Use Of Medicines Research Articles

ROLE OF TROPICAL PLANTS IN ASTHMA MANAGEMENT

Africa is endowed with a rich variety of plants. Most of the plants are used to treatment and manage diseases; thus, promoting good health. New plants are usually tried when observed that domestic animals feed on them without experiencing any visible discomfort. However, the use of traditional medicine has been neglected as soon as modern medicine began to flourish. As associated side-effects of synthetic drugs are increasingly being discovered, there is a need to explore the use of plant-based therapeutics in the management of diseases like hypertension, asthma and cancer that have resulted in huge loss of human resources and economic downturn. Therefore, two hundred reports of empirical studies on the application of tropical plants in the management of asthma were collected from credible online sources, organised, studied, and analysed. The results demonstrated the plants some of the plants studied exhibited anti-asthma properties using anti-inflammatory, anti-histamine responses, and antioxidant mechanisms, respectively. Hence, tropical plants possess certain bioactive compounds with anti-asthma effects. Objectively applied, tropical plants can be used to effectively prevent and manage asthma with minimal or no side-effects.

Investigation of Phytochemical and Antidepressants Activity of Cinnamon Powder Extract

Neurodegenerative disease is the most common type of mobility issue, but unfortunately, there is now no medication that can alter the course of the disease. We don't know what causes this ailment. In mouse models of Parkinson's disease induced with 1‐methyl‐4‐phenyl‐1,2,3,6‐tetrahydropyridine, the oral administration of cinnamon powder and sodium benzoate may prevent the death of dopaminergic cells, dysregulation of striatal neurotransmitters, and motor impairments. The mechanisms driving its function include controlling autophagy, antioxidant effects, Parkin, DJ-1, and glial cell line-derived neurotrophic factor activation, TLR/NF-κB pathway modulation, and excessive proinflammatory response prevention. Moreover, research carried out in both laboratory and living organism settings has shown that cinnamon extracts may impact the oligomerisation and aggregation of α-synuclein. This article's goal is to discuss recent findings about this phytochemical's potential as a novel treatment for Parkinson's disease (PD). We highlight additional areas of mechanism that require investigation and possible constraints that must be overcome before this phytochemical may be used in PD trials. Neurodegenerative disease is the most common type of mobility impairment, and unfortunately, there is now no medication that can alter this disease. We don't know what causes this ailment. There has been a recent uptick in interest in medicinal plant use because of the novelty, safety, and relative affordability of this field. The characteristic flavour and aroma of cinnamon, a spice that is often used, may have neuroprotective effects on people with Parkinson's disease (PD) and other neurodegenerative diseases. The essential oils of Cinnamomum species, such as cinnamaldehyde and sodium benzoate, have shown in vitro that they can protect cells from oxidative stress, ROS generation, and autophagy dysregulation. Consequently, these oils may exert a neuroprotective effect. The in vivo evidence suggests that cinnamon powder and sodium benzoate, when administered orally to Parkinson's disease models in mice, may prevent the death of dopaminergic cells, dysregulation of striatal neurotransmitters, and motor deficits. In this essay, we will go over the latest research on this phytochemical and its potential as a novel treatment for Parkinson's disease (PD). Incorporating this phytochemical into experimental PD treatments requires further investigation into additional molecular aspects and the potential overcoming of constraints and obstacles.

ОЦЕНКА И ПРОГНОЗИРОВАНИЕ РИСКА ПАЦИЕНТСКОГО НОН-КОМПЛАЕНСА В СИСТЕМЕ СПЕЦИАЛИЗИРОВАННОЙ ФАРМАЦЕВТИЧЕСКОЙ ПОМОЩИ НАСЕЛЕНИЮ С ОНКОЛОГИЧЕСКИМИ ЗАБОЛЕВАНИЯМИ

Cardiovascular, oncological and other diseases occupy a significant place in the structure of morbidity and causes of death of the population, the growth of which largely depends on lifestyle and risk factors. Identification of risk factors contributing to the development of cancer is one of the main achievements of epidemiology of the 21st century. Subsequent research helped scientists to build multifactorial algorithms for predicting the risks of cancer and mortality from them, which greatly facilitated the work of practitioners in the field of risk stratification. The above indicates that the research results of many foreign and domestic authors confirm that significant predictors of cancer are risk factors such as old age, pre-existing cancer in blood relatives, smoking, obesity, alcohol, certain types of viral infections, certain chemicals, ionizing radiation, including UV rays of the sun and others. It is known that reducing the influence of risk factors leads to a decrease in morbidity and mortality from cancer. An important condition in the treatment of oncological diseases is the rational and effective use of medicines. Pharmaceutical specialists play an active role in this process. In the treatment of long-term or lifelong diseases, such as cancer, great importance is attached to the process of daily pharmacotherapy, compliance with the rules of adherence to treatment or compliance. Thus, problems with patients performing medical appointments are based on a complex of factors, including psychological and behavioral ones, including patients' adherence to treatment.

