Need For Long-term Medication Research Articles

Drought Stress Amelioration Attributes of Plant-Associated Microbiome on Agricultural Plants.

The future global food security depends on the availability of water for agriculture. Yet, the ongoing rise in nonagricultural uses for water, such as urban and industrial uses, and growing environmental quality concerns have increased pressure of irrigation water demand and posed danger to food security. Nevertheless, its severity and duration are predicted to rise shortly. Drought pressure causes stunted growth, severe damage to photosynthesis activity, loss in crop yield, reduced seed germination, and reduced nutrient intake by plants. To overcome the effects of a devastating drought on plants, it is essential to think about the causes, mechanisms of action, and long-term agronomy management and genetics. As a result, there is an urgent need for long-term medication to deal with the harmful effects of drought pressure. The review focuses on the adverse impact of drought on the plant, physiological, and biochemical aspects, and management measures to control the severity of drought conditions. This article reviews the role of genome editing (GE) technologies such as CRISPR 9 (CRISPR-Cas9) related spaces and short palindromic relapse between proteins in reducing the effects of phytohormones, osmolytes, external compounds, proteins, microbes (plant growth-promoting microorganism [PGPM]), approach omics, and drought on plants that support plant growth. This research is to examine the potential of using the microbiome associated with plants for drought resistance and sustainable agriculture. Researchers also advocate using a mix of biotechnology, agronomic, and advanced GE technologies to create drought-tolerant plant varieties.

Assessment of the attitude toward medication and reasons for drug compliance among schizophrenic patients attending the tertiary care hospital

Abstract Introduction: Medication compliance is one of the most difficult challenges in the management of schizophrenia in India. Compliance broadly means the extent to which a person’s behavior, in terms of taking medications, following diets and executing lifestyle changes, visiting for follow-up, etc., coincides with medical and health advice. The current study has tried to assess the attitudes and reasons for compliance as well as noncompliance among patients with schizophrenia, which can provide the basis for planning effective interventional strategies for the mental health professionals for improving compliance of the patient in the future. Methodology: A hospital-based noninterventional cross-sectional study was done on 135 schizophrenic patients attending the outpatient services in the Department of Psychiatry, Government General Hospital, Kurnool, hospital by convenient sampling method for 6 months from October 2021 to March 2022, after obtaining approval from the institutional ethical committee. Data were collected and entered in Microsoft Excel and analyzed using the Statistical Package for Social Sciences (SPSS) 16 version software. Results: The prevalence observed in the present study, 75 (55.56%) participants were compliant, i.e., had a positive attitude toward medication and 60 (44.44%) participants were noncompliant toward medication. Higher mean scores for the Positive and Negative Syndrome Scale score were seen in the compliant group (101.25 ± 19.27) than the noncompliant group (100.98 ± 22.51). Conclusion: Main reasons for drug noncompliance identified in the present study were financial difficulty, distance from the hospital, improvement or no improvement in symptoms, side effects, lack of insight into the mental illness, and lack of awareness about the need for long-term medication.

