Longer Duration Of Use Research Articles

Karbamazepin Kullanan Hastalarda Serum Lipid Düzeylerinin Değerlendirilmesi

Epilepsy is a neurological disease that requires long-term drug therapy. Carbamazepine (CBZ) is a drug that is effective in partial seizures, including complex partial seizures, and tonic-clonic seizures. It was aimed to evaluate the effect on serum lipid profile in patients who used CBZ. Medical biochemistry laboratory data between January and December 2021 were analyzed retrospectively. Patients (n=59) who used monotherapy and at least 2 years of CBZ were included in the study. Patients under 18 years of age were not included. In the control group, 34 healthy people with normal blood parameters, who applied to outpatient clinics for different reasons at the same age, and did not have a disease that would affect the lipid profile, were selected. The mean age of the patients was 36 ±8 years. LDL-cholesterol levels were found to be higher in patients treated with carbamazepine compared to the control group (p<0.05). There was no significant difference in serum triglyceride (TG), and HDL-cholesterol levels in the patient and control groups (p>0.05). There was no gender difference in the effect of carbamazepine on LDL-cholesterol (p>0.05). High serum LDL-cholesterol levels cause atherosclerosis and coronary artery disease. The lipid profile of carbamazepine, which is used regularly at the therapeutic level, changes. Due to the association of high LDL-cholesterol levels with atherosclerosis, it is important to monitor lipid levels in patients using CBZ, especially considering the long duration of use of this pharmacotherapy.

Associations of Oral Contraceptive Use With Cardiovascular Disease and All-Cause Death: Evidence From the UK Biobank Cohort Study.

Background The associations of oral contraceptive (OC) use with cardiovascular disease (CVD) and all-cause death remains unclear. We aimed to determine the associations of OC use with incident CVD and all-cause death. Methods and Results This cohort study included 161 017 women who had no CVD at baseline and reported their OC use. We divided OC use into ever use and never use. Cox proportional hazard models were used to calculate hazard ratios and 95% CIs for cardiovascular outcomes and death. Overall, 131 131 (81.4%) of 161 017 participants reported OC use at baseline. The multivariable-adjusted hazard ratios for OC ever users versus never users were 0.92 (95% CI, 0.86-0.99) for all-cause death, 0.91 (95% CI, 0.87-0.96) for incident CVD events, 0.88 (95% CI, 0.81-0.95) for coronary heart disease,0.87 (95% CI, 0.76-0.99) for heart failure, and 0.92 (95% CI, 0.84-0.99) for atrial fibrillation. However, no significant associations of OC use with CVD death, myocardial infarction, or stroke were observed. Furthermore, the associations of OC use with CVD events were stronger among participants with longer durations of use (P for trend<0.001). Conclusions OC use was not associated with an increased risk of CVD events and all-cause death in women and may even produce an apparent net benefit. In addition, the beneficial effects appeared to be more apparent in participants with longer durations of use.

133-LB: Proof-of-Concept Study Results with a New Osmotic-Pressure–Based Continuous Glucose Sensor

Background: The Sencell sensor (Lifecare AS, Bergen, Norway) uses glucose induced changes in an osmotic pressure chamber for continuous measurement of glucose concentrations in the subcutaneous tissue. A close to linear correlation between the raw sensor signal and the glucose concentration and a very long duration of use (of up to 6-12 months or longer) are theoretically to be expected. The final device is planned to have the size of a grain of rice and to be implanted employing wireless energy and data transfer. Method: For a first clinical proof of concept study in humans, a wired version of the core sensing technology was embedded into a 4 mm needle and inserted into the abdominal subcutaneous tissue of healthy volunteers. The study was conducted to collect first human proof-of-concept performance data for algorithm development during meal experiments and for further device optimization. The raw data was analyzed after one-point calibration and minor trend correction in comparison to the Statstrip blood glucose meter and the Freestyle Libre 2 glucose sensor. Results: Seven participants (5 female, 2 male, age: 49±11 years) delivered a total of 105 direct comparator data-points (vs. Statstrip blood glucose meter) during repeated meal experiments with observation periods between 2 h and up to 72 days. The osmotic-pressure sensor followed glucose changes similar to the FreeStyle Libre device and reached an MARD of 9.8% in comparison to StatStrip (87 % and 13 % of the datapoints were lying in zones A and B of the consensus error grid, respectively). Conclusions: In this first human proof-of-concept study, the osmotic-pressure based continuous glucose sensor was shown to track s.c. glucose concentrations in a comparable manner as the Libre 2 needle sensor. The clinical performance characteristics of the first wired prototypes provide an encouraging perspective for the upcoming next development steps. Disclosure A. Pfützner: Consultant; Novo Nordisk A/S, Research Support; LifeScan Diabetes Institute, Speaker's Bureau; AstraZeneca, Stock/Shareholder; Lifecare A/S, Diakard. M. Hanna: None. N. Thomé: None. H. Jensch: None. Funding Lifecare AS (LIFC-SEN-001)