АНАЛИЗ ОБЪЕМА ПОТРЕБЛЕНИЯ ЛЕКАРСТВЕННЫХ ПРЕПАРАТОВ ПРИ ЛЕЧЕНИИ ЭПИЛЕПСИИ В СТАЦИОНАРЕ

The article presents the results of the study of the volume of consumption of medicinal drugs for the treatment of patients diagnosed with epilepsy. As a result of retrospective processing of case histories (continuous sampling for 2021-2023) obtained in the inpatient department of the Clinic of Nervous Diseases named after A.Y. Kozhevnikov of Sechenov University, we identified medicines with the highest NDDD value (number of defined daily doses) for each of the 8 allocated clinical and statistical groups. Among all clinical and statistical groups, the G40.0 group had the highest consumption. In clinical and statistical groups G40.0, G40.8 and G40.9, valproic acid and levetiracetam were found to have the highest NDDD value. In addition, the consumption volume analysis showed that in clinical and statistical group G40.8, the neuroleptics quetiapine and teraligene are used relatively more frequently than in other diagnoses. In clinical and statistical groups G40.1, G40.2, and G40.4, the medicines valproic acid, levetiracetam, and lamotrigine were used, respectively. B vitamins accounted for the highest consumption among all clinical and statistical groups, except for G40.2. The results obtained may become the basis for the development of recommendations to optimize the use of medicines and improve the quality of drug care for patients with epilepsy at the inpatient stage.

Analgesic Effects of Methanol Leaf Extracts from Datura alba ness in Male Wistar Rats through Reduction of C-reactive Protein Levels

Introduction: The increasing interest in utilizing natural products from medicinal plants for pain management stems from their wide availability and minimal side effects. This study aims to evaluate the toxicity profile of Datura alba ness (DAN) extracts and assess their potential analgesic activity through preventive and therapeutic analgesia models in Wistar rats, as well as to investigate the possible mechanisms of action using molecular docking. Materials and Methods: Fresh leaves of DAN were collected from a garden in the Abua/Odua Local Government Area of Rivers State, Nigeria. The leaves were extracted using cold maceration to obtain ethanolic extracts of Datura alba ness (MEDAN). Twelve mice (19-30g) were used for toxicity study, while sixty Wistar rats (140-180g) were used for analgesic studies. Serum C-reactive protein levels were determined using ELISA methods, and molecular docking simulations were conducted using AutoDock and Discovery Studio Visualizer. Results: The results indicated that MEDAN was very safe, with an LD50 of 5000 mg/kg. The findings demonstrate that MEDAN significantly increased the pain threshold in male Wistar rats after three weeks of administration in a dose-dependent manner during the preemptive analgesia study, while pain thresholds increased within one hour but decreased over time in the therapeutic analgesia study. The combination of MEDAN with a standard drug (Flexicam) resulted in improved analgesic effects at the 500 mg/kg dose. Additionally, the study revealed that MEDAN significantly reduced serum C-reactive protein levels after three weeks of oral administration. Molecular docking studies indicated that stigmasterol, gamma-sitosterol, and cholest-5-en-3-ol, 24-propylidene-(3β) from MEDAN demonstrated binding affinity to C-reactive protein receptors, mimicking the effects of the reference drug, celecoxib. Conclusion: This study concludes that ethanolic extracts of Datura alba ness exhibited significant efficacy in pain reduction by lowering C-reactive protein levels. This effect was especially enhanced when the 500 mg/kg dose of MEDAN was combined with the standard drug, Flexicam. The findings provide a scientific basis supporting the traditional medicinal use of Datura alba ness for pain management.

