Medication Intake Research Articles

Polypharmacy and associated factors in the older population in Germany: Results Gesundheit 65+ study

Abstract Background Polypharmacy, the use of 5 or more medications simultaneously, favors the risk of adverse drug events, drug interactions, potentially inappropriate medication (PIM), hospitalizations, falls, frailty, and mortality. This analysis presents the prevalence of polypharmacy and associated factors in people aged 66+ years living in Germany. Methods Data from the nationally representative Study on Health of Older People in Germany (Gesundheit 65+) conducted between 2021-2023 by the Robert Koch Institute, was analyzed. All medicines used, prescribed and over-the-counter, in the 7 days before the interview were documented and classified into anatomical therapeutic chemical codes. Weighted prevalences and associated factors for polypharmacy are presented. Results 96% of the sample (N = 1,474) took at least 1 medication in the 7 days before the interview. Of these, 39% took up to 4 medications, 39% 5-9 and 22% 10+. The overall prevalence of polypharmacy was 61% (95%CI 58-65%) and was significantly higher in women (64%) than in men (59%). Polypharmacy increased with age, from 52% in the age group 66-74 (53% in men, 51% in women), 66% in the age group 75-84 (63% in men, 69% in women) to 81% in the age group 85 + (72% in men, 86% in women). People with low educational level had a polypharmacy prevalence of 63% (58% in men, 66% in women) compared to 56% (55% in men, 58% in women) in those with high educational level. Severe difficulties in organizing daily medication intake were reported in 1% of people taking up to 4 medicines, in 4% of people taking between 5-9 medicines and in 16% of people taking 10+. The prevalence of PIM increased with the number of medicines used: 13% in 1-4 medicines, 31% in 5-9 medicines, and 53% in 10+ medicines. Conclusions Polypharmacy was more frequent in women, older age groups and in people with low educational level. It was associated with increased difficulty in organizing medication intake and with PIM use. Key messages • Polypharmacy is very common, affecting more women, older age groups, people with a low educational level and is associated with PIM use. • Strategies to promote appropriate medication use are needed.

Short-term effects of ambient temperature variability on myocardial infarction hospitalizations in Sweden: A nationwide case-crossover study

Abstract Background Climate change threatens human health and general welfare via multiple dimensions. However, the short-term effect of temperature variability, a crucial aspect of climate change, on myocardial infarction (MI) remains largely unexplored. Purpose We aimed to assess the short-term effects of temperature variability on MI hospitalizations within the nationwide SWEDEHEART registry. Methods This population-based nationwide study involved 228,897 MI patients from the SWEDEHEART registry in Sweden from 2005 to 2019. High-resolution (1 km × 1 km) daily mean ambient temperature was estimated using a spatiotemporal machine learning methodology and assigned to patients’ home addresses. Temperature variability was calculated as the difference between the same-day (as the MI event) ambient temperature and the average temperature recorded over the preceding seven days. Specifically, an upward temperature shift represents a rise in the current day’s temperature relative to the seven-day average, while a downward temperature shift indicates a corresponding decrease. A time-stratified case-crossover design incorporating a conditional logistic regression model with distributed lag non-linear model was applied to estimate the association between ambient temperature variability and total MI, ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI). Moreover, we assessed potential effect modification by sex and medication intake. The results were expressed as odds ratio (OR, with their 95% confidence intervals [CIs]) per 1°C increase in temperature variability. Results Our study found that a 1°C increase in upward temperature shift was significantly associated with increased risks for total MI, STEMI, and NSTEMI (OR [95% CI]: 1.010 [1.006-1.015], 1.014 [1.006-1.022], and 1.009 [1.004-1.014], respectively). Furthermore, a 1°C greater in downward temperature shift was significantly associated with decreased risks for total MI and NSTEMI (OR [95% CI]: 0.995 [0.991-0.999], and 0.993 [0.988-0.998], respectively). Moreover, we found that males and patients who were on any heart medication, particularly digitalis, were at a higher risk of MI associated with exposure to higher upward temperature shifts compared to females and their counterparts not taking these medications. Conclusions This nationwide case-crossover study provides novel evidence that short-term exposure to increasing upward temperature shift is associated with an increased risk of MI hospitalization. Our finding highlights the cardiovascular health threats posed by upward temperature shifts, which are anticipated to increase in frequency and intensity due to climate change.