Evaluation of Inhaler Technique In COPD And Asthma Patients

Background: Asthma and COPD remain poorly controlled diseases that significantly affect the quality of life of patients. Inhalers are the main therapeutic options. Poor inhaler technique is a major factor that leads to poor clinical consequences, affecting the effectiveness of treatment and further control of symptoms. Aim of the Study: the present study aims at evaluating the inhaler technique and its clinical consequence in COPD and asthma patients .Patients and Methods: This is a cross sectional study of 70 patients, 35 with COPD and 35 with Asthma, who are already on inhaler drugs in their treatment. The use of inhaler was evaluated by a checklist that contains seven steps of inhaler use; by asking the patients to use their inhalers as usual, the correct or incorrect steps were recorded. The result of each patient checklist was correlated with the patient demographic parameters and level of control of his disease (COPD or asthma) by using COPD assessment test (CAT) or asthma control test (ACT) respectively. The Results: A total of 70 patients were enrolled in this study; 35 had COPD and 35 were asthmatic. The COPD patients were significantly older than asthmatic, mean age was 65.5 ± 5.8 (range: 55 – 75) years and 36.4 ± 13.9 (range: 16 – 65) years, respectively. (P. value &lt; 0.05). Males were dominant among COPD patients than asthmatic group; they contribute to 80% and 45.7%, respectively,(P. value &lt; 0.05). The level of education was not significantly different between the groups (P &gt; 0.05). Current smokers were significantly more frequent in COPD group than in asthmatic group, 40% vs. 14.3%, respectively. The duration of inhaler use was significantly longer in asthmatics than in the COPD group members; the mean duration of use was 5.2 ± 4.5 (range: 1 – 20) years in asthmatic compared to 2.4 ± 1.1 (range: 1 – 6) years in COPD group. Dry powder inhalers (DPI) were relatively more frequently used than metered dose inhalers (MDI) where DPI used by 51.4% and 54.3% in COPD and asthmatic group, respectively. The level of education of patients and longer duration of inhaler use correlate positively with good technique, while no significant correlation with other variables. Conclusion: A large proportion of the participants had a poor inhaler technique regardless of the type of disease and of inhaler (DPI or MDI). There was a positive correlation between proper use of inhaler and high educational level of patients and longer duration of use.

The Association Between Progestin Generation in Hormonal Contraceptives and Sociosexuality

Hormones are important for regulating women’s sexuality. Many women take hormonal contraceptives (HCs) which add synthetic hormones to women’s endocrine systems and disrupt the links between gonadal hormones and sexuality. Further, there are different types of HCs which may act differently. Whereas past research has combined all women using different types of HCs into a single comparison group, the present research explores how different methods of administration and different progestin generations may differentially affect women’s sociosexuality(SOI). 1024 female participants from 3 samples reported SOI using the revised sociosexuality inventory, HC status, method of administration, length of use, brand, and cycle information in an online survey. Results indicate that compared to women who were not using HCs, women who were using HCs containing 1st, 2nd, and 3rd generation progestins reported more unrestricted SOI attitudes. However only 2nd and 3rd generation progestin users had more unrestricted SOI attitudes than women not on HCs in the pre-luteal phases of their cycle (when sexual interest is naturally heightened). Lastly, evidence suggests that women return to ovulatory cycles after a year of using the hormonal IUD. We tested for time effects between pill using groups and IUD using groups and found an interaction such that longer duration of use on the IUD was associated with more unrestricted SOl attitudes, while oral contraceptive users did not differ in SOI independent of time using the method. Results highlight the need to understand the psychobiological processes affected by different variations of HCs.