LBODP076 Hypophysitis Misdiagnosed As Pituitary Macroadenoma During Pregnancy

Abstract Introduction Surgical treatment of nonfunctioning symptomatic pituitary macroadenoma may be associated with significant morbidity and the need for long-term medications. In late pregnancy and the postpartum periods, lymphocytic hypophysitis can present as a pituitary macroadenoma. We present a rare case of a pregnant patient who underwent pituitary surgery for lymphocytic hypophysitis. Case presentation A 37-year-old woman was evaluated for headaches and double vision during the third trimester of her pregnancy. A visual field exam showed bitemporal hemianopsia. Brain magnetic resonance imaging (MRI) showed a 2 cm intrasellar tumor with suprasellar extension, interpreted as a pituitary macroadenoma. The patient underwent a cesarean section. Labs after delivery showed IGF-1: 153 ng/ml (79-259), LH: < 0.2 mIU/ml (1.9-12.8), FSH: 6.4 mIU/ ml (2.3-12.6), Prolactin: 4.3 ng/ml (2.2-30.3), and a low morning cortisol: 2.4 ug/dl (4.2- 22.4). Pituitary MRI with intravenous contrast found a stable pituitary macroadenoma with suprasellar extension compressing the optic chiasm and prechiasmatic optic nerves without evidence of apoplexy. She underwent image-guided endoscopic transsphenoidal resection of the pituitary mass. Postoperatively, she developed diabetes insipidus that was treated with desmopressin. She was treated with steroids for secondary adrenal insufficiency and levothyroxine for central hypothyroidism. The pathology report showed hypophysitis; a lymphoplasmacytic infiltrate identified within the specimen with increased IgG4 expression. Differential diagnoses included IgG4-related hypophysitis and lymphocytic hypophysitis with an IgG4-expressing plasma cell component. Serum IGG 4 was 62 mg/dl (normal: 2 - 96 mg/dl); however, patient was already on steroids. She has been requiring hydrocortisone, levothyroxine, and desmopressin. Discussion Lymphocytic hypophysitis often occurs in late pregnancy or the postpartum period. MRI usually shows a pituitary mass, mimicking an adenoma. However, differences between lymphocytic hypophysitis and pituitary adenoma, using different imaging techniques, have been described. Lymphocytic hypophysitis should be considered in the differential diagnosis of women presenting with pituitary enlargement in the peripartum period. These patients may benefit from conservative treatment with glucocorticoids based on clinical suspicion. Presentation: No date and time listed

Stopping antidepressants: withdrawal symptoms and rebound effects : Review and practical recommendations

Stopping antidepressants can cause withdrawal (discontinuation) symptoms, the return of the original illness, and rebound. The latter means that the disease will return stronger, faster, or with greater likelihood than if it had not been treated with medication. The Psychiatry Working Group of the Drug Commission of the German Medical Association (AkdÄ) presents the scientific findings and provides practical recommendations for action. Withdrawal symptoms are multiform; unspecific physical symptoms are predominant. Distinguishing them from the recurrence of depressive symptoms can be difficult. Most of them are mild and self-limiting. There is insufficient evidence on the extent and frequency of rebound depression. The rebound risk implies that when establishing the medication, the short-term benefit must be weighed against the possible long-term risk of chronic depression or the possible need for long-term medication. Patients should be informed about the risk of withdrawal both as early as the joint decision-making process about treatment initiation and regularly during the course of treatment. Withdrawal should take place gradually, except in emergency situations, whereby small steps should be taken, especially in the low-dose range.

Lithium: The best current treatment for the well-informed bipolar patient.

Lithium is the gold standard in the maintenance treatment of bipolar disorders. When used properly, lithium can bring about dramatic improvements in the course of this disease, with, in general, good tolerability, also in comparison with other approved treatment options. However, it's not a panacea for every individual patient at every stage of the disease. There is a significant number of patients who do not respond to or do not tolerate the usually recommended therapeutic serum concentrations of 0.6 - 0.8 mmol/l. Given its potential toxicity, lithium is a drug for the informed cooperating patient, who has developed an acceptance regarding his illness and the need for long-term medication and regular check-ups. High-quality group psychoeducation may greatly help for the majority of patients for successful long-term treatment with lithium, based on "shared decision making" with an openness to flexible patient-centered solutions with regard to dosage issues, side effect management and stand-by add-on/combination treatment. Under the above conditions, lithium should be offered and recommended to every patient with bipolar disorders early in the course of the disease as the mainstay of long-term treatment. Against this background, lithium should also be used more often in the acute treatment of manic episodes, if needed in combination with other mood stabilizing drugs that are approved for this purpose and may have a more rapid onset of action, in order to facilitate the path to successful long-term treatment with lithium.