Patient factors associated with complementary and alternative medicine use among cancer patients at a county referral hospital, Kenya

BACKGROUND Despite numerous global reports on the use of complementary and alternative medicine (CAM), no studies have been published regarding its use at Machakos Level 5 Hospital. Therefore, this study aims to identify patient-related factors associated with CAM use among cancer patients at this Level 5 hospital in Kenya. METHODOLOGY A mixed method, cross-sectional design was implemented at Machakos level five hospital in Kenya. A Census was carried out, using a face-to-face researcher-administered questionnaire among 80 cancer patients receiving treatment at the clinic. Critically ill and mentally unstable patients were excluded. A Chi-square test assessed variable associations, considering p < 0.05 as statistically significant. Logistic regression analyzed variable relationships. RESULTS Gender was significantly associated with CAM use (p=0.014). Regression analysis revealed that Male patients were 79% less likely to use CAM (OR=0.21, 95% CI 0.042-1.003, p=0.050). Patients who had received radiotherapy were likely to use CAM (p=0.032), however, on regression analysis there was no significant association. Believes that CAM improves health (χ2=9.231, p-0.010), supports conventional treatment (χ2=15.620, p-0.001), cures cancer (χ2=12.661, p-0.002), manages treatment side effects (χ2=11.045, p-0.004), relieves cancer symptoms (χ2=9.008, p-0.011), promotes self-healing (χ2=16.969, p-0.001), and gives hope (χ2=17.512, p-0.001) were significantly associated with CAM use. CONCLUSION AND RECOMMENDATION. There was a significant association between patient characteristics and CAM use among cancer patients. Improving patient-healthcare worker communication could encourage reporting of CAM usage. Further research is needed to explore the efficacy, safety, and tolerability of CAM in cancer patients.

In-vitro evaluation of antioxidant properties of aqueous extracts of Murraya koenigii, Aegle marmelos and Laurus nobilis

This study investigates the antioxidant properties of aqueous extracts of Murraya koenigii (curry leaf), Aegle marmelos (bael) and Laurus nobilis (bay leaf) using in vitro assays. The plants have been traditionally used in Indian medicinal systems for the treatment of various metabolic disorders. Aqueous extracts from the leaves of Murraya koenigii, fruit pulp of Aegle marmelos and leaves of Laurus nobilis were prepared. The total phenolic content and total flavanoid content was also determined in these aqueous extracts. They were tested for their ability to scavange free radicals by DPPH assay, ABTS assay and FRAP assay which are elevated during various metabolic disorders. The results suggest that all the three plants exhibited significant antioxidant activities. But strongest antioxidant properties were exhibited by Murraya koenigii leaf extract followed by the pulp of Aegle marmelos and lowest antioxidant activity was exhibited by Laurus nobilis extract, supporting their use in traditional medicine and potential development into therapeutic agents. So, this research suggested that these medicinal plants possess a significant antioxidant potential and are important source of natural antioxidants and can be effectively used in treating oxidative stress disorders. As a result, the study's significant findings demonstrate that it is a step towards evidence-based phytomedicine.

Phytochemical screening and evaluation of antiradical and antimicrobial activities of Annona senegalensis and Detarium microcarpum leaves used in Benin to treat urinary infections

The challenge of resistance to synthetic antimicrobials necessitates new alternative solutions. Medicinal plants are rich in active compounds with various medicinal properties that can be used in treatment of urinary infections. This work aims to highlight the value of Annona senegalensis and Detarium microcarpum by evaluating phytochemical and antimicrobial potentials of their leaf extracts. Qualitative and quantitative analyses were carried out using color and precipitation reactions and spectrophotometric assays. The antiradical activity was evaluated using the DPPH test, and the antimicrobial activity was assessed by the agar diffusion method. Phytochemical screening showed that both plants contain anthraquinones, catechic tannins, coumarins, flavonoids, reducing compounds, sterols and terpenes. Hydroethanolic extract of Detarium microcarpum and A. senegalensis showed IC50 inhibition percentages of 0.20 mg/mL and 0.22 mg/mL respectively. Regarding antimicrobial activity, the hydroethanolic leaf extracts of D. microcarpum and A. senegalensis were found to be bactericidal and fungicidal against the tested bacteria and molds. This extract showed more pronounced antimicrobial activity than amoxicillin and ciprofloxacin, which are synthetic antimicrobials. Diversity of secondary metabolites and notable antimicrobial activity of D. microcarpum and A. senegalensis may justify their use in traditional medicine for treating urinary infections in Benin.