Why intrauterine device (IUD) utilization is low in southwestern Ethiopia. A mixed-method study.

An intrauterine device (IUD) is a highly effective long-acting and reversible contraceptive method widely available around the world. However, only a small proportion of women in developing countries, including Ethiopia, are currently using the method. Therefore, this study aimed to identify why IUD utilization is low in southwestern Ethiopia. A mixed-method study involving health facilities and communities was conducted. The focus group discussions and key informant interviewees for the qualitative study were selected purposively, whereas 844 women family planning users were selected using systematic random sampling from November 1-30, 2020. Quantitative data was collected using Open Data Kit and analyzed using Stata version 16.0. Multivariable logistic regression analyses were done to identify significant factors influencing IUD use. The qualitative data were tape-recorded, transcribed, and finally, thematic analyses were done. A total of 784 participants were involved in the study yielding a response rate of 92.9%. Among all respondents, only 1.3%, 2.4%, and 30.0% had been using an IUD, preferred an IUD, and had the intention to use an IUD, respectively. The main reported barriers to use an IUD among qualitative participants were fear of side-effects, religious prohibitions of contraception use, husband disapproval, lack of training by health workers, misconceptions, and longer duration of use. IUD information (AOR = 2.19 [CI: 1.56-3.08]), and rich wealth status (AOR = 1.70 [CI: 1.13-2.56]) were associated with the intention to continue or start to use an IUD. IUD use and information on IUDs in the study area was very low. Information about IUDs, wealth status, and partner disapproval were determinant factors for intention to use an IUD. Thus, a regular awareness creation program using accessible media platforms by the government and stakeholders on IUD use is necessary to provide reliable information to the community and resolve misconceptions. In addition, women's empowerment to balance partner dominance on decision-making of contraception use and health care worker training on long-acting reversible contraceptives (LARCs) to increase access to LARC services are necessary to increase uptake of LARCs in general and of IUDs, in particular in the study regions.

Hormonal contraception & face processing: Examining face gender, androgenicity & treatment duration

Previous cross-sectional studies observed differences between users and non-users of combined oral contraceptives (COCs) in both the structure and function of the fusiform face area (FFA) related to face processing. For the present study 120 female participants performed high-resolution structural, as well as functional scans at rest, during face encoding and face recognition. Participants were either never-users of COCs (26), current first-time users of androgenic (29) or anti-androgenic COCs (23) or previous users of androgenic (21) or anti-androgenic COCs (21). Results suggest that associations between COC-use and face processing are modulated by androgenicity, but do not persist beyond the duration of COC use. The majority of findings concern the connectivity of the left FFA to the left supramarginal gyrus (SMG), which is a key region in cognitive empathy. While connectivity in anti-androgenic COC users differs from never users irrespective of the duration of COC use already at rest, connectivity in androgenic COC users decreases with longer duration of use during face recognition. Furthermore, longer duration of androgenic COC use was related to reduced identification accuracy, as well as increased connectivity of the left FFA to the right orbitofrontal cortex. Accordingly, the FFA and SMG emerge as promising ROIs for future randomized controlled trials on the effects of COC use on face processing.

Photo-responsive Zinc Oxide-coated alumina ceramic membrane with super-wettable and self-cleaning features fabricated by single step RF magnetron sputtering for oily water treatment