Use of alendronate in the therapy of osteoporosis

Treatment of osteoporosis is a difficult task due to the need for long-term medication and maximum safety. The main goal of osteoporosis treatment is to prevent bone fractures. According to the national clinical guidelines for the treatment of osteoporosis, nitrogen-containing bisphosphonates are among the first-line drugs for the prevention and treatment of this disease. The diversity in the side chain structure determines the strength with which bisphosphonates bind to hydroxyapatite, are distributed, and remain in bone tissue for a certain time after treatment has been completed. They are the drugs of choice as they have proven efficacy in reducing the risk of fractures, and at the same time an acceptable safety profile. Bisphosphonates are the most well-known and studied drugs, successfully used in all countries for the treatment of various forms of osteoporosis. When using oral forms of bisphosphonates, the most expected undesirable phenomenon is esophagitis. The development of new forms of well-known and proven medicines that reduce adverse events and increase adherence to treatment is extremely important and promising. Of the latest achievements in this regard, it should be noted a new form of alendronate-Binosto-effervescent soluble tablet, the use of which reduces the risk of irritating effects on the upper gastrointestinal tract.

POTENTIAL HOLISTIC PREVENTIVE AND THERAPEUTIC EFFECTS OF GARCINIA MANGOSTANA EXTRACT OR ISOLATES IN TYPE 2 DIABETES MELLITUS: A REVIEW

Objective: The need for long-term medication in diabetes mellitus has led to a search for herbal medicines as alternative treatments. Several studies have shown that extract or isolates of Garcinia mangostana can help prevent and treat type 2 diabetes mellitus (T2DM).
 Methods: This review was conducted by searching various databases, including PubMed, ClinicalKey, ScienceDirect, and EBSCOhost. We analyzed papers published within the previous 10 y.
 Results: All in vitro, in vivo, and clinical studies that evaluated the pharmacological effects of extract or isolates of G. mangostana in T2DM were reviewed. G. mangostana was found to suppress adipogenesis and regulate lipid homeostasis, thus improving lipid profiles and preventing T2DM. G. mangostana also demonstrated hypoglycemic properties, including the ability to decrease fasting blood glucose and mildly increase pancreatic β-cell numbers and activity. The mangosteen-treated group in one study showed a decrease in Homeostatic Model Assesment for Insulin Resistance (HOMA-IR), indicating improved insulin sensitivity, along with a significant decrease in the high-sensitivity CRP (hs-CRP) levels. Histopathology showed that the α-mangostin-treated group had less damage to pancreatic β cells, healthier hepatocytes and central veins, and less glomerular and tubular epithelial necrosis than the diabetic control group. Moreover, the antioxidant effect of G. mangostana was shown to protect against the micro-and macrovascular damage caused by T2DM.
 Conclusion: Extract or isolates of G. mangostana possess strong potential to prevent and treat T2DM. Further research evaluating long-term outcome biomarkers in humans is needed to confirm the drug’s glycemic control capacity.

Factors affecting self-reported medication adherence and hypertension knowledge: A cross-sectional study in rural villages, Yogyakarta Province, Indonesia.

Objectives This study assessed medication adherence and hypertension knowledge, and their predictive factors, in people with hypertension, living in rural communities in Indonesia. Methods Data were acquired from 384 people living in eight rural villages via a researcher-administered questionnaire, a validated adherence scale, and a standardized hypertension knowledge survey. Multivariate analysis was used to identify the predictors of adherence and knowledge. Results Fifty-nine (15%) participants had good hypertension knowledge (score ≥ 8 out of 10). Compared to participants with poor knowledge, these participants had higher formal education (odds ratio = 2.7, 95% confidence interval = 1.5-4.7), and lived closer to a community health center (odds ratio = 1.8, 95% confidence interval = 1.0-3.3). Knowledge gaps about the need for long-term medication, hypertension complications, and the target blood pressure were identified. Good hypertension knowledge predicted good adherence to medication (odds ratio = 7.1, 95% confidence interval = 3.3-15.2). Only 42 (11%) participants were considered to have good adherence. Reasons for intentional nonadherence were beliefs that medicines should be taken only when symptoms are evident, limited access to healthcare services, and a preference using traditional medicines. Conclusion Strategies for addressing knowledge gaps and misconceptions about hypertension medication are needed, particularly for people with a low educational level and those living some distances from healthcare facilities.

