Medical Drug Use Research Articles

DETERMINING THE RISK OF CARDIOVASCULAR DISEASE IN PATIENTS DIAGNOSED WITH SCHIZOPHRENIA AND BIPOLAR AFFECTIVE DISORDER.

In Schizophrenia (SCZ) and Bipolar Affective Disorder (BAD) patients using the Framingham Heart Risk Scoring (FHRS), we aimed to investigate the possible cardiac arrhythmia risk by calculating electrocardiogram (ECG) parameters (QT, QTc, Tpe, and TPE/QTc ratios), which are ventricular repolarization markers. A total of 140 BAD and 253 SCZ patients were included in the study. Age, blood test results (fasting blood glucose, LDL-HDL-TC levels, hemogram values), blood pressure and heart rate, smoking status, antihypertensive drug use, and FHRS were calculated from the patient files, and sociodemographic information was recorded. In addition, ECG calculations were performed, and QT, QTc, TPe, TPe/QTc ratios and heart rate were measured. When we evaluated the cardiac risk indexes of SCZ and BAD patients, we detected that FHRS was higher in smokers, female patients, and those with other medical diseases such as diabetes mellitus (DM) (p<0.05). In addition, we found that QTc rates, markers of ventricular repolarization, were associated with FHRS, the number of antipsychotics used, patient age, disease duration, and the number of hospitalizations. TPe and QT rates were found to increase in parallel with FHRS. In addition, a positive correlation was found between QTc rates in females, patients with DM, and those using additional medical drugs. (p<0.05) In BAD and SCZ patients, diabetes diagnosis, other medical drug use, a high Framingham heart score, the number of antipsychotics, the disease duration, the patient&apos;s age, and an increased number of hospitalizations may increase the risk of cardiac arrhythmia. Therefore, possible cardiac risk should be considered in patients with chronic drug use, such as BAD and SCZ. Regulating the treatment and follow-up of this group of patients against possible cardiac risks will reduce cardiac mortality and morbidity

Three oral Chinese patent medicines for children with tic disorder: a rapid health technology assessment

This study aims to comprehensively evaluate the clinical value of Shaoma Zhijing Granules(SZG), Changma Xifeng Tablets(CXT), and Jiuwei Xifeng Granules(JXG) in the treatment of children with tic disorder with the method of rapid health technology assessment(RHTA), which is expected to serve as a reference for medical and health decision-making and clinical rational use of drugs in children. To be specific, relevant articles were retrieved from eight databases and three clinical trial registry platforms. After the quality evaluation, rapid assessment was carried out from the dimensions of disease burden and unmet needs, technical characteristics, safety, efficacy and economy, and the results were analyzed and presented descriptively. A total of 22 articles(1 in English, 21 in Chinese) were screened out: 18 randomized controlled trials(RCTs) and 4 clinical controlled trials(CCTs). Among them, 5 were about the SZG(all RCTs) and 9 were on CXT(6 RCTs and 3 CCTs). The rest 8 focused on JXG(7 RCTs and 1 CCT). Moreover, the overall risk of bias for 94.40% RCTs was evaluated as &quot;some concerns&quot; and only one(5.60%) had high risk of bias. In terms of quality, the 4 CCTs scored 5-6 points(&lt;7 points), suggesting low quality. SZG alone or in combination with tiapride has obvious advantages in improving traditional Chinese medicine syndromes and tic symptoms compared with tiapride alone, with the average daily cost of CNY 79.44-119.16. Compared with conventional western medicine or placebo, CXT alone or in combination with conventional western medicine can improve the total effective rate and alleviate tic symptoms, and the average daily cost is CNY 22.50-67.50. JXG alone or in combination with conventional western medicine can effectively relieve tic symptoms compared with conventio-nal western medicine or placebo, with the average daily cost of CNY 82.42-164.85. The adverse events related to the three Chinese patent medicines mainly occurred in the digestive, respiratory, and nervous systems, all of which were mild. In general, SZG, CXT, and JXG are effective for children with tic disorder. They have been approved to be used in this field, of which SZG was approved in 2019, with the most up-to-date research evidence and high-quality RCT in Q1 journals. However, the comparative analysis of the three was affected by many factors, which should be further clarified. Based on the large sample data available in multiple dimensions, a comprehensive comparative evaluation of the three Chinese patent medicines should be carried out, thereby highlighting the advantages and disadvantages of them and serving a reference for rational clinical use and drug supervision.