Zinc Oxide (ZnO) coated alumina ceramic membrane with super-wettable and photo-responsive self-cleaning features was fabricated by radio frequency (RF) magnetic sputtering, and used as a filtering medium in the dead-end filtration system for oily water treatment. The chemistry of the material in conjunction with the optimum surface roughness accomplish by RF magnetic sputtering rendered a unique surface wettability, favorable for water passing oil-in-water emulsion separation. The second desirable functionality of the membrane is its self-cleaning potential under light irradiation, owing to the efficient photo-catalytic property of ZnO. Oil-surface-air and water-surface-air interfacial contact angles for the membrane surface were measured using goniometer and they are close to 0° (superhydrophilic / superoleophillic in air), whereas under the water oil-surface-water interfacial contact angle switched to 158.70° (underwater superoleophobic). The oil-in-water emulsion separation efficiency, the water permeate flux were measured at different trans-membrane pressures, and oil concentrations in oily water emulsion, and the results showed that 99.9% oil-in-water emulsion separation efficiency was maintained for a range of trans-membrane pressure, and oil concentration for a long duration of use. The highest permeate flux rate and separation efficiency (%) of the fabricated Zinc oxide-coated alumina ceramic membrane were found to be ∼325 L/m2.h and 99.9%, respectively at 2 bar using surfactant stabilized oil-in-water emulsions as feed. However, the water flux declined with reduced trans-membrane pressure, increased oil concentration and with the long use of the membrane. The advantage of ZnO-coated alumina ceramic membrane is that it is water passing, and hence the oil clogging of the membrane is quite minimal. However, with the long use the membrane is prone to the deposition of oily contaminant on the membrane surface, which resulted in low water permeate flux, and this problem was resolved, and the original permeate flux was restored by routine self-cleaning of the membrane surface by illuminating light on the photo-catalytic ZnO film on the membrane surface. In addition to the wettability studies of the membrane, the structural, chemical and morphological characterizations of the material, and the coated membrane were carried out.

Hydrochlorothiazide use and risk of keratinocyte carcinoma and melanoma: A multisite population-based cohort study

The association between hydrochlorothiazide (HCTZ) and skin cancer remains controversial. To determine whether HCTZ is associated with an increased risk of skin cancer compared with angiotensin-converting enzyme inhibitors and calcium channel blockers. Two new-user, active comparator cohorts were assembled using 6 Canadian databases. Site-specific hazard ratios (HRs) with 95% CIs were estimated using standardized morbidity ratio weighted Cox proportional hazard models and pooled using random-effects meta-analysis. HCTZ was not associated with an overall increased risk of keratinocyte carcinoma compared with angiotensin-converting enzyme inhibitors or calcium channel blockers, although increased risks were observed with longer durations (≥10years; HR: 1.12; 95% CI: 1.03-1.21) and higher cumulative doses (≥100,000mg; HR: 1.49; 95% CI: 1.27-1.76). For melanoma, there was no association with angiotensin-converting enzyme inhibitors, but a 32% increased risk with calcium channel blockers (crude incidence rates: 64.2 vs 58.4 per 100,000 person-years; HR: 1.32; 95% CI: 1.19-1.46; estimated number needed to harm at 5years of follow-up: 1627 patients), with increased risks with longer durations and cumulative doses. Residual confounding due to the observational design. Increased risks of keratinocyte carcinoma and melanoma were observed with longer durations of use and higher cumulative doses of HCTZ.

Compliance to Topical Minoxidil and Reasons for Discontinuation among Patients with Androgenetic Alopecia.

This study assessed the levels of compliance to topical minoxidil (TM) among male and female patients with androgenetic alopecia (AGA) and analyzed the factors associated with minoxidil discontinuation. A retrospective study was conducted among 400 consecutive patients with AGA who presented to a dermatology clinic and who were prescribed minoxidil 2% or 5% in the past 5years. Demographic factors, other previous treatments, and minoxidil parameters including the dose (2% or 5%), total duration of use, treatment results, and side effects were collected. The mean age of the patients was 32.41years [standard deviation (SD) 8.18], and 66.5% were female. The majority of patients (82.5%) did not receive any previous treatment for AGA. Of the total patients, 345 (86.3%) have discontinued minoxidil. Discontinuation rate showed no association with sex (p = 0.271), age category (p = 0.069), or previous treatment (p = 0.530). Furthermore, the likelihood of minoxidil discontinuation decreased with the increase in treatment duration (p < 0.001) and was significantly lower among patients who reported improvement (69.3%) or stabilization of hair shedding (64.1%) compared with those who reported baby hair (88.9%) or no efficacy (95.3%) (p < 0.001). Furthermore, having experienced an adverse effect of minoxidil was associated with 93.6% discontinuation rate compared with 75.8% in the case of no side effects (p < 0.001). Adjusted analysis showed that minoxidil discontinuation was independently association with longer duration of use [> 1year; odds ratio (OR) 0.22; p < 0.001], perceived improvement (OR 0.17; p < 0.001) or stabilization (OR 0.14; p < 0.001), and the occurrence of side effects (OR 3.06; p = 0.002). The clinical use of TM in AGA is limited by a substantially low compliance even in absence of adverse effects. We emphasize the importance of educating patients regarding the treatment's side effects and the need to use minoxidil for a minimum of 12months to assess treatment efficacy.