The assessment of society’s acceptance of artificial intelligence use in healthcare

Abstract Background We observe the surge of interest and application of artificial intelligence (AI) in various areas. AI use in healthcare and medicine is followed by society with interest; however, acceptance varies depending on the area of its application. This study aimed to understand the differences in acceptance depending on the type of solution and explain the factors influencing the attitude toward the use of AI in healthcare. Methods The data from the online survey was collected from a representative sample of 1109 adult Internet users in Poland. The respondents were asked about their acceptance of AI use for several purposes in healthcare. Based on the responses to these items, an ad-hoc score of AI acceptance in healthcare (AIAHC) was developed. The determinants of AIAHC were assessed with uni- (ULRM) and multivariable linear regression (MLRM) models. Results The highest acceptance of AI use was found for monitoring medication intake at home: mean (standard deviation, SD)-3.81 (1.39), the lowest for AI making decisions about the mode of therapy -2.78 (1.35). ULRMs showed that significant predictors of AIAHC were age, gender, chronic disease, vocational status, income, the use of the Internet (IU), and e-health literacy (eHL). In MLRM, only gender, vocational status, income, and eHL maintained a significant relationship with AIAHC. Males showed significantly higher AIAHC than females (B, 95%CI: 2.56, 1.42 - 3.71), and students had higher AIAHC than employees (B, 95%CI: 3.01, 0.14 - 5.89). Persons who refused to reveal their income demonstrated lower acceptance of AI use than those who revealed their income (B, 95%CI: -4.64, -6.54 - -2.74). Finally, greater eHL favored higher AIAHC (B, 95%CI: 0.46, 0.34 - 0.57). Conclusions Evidently, there is a hierarchy of potential areas of application in terms of society’s acceptance. Improving eHL should exert a positive effect on the acceptance of innovative technologies, including AI, in healthcare. Key messages • Citizens show moderate enthusiasm toward the broader use of AI in healthcare. • E-health literacy exerts a positive effect on the introduction of AI-based solutions in healthcare.

Time-series clustering of raw recordings of 24-hour ambulatory blood presssure for risk stratification in general population

Abstract Objective 24-hour ambulatory blood pressure measurements (ABPM) is the best out-of-office BP measurement used to refine cardiovascular (CV) risk stratification. Currently, only summary ABPM indexes are used in the clinical practice while the temporal characteristics of the raw BP recordings have not been explored. Therefore, in this study we employed an unsupervised machine learning (ML) algorithm suitable for multivariate time-series analysis to identify distinct BP and heart rate (HR) profiles associated with the incidence of adverse CV events. Design and Method In 1391 community-dwelling individuals (mean age, 46.9 years; 50.97% women), we acquired 24-hour ABPM and clinical data and collected CV events (n=399) on average 22 years later. We employed multivariate dynamic time warping and k-medoids algorithm on the raw recordings of systolic and diastolic BP and HR. To assess the clinical significance of the derived clusters, we compared the clinical characteristics and the incidence of adverse events. We validated the trained model using 24-hour ABPM obtained from external population cohort (n=1137). Results The silhouette score and Dunn index showed that the optimal number of clusters was 4. Across all clusters we observed significant difference in age and sex distribution. Cluster 4 had the worst CV risk factors profiling, with higher office BP and anti-hypertensive medication intake compared to the other clusters. We observed differences in the incidence of adverse events between clusters (Figure), with cluster 1 representing the lowest risk group and cluster 4 the highest. After adjusting for traditional CV risk factors, including office systolic BP, cluster 1 had the lowest risk (HR:0.92; 95%CI:0.84-0.99; P=0.036) and cluster 4 the highest (HR:1.13; 95%CI:1.03-1.24; P=0.006) as compared to the average population risk. The analysis of the external validation cohort revealed similar ABPM patterns and clinical characteristics. Conclusion Employing an unsupervised ML model on the raw ABPM recordings we identified clinically meaningful clusters associated with an increasing cumulative incidence of CV events. This ML analysis paves the way towards utilization of temporal BP and HR information and subsequently optimization of CV risk stratification.