Sonothrombolysis after percutaneous coronary intervention in STEMI patients with increased risk for microvascular obstruction: a multicenter randomized controlled trial

Abstract Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): Lantheus. Introduction Despite successful recanalization with percutaneous coronary intervention (PCI), approximately 50% of patients with ST-elevation myocardial infarction (STEMI) suffer from ongoing infarction due to microvascular obstruction (MVO) (1). The use of intravascular microbubbles with concomittant intermittent high mechanical index (HMI) ultrasound impulses has been shown to dissolve thrombi and augment microvascular perfusion through vasodilative pathways (2). This technique, also termed sonothrombolysis, could be used in STEMI patients at high risk of developing MVO, to enhance reperfusion and limit infarct size. Methods In this multi-center, prospective, randomized controlled trial, 118 STEMI patients with increased risk for MVO (defined as occlusion of the LAD artery [center 1] or incomplete ST-resolution (≤70%) on the ECG after PCI irrespective of culprit artery [center 2]) will be randomized to sonothrombolysis or control. Sonothrombolysis treatment consists of a 3% infusion of lipid-coated microspheres with 40–80 transthoracic intermittent HMI ultrasound flashes. Control cases receive a 3% lipid-coated microspheres infusion with low mechanical index ultrasound and no more than 6 HMI flashes for perfusion imaging. Primary endpoints are infarct size (% of LV mass) and left ventricular ejection fraction (LVEF %) as assessed on cardiac magnetic resonance (CMR) imaging two months after inclusion. Secondary endpoints include changes in infarct size and LVEF on CMR (CMR &amp;lt; 1 week vs CMR at 2 months), ST-resolution, and clinical outcome at six months after inclusion. Results To date, 100 patients have been included. Mean age was 62 (± 12) and 82 patients (82%) were male. Culprit artery in patients included in center 2 was LAD in 38 patients (72%),RCA in 11 patients (21%) and LCX in 4 patients (7%). Time to first medical contact was 97 (IQR: 48–174) and 105 (IQR: 55–228) minutes and time from diagnosis to PCI was 45 (IQR: 36–63) and 49 (IQR: 40–59) minutes in the sonothrombolysis group and in the control group respectively. Summed ST-elevation on ECG before and after PCI (before randomization) was not statistically different: 11.5 mm (6.5 – 16.1) and 11.2 mm (5.9–16.9) (p = 0.81) before PCI and 8.4 mm (4.3 – 13.0) and 9.7 mm (4.1–16.4) (p = 0.39) after PCI, in the sonothrombolysis and control group. No differences between the groups were observed in medical history and drug use before admission. Conclusions STEMI patients with LAD occlusion and patients with incomplete ST-resolution on ECG after PCI are at increased risk of MVO and have worse clinical prognosis (3). This clinical trial aims to assess efficacy of post-PCI sonothrombolysis in this patient population to limit final infarct size and salvage myocardial function. Currently, 100 patients have been included with overall similar baseline characteristics. Inclusion, blinded assessment of primary and secondary endpoints and clinical follow up is expected to be completed in 2023.