Use of Chemical Hair Straighteners and Fecundability in a North American Preconception Cohort.

Chemical hair straighteners ("relaxers") are used by millions of North Americans, particularly women of color. Hair relaxers may contain endocrine-disrupting compounds, which can harm fertility. We evaluated the association between hair relaxer use and fecundability among 11,274 participants from Pregnancy Study Online (PRESTO), a North American preconception cohort study. During 2014-2022, participants completed a baseline questionnaire in which they reported their history of relaxer use and completed follow-up questionnaires every 8 weeks for 12 months or until pregnancy, whichever came first. We used multivariable-adjusted proportional probabilities regression models to estimate fecundability ratios (FRs) and 95% confidence intervals (CIs). Relative to never use, fecundability was lower among current (FR= 0.81, 95% CI: 0.64, 1.03) and former (FR= 0.89, 95% CI: 0.81, 0.98) users of hair relaxers. FRs for first use of hair relaxers at ages <10, 10-19, and ≥20 years were 0.73 (95% CI: 0.55, 0.96), 0.93 (95% CI: 0.83, 1.04), and 0.85 (95% CI: 0.74, 0.98), respectively. Fecundability was lowest among those with longer durations of use (≥10 years vs. never: FR= 0.71, 95% CI: 0.54, 0.91) and more frequent use (≥5 times/year vs. never: FR= 0.82, 95% CI: 0.60, 1.11), but associations were nonmonotonic. In this preconception cohort study, use of chemical hair straighteners was associated with slightly reduced fecundability.

The Cumulative Use of Muscle Relaxants and the Risk of Alzheimer's Disease: A Nationwide Case-Control Study.

Use of pharmacological treatments is one possible modifiable risk factor for cognitive disorders. To investigate if the use of muscle relaxants is associated with the risk of Alzheimer's disease (AD). The study was performed in a nested case-control design. Altogether 70,718 community-dwelling residents of Finland who received AD diagnosis in 2005-2011 were included as cases (the MEDALZ study). Each case was matched with four controls without AD by age, sex, and region of residence (N = 282,858). Data was extracted from Prescription register (1995-2012), Special Reimbursement register (1972-2012), and Hospital Discharge register (1972-2012). Drug use periods were modeled with PRE2DUP-method. Defined daily dose (DDD) was used to quantify the use. Analyses were conducted for any muscle relaxant use, and drug specific analyses were done for orphenadrine and tizanidine. A five-year lag window prior to the diagnosis was used, and results analyzed with conditional logistic regression. The use of any muscle relaxant was associated with the risk of AD, aOR (95% CI) 1.04 (1.02-1.07). Stronger associations were observed with longer use (>366 days, aOR 1.12 (1.03-1.21)) than shorter use (1-365 days aOR, 1.04 (1.02-1.06)) compared to non-users. Dose-response was not observed. Tizanidine was not associated with AD, whereas cumulative exposure of orphenadrine (≥101 DDDs) was associated with the risk of AD, aOR 1.19 (1.07-1.32). Muscle relaxant use was associated with the risk of AD and higher exposure to orphenadrine showed increased risk. Further studies on higher doses and longer durations of use are warranted.

Sodium-glucose cotransporter 2 (SGLT2) inhibitors and non-small cell lung cancer survival.