Associação entre prática de atividade física no tempo de lazer e medicação permanente em adultos de uma região de baixo nível socioeconômico

Few studies have investigated the association between leisure-time physical activity and long-term medication use in Brazilian populations, especially those of low socioeconomic status. The objective of this study was to analyze the association between the need for long-term medication and leisure-time physical activity in adults from the Ermelino Matarazzo district, a low-income region in Sao Paulo, Brazil. A population-based cross-sectional study was conducted in 2007 and involved 890 subjects aged 18 years or older. Data regarding the need for long-term medication and types of medications used were collected using a questionnaire. Leisure-time physical activity was measured using the long version of the International Physical Activity Questionnaire. Descriptive analysis, chi-square test, and simple and multiple binary and multinomial logistic regression analysis were used. Among the subjects studied, 29.2% reported the need for long-term medication and 10% required at least two different types of medications. After adjustment for gender, age, education level and Body Mass Index, subjects who did not perform at least 150 min/week of leisure-time physical activity presented 2.78 (95% confidence interval - 95%CI: 1.45; 5.30) and 4.69 (95%CI: 1.90; 11.53) times the odds of requiring long-term medication and two or more types of medications rather than none, respectively, than those who did. Broader discussion of the interaction between medication, leisure-time physical activity and social and economic aspects is needed to reduce inequalities and to improve the health of individuals of low socioeconomic status.

Asthma in the workplace: a case-based discussion and review of current evidence

The relationship between asthma and the workplace is important to consider in all cases of adult asthma. Early identification of a cause in the workplace offers an opportunity to improve asthma control significantly and reduce the need for long-term medication if further exposures to the cause can be avoided. This typical but fictitious case is designed to give the reader clinical information in the order this would normally be received in clinical practice, with a real-time commentary about management decisions. Pertinent recent guidance is cited to stress the importance of evidence-based practice.

14 Comprehensive Expression of Recombinant House Dust Mite Allergens for Component-Resolved Diagnosis

BackgroundAllergen-specific immunotherapy (SIT) is the only promising treatment of allergy. However, current SIT has limitations such as a need for long-term medication and a risk of systemic anaphylaxis. Those issues are raised mainly because current SIT procedure is carried out using crude allergen extract, which may also induce a harmful neo-sensitization. Use of defined recombinant allergens would be a preferable alternative for the next generation SIT vaccine as well as for the development of component-resolved diagnosis (CRD), which enables to prescribe a patient-tailored vaccine. Objective of this study is to construct a production system of recombinant house dust mite (Dermatophagoides farinae) allergens, and to test their usefulness for molecular diagnosis.MethodsThus far, the WHO/IUIS allergen nomenclature subcommittee has approved 24 Dermatophagoides allergens. Among them, we sought to express 20 groups of D. farinae allergens (Der f 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 13, 14, 15, 16, 17, 18, 20, 21, and 22) using the Escherichia coli cold shock expression system. We also tried to express additional new antigens [Mag133 (a highly-conserved UK114/YER057c/YjgF family member), DFA22 (a new group 2 family member), and DFA67 (peroxiredoxin)] that we originally identified as major allergens with high IgE-binding frequencies. IgE-binding ability of those recombinant allergens was assessed by western blot analysis. We also tested whether these allergens were applicable for the development of CRD.ResultsWe confirmed successful expression of above D. farinae allergen molecules as soluble recombinant proteins. Western blot analysis revealed that these recombinant allergens retained IgE-binding capacity. We also found that house dust mite-allergic patients showed differential IgE-binding signatures against them, suggesting that our recombinant allergens are useful to determine sensitized allergen molecules in individual patients.ConclusionsHere we carried out the comprehensive expression of recombinant D. farinae major allergens. The recombinant allergen repertoire offers an essential platform for the future molecular diagnostics of dust mite allergy.