Cancer pain: way to overcome

Cancers are among the leading causes of morbidity and mortality worldwide. Cancer itself or cancer treatment often causes pain which can affectthe quality of life. Cancer pain management is an essential part of cancer treatment and palliative care. Cancer patients may require pain management at any stage of their disease, not only at the end. Expert opinion and statistics from country experiences from numerous low-income countries, where treatment coverage is typically inadequate or non-existent, indicate that around 80% of cancer patients feel moderate or severe pain that lasts on average 90 days. As a result, cancer pain is a major source of avoidable unnecessary suffering. Cancer pain management plans often involve pharmacological and nonpharmacological therapies and psycho-social and spiritual support. Palliative care and pain management are critical components of Universal Health Care. The medical use of narcotic drugs is essential for the treatment of pain and suffering. Therefore appropriate provisions must be made to assure their availability for such purposes. Some obstacles exist that limit the appropriate management of cancer-related discomfort. Communication difficulties, lack of pain management training and education, ethnic/cultural/ religious disparities, opiophobia among health professionals and the general public, and restricted availability to opioids are the primary barriers to successful cancer pain treatment. To combat cancer pain and reduce the suffering of these incurable people, education and training of health professionals on cancer pain management, provision of suitable holistic supports, opioids should be made accessible and available, and general awareness development are some examples. All government and nongovernment players must come forward and work together to win this battle. Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 187

Bleeding risk after acupuncture in patients taking anticoagulant drugs: A case control study based on real-world data

ObjectivesPatients on anticoagulant medications may be at a higher risk of bleeding after acupuncture. This study aimed to assess the association between anticoagulant drug use and bleeding after acupuncture. DesignCase control study SettingWe analysed the diagnosis and treatment records (2000–2018) of a random sample of two million patients from the National Health Insurance Research Database in Taiwan. Interventionsanticoagulant and antiplatelet drugs Main outcome measuresThe incidence rates of major (visceral bleeding or ruptured blood vessels requiring transfusion) and minor (skin bleeding or contusion) bleeding after acupuncture ResultsWe included the records of 13,447,563 acupuncture sessions in 821,946 participants and followed up the patients for 14 days after each session. The incidence of minor bleeding was 8.31 per 10,000 needles, whereas that of major bleeding was 4.26 per 100,000 needles. Anticoagulants significantly increased the risk of minor bleeding (adjusted OR = 1.15 (1.03–1.28)), but the risk of major bleeding did not reach statistical significance (adjusted OR = 1.18 (0.8 0–1.75)). Anticoagulants, such as warfarin (adjusted OR = 4.95 (2.55–7.64)), direct oral anticoagulants (adjusted OR = 3.07 (1.23–5.47)), and heparin (adjusted OR = 3.72 (2.18–6.34)) significantly increased the risk of bleeding. However, antiplatelet drug was not significantly associated with post-acupuncture bleeding. Comorbidities including liver cirrhosis, diabetes, and coagulation defects, were the risk factors for bleeding after acupuncture. ConclusionsAnticoagulant drugs may increase the risk of bleeding after acupuncture. We encourage physicians to ask patients in detail about their medical history and drug use prior to acupuncture treatment.

Persistent myopericarditis after heterologous SARS-CoV-2 mRNA vaccination.

KEY POINTS A healthy 41-year-old man on vacation presented to the emergency department of a local hospital with central, constant, stabbing chest discomfort that worsened with inspiration. He reported no recent illness, and no medication or recreational drug use. His only medical history was Gilbert

Medical use and combination drug therapy among US adult users of central nervous system stimulants: a cross-sectional analysis

ObjectiveExamine patterns of adult medical use of amphetamine and methylphenidate stimulant drugs, classified in the USA as Schedule II controlled substances with a high potential for psychological or physical dependence.DesignCross-sectional...

Trends in healthcare utilisation of patients with migraine in South Korea: a retrospective observational study using Health Insurance Review and Assessment Service National Patient Sample data from 2010 to 2018

ObjectiveThis study used 2010–2018 Health Insurance Review and Assessment Service National Patient Sample data to analyse the distribution and healthcare utilisation of patients with migraine in South Korea.DesignRetrospective, observational study...