Sodium-glucose cotransporter 2 (SGLT2) inhibitors are a relatively new class of antidiabetic drugs with demonstrated renal and cardiovascular disease benefit. This study evaluates the role of SGLT2 inhibitors on the survival of non-small cell lung cancer (NSCLC) patients. We used National Surveillance, Epidemiology and End Results (SEER)-Medicare linked data. Twenty four thousand nine hundred fifteen NSCLC patients newly diagnosed between 2014 and 2017 with pre-exiting diabetes and aged 66 years or older were included and followed to the end of 2019. Information on SGLT2 inhibitors use was extracted from the Medicare Part D file. SGLT2 inhibitor use was associated with significantly reduced mortality risk after adjusting for potential confounders (HR = 0.68, 95% CI = 0.60-0.77) with stronger association for longer duration of use (HR = 0.54, 85% CI = 0.44-0.68). Further, we found that SGLT2 inhibitor use was associated with a significant reduced risk of mortality regardless of patients' demographic, tumour characteristics and cancer treatments. Our large SEER-Medicare linked data study indicates that SGLT2 inhibitors use was associated with improved overall survival of NSCLC patients with pre-existing diabetes. Further studies are needed to confirm our findings and elucidate the possible mechanisms behind the association.

Maintenance Proton Pump Inhibitor Use Associated with Increased All-Cause and Cause-Specific Mortality in Sweden

BackgroundProton pump inhibitor (PPI) use has increased over the last decades and has been associated with multiple adverse events and potentially even overall survival.AimsWe aimed to investigate the association between proton pump inhibitor maintenance use and all-cause and cause-specific mortality, addressing confounding by indication and duration of use.MethodsThis Swedish population-based cohort study included all adult (N = 935,236) PPI and histamine-2 receptor antagonist maintenance users (≥ 180 days use) during 2005–2014. Standardised mortality ratios (SMRs) and 95% confidence intervals were calculated for all-cause and cause-specific mortality comparing the risk among PPI/H2RA users to that of the Swedish background population, stratified by age, sex, calendar period, indication and duration of use. Multivariable Poisson regression models were used to compare PPI use to H2RA use, expressed as incidence rate ratios and 95% confidence intervals.ResultsPPI and histamine-2 receptor antagonist use were associated with an increased risk of all-cause mortality (SMR = 1.35; 1.34–1.36; SMR = 1.31; 1.27–1.36, respectively). The highest SMRs were found in the youngest age groups. In direct comparison, PPI use showed a higher mortality risk than histamine-2 receptor antagonist use (incidence rate ratios = 1.42; 1.38–1.46). PPIs were related to increased cancer (SMR = 1.21; 1.20–1.22), and cardiovascular mortality (SMR = 1.36; 1.35–1.37). Increased SMRs were observed for most indications. Longer duration of use was associated with a higher mortality among PPI users but not among histamine-2 receptor antagonist users.ConclusionMaintenance PPI use was associated with an increased risk of all-cause and cause-specific mortality, and the risk increased with prolonged duration.

Feral pig (Sus scrofa) activity and landscape feature revisitation across four sites in eastern Australia

Quantifying feral pig movements and understanding the fine-scale ecological drivers of feral pig landscape use are important factors for optimising pest management programs. We tracked 59 GPS-collared feral pigs at four sites in eastern Australia between 2017 and 2021, for a mean of 375 ± 277 (s.d.) days. The mean number of successful GPS fixes was 15 577 ± 11 833 (s.d.) and these were recorded at 30-min intervals. We calculated mean hourly and daily distances travelled to determine feral pig activity and investigated the influence of sex, site, season and time of day on this activity. We also investigated the proximity of highly active sites to habitat covariates, along with intensity and frequency of site use. Male daily movement, 4.9 km (95% CI = 4.2, 5.6 km), was significantly greater than it was for females, 3.6 km (95% CI = 3.0, 4.1 km) and males maintained a high level of activity all night, while female activity was predominantly crepuscular. Study site was a significant determinant of daily movement, but season was not, across either sex or site. Highly-visited site selection was negatively associated with distance from creeks, dams, cultivation, open herbaceous vegetation and medium woody vegetation. Both medium woody vegetation and dam sites had the longest duration of use (3 and 2.7 h respectively) and the shortest time between visitations (14.5 and 13 h respectively). Quantifying feral pig activity and key habitat feature preference are important steps in improving management programs. Better prediction of feral pig movement and behaviour allows for more targeted placement of control tools, potentially increasing encounter rates.