A toxicological assessment of Ganoderma lucidum and Cordyceps militaris mushroom powders

Gonoderma lucidum (G. lucidum) and Cordyceps militaris (C. militaris) are among the many mushrooms known for their long history of use in traditional medicine. Wildcrafted sources of mushrooms including G. lucidum and C. militaris can be limited from a scarcity and quality perspective, but solid fermentation processes in cultivation settings can provide an efficient way to deliver whole mushroom preparations of a consistent composition. Despite the historical use of these mushrooms, few published reports have explored their potential subchronic oral toxicity or genotoxicity, either from specific components or whole mushroom preparations. The purpose of this study was to assess the potential for acute toxicity, subchronic toxicity, and genotoxicity of powders produced from G. lucidum mycelial biomass and fruiting body (“Organic Reishi M2-102-02 powder”) cultured on oats, and C. militaris mycelial biomass, stroma, and fruiting body (“Organic Cordyceps M2-116-04 powder”) cultured on oats. Results of the testing demonstrate that both Organic Reishi M2-102-02 powder and Organic Cordyceps M2-116-04 powder were not acutely toxic, did not exhibit subchronic oral toxicity in rats at doses up to the highest dose tested of 2,000 mg/kg bw/day, and did not have genotoxic potential based on in vitro and in vivo genotoxicity assays.

Efficacy of integrated traditional Chinese and western medicine in managing mild-moderate acute pancreatitis: a real-world clinical perspective analysis

BackgroundGiven the prevalent utilization of integrated traditional Chinese and western medicine (ITCWM) in the management of acute pancreatitis, the majority of studies have concentrated on severe cases, lacking robust evidence-based medical research. Real-world investigations can provide an objective assessment of the clinical effectiveness of combining traditional Chinese medicine with western medicine. Consequently, relying on real-world research, we intend to evaluate the clinical efficacy and safety of the combined approach in treating mild to moderate acute pancreatitis.MethodsA total of 563 AP patients from Henan Central Hospital were collected from January 2019 to October 2023. A propensity score matching (PSM) analysis was conducted to evaluate the clinical efficacy of traditional Chinese medicine (TCM) in treating mild to moderate acute pancreatitis. Patients were divided into a control group (61 cases) and an integrated traditional Chinese and Western medicine (ITCWM) group (120 cases). To further assess the clinical efficacy of TCM enema in the treatment of mild to moderate acute pancreatitis, PSM analysis was conducted across three groups. The patients were categorized into a control group (n = 49), an oral TCM treatment group (OCM group, n = 274), and an oral TCM plus enema treatment group (OCM+E group, n = 131). Logistic regression was used to analyze factors after treatment in each group, and the Kaplan-Meier method compared symptom duration in each group.ResultsCompared with the control group, the ITCWM group significantly decreased C-reactive protein (CRP, mg/L) (17.8 [1.2–59.5] vs. 8.0 [3.3–33.5], P = 0.022), shortened the duration of abdominal distension, abdominal pain, nausea and bitter taste symptoms (P < 0.05), and shortened the length of hospital stay (median 19.0 and 11.5 days, respectively, P = 0.001); Compared with the other two groups, the neutrophil percentage (NEUT%) was lower (74.1 vs. 61.9 vs. 59.5, P < 0.05) and serum prealbumin (PA, mg/L) was higher (116.0 vs. 184.4 vs. 220.0, P < 0.05), the length of hospitalization (days) was shortened (19.0 vs.12.0 vs.10.0, P < 0.05) in the OCM+E group.ConclusionThe combination of traditional Chinese medicine and modern medicine has been shown to effectively decrease inflammatory indicators in patients with mild to moderate acute pancreatitis, leading to a reduction in symptom duration and hospitalization period, as well as promoting disease recovery. Notably, the use of traditional Chinese medicine in conjunction with enema therapy yields more pronounced benefits.

Phytochemical analysis of stem and leaves extracts of Tinospora cordifolia (Thunb.) Miers

Tinospora cordifolia (Thunb.) Miers is a large deciduous, creeping shrub belonging to the family Menispermaceae. The phytochemical analysis of the plants is very important commercially and has great interest in pharmaceutical companies for the production of the new drugs for curing of various diseases. The present study involves the qualitative phytochemical analysis of the selected medicinal plants. The aim of this study is carried out to analyze the phytochemical compounds in stem and leaves extracts of selected plant by using phytochemical screening tests. The leaf and stem extracts of the plant is expressed the presence of several phytochemicals viz., flavonoids, amino acids, diterpines, protein, saponins and carbohydrates. The result of phytochemical screening tests revealed that diterpines and carbohydrates are positive in all extracts. But flavonoids and saponins only present in methanol and ethanol extracts. The studies justify that T. cordifolia use in traditional medicines. The investigation further proposed that the phytochemicals present in stems and leaves of the plant, which can be used as natural antioxidants in medicinal drugs.