Narcotics information management system in South Korea: system development and innovation

BackgroundAs the misuse and abuse of medical narcotics are increasing in South Korea, an information system for the integrated information management of medical narcotic drugs across the nation is needed. This paper presents the development process of the Narcotics Information Management System (NIMS) for the monitoring of medical narcotics usage and the results of its implementation.MethodsAs the NIMS enforces that all narcotics handlers digitally report all information on handling medical narcotic drugs, the functional requirements of the NIMS have been identified in accordance with the Narcotics Control Act. In addition to the functional requirements, the non-functional requirements of the NIMS have been elicited by major narcotics handlers and their associations. The non-functional requirements include privacy, availability, connectivity, interoperability, and data integrity. The system design with entity-relationship diagrams and its implementation processes have been presented.ResultsThe NIMS encompasses all narcotic handlers, which comprise exporting, importing, and pharmaceutical companies; wholesalers; hospitals and clinics; and pharmacies, collecting over 120 million cases annually. It enables transparent monitoring throughout the life cycle, from manufacturing, sales, purchase, and disposal of narcotics. As a result, the number of prescriptions for medical narcotics has been reduced by 9.2%.ConclusionsTo the best of our knowledge, the NIMS is the world's first system to manage all information on the total life cycle of medical narcotics, including imports, production, distribution, use, and disposal of drugs. This system has enabled the safety management and monitoring of medical narcotic drugs. Additionally, it provides consistent and transparent information to physicians and patients, leading to the autonomous safety management of narcotics. The successful development of the NIMS can provide guidelines for implementing a narcotics management system in other countries.

KNOWLEDGE AND ATTITUDE OF SELF-MEDICATION AMONG HEALTHCARE AND NON-HEALTHCARE STUDENTS OF LAHORE, PAKISTAN

Introduction: Self-medication is regarded as the system of taking medicines without the consultation of licensed medical practitioner. Self-medication leads to irrational use of medical drugs which is hazardous for health. The prevalence of this crucial issue is rapidly increasing worldwide. The present study was aimed to access the pattern of self-medication trends in healthcare students and non-healthcare students of Lahore, Pakistan. Methods: A cross-sectional survey based observational study has been conducted to access the knowledge along with the attitude of medical and non-medical students regarding self-medication. The study settings included different universities and medical colleges of Lahore, Pakistan. A total of 301 students from medical department and other departments were included in the study. A validated self-medication assessment questionnaire was used to access the knowledge along with attitude pattern of self-medication among healthcare students as well as non-healthcare students. Results: The findings of the present study presented that medical students are more aware of the potential side effects and adverse reactions of the self-medicated drug as compared to the non-medical students. Whereas, trends of self-medication was observed to be slightly higher in healthcare students as compared to the non-healthcare students. Moreover, the frequency of antibiotic use was comparatively more frequent in medical students as compared to the non-medical graduates. Whereas, the use of painkillers without prescription was more prevalent in non-medical students as compare to the medical graduates. Conclusion: There has been a significant difference in knowledge of healthcare students and non-healthcare students of Lahore, Pakistan. Although both healthcare and non-healthcare students have high prevalence of self-medication but differences have been observed in case of drugs taken. Healthcare students practice self-medication more as compared to the non-health-care students. Peer Review History: Received: 10 November 2022; Revised: 18 December; Accepted: 5 January 2023, Available online: 15 January 2023 Academic Editor: Dr. Asia Selman Abdullah, Pharmacy institute, University of Basrah, Iraq, asia_abdullah65@yahoo.com Received file: Reviewer's Comments: Average Peer review marks at initial stage: 5.5/10 Average Peer review marks at publication stage: 7.0/10 Reviewers: Dr. A.A. Mgbahurike, University of Port Harcourt, Nigeria, amaka_mgbahurike@yahoo.com Prof. Hassan A.H. Al-Shamahy, Sana'a University, Yemen, shmahe@yemen.net.ye Similar Articles: ANTIMICROBIALS SELF MEDICATION AMONG PARAMEDICAL STUDENTS IN A NIGERIAN UNIVERSITY ANTIBIOTICS KNOWLEDGE AND THEIR USES AGAINST VARIOUS DISEASES AMONG THE DORMITORY STUDENTS OF A RESIDENTIAL UNIVERSITY IN BANGLADESH: A PILOT STUDY

A methodology to explore the road safety impact of fitness to drive solutions for commercial drivers: The PANACEA project

