to 5, and fluconazole from 4 to 10 compared to pre-pandemic use. In the outpatient settings (units are in fills/1000 unique patients), levofloxacin use doubled from 3 to 6, cefuroxime use increased from 0.5 to 2 and Azithromycin use dropped from 80 to < 20, with concomitant increase in doxycycline use from 45 to 60. Outpatient antibiotic prescriptions were high for levofloxacin, doxycycline and cefuroxime and increases corresponded to peaks in cases of COVID-19. Conclusion Our analysis demonstrates that COVID-19 had shifted the antibiotic consumption curve towards treatment of pneumonia and invasive fungal infections (in seriously ill patients) which has key implications for AMS. Implementation of stringent AMS and mandatory Infectious disease consultation for all COVID 19 infections helped keep our antibiotic consumption well below the national average and curtail AMR. Disclosures All Authors: No reported disclosures

The Study of Clinical Profile of Patients With Mucormycosis During COVID-19 Pandemic in Tertiary Care Hospital.

Mucormycosis has gained a huge number of cases in the second wave of post COVID-19 infection, which may be attributed to increased awareness, advancement in diagnostic techniques, and an increase in the prevalence of predisposing factors. This study evaluated the pattern, risk factors, and clinical profile of patients with mucormycosis during the second wave of the COVID-19 pandemic. A prospective observational study was conducted in the Department of Emergency Medicine of a dedicated tertiary care hospital for COVID-19. The Institutional Ethics Committee approved the study. One hundred five patients diagnosed with mucormycosis were included from June 2021 to December 2021. Informed consent was obtained from the patients. Data on demography, clinical features, predisposing factors, co-morbid conditions, and microbiological samples were obtained and analyzed. Out of 105 patients, 71 were male, and 34 were female. The patient presented with mucormycosis between the 2nd and 3rd week of post COVID-19 infection. Incidence was mainly seen in patients in their fifties, mostly associated with diabetes mellitus (DM) (53.30%), oxygen administration (80%), and previous use of steroids (45.71%). Predominantly, males were more affected.The most common presentation was headache (50.47%), orbital pain with restricted ocular movement (47.67%), proptosis (42.85%), and diminished vision (41.90%). Rhino-orbital-cerebral mucormycosis (ROCM) was themost common presentation of mucormycosis, while only five cases of pulmonary mucormycosis were found. ROCM was the most common presentation of mucormycosis between the second and thirdweek of post COVID-19 infection. Diabetes mellitus and inadvertent use of steroids were major predisposing factors. Therefore, a high degree of suspicion and early diagnosis with initiation of treatment is warranted in cases of mucormycosis in post COVID-19 infection.

Impact of European Union label changes to avoid inadvertent use of medicinal products containing methotrexate for once-weekly administration: A survey amongst prescribers, pharmacists and patients on awareness, knowledge, and behaviour.

To determine the effectiveness of risk minimisation measures (RMM) to avoid inadvertent daily instead of weekly methotrexate (MTX) use, introduced by the European Medicines Agency (EMA) from 2019 onwards. Using a cross-sectional online survey in France, Greece, Germany, Poland, and Sweden in 2022, we assessed awareness, knowledge, and self-declared behaviour for respondents who prescribed, dispensed, or used once-weekly MTX in the last 3 months. Respondents' answers were considered as 'successful' with regards to RMM effectiveness (vs. unsuccessful) if they provided correct ('desirable') responses to 100% of questions regarding awareness and self-declared behaviour and correct responses to ≥80% of questions about knowledge. Per target population, an outcome was considered successful if achieved by ≥80% of respondents. Effectiveness of RMM was defined by ≥80% being successful on all outcomes. One-hundred-fifty-one prescribers, 150 pharmacists, and 150 patients completed the survey. Success rates were 56% (95% CI 48.0%-64.3%) for awareness, 42% (95% CI 34.4%-50.7%) for knowledge, and 31% (95% CI 23.8%-39.2%) for self-declared behaviour among prescribers, 18% (95% CI 12.8%-25.8%) for awareness, 7% (95% CI 3.7%-12.7%) for knowledge, and 50% (95% CI 41.7%-58.3%) for self-declared behaviour among pharmacists, and 29% (95% CI 21.6%-36.6%) for awareness, and 3% (95% CI 1.1%-7.6%) for knowledge among patients. Overall success was not attained by any target population. RMM were evaluated as not effective across outcomes of awareness, knowledge, and self-declared behaviour in prescribers, pharmacists, and patients. Findings suggested we need continued efforts for RMM across all target populations and across all outcomes.

Risk factors for prevalence of retinopathy of prematurity in a tertiary care centre of North India

Background: The goal of the current study was to shed light on the risk factors responsible for the prevalance of ROP in infants born before 34 weeks of gestation or in infants born with birth weights under 2000 g admitted in NICU at a tertiary care hospital. Methods: This study was a hospital based prospective observational study conducted on 160 neonates after ethical clearance within a period of four months. The study population comprised of neonates less than 34 week of gestational age and with birth weight less than 2000 gm and gestational age between 34-36 weeks. All statistical analysis was done using appropriate statistical software like SPSS (Statistical Sciences Package for Social). Categorical / Nominal variables were indicated as number and percentage and were surveyed using Chi square test or Fischer exact test. Continuous variables were expressed as mean and standard deviation. Results: Among the 160 neonates screened, 30 neonates were found to have Retinopathy of prematurity, giving a rate of 18.8% for ROP. Among the 30 neonates with ROP, 10 (33.3%) delivered at gestational age <32 weeks, 12 (40%) had respiratory distress syndrome, 19 (63.3%) had sepsis, 23 (76.7%) required oxygen therapy, 5 (16.7%) received mechanical ventilation, 18 (60%) received blood transfusion, 17 (56.7%) had hypoglycemia. Other risk factors have been discussed in detail in the article. Conclusion: Prematurity, low birth weight, inadvertent use of oxygen therapy blood transfusion, sepsis and hypoglycemia were found to be significant risk factor for ROP.