A quantitative investigation in a territory of Italy on citizens' attitudes towards medicines through the COVID-19 pandemic: the importance of possible indirect effects caused by the pandemic.

The COVID-19 pandemic has greatly influenced many aspects of everyday life, particularly that of the general population health. In order to better understand the potential impacts of the COVID-19 pandemic on people's attitudes toward medicines use, a quantitative investigation was conducted in a territory of Sardinia region, Italy. Stratification of the random multilevel population sample was based on gender, age range, and territory. The methodological strategy to verify the potential approach changes towards medicines due to the COVID-19 pandemic consisted of oral interviews with adult citizens and unrecognizability preservation. Investigation, also supported by a study completed before the insurgence of the pandemic about taking medicines, interrupting treatments without consulting, and reading the information leaflet, allowed to explore citizens' attitudes before and during pandemic, and changing. The most relevant findings are the tendency towards a higher occurrence of self-interruption of treatments and an increased interest in the information leaflet (package leaflet), but not an increased self-administration of medicines. These results indicate new indirect effects of the COVID-19 pandemic that could exert an additional impact on the state of citizens' health and health systems. The study, with reference to prophylactic medical treatments and based on some considerations concerning the pandemic from its insurgence to today, also provides solutions for related problems for the present or future periods of health emergencies.

Evaluation of biocompatibility and osteoconductivity of a hybrid cell-tissue graft for bone regenerative medicine

Aim – to evaluate in vitro the biocompatibility and osteoconductivity of a hybrid graft based on a bioorganic matrix, human bone marrow mesenchymal stromal cells (BM-MSC) and osteogenic growth factors. Material and methods. Bioorganic matrices were studied for biocompatibility with human BM-MSC culture used in traumatology and orthopedics. For promoted osteogenic differentiation of BM-MSCs, allogeneic plasma enriched with soluble platelet factors was used. The osteogenic potential of BM-MSCs by the synthesis of mRNAs of early (transcription factor 2 (Run X2), alkaline phosphatase (ALP)) and late genes (osteopontin (OSP)) osteogenesis was analyzed. The properties of cell adhesion and proliferation of MSCs in the conditions of a three-dimensional hybrid graft by the MTT test and fluorescence microscopy were assessed. Results. The biocompatibility of the studied bioorganic matrices with human BM-MSCs was established. The collagen matrix promoted rapid cell adhesion and proliferation between the scaffold fibrils. It has also been established that allogeneic platelet-rich plasma affects the osteogenic differentiation of human BM-MSCs in vitro, increasing the expression of marker genes RunX2, ALP, OSP. When modeling a hybrid graft in vitro, the formation of a tight contact between the alloimplant and collagen biopolymer using MSCs was shown. Conclusion. The biological properties of the developed hybrid cell-tissue graft characterize its biocompatibility and osteoconductivity of its constituent components, which makes it promising for use in regenerative medicine, especially in reconstructive surgery of bone defects.

Use of Complementary and Alternative Medicine by Greek Patients with Inflammatory Bowel Disease

Background and Objectives: Complementary and alternative medicine (CAM) is regularly used by several patients with inflammatory bowel disease (IBD) in many countries. Data concerning the use of CAM in Greek patients with IBD are lacking. This study aimed to determine the prevalence and indicators of CAM use in Greek IBD patients. Patients and Methods: Adult patients with IBD attending our specialized IBD department in “Metropolitan General” Hospital, Holargos, Greece, completed a special questionnaire regarding the use of CAM. Several clinical and epidemiological characteristics were recorded. The results were compared with a disease-control group (patients with irritable bowel syndrome or gastroesophageal reflux disease). The study outcome was the prevalence of CAM use in both groups. In this study, 270 patients, of whom 128 were female, with IBD (Crohn’s disease 134 and ulcerative colitis 136) and a median age of 42.3 ± 17.5 years (range 31–52), and 138 patients serving as the disease control group were analyzed. Results: The prevalence of previous and current CAM use in patients with IBD was 36.3% versus 27.5% in the control group (no significant differences). No significant differences were also noticed between the patients with either CD or UC. In the multivariable analysis, university education and treatment with steroids and TNF-α inhibitors were independent social indicators of CAM use. Conclusions: The percentage of CAM use by the Greek patients with IBD was quite high, similar to other European countries. Although numerically higher, this percentage was not significantly different compared with the disease control group. The use of CAM in IBD patients in Greece is associated with a higher educational level, and treatment with steroids and TNF-α inhibitors.