High Clinical Burden of Cryptosporidium spp. in Adult Patients with Acquired Immunodeficiency in Ghana

There is a paucity of information on the prevalence, risk factors, and clinical correlates of people living with HIV (PLWH) who are co-infected with Cryptosporidium spp. in the post-combined antiretroviral therapy era in Ghana. To provide such data, in this observational study, stool samples of 640 HIV-positive and 83 HIV-negative individuals in Ghana were screened for Cryptosporidium spp. Additionally, sociodemographic parameters, clinical symptoms, medication intake, and immunological parameters were assessed. The prevalence of Cryptosporidium spp. was 11.8% (n = 73) in HIV-positive and 1.2% (n = 1) in HIV-negative participants (p < 0.001). Within the group of HIV-positive participants, the prevalence reached 26.0% in patients with CD4+ T cell counts below 200 cells/µL and 46.2% in the subgroup with CD4+ T cell counts below 50 cells/µL. The frequencies of the clinical manifestation of weight loss and gastrointestinal symptoms were significantly higher in patients with Cryptosporidium spp. compared to those without co-infection (45.8% vs. 21.4%, p < 0.001 and 22.2% vs. 12.2%, p = 0.031, respectively). In the modern post-cART era, the acquisition of Cryptosporidium spp. among PLWH in Ghana is driven largely by the degree of immunosuppression. Access to cART and screening for Cryptosporidium spp. as part of routine care might help control and reduce the burden of the infection.

Objective detection of wheeze at home by parents through a digital device: usage patterns and relationship with SABA administration.

Wheezing is an important indicator of exacerbated respiratory symptoms in early childhood and must be monitored to regulate pharmacological therapy. However, parents' subjective perception of wheezing in their children is not always precise. We investigated the objective identification of children's wheezing by parents using a digital wheeze detector (WheezeScanTM, OMRON Healthcare Co. Ltd), its longitudinal usage patterns, and its relationship with SABA administration. We conducted a secondary nested analysis of data from the intervention arm of a multi-center randomized controlled trial completed in 2021-2022 in Berlin (Germany), London (United Kingdom), and Istanbul (Turkey). Children aged 4 to 84 months with doctor's diagnosed wheezing (GINA step 1 or 2) were included. Using an electronic diary (Wheeze-MonitorTM, TPS), parents monitored and recorded for 120 days at home the presence or absence of their child's wheezing, detected both, with WheezeScanTM ("objective" wheezing), and subjective ("perceived" wheezing). Parents also recorded the child's symptoms, medication intake, and family quality of life. Questionnaires regarding symptom control, quality of life, and parental self-efficacy were answered at baseline and after 90 and 120 days. Eighty-one/87 families completed the intervention arm of the study. WheezeScanTM was on average used 0.7 (SD 0.6) times a day, with each patient reporting a positive, negative, or "error" outcome on average in 57%, 39%, and 5% of measurements, respectively. The use of WheezeScanTM declined slightly during the first 90 days of monitoring and steeply thereafter. Repeated usage of WheezeScanTM in the same day was more frequent after a "wheeze" (HR 1.5, 95% CI 1.37-1.65, p < 0.001) and an "error" (HR 2.01, 95% CI 1.70-2.38, p < 0.001) result, compared to a "no wheeze" outcome. The average per-patient daily agreement between "objective" and "perceived" wheezing/non-wheezing was 75% at the start of the monitoring period and only weakly persisted as time passed (Spearman's rho=0.09). The frequency of short-acting beta-2-agonists (SABA) administration was lower in days with closely interspaced consecutive device uses during which the patient's status was perceived as "never wheeze" (32/455, 7%) than in those perceived as "persistent wheeze" (53/119, 44%; OR 36.6, 95% CI [14.3, 94.1]). Daily use of a digital WheezeScanTM at home allows parents to detect their child's unperceived wheezing and discloses to caregivers the longitudinal patterns of a child's wheezing disorder. Digital monitoring of wheezing also highlights poor adherence to guidelines in SABA administration for wheezing children, with under-treatment being much more frequent than over-treatment. This pioneering study opens new perspectives for further investigation of digital wheeze detectors in the early diagnosis and proper self-management of wheezing disorders in childhood.

Effectiveness of Mobile Application-Based Intervention on Medication Adherence Among Pulmonary Tuberculosis Patients: A Systematic Review.