In Europe, one in four road deaths occurred in an accident involving a goods vehicle in 2018 (ETSC 2020). Commercial drivers are at higher risk for suffering from physiological, psychological and prescribed medication and illicit drug use, including alcohol misuse. Fitness to drive or driver state monitoring systems integrate technologies able to detect altered driver states and provide them feedback. They constitute an emerging phenomenon, and their effects on changing people's behaviour to drive more safely, and in general, their impact on road safety should be better investigated.The scope of this paper is to present a methodology able to simulate different scenarios to understand how a driver state monitoring system can support improving road safety in the European Union. A conceptual framework is presented to support the definition of the impact assessment methodology and is applied to the PANACEA European research project. The project develops an integrated solution for driving ability assessment of commercial drivers, paired with a countermeasure and coaching solution. The PANACEA system uses algorithms and technologies for detecting, monitoring and assessing alcohol consumption, licit (barbituric) and illicit (methadone substitute) drugs, fatigue and cognitive load (Commercial Health Toolkits (CHTs)). It also provides strategic, tactical and operational countermeasures that will be tested and evaluated to assess their effectiveness and acceptance by the system's users.The methodology presented is able to assess both a single and multiple countermeasures among those developed within the project. Different scenarios have been considered by modifying the variables according to the screening prevalence, solution acceptance level, driving context and time. The methodology uses the results from the project pilot studies in terms of accuracy, sensitivity, and specificity of CHTs and countermeasures results in combination with evidence from the existing literature.

Reducing Risk of Diabetes Mellitus among Women: Role of mHealth in implementing Government of India Gestational Diabetes Management Guidelines

India significantly contributes to the global prevalence of Diabetes Mellitus as well as Gestational Diabetes Mellitus (GDM).GDM plays a major role in development of type 2 DM. There is a need to address this issue. Ministry of Health and Family Welfare has issued national guidelines for screening and management of GDM as a part of antenatal care. This involves screening, medical nutrition therapy, follow-up and use of anti-diabetic drugs; as required for the antenatal women. Regular follow-up, monitoring and counselling are the crucial aspects of this intervention. For proper implementation of these strategies, use of modern technology advancements like Mobile Health (mHealth) technology would be supportive. mHealth interventions have been evident in promoting health, disease management, and cost effective. Primary health care interventions especially antenatal and postnatal care combined with mHealth would ensure the effective control and management of the GDM.

Исторические предпосылки клинических и доклинических исследований лекарственных препаратов для медицинского применения

Исторические предпосылки клинических и доклинических исследований лекарственных препаратов для медицинского применения

A comparison of medically serious suicide attempters admitted to intensive care units versus other medically serious suicide attempters

BackgroundMedically serious suicide attempts (MSSA) represent a subgroup of clinically heterogeneous suicidal behaviours very close to deaths by suicide. A simple definition of an MSSA is a suicide attempt with life-threatening consequences, regardless of the severity of the attempter’s mental disorder. Few studies have specifically analysed the heterogeneity of MSSA. Therefore, the aim of this study is to describe the profile of individuals who made a highly severe MSSA and to compare those admitted to Intensive Care Units (ICU) – including Burn Units– with other MSSA admitted to other medical and surgical units.MethodsThe study sample consisted of 168 patients consecutively admitted to non-psychiatric wards from two public hospitals in Barcelona after an MSSA during a 3-year period. In order to select more severe MSSA, the minimum hospital stay was expanded from Beautrais’ definition of ≥ 24 h to ≥ 48 h. Mean hospital stay was 23.68 (SD = 41.14) days. Patients needing ICU treatment (n = 99) were compared to other MSSArs (n = 69) that were admitted to other medical and surgical units, not requiring intensive care treatment, with an initial bivariant analysis followed by a logistic regression analysis using conditional entrance.ResultsMedically serious suicide attempters (MSSArs) spent more time hospitalized, more frequently reported recent stressful life events, were more likely to have at least one prior suicide attempt (SA) and their current attempt was more frequently non-planned, compared to the profile of MSSArs reported in previous studies. The most frequent method was medication overdose (67.3%) and jumping from heights (23.2%). Among those who chose more than one method (37.6%), the most frequent combination was medication overdose and drug use. Affective disorders and personality disorders were the most frequent diagnoses. Higher educational level, history of previous mental disorders and prior lifetime suicide attempts were significantly more frequent among those admitted to ICU compared to other MSSArs. Patients needing admission to ICU less frequently used self-poisoning and cuts.ConclusionsMSSA needing ICU admission can be regarded clinically as similar to attempts resulting in suicide. More research on this type of highly severe suicide behaviour is needed due to its serious implications both from a clinical and public health perspective.