Factors Affecting Epilepsy Development and Epilepsy Prognosis in Cerebral Palsy

A study was conducted between November 2006 and October 2009 to determine the factors predicting the presence and prognosis of epilepsy in patients with cerebral palsy. We enrolled 2 groups of patients: 42 with cerebral palsy in group 1 and 56 patients with cerebral palsy and epilepsy in group 2. The subjects in group 2 were considered to have good epilepsy prognosis if they were free of seizures for the previous year; otherwise they were considered to have poor epilepsy prognosis. In group 2, neonatal epilepsy, family history of epilepsy, and moderate to severe mental retardation were significantly higher than in group 1 (P < 0.05). In univariate analysis, neonatal seizures, epileptic activity as measured by electroencephalography, and polytherapy were found to be predictors of poor epilepsy prognosis. Additionally, the need for long-term medication to control seizures unfavorably affects prognosis. In logistic regression analysis, neonatal seizure and interictal epileptic activity in electroencephalography were found to be independent predictors of poor epilepsy outcome. In addition, logistic regression analysis revealed that increasing age reduces the success of epilepsy treatment. Neonatal seizures, family history of epilepsy, and mental retardation were found to be important and independent predictors of development of epilepsy in patients with cerebral palsy.

Diagnosis and management of elite young athletes undergoing arrhythmia intervention

BackgroundSudden cardiac death is the most common cause of mortality in young athletes. In some of these, the final pathway is arrhythmia. The authors aimed to identify the incidence, diagnosis...

ECNP consensus meeting. Bipolar depression. Nice, March 2007

ECNP consensus meeting. Bipolar depression. Nice, March 2007

Transdermal Delivery of Treatment for Alzheimer’s Disease

There is increasing interest in the potential of transdermal drug delivery systems for the treatment of neurological disorders, especially in the elderly. In this population, the higher incidence of chronic diseases, such as diabetes mellitus, cardiovascular disease, neurological disease and chronic pain, has dramatically increased the need for long-term medications. Additionally, elderly patients often have a combination of several chronic diseases, meaning drug delivery, drug-drug interactions, absorption/blood concentrations, toxicity and compliance are of concern for patients as well as for their caregivers and physicians. Recent efforts have focused on developing pharmaceutical preparations that overcome these issues. For example, rate-controlled drug delivery systems have been under active development. Transdermal drug delivery systems have been developed to deliver phenserine, rivastigmine, nicotine and estradiol for the management of cognitive and behavioural dysfunctions in patients with Alzheimer's disease because this form of administration has several advantages, including maintenance of sustained therapeutic plasma concentrations of drugs, easy application and reduced systemic adverse effects. Thus, transdermal drug delivery for elderly patients offers promise as the ideal therapeutic approach to treating Alzheimer's disease.This article reviews the technical principles underlying the development of transdermal drug delivery systems, focusing on cholinesterase inhibitors, and the prospects for future development. The clinical performance of transdermal patches, again with emphasis on cholinesterase inhibitors, is also reviewed.

Spitting into the Wind: The Irony of Treating Chronic Disease

To propose a paradigm shift in the role of the pharmacist by encouraging pharmacists' involvement in the achievement and maintenance of healthy lifestyles in their patients, thus reducing the need for long-term medications. Peer-reviewed medical literature, contemporary lay literature, news releases from health organizations/associations, United States health standards, and professional experiences of the authors. Our current paradigm for the management of chronic disease is malaligned. The medications we use are helpful for many patients with chronic disorders, but they are not curative and leave many individuals with unwanted adverse effects that are often treated with additional medication. The more effective approach to managing many patients with chronic diseases induced through unhealthy lifestyles would be to eat properly, exercise to maintain ideal body weight, and abstain from harmful substances. Managing the root causes of chronic disease would eliminate most of the unhealthy consequences and perhaps reduce the need for long-term medication. Pharmacists have the knowledge and capacity to assist in this endeavor. Influencing patients to achieve ideal body weight through proper diet and exercise, encouraging people to stay well, and then helping them to keep well are roles for the pharmacist. If pharmacists made wellness and disease prevention part of their practices, they would have greater impact on improving patients' overall health. Without treating the primary cause of a condition and only treating the symptoms of unhealthy lifestyles, we are in many ways "spitting into the wind."

Outcome of cataract surgery considering the preoperative situation: a study of possible predictors of the functional outcome

AIMTo analyse possible predictors of the self assessed functional outcome of a cataract extraction.METHODSThe patients’ self assessed visual function was studied by use of a questionnaire, the “Catquest”, before and...