Fustin, a Potent Phytochemical, Attenuates Scopolamine-induced Memory Impairment and Neurodegeneration by Modulating Neuroinflammation and Neurotransmitters.

Fustin, a photogenic flavanol found in the plant Rhus verniciflua Stokes, has been involved in multiple disease ailments and has a beneficial pharmacological effect and a history of use in traditional medicine. The present research aimed to study the impact of fustin on scopolamine (SCOP)-induced memory impairment and neurodegeneration by modulating neuroinflammation and neurotransmitters in rats. A total of 30 healthy Wistar rats were allocated into five groups (n=6). Group I- served as control and received saline solution (1mL/kg i.p.), group -II- fustin (100 mg/kg, orally), group -III -SCOP (1 mg/kg, i.p.), and group -IV and V were given fustin (50 and 100 mg/kg/p.o.) with SCOP (1 mg/kg, i.p.) for 14-days. After 14 days, 2 hours after SCOP injection, the Y-maze and Morris water maze (MWM) tests were performed. After behavioral tests rats were subsequently euthanized, and brain supernatants were used to estimate choline-acetyltransferase (ChAT), acetylcholinesterase (AChE), antioxidant [superoxide dismutase (SOD), catalase (CAT), and glutathione (GSH)], and total protein, oxidative stress markers [nitrate and malondialdehyde (MDA)], pro-inflammatory markers [tumor necrosis factor (TNF-α), and Interleukins-1β (IL-1β) and IL-6]. Also, neurotransmitters such as serotonin (5-HT), dopamine (DA), ϒ-amino butyric acid (GABA), acetylcholine (Ach), and noradrenaline (NA) contents were performed. Fustin exhibited substantial behavioral improvement in the Y-maze measures spontaneous alterations percentage (SA%) and decreased latency time following the acquisition and prolonged time spent in the probe trial in the MWM test. Moreover, fustin inhibits enhanced neuroinflammatory cytokines and oxidative stress markers and improves the neurotransmitters. The findings of this study suggest that fustin inhibits SCOP impact on cognitive abilities in rats. The present investigation demonstrates that fustin, a potent phytochemical, effectively mitigated the behavioral and physiological changes induced by SCOP in rats. This was primarily achieved by modulating the levels of inflammatory response and neurotransmitters.

Association of adverse childhood experiences with adult-onset cardiometabolic conditions and prescription medicine use

Abstract Association of adverse childhood experiences with adult-onset cardiometabolic conditions and prescription medicine use Background and importance Adverse childhood experiences are potentially preventable and traumatic events that occur during childhood. Childhood exposure to trauma is highly prevalent and adults who had adverse childhood experiences are at increased risk of developing physical conditions. However, effect of adverse childhood experiences on health outcomes remains underrecognized. Aim Here, we aimed to measure the association of cumulative adverse childhood experience with adult physical condition and use of prescription medicines in general population. Methods We conducted a cross-sectional analysis using the population-based health study including 21083 participants at age 40 years or older. Self-reported adverse childhood experiences before age at 18 years, present or previous cardiometabolic conditions, and present or previous use of medications prescribed for cardiometabolic conditions were used in our analysis. Cox proportional hazards regression was used to estimate age, sex, smoking, education, and income-adjusted risk of cardiometabolic condition and prescription medicine use after adverse childhood experiences. Association of multimorbidity and using multiple prescription medicines with adverse childhood experience was analyzed using generalized linear model with ordinal classification. Results We found that having a history of adverse childhood experience was associated with increased risk of subsequent cardiometabolic conditions; hazard ratios ranged from 1.117 (95% CI, 1.054 – 1.185) to 1.341 (95% CI, 1.181 – 1.522). Furthermore, adverse childhood experience was associated with multimorbidity of cardiometabolic conditions (odds ratio [OR], 1.195; 95% CI, 1.117 – 1.279) and increased risk of using multiple prescription medicines (OR, 1.131; 95% CI, 1.057 – 1.210). Notably, we observed the dose – effect relationships of cumulative adverse childhood experience to the increased risk of 5 among 6 cardiometabolic conditions and to the increased risk of using 4 among 6 prescription medicines. Furthermore, cumulative adverse childhood experience had the dose – effect associations with multimorbidity of cardiometabolic conditions (ORs ranged from 1.120 [95% CI, 1.033 – 1.214] to 1.526 [95% CI, 1.276 – 1.825]) and using multiple prescription medicines (ORs are 1.393 [95% CI, 1.195 – 1.624] and 1.572 [95% CI 1.315 1.879]). Conclusions and relevance: Our findings implicate cumulative adverse childhood experience as a risk factor for later cardiometabolic conditions and use of medicines prescribed for cardiometabolic conditions. Our results are significant by suggesting inquiry into adverse childhood experience exposure during clinical consultations, services to alleviate the burden and increasing resilience in addition to strategies aimed at prevention of cardiometabolic conditions might improve health outcomes.