To analyze the effectiveness of mobile application-based interventions on medication adherence among pulmonary tuberculosis patients. Intervention articles involving patients with pulmonary tuberculosis and/or their families, utilizing mobile application-based intervention research designs, assessing patients individually or in groups with or without a control group, using mobile application-based interventions that can be accessed via a browser, utilizing adherence to treatment as the primary outcome, and written in English and Indonesian were included. The articles published from 2012 to 2022 were obtained from EBSCO Host, ProQuest, GARUDA, PubMed, Scopus, and Cochrane Online Library databases. The Critical Assessment Standards Program was used to assess the trustworthiness, relevance, and results of the published articles. The quality of the articles was assessed according to Johns Hopkins Nursing Evidence-Based Practice guidelines. Seven studies reported that mobile application-based interventions can improve medication adherence, including treatment success, number of missed drugs, correct intake of medications, adherence to health programs, timeliness, and frequency of clinic visits. This review only analyzed the impact of mobile application-based interventions on patients, and their effects on the family, social, and health services were not covered.

Exploring the Chemopreventive Effect of Medication on Gene Expression Linked to Colorectal Cancer: An Observational and Mendelian Randomization Analysis in Healthy Colon Mucosa

Gene expression appears altered in apparently normal tissue surrounding tumor tissue. The observed biological alterations in the tumor microenvironment play a crucial role in cancer development and are named the cancer field effect (FE). A robust set of overexpressed FE genes in tissue surrounding colorectal cancer (CRC) tumor were identified in previous studies. Our study aimed to investigate the influence of common medication intake and modifiable risk factors on FE gene expression using a colonic mucosa sample dataset of healthy individuals (BarcUVa-Seq). We applied expression enrichment analysis of the FE genes for each studied medication and factor. Both observational and instrumental (Mendelian randomization) analysis were conducted, and the results were validated using independent datasets. The findings from the observational and instrumental analyses consistently showed that medication intake, especially metformin, considerably downregulated the FE genes. Chemopreventive effects were also noted for antihypertensive drugs targeting the renin–angiotensin system. Conversely, benzodiazepines usage might upregulate FE genes, thus fostering a tumor-promoting microenvironment. In contrast, the findings from the observational and instrumental analyses on modifiable risk factors showed some discrepancies. The instrumental results indicated that obesity and smoking might promote a tumor-favorable microenvironment. These findings offer insights into the biological mechanisms through which risk factors might influence CRC development and highlight the potential chemopreventive roles of metformin and antihypertensive drugs in CRC risk.

Gastric stasis in migraine and the efficacy of antimigraine drugs

Migraine is characterized by severe headache attacks with the development of accompanying symptoms. Among the most common are nausea and vomiting, which limit the intake of oral medications and thus reduce the speed of onset of pain relief and the efficacy of treatment in general. The development of gastric stasis in migraine is considered to be one of the most important reasons for the delayed absorption and inconsistent effect of oral triptans. The rapid action of triptans in the form of orally dispersible tablets, efficacy in relieving pain and accompanying symptoms, and ease of administration make this form favorable as a first-line agent for the relief of migraine attacks.

Association between early menarche and hypertension in pre and postmenopausal women: Baependi Heart Study.

Early menarche has been associated with an increased risk of arterial hypertension. Whether the association between early menarche and hypertension is independent of menopausal status is unknown. This study aimed to investigate the association between early menarche and hypertension in pre and postmenopausal women. This cross-sectional study analyzed data from 1406 women aged 18-100. Age at menarche, menopause status, hemodynamic, anthropometric, and biochemical data were collected by using standard protocols. Menarche <12 years was defined as early menarche. Systolic blood pressure ≥140 mmHg and/or diastolic ≥90 mmHg and/or intake of antihypertensive medication, were used as criteria for hypertension. In total, 21.3% of women had early menarche (<12 years), and the frequency of hypertension was 38.7%. Premenopausal women with early menarche had a 58% higher chance of developing hypertension, even after adjusting for age, obesity, and smoking [odds ratio (OR) 1.58; (95% confidence interval, CI 1.016-2.461)]. In postmenopausal women, age, obesity, and diabetes mellitus were predictors of hypertension, while early menarche was not. The odds of hypertension were higher with early menarche, but only in women of reproductive age. In postmenopausal women, the physiological changes inherent to aging and the presence of more comorbidities, such as diabetes, might overlap the influence of early menarche on hypertension.