Histological and anatomic changes in Barrett’s esophagus after antireflux surgery

Objective: The best treatment approach for patients with documented Barrett’s esophagus remains controversial. There is currently no well designed prospective study examining the effect of successful antireflux surgery on Barrett’s esophagus. Methods: Fourteen patients with histologically proven Barrett’s esophagus underwent standard antireflux surgery followed by careful endoscopic, histological, and symptomatic follow-up beginning at 2–4 wk after surgery. Pre- and postoperative symptoms, patient functional assessment scores, lower esophageal sphincter pressure, and 24-h pH studies were compared, in addition to monitoring patients for evidence of squamous re-epithelialization and dysplasia. Results: Patients demonstrated statistically significant improvement in symptoms, functional assessment scores, lower esophageal sphincter pressure, and 24-h pH assessments after antireflux surgery. Two patients had complete disappearance of short segments (2 and 3 cm) of Barrett’s esophagus. Ten additional patients demonstrated evidence of squamous re-epithelialization, although biopsies often showed mixed components of squamous and columnar epithelium. No patients showed progression of dysplastic change, and four patients demonstrated the disappearance of low grade dysplasia throughout the period of the study. Conclusion: Successful antireflux surgery can produce at least partial squamous re-epithelialization in Barrett’s metaplasia and stabilization or apparent improvement in dysplasia in some patients without the need for long term medication. Continued long term endoscopic and histologic follow-up is still required in all patients with Barrett’s esophagus after antireflux surgery.

Histological and anatomic changes in Barrett's esophagus after antireflux surgery.

The best treatment approach for patients with documented Barrett's esophagus remains controversial. There is currently no well designed prospective study examining the effect of successful antireflux surgery on Barrett's esophagus. Fourteen patients with histologically proven Barrett's esophagus underwent standard antireflux surgery followed by careful endoscopic, histological, and symptomatic follow-up beginning at 2-4 wk after surgery. Pre- and postoperative symptoms, patient functional assessment scores, lower esophageal sphincter pressure, and 24-h pH studies were compared, in addition to monitoring patients for evidence of squamous re-epithelialization and dysplasia. Patients demonstrated statistically significant improvement in symptoms, functional assessment scores, lower esophageal sphincter pressure, and 24-h pH assessments after antireflux surgery. Two patients had complete disappearance of short segments (2 and 3 cm) of Barrett's esophagus. Ten additional patients demonstrated evidence of squamous re-epithelialization, although biopsies often showed mixed components of squamous and columnar epithelium. No patients showed progression of dysplastic change, and four patients demonstrated the disappearance of low grade dysplasia throughout the period of the study. Successful antireflux surgery can produce at least partial squamous re-epithelialization in Barrett's metaplasia and stabilization or apparent improvement in dysplasia in some patients without the need for long term medication. Continued long term endoscopic and histologic follow-up is still required in all patients with Barrett's esophagus after antireflux surgery.

A controlled study of the long-term prognosis of adult still's disease

To assess the long-term prognosis of patients with adult Still's disease for physical and psychological disability, pain, social functioning, social support, medication use, formal education, occupation, time lost from work, and family income, and to contrast these results with those of same-sex sibling controls. Patients were recruited from medical center-based cohorts in Pittsburgh and Eastern Canada and from a national survey of rheumatologists. Patients and same-sex sibling controls completed the Health Assessment Questionnaire for physical disability, the psychological and social function domains of the Arthritis Impact Measurement Scales, and the Interpersonal Skills Evaluation List questionnaire for social support, and replied to questions on medication use, formal education, occupation, time lost from work, and family income. One hundred four of 111 eligible adult Still's patients (94%) provided data. They identified 86 same-sex sibling controls, of whom 60 (70%) participated. The mean duration of adult Still's disease was 10 years. Approximately half of patients continued to require medication even 10 years after diagnosis. Patients had significantly higher levels of pain, physical disability, and psychological disability when compared with the controls. However, the levels of pain and physical disability were low compared to patients with other rheumatic diseases. Educational achievement, occupational prestige, social functioning and support, time lost from work, and family income were similar for both patients and controls. Despite causing disability, pain, and, in many, the need for long-term medication, patients with adult Still's disease are resilient. The disease did not interfere with educational attainment, occupational prestige, social functioning and support, time lost from work, or family income.