Determinants of long-term opioid use in hospitalized patients.

Long-term opioid use is an increasingly important problem related to the ongoing opioid epidemic. The purpose of this study was to identify patient, hospitalization and system-level determinants of long term opioid therapy (LTOT) among patients recently discharged from hospital. To be eligible for this study, patient needed to have filled at least one opioid prescription three-months post-discharge. We retrieved data from the provincial health insurance agency to measure medical service and prescription drug use in the year prior to and after hospitalization. A multivariable Cox Proportional Hazards model was utilized to determine factors associated with time to the first LTOT occurrence, defined as time-varying cumulative opioid duration of ≥ 60 days. Overall, 22.4% of the 1,551 study patients were classified as LTOT, who had a mean age of 66.3 years (SD = 14.3). Having no drug copay status (adjusted hazard ratio (aHR) 1.91, 95% CI: 1.40-2.60), being a LTOT user before the index hospitalization (aHR 6.05, 95% CI: 4.22-8.68) or having history of benzodiazepine use (aHR 1.43, 95% CI: 1.12-1.83) were all associated with an increased likelihood of LTOT. Cardiothoracic surgical patients had a 40% lower LTOT risk (aHR 0.55, 95% CI: 0.31-0.96) as compared to medical patients. Initial opioid dispensation of > 90 milligram morphine equivalents (MME) was also associated with higher likelihood of LTOT (aHR 2.08, 95% CI: 1.17-3.69). Several patient-level characteristics associated with an increased risk of ≥ 60 days of cumulative opioid use. The results could be used to help identify patients who are at high-risk of continuing opioids beyond guideline recommendations and inform policies to curb excessive opioid prescribing.

Medical Use, Decriminalization, and Legalization of Narcotic Drugs and Psychotropic Substances-What Does It Mean and What Is Its Current Status in India?

Medical Use, Decriminalization, and Legalization of Narcotic Drugs and Psychotropic Substances-What Does It Mean and What Is Its Current Status in India?

Development of an Open-Source Annotated Glaucoma Medication Dataset From Clinical Notes in the Electronic Health Record.

To describe the methods involved in processing and characteristics of an open dataset of annotated clinical notes from the electronic health record (EHR) annotated for glaucoma medications. In this study, 480 clinical notes from office visits, medical record numbers (MRNs), visit identification numbers, provider names, and billing codes were extracted for 480 patients seen for glaucoma by a comprehensive or glaucoma ophthalmologist from January 1, 2019, to August 31, 2020. MRNs and all visit data were de-identified using a hash function with salt from the deidentifyr package. All progress notes were annotated for glaucoma medication name, route, frequency, dosage, and drug use using an open-source annotation tool, Doccano. Annotations were saved separately. All protected health information (PHI) in progress notes and annotated files were de-identified using the published de-identifying algorithm Philter. All progress notes and annotations were manually validated by two ophthalmologists to ensure complete de-identification. The final dataset contained 5520 annotated sentences, including those with and without medications, for 480 clinical notes. Manual validation revealed 10 instances of remaining PHI which were manually corrected. Annotated free-text clinical notes can be de-identified for upload as an open dataset. As data availability increases with the adoption of EHRs, free-text open datasets will become increasingly valuable for "big data" research and artificial intelligence development. This dataset is published online and publicly available at https://github.com/jche253/Glaucoma_Med_Dataset. This open access medication dataset may be a source of raw data for future research involving big data and artificial intelligence research using free-text.

Signal and Noise: Proton Pump Inhibitors and the Risk of Dementia?