Features of the nasal microbiota in patients with allergic rhinitis: A review

The article analyzes the data of modern literature on the microbiota of ENT organs in normal and pathological conditions. The microbiota plays an important role in maintaining homeostasis by influencing metabolism, the immune system and human physiology. This complex of microorganisms includes bacteria, viruses and fungi that form the biofilm of otolaryngological organs, which prevents the penetration of pathogenic microorganisms. Different parts of the human upper respiratory tract have similar types of bacteria, but it differs dramatically at the level of families and genera. In addition, the balance of microbial flora depends on the immune system status, environmental factors, medication intake, age, race, lifestyle, as well as the health of other ENT organs. Changes in the nasal mucosa in allergic rhinitis are often associated with an increase in the content of bacteria. For example, Staphylococcus aureus can cause more severe nasal congestion in conjunction with protracted rhinitis and sinusitis. The production of bacterial proteinases contributes to easier penetration of allergens and activation of mucosal cells. The absence of microbiota can increase the response of the immune system and reduce the number of cells that contribute to the regulation of inflammation. This review presents an analysis of the composition of the normal microflora of otolaryngological organs and its effect on the occurrence of allergic rhinitis.

The Evidence for Diet as a Treatment in Migraine-A Review.

Background/objectives: The connection between diet and migraine has gained increasing attention in migraine research due to its potential relevance as part of migraine treatment. This study reviewed the current evidence on the use of diets or specific foods in the prevention of migraine. Methods: A PubMed search was performed with the keywords "diet and migraine" OR "brain-gut-axis and migraine". One author (KVN) screened titles, abstracts, and full-text articles and excluded or included them based on eligibility criteria. Results: A ketogenic diet and a "Dietary Approaches to Stop Hypertension" diet reduced attack duration (p < 0.002), frequency (p < 0.05), and severity (p < 0.01). The ketogenic diet also reduced monthly medication intake (p ≤ 0.05). A low-fat vegan diet mixed with an elimination diet reduced the attack duration (p < 0.01), frequency (p < 0.05), severity (p < 0.0001), and percentage of medicated headaches (p < 0.001). Elimination diet reduced attack duration (p < 0.05), frequency (p < 0.02), severity (p < 0.01), and medication intake (p < 0.002). Elimination diet with IgG-positive foods reduced attack frequency (p < 0.001), and total medication intake (p < 0.01). Gluten-free diet reduced frequency (p = 0.02) and severity (p = 0.013). Conclusions: Certain diets and food items may trigger attacks in some migraine patients, though the overall evidence supporting this is limited. Modifying a diet may reduce symptoms such as attack duration, frequency, severity, and medication intake. However, the included studies' small populations and diverse study designs make the results difficult to apply in clinical practise. Further high-quality, double-blinded, randomised controlled trials are necessary to confirm the association between diet and migraine.

Interventions for Escalating Crisis Situations in Inpatient Acute Psychiatric Treatment - Results of a Content Analysis of Joint Crisis Plans

Identification of interventions to prevent coercive measures in the event of escalating crisis situations in an inpatient acute psychiatric treatment context. Content analysis of 98 joint crisis plans (JCP) using frequency analysis (secondary data analysis). In over half of the joint crisis plans, withdrawal to a low-stimulation environment (64.3%), a conversation (62.2%), and a walk (57.1%) were agreed upon as intervention for escalating crisis situations. A significant difference (p=0.020) was found in relation to the intake of (on-demand) medication, which was determined exclusively by males. The results provide potentially helpful suggestions for escalating crisis situations and gender-specific findings with regard to the agreed interventions.