PATTERNS OF METHAMPHETAMINE USE AND ITS ASSOCIATIONS WITH PSYCHIATRIC SYMPTOMS IN PATIENTS UPON ADMISSION AT THE NATIONAL REHABILITATION CENTER LIDO BOGOR, INDONESIA

Objective: Methamphetamine (MA) is a substance that is heavily abused worldwide. This present study aimed to investigate the association between the patterns of methamphetamine use and psychiatric symptoms in patients upon admission at The National Rehabilitation Center, Lido Bogor.&#x0D; Methods: This was a cross-sectional study of MA abusers during the period of January 2016–December 2018 at The National Rehabilitation Center, Lido, Bogor. This study was done by assessing medical records. The inclusion criteria were MA abusers at the age of 18 y and above. Assessment of psychiatric symptoms was evaluated using Addiction Severity Index (ASI). Microsoft Excel and SPSS version 22.0 were used to process the data.&#x0D; Results: The inclusion criteria were fulfilled by 1842 MA abusers. We found that 770 (41.8%) of MA abusers were assessed with psychiatric symptoms according to ASI. Depression was the most prevalent psychiatric symptom (31.9%), followed by anxiety (24.5%), and psychosis (8.9%). According to the results of multivariate analysis, the demographic profile and the mode of MA administration that are associated with the psychiatric symptoms were: female [odds ratio (OR): 1.95; 95% confidence interval (CI): 1.25–2.96, p&lt;0.001], 5-year duration of use [OR 1.43; 95% CI: 1.43 (1.19–1.73), p&lt;0.001], smoking as the route of administration [OR 1.3; 95% CI: 1.08–1.56, p&lt;0.001, p = 0.006], and concomitant use with other narcotics [OR 1.76; 95% CI: 1.46–2.13, p&lt;0.001].&#x0D; Conclusion: Among MA abusers admitted to The National Rehabilitation Center, the main factors associated with psychiatric symptoms were: female, long duration of use, smoking as the route of administration, and concomitant use with other narcotics.

Estimating Risk of Antidepressant Withdrawal from a Review of Published Data.

Adaptation of the brain to the presence of a drug predicts withdrawal on cessation. The outcome of adaptation is often referred to as 'physical dependence' in pharmacology, as distinct from addiction, although these terms have unfortunately become conflated in some diagnostic guides. Physical dependence to antidepressants may occur in some patients, consistent with the fact that some patients experience withdrawal effects from these medications. It is thought that longer duration of use, higher dose and specific antidepressants affect the risk of antidepressant withdrawal effects as they might cause greater adaptation of the brain. We searched PubMed for relevant systematic reviews and other relevant analyses to summarise existing data on determinants of antidepressant withdrawal incidence, severity and duration. Overall, data were limited. From survey data, increased duration of use was associated with an increased incidence and severity of withdrawal effects, consistent with some evidence from data provided by drug manufacturers. Duration of use may be related to duration of withdrawal effects but data are heterogenous and sparse. Serotonin and noradrenaline reuptake inhibitors and paroxetine are associated with higher risks than other antidepressants, though data for some antidepressants are lacking. Higher doses of antidepressant has some weak association with an increased risk of withdrawal, with some ceiling effects, perhaps reflecting receptor occupancy relationships. Past experience of withdrawal effects is known to predict future risk. Based on these data, we outline a preliminary rubric for determining the risk of withdrawal symptoms for a particular patient, which may have relevance for determining tapering rates. Given the limited scope of the current research, future research should aim to clarify prediction of antidepressant withdrawal risk, especially by examining the risk of withdrawal in long-term users of medication, as well as the severity and duration of effects, to improve the preliminary tool for predictive purposes. Further research into the precise adaptations in long-term antidepressant use may improve the ability to predict withdrawal effects for a particular patient.