CANNABIS: USO TERAPÊUTICO E DESAFIOS PARA SUA APLICABILIDADE MEDICINAL NO BRASIL

Introduction: The legalization of medicinal marijuana use has been a controversial and constantly debated topic in recent years worldwide. Marijuana, also known as cannabis, is a plant that contains various chemical components, including THC (tetrahydrocannabinol) and CBD (cannabidiol), which are the main compounds responsible for its medicinal effects. Although many countries have already established regulations for the therapeutic use of cannabis, there are still many barriers to overcome. Objective: To explore the methodology of therapeutic use and the challenges for the application of cannabis, focusing on its medicinal use, identifying notable challenges and the regulatory aspects involved. Methodology: This study is based on a bibliographic review with a qualitative methodology, centered on the subjective nature of the verified bibliography through literary studies. The works reviewed were published between 2020 and 2023, collected from three main sources: LILACS and PUBMED databases. Results: The review identified significant evidence pointing to the therapeutic potential of Cannabis sativa L., particularly in the treatment of neurological conditions such as epilepsy, multiple sclerosis, and anxiety disorders. However, it also highlighted the major regulatory challenges faced in countries like Brazil, where the cultivation of cannabis for medicinal purposes remains prohibited. This prohibition increases treatment costs and limits accessibility for patients. Additionally, the results revealed a growing acceptance among healthcare professionals and patients, suggesting a likely increase in the demand for medicinal cannabis in the coming years. Conclusion: Although there is robust evidence supporting the efficacy of cannabis for medicinal purposes, significant regulatory and legal barriers remain, particularly in countries with restrictive policies. A reformulation of regulatory frameworks is urgently needed to expand patient access and promote the development of local medicinal cannabis industries. Further investment in scientific research is also essential to ensure that regulatory decisions are based on comprehensive and context-specific data.

Traditional medicine use to manage hypercholesterolemia, hyperglycaemia and hypertension in Ecuador

Abstract Background Although the use of traditional medicine (TM) to manage health issues is frequently reported, clinical guidelines often overlook this practice. This study aimed to describe the frequency of TM use to control 3 cardiometabolic risk factors for non-communicable diseases (arterial hypertension, hypercholesterolemia, and hyperglycaemia, collectively referred to as CMRF here); and associated sociodemographic, economic, and clinical characteristics. Methods Descriptive cross-sectional study with a representative population of two health districts in Ecuador, one urban in southern Quito and one in a forested rural area with diverse ethnic groups in Esmeraldas. We included 602 individuals with at least one CMRF and calculated the proportion of those who reported regular use of TM (herbal or traditional remedies) to control their CMRF. We used a multivariable logistic regression model to calculate Odds Ratios for TM use according to sociodemographic, economic, and clinical characteristics. Results TM was commonly used to control CMRF in both sociocultural contexts (39.4% Esmeraldas, 31.1% Quito), often in combination with conventional medicine (CM). A notable percentage of people (33.9% Esmeraldas, 39.0% Quito) did not take any treatment for their CMRF, and the rest used CM alone. In both settings, education was significantly associated with TM use. While in Quito people with higher education were more likely to use TM (aOR 2.04, 95%CI 1.03-3.90), in Esmeraldas, it was more common among people without formal schooling (aOR 3.76; 95%CI 1.59-8.88) as well as those of younger age (aOR per year 0.97; 95%CI 0.95-0.99) and from Afro-Ecudorian ethnicity (aOR 2.13; 95%CI 1.02-4.45). Conclusions Traditional medicine is used by a significant portion of Ecuador’s population, highlighting the need for a more accessible and intercultural approach to healthcare. Key messages • The use of traditional medicine to address hypertension, hypercholesterolemia, and hyperglycaemia appears to be widespread in different sociocultural and economic contexts of Ecuador. • To promote intercultural health, understanding the diverse sociocultural patterns associated with the use of traditional medicine, often combined with conventional medicine, is crucial.