5103 Synthroid Absorption Conundrum: A Case Deciphered

Abstract Disclosure: H. Nadeem: None. O. Alzohaili: None. Hypothyroidism is a disorder requiring lifelong Synthroid therapy. Untreated patients have high morbidity rate and suffer from weight gain, cold intolerance, fatigue and constipation. Inadequate therapeutic outcomes may result in the case of malabsorption, like GI tract conditions, medication interactions and dietary ingredients. Here, we describe the case of a 50-year-old woman who despite compliance to therapy, had refractory hypothyroidism. Complexity of unexplained Synthroid malabsorption is highlighted, emphasizing the importance of managing and optimizing thyroid hormone replacement therapy. A 50-year-old woman with a history of papillary carcinoma s/p thyroidectomy and radioactive iodine therapy came in with fatigue, weight gain and constipation. Despite taking Synthroid 150 mcg, thyroid function tests (TFTs) remained high with TSH 150 uIU/mL and fT4 0.25 ng/dL. Her dose was gradually increased until it reached 1800 mcg yet repeat TFTs showed refractory hypothyroidism with TSH 179 uIU/mL, fT4 0.8 ng/dL. Compliance was addressed to which she demonstrated strict adherence, while avoiding concurrent intake of food, supplements or medications interfering with the absorption. Autoimmune conditions were ruled out and no dietary patterns affecting absorption were identified. A thyroid absorption test was then performed, during which 2100 mcg of Synthroid were given orally in the AM, and thyroid hormones were measured for 8 hours. She was found to have a TSH in 200s uIU/mL and fT4 &amp;lt;0.10 ng/dL, deeming her to have refractory hypothyroidism. She was seen by GI and had an EGD/ colonoscopy, revealing no abnormalities. In a follow up visit, she was still complaining of the same symptoms, periorbital edema, and mild confusion. Her TSH was still elevated at 225 uIU/mL. She was then started on IV 500 mcg of weekly Synthroid infusions and after several weeks, she reported symptoms improvement. Subsequent TFTs showed a progress in TSH, now 26.6 uIU/mL, with fT4 1 ng/dL, indicating successful management of Synthroid malabsorption. During this process, she had a nutritional assessment and was consistently having hyperlipidemia with LDL 243 mg/dL. She was compliant with Praluent and max dose of atorvastatin 80 mg, but LDL only decreased to 134 mg/dL after adjusting her thyroid hormone levels. With nonadherence being the top cause of medication non responsiveness, ruling out causes of malabsorption is vital. In this case, compliance, nutritional assessment, medication interactions, GI abnormalities, autoimmune conditions were all addressed and no interfering factors were identified. IV treatment with unexplained thyroid hormone malabsorption was the effective treatment, ultimately improving outcomes. With the hope to transition her to oral medication, the possibility of it happening is still not clear. More research is necessary to discover the underlying causes in such an exceptional case. Presentation: 6/2/2024

Epidemiology of acute childhood poisoning in pediatric emergencies in Western Mexico.

The increase in the production of substances to enhance the quality of life, the biodiversity of the different ecosystems in Mexico, and the unique characteristics of pediatric patients, contribute to intoxications within this population. Analytical retrospective study of admissions to pediatric emergency care due to poisoning in < 16-year-old (2016 to 2020). Included variables were age, gender, type of toxic substance, exposure characteristics, and the season of the year. Frequencies, percentages, range, average and standard deviation were obteined. In the bivariate análisis, the Chi square test was used. A p-value < 0.05 was considered statistically significant. Over 5 years, there were 459 cases, with a prevalence of 3.16%. No gender predominance was observed. The most common was caused by venomous animals (28.5%), followed by medication ingestion (27.6%). Only 5% of cases were suicide attempts, the rest were accidental (95%). Children up to 5 years old were more commonly by medication ingestion, hydrocarbons, or household products (p = 0.03, p = 0.0001), while the causes in older children were contact with venomous animals and ingestion of stimulants drugs (alcohol, amphetamines, cannabis, cocaine) (p = 0.0001, p = 0.006). Intoxication with quaternary ammonium herbicides was lethal in all cases. Children under the age of 5 are more susceptible to intoxication from common household products. Older kids tend to be more frequently a combination of stimulants drugs.

Methanolic stem-bark extracts of Adansonia digitata modulates haematological and antioxidant parameters in streptozotocin-induced diabetic rats