The association between proton pump inhibitor (PPI) use and dementia remains controversial. This cohort study re-examines this issue, addressing shortcomings identified in previous publications using a population-based and a high-dimension propensity-score matched cohort to follow patients for up to 22 years. Cox regression models using baseline characteristics, a lag period, and time-varying variables were used to examine the risk of dementia by cumulative PPI exposure. High-dose PPI users (> 180 days of use) had significantly higher risk of dementia in crude Cox models. After adjustment for medical diagnoses and prescription drug use, these associations disappeared. Among high-dose users starting PPI therapy between 46 and 55 years old, the unadjusted hazard ratio (HR) was 1.55 (95% confidence interval (CI) 1.14, 2.10); the adjusted hazard ratio (aHR) was 1.10 (95% CI 0.80, 1.51). For high-dose users starting therapy between 56 and 65 years, HR=1.22 (95% CI1.03, 1.44); aHR=0.99 (95% CI 0.83, 1.17). High-dose users between the ages of 66 and 75 years had no association with the risk of dementia. The use of lag models or time-varying parameters similarly found some association with dementia in crude, but not multivariable Cox models. Although high-dose PPI users were more likely to develop dementia, they were more likely to be diagnosed with dementia risk factors, such as diabetes and cardiovascular disease, which are risk factors for dementia. Controlling for these conditions using multivariable models or a propensity-score matched cohort eliminated this association.

Dentistry and Drug Adverse Events: Between Responsibilities and Regulations.

The purpose of this paper is to renew interest and attention to the medical history, prescription, and/or use of drugs during dental practice. The work analyzes the issue of the use of drugs in dentistry from both a clinical and a medical-legal point of view. The laws governing the matter were also taken into consideration, relating them to the roles of prescriber and user that the dentist can acquire. Analysis of various aspects of this matter demonstrates that it is necessary for dentists to know the drugs and medical substances, their characteristics and properties, related effects, and interactions in order to use them appropriately and adequately. Knowledge of interferences, reactions, and adverse events or complications helps to reduce errors and protect patients' health. Furthermore, knowledge of the national and international reference standards relating to the use of drugs leads to a reduction in medico-legal questions. In conclusion, knowledge and adequate and appropriate use of drugs reduces the possibility of accidents, adverse events, medico-legal consequences, and disputes with patients. Documented and traceable choices allow the analysis and valuation of professional conduct. Authors perceived the topic of informed consent of patients as relevant to the adequate procedure of prescribing drugs related to dentistry practice; therefore, representative conditions of patients at risk should be illustrated in practice. Legal duties related to physician drug prescription and use must be considered and carefully checked.

Correlation of Triglyceride-Rich Lipoprotein Cholesterol and Diabetes Mellitus in Stroke Patients.

Previous studies have revealed that triglyceride-rich lipoprotein cholesterol (TRL-c) is closely related to diabetes mellitus (DM) in hypertensive patients. However, this relationship in stroke patients has not been reported. The aims of this study are to investigate the relationship between TRL-c and diabetes in adult Chinese stroke. Patients with stroke treated in the Department of Neurology of the Second Affiliated Hospital of Nanchang University from January 2019 to January 2021 were selected. TRL-c was calculated from total cholesterol minus (high-density and low-density lipoprotein). DM was diagnosed based on previous medical history (diagnosed by secondary hospitals or above) and/or current use of hypoglycemic drugs and/or intravenous blood glucose measurement (fasting blood glucose ≥7.0 mmol/L or nonfasting blood glucose > 11.1 mmol/L). The relationship between the TRL-c and DM was determined using multivariate logistic regression, smoothing curve fitting (penalized spline method), and subgroup analysis. A total of 890 patients with stroke (age, 66.1 ± 11.8 years) were enrolled, including 329 females. Multivariate logistic regression analysis demonstrated that TRL-c had a positive association with DM (OR 1.88; 95% CI: 1.22 to 2.89). Strong linear associations of TRL-c with DM were confirmed by restricted cubic spline analysis. And the association between TRL-c and DM was consistent in the different subgroups. Positive associations were found between TRL-c and DM in patients with stroke.