GLP1-RA versus DPP4 inhibitors on cardiovascular outcomes: A three-year real-world analysis

Abstract Background Cardiovascular outcome trials of GLP1-RAs have massively impacted the clinical practice in the management of patients with type 2 diabetes. The cardiovascular protective properties of GLP1-RA compared to DPP4 have been demonstrated in an observational setting before, however recent methodological developments have enabled clinically relevant effect estimation. Aim This study aimed to evaluate the real-world cardiovascular outcomes of GLP1-RA versus DPP4 inhibitors in patients with type 2 diabetes and high cardiovascular risk. Methods In this study, we utilized the Danish nationwide registers to identify new users of GLP1-RA or DPP4 therapies from 2012 to 2022. Participants were required to be either at least 50 years of age and have one or more of the following conditions: hypertension, chronic obstructive pulmonary disease, cardiovascular disease, or chronic renal disease or be at least 60 years of age and have hypertension. Additionally, their glycated hemoglobin (HbA1c) levels needed to be 53 mmol/mol or higher within the year preceding their first prescription date for these therapies. The index date was defined as the initial prescription date, and comorbidities and medicine use were evaluated up to 10 years prior to this date. Individuals who had filled prescriptions for SGLT2 inhibitors within six months prior to their index date were excluded from the study. The outcome of interest was a composite of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke (MACE). Patients were followed for up to three years until MACE, all-cause mortality, emigration, or until the end of follow-up on December 31, 2022. To assess the three-year risk of MACE, the Aalen Johansson estimator was used. A casual inference framework was employed estimating the three-year average treatment effect using g-formula based on Cox regression with competing risk. Results A total of 26,190 individuals were included, with 19,494 initiating DPP4 inhibitor therapy and 6,696 initiating GLP1-RA therapy. The three-year risk of MACE was 8.56% (95% confidence interval [CI]: 8.11 to 9.00) for the DPP4 initiator group, compared to 4.76% (95% CI: 4.08 to 5.43) for the GLP1-RA initiator group. Emulating what would have happened had all included individuals initiated GLP1-RA treatment versus had all initiated treatment with DPP4, accounting for age, sex, income, education, degree of urbanization, diabetes duration, baseline hba1c level, co-medicine, and co-morbidities, we estimated an three-year average treatment effect of -2.05% (95% CI:-2.92;-1.18) , p-value<0.001) for GLP1-RA initiation versus DPP4 initiation for MACE. Conclusion Our findings suggest that GLP1-RA use is associated with a significantly lower risk of MACE compared to DPP4 inhibitors in a real-world population of patients with type 2 diabetes and high cardiovascular risk. This supports the cardiovascular protective role of GLP1-RA in clinical practice.

Knowledge and perspectives about medicinal cannabis in nurses and nursing students in Portugal

Abstract Background The opening up of legislation on medicinal cannabis in recent years has been a determining factor in the growth of this therapy. In Europe, regulation of medicinal use is a reality in several countries. Nurses can play a leading role in its administration, helping to ensure that it is carried out more effectively and assuming a fundamental role in the success of the therapy. It is therefore pertinent to analyze the knowledge of nurses and nursing students in Portugal about medicinal cannabis. Methods Quantitative descriptive study. A self-completion questionnaire was drawn up and made available on the google forms platform. It was face-validated, content-validated and approved by the Ethics Committee. The instrument included sociodemographic data, questions about cannabis knowledge and perspectives. Descriptive statistics were analyzed. Results Out of a total of 610 responses, 318 were nurses and 292 nursing students. Medical cannabis is considered legitimate by 79.6% of nurses and 84.3% of students. When asked about the functions of the endocannabinoid system, 71.7% of nurses and 79.5% of students said they had no knowledge. 88.7% of nurses and 79.5% of students disagreed that they had sufficient knowledge to advise users on the use of medicinal cannabis. Also, 38.4% believe that their patients use cannabis illegally to manage the symptoms of illnesses. Conclusions There is a need for continuing training for nurses and for the undergraduate and postgraduate nursing curricula to include this emerging area. Key messages • The results show that this issue is a public health problem. It reinforces the need to formulate public policies in this area and to implement training for nurses and nursing students. • These measures will be fundamental in preventing the use of illegal cannabis and promoting the safe use of medicinal cannabis.