Background and AimDiabetes mellitus is associated with haematological abnormalities and oxidative stress, contributing to disease progression and complications. Adansonia digitata, is a traditional medicinal plant well known for its potential therapeutic properties. This study investigates the effects of methanolic stem-bark extracts of Adansonia digitata on haematological and antioxidant status in streptozotocin-induced diabetic rats. Experimental ProcedureFourty-two wistar rats were distributed into 6 groups of 7 each. Group 1 served as normal control, group 2 to 6 animals were made diabetic by intraperitoneal administration of single dose of 50 mg kg-1 streptozotocin. Group 2 served as the negative control and did not receive treatment, group 3 served as the positive control and received 150 mg kg-1 metformin (Glucophage) (standard drug), while group 4, 5 and 6 received oral treatment of 100 mg kg-1, 200 mg kg-1 and 300 mg kg-1 of Adansonia digitata stem-bark methanolic extract respectively for 21days, after which the animals were sacrificed, and blood and liver were collected for haematological analysis including White Blood cell (WBC), red blood cell (RBC), haemoglobin (HGB), hematocrit (H CT), platelet (PLT), mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH), mean corpuscular haemoglobin concentration (MCHC), total bilirubin (TB), direct bilirubin(DB) and indirect bilirubin (IB) concentration and antioxidant parameters including antioxidant enzymes [catalase (CAT) and superoxide dismutase (SOD) activities] and oxidative stress marker [thiobarbituric acid reactive substance (TBARS)]. ResultsSTZ administration evoked a marked (p < 0.05) decline in the level of WBC, RBC, HGB, PLT, LYM and MCV in the diabetic rats when compared with the normal control. Howbeit, treatment with methanolic extracts of adansonia digitata stem-bark led to a profound (p < 0.05) increase in concentrations of these parameters close to the normal. In addition, STZ caused a non-significant (p > 0.05) decrease in MCH and MCHC. On the contrary, STZ caused an insignificant (p > 0.05) increase in the levels of TB and DB, but a significant (p > 0.05) increase IDB level in the diabetic control group when compared with the normal control group, while treatment with stem-bark extracts resulted in a marked (p > 0.05) fall in IDB level. Furthermore, there was a marked (P < 0.05) reduction in the activity of hepatic CAT and SOD and a considerable (P < 0.05) elevation in Malondialdehyde (MDA) level in the hepatic tissue of the diabetic control. Nonetheless, Adansonia digitata stem-bark extracts profoundly (P < 0.05) raised the activities of the enzymes and concomitantly counteracted MDA level. The extract elicited strong potency at 300 mg kg-1 which is comparable to metformin (Glucophage). ConclusionConsequently, this study advocates for the utility of Adansonia digitata extracts for the development of novel drugs for combating diabetes mellitus, associated hematological and oxidative stress complications and other ailments. Further research is needed to evaluate the clinical relevance of these effects in human subjects and to provide information on the sustained efficacy of the extracts in chronic models. Significant statementOxidative stress and hematological abnormalities are two of the consequences linked to diabetes mellitus. Anaemia and poor blood coagulation are two haematological changes that increase the risk of diabetes-related illness and death. Furthermore, oxidative stress is essential to the pathophysiology of diabetic complications such as nephropathy and cardiovascular disease. In addition, there are reports on hematological and biochemical alterations in diabetic subjects arising from the intake of synthetic antidiabetic medications.. Consequent to the safety, ease of use, efficacy, and lack of cytotoxic side effects of plants’ herbs, the study of Adansonia digitata's methanolic stem-bark extracts on haematological and antioxidant parameters in streptozotocin-induced diabetic rats is of paramount importance as the extracts' capacity to modify these parameters, will lead to the development of novel drugs that cures anemia, other blood abnormalities, and oxidative stress linked to diabetes as well as other ailments.

Obstructive Salivary Gland Disorders - A Malaysian Patient Series.

Introduction Obstructive salivary gland disease is a frequently encountered clinical entity that can present to various health practitioners. Obstructive sialadenitis can lead to recurrent infections and debilitating quality-of-life issues. Objective There is a paucity of published data regarding obstructive salivary disorders among the multiracial Asian population. The present study aimed to determine the demographic pattern and risk factors of obstructive salivary gland disorders with the goal of better management of this condition. Methods A retrospective cross-sectional study was conducted at a tertiary institution over a period of 5 years. Results A total of 256 (9.84 for every 1,000) patients were found to have salivary disorders, 10% of who were diagnosed to have obstructive disorder. Among the obstructive salivary disorders, 76% had sialolithiasis, 19% had recurrent parotitis, and 1 patient had chronic sialadenitis. We observed a small female preponderance for obstructive salivary disorders. This study revealed that smoking is a significant risk factor ( p = 0.041; prevalence ratio = 2.54, 95% confidence interval 1.12-5.78), and smokers were 2.5 times more likely to develop obstructive salivary disorders. There was no statistical correlation between the prevalence and other risk factors like infection, dehydration, intake of medications, history of diabetes mellitus, radiotherapy, and autoimmune disorders. Conclusion Our study results demonstrated that the prevalence of obstructive salivary gland disorders was 0.1%. This study provided a better understanding of the prevalence and risk factors of obstructive salivary disorders, which facilitate timely management and improves quality of life.

Treatment adherence and quality of life in colombian patients with lupus nephritis.