Modernization of the technological communication network at railway transport facilities using PON technology

The existing telecommunication network the construction principle of which is nowadays based on active equipment that is required to be serviced due to its outmoded technology was considered. The modernization measures of telecommunication network at large freight terminals with the use of PON technologies which allow to complete properly and on time freigh handling, receipt of cargo, dispatch of cargo, making up and breaking down of cargo trains, shunting works were provided. It was decribed the stucture of PON technology which includes one OLT optical line terminal per network, a set of nodes of ONT subscribers connected to OLT by means of splittera over one fibre. OLT allocates time for information broadcasting to avoid the overlap of outgoing signals, to improve communication quality, noise immunity from ONT subcribers. Modernization of telecommunication network suppose the replacement of existing electrical cables laid in the cable channels on the fiber optic. Located at the station equipment and ATS Definity SI in the line-switching room will be removed. There will be a new small-size multifunctional equipment which allow to connect a large number of subscribers providing a broad range of service. Properly selected type of optical cable will allow to achieve a long duration of use of a new technological network with further development prospects, to use it only for organizing work at a large freight railway station.

Barriers to enrolling in voluntary treatment programs in Malaysia: a study of women who use methamphetamine (WWUM)

Women with substance use disorders (SUDs) have been widely reported to face barriers in seeking treatment. We sought to identify barriers that prevented women who use methamphetamine (WWUM) from accessing the decade-old Voluntary Treatment Centers (VTCs) in Malaysia. A total of 153 WWUM who were undergoing rehabilitation for methamphetamine use at a compulsory drug detention center (CDDC) were recruited for this cross-sectional study. Data were collected by canvasing a structured questionnaire through face-to-face meetings. Of the total sample, 131 (86%) were Malays, with a mean age of 32.1 years. The commonly cited treatment barriers were the belief that methamphetamine use was not problematic (42%), not knowing how to seek treatment (38%), feeling embarrassed to seek treatment (33%), the lack of family support (24%), and the long waiting time for enrollment (23%). Logistic analyses indicated that a longer duration of use increased the odds of not acknowledging methamphetamine use as a problem while older participants had lower odds of holding a similar view. A longer duration of use also increased the odds of claiming treatment was not needed but lowered the odds of asserting a lack of confidence in treatment. Furthermore, Malays had higher odds of lacking family support in seeking treatment while being employed lowered the odds of not wanting treatment. Addressing these concerns will hopefully encourage higher participation of WWUM in voluntary treatment programs.

Sodium-glucose cotransporter 2 (SGLT2) inhibitor initiation and hepatocellular carcinoma prognosis.

IntroductionSodium-glucose cotransporter 2 (SGLT2) inhibitors are a relatively new class of antidiabetic drugs. Emerging findings from laboratory studies indicate that SGLT2 inhibitors can improve liver function and suppress the proliferation of hepatocellular carcinoma (HCC) cells. The aim of this study was to test the hypothesis that initiation of SGLT2 inhibitors improves HCC prognosis in a human population.MethodsWe used National Surveillance, Epidemiology and End Results (SEER)—Medicare linked data in the United States to evaluate the role of SGLT2 inhibitor initiation on the survival of HCC patients. 3,185 HCC patients newly diagnosed between 2014 and 2017 aged 66 years or older with pre-existing type 2 diabetes were included and followed to the end of 2019. Information on SGLT2 inhibitor initiation was extracted from the Medicare Part D file.ResultsSGLT2 inhibitor initiation was associated with significantly lower mortality risk after adjusting for potential confounders (HR = 0.68, 95% CI = 0.54–0.86) with stronger association for longer duration of use (HR = 0.60, 95% CI = 0.41–0.88). Further, we found that SGLT2 inhibitor initiation was associated with a lower risk mortality risk ranging from 14% to 60% regardless of patient demographic variables, tumor characteristics, and cancer treatments.ConclusionOur large SEER-Medicare linked data study indicates that SGLT2 inhibitor initiation was associated with improved overall survival of HCC patients with pre-existing type 2 diabetes compared with no SGLT2 inhibitor use. Further studies are needed to confirm our findings and elucidate the possible mechanisms behind the association.