As with many other chronic diseases, systemic lupus erythematosus (SLE) and lupus nephritis (LN) have significant impacts on the health-related quality of life (HRQoL). Medication non-adherence is a significant challenge in the management of SLE, with consistently up to 75% of patients being non-adherent with their SLE medications. There is a need to assess the patient's perspective using patient-reported outcomes (PROs) to better understand the current impact of LN on HRQoL and treatment adherence in our region. The aim of this study was to explore the relationship between HRQoL and treatment adherence in patients with LN from the Colombian Caribbean. A cross-sectional study was conducted from June to December 2022, including patients with biopsy-proven LN. HRQoL and treatment adherence were assessed using the Lupus Quality of Life (LupusQoL) and the Compliance Questionnaire in Rheumatology 19 (CQR19) instruments, respectively. Patients were categorized as adherent or non-adherent based on medication intake (defined as >80% correct dosage). Principal component analysis (PCA) was employed to identify principal components between adherent and non-adherent patients. A total of 42 patients with LN were included. Of these, 38 (90%) were female, and the mean age was 31 ± 10 years. Proliferative class IV was the predominant histopathological profile (90%). Twenty-five (60%) patients were categorized as non-adherent. Across all LupusQoL domains, a comprehensive range of responses was observed. Pain, planning, and intimate relationships domains remained unaffected, while burden to others domain had the lowest score. Poorer planning score correlated with older age (r = -0.72; p < .05) and longer disease duration (r = -0.74; p < .05). SLEDAI-2K correlated with the pain domain (r = -0.78; p < .05). Non-adherent patients exhibited significantly worse pain domain scores compared to adherent counterparts (p < .05). PCA showed strong interactions between planning and pain, as well as between physical health and body image domains. LupusQoL pain domain scores were significantly worse in non-adherent patients compared to adherent patients. Effective pain management could be a determinant in HRQoL and treatment adherence rates in our population.

Influence of statin potency and liposolubility on Alzheimer’s disease patients: A population-based study

Although Alzheimer’s disease (AD) cause is still unknown, there are several known risk factors, such as dyslipidemia. Statins are the most prescribed lipid-modifying therapies. Recent research has suggested a relationship between statins and AD, nevertheless, their ability to prevent AD is still unclear. Therefore, this cross-sectional study aimed to examine the relationship between statin use and anti-AD drug prescription. For that purpose, a database containing information on medications prescribed to patients aged 50 years or older (n = 233183) between 2018 and 2020 was used. Defined daily doses (DDDs) were calculated according to the ATC/DDD index 2023. Statistical analyses, with logistic regression and cumulative incidence, were carried out to assess statins and anti-AD drug consumption. As a result, a total of 47852 patients aged more than 70 years who were prescribed at least one antihypertensive, antidiabetic or lipid-modifying agent were included in the study. Of these, 45345 patients were classified within the cardiovascular risk group and 2483 were classified as patients with only hyperlipidemia. Patients using low-potency or hydrophilic statins had lower odds of anti-AD usage when compared to high-potency or lipophilic statins, respectively. Similarly, rosuvastatin and pitavastatin had lower odds of anti-AD medication intake when compared to atorvastatin. Finally, pitavastatin DDDs were prone to lower the odds of anti-AD medication usage when compared to rosuvastatin. In conclusion, a potential association between statins and the intake of AD medication has been observed. Specifically, low-potency (pitavastatin) and hydrophilic (rosuvastatin) statins were associated with less use of anti-AD medication.

Can Digital Health Improve Therapeutic Compliance in Oncology?

Therapeutic compliance, or adherence, is critical in oncology because of the complexity and duration of cancer treatment regimens. Nonadherence can lead to suboptimal therapeutic outcomes, increased disease progression, higher mortality rates, and elevated health care costs. Traditional methods to enhance compliance, such as patient education and regular follow-ups, have shown limited success. This review examines the potential of digital health technologies to improve adherence in oncology. Various studies and trials are analyzed to assess the effectiveness of these technologies in supporting patients with cancer. mHealth applications have been shown to improve medication adherence through features like medication reminders and symptom tracking. Telemedicine facilitates continuous care and reduces the need for travel, significantly improving adherence and patient satisfaction. Patient-reported outcome measures enhance clinical decision making and personalized treatment plans by incorporating patient feedback. Electronic medical records and patient portals improve compliance by providing easy access to medical information and fostering better patient-provider communication. Connected pillboxes aid in consistent medication intake and reduce dispensing errors. Digital health technologies offer significant benefits in oncology by enhancing patient engagement, improving adherence to treatment protocols, and enabling comprehensive cancer care management. However, challenges such as the digital divide, data privacy concerns, and the need for tailored interventions must be addressed. Future research should focus on evaluating the effectiveness of digital interventions and developing personalized digital health tools to maximize therapeutic compliance.