Pharmacological Measures Research Articles

Pain management in the postoperative period of amputation surgeries: A scoping review.

Pain in the postoperative period of amputation surgeries, when not managed correctly, can have consequences for the patient. The aim of this study was to map the scientific evidence on pain management in patients in the postoperative period of amputation surgeries. Scoping review with elaboration based on the recommendations of the Joanna Briggs Institute, supported by The PAGER framework and guided by the PRISMA-ScR Checklist. The survey was conducted in August 2022 in 10 data sources. The 3300 publications found were analysed by two independent reviewers, after applying inclusion and exclusion criteria, 16 studies were selected. Publications occurred between the years 1997 and 2022 and mainly dealt with the management of residual pain and phantom limb through pharmacological measures with pain assessment made by numerical scales. The literature pointed out strategic uses of analgesics and highlighted technologies for neurostimulation through catheters. The need for new studies with non-pharmacological measures and with designs that can prove their effectiveness is reinforced. The knowledge of these strategies by health professionals allows adequate pain management and patient follow-up for a less traumatic recovery. To patient or public involvement in this scoping review.

Outperformance of interleukin-6 over placental alpha microglobulin-1 in predicting preterm delivery in symptomatic women

Threatened preterm labor is the major cause of hospital admission during the second half of pregnancy. An early diagnosis is crucial for adopting pharmacologic measures to reduce perinatal mortality and morbidity. Current diagnostic criteria are based on symptoms and short cervical length. However, there is a high false-positive rate when using these criteria, which implies overtreatment, causing unnecessary side effects and an avoidable economic burden. This study aimed to compare the use of placental alpha microglobulin-1 and interleukin-6 as vaginal biomarkers combined with cervical length and other maternal characteristics to improve the prediction of preterm delivery in symptomatic women. A prospective observational study was conducted in women with singleton pregnancies complicated by threatened preterm labor with intact membranes at 24+0 to 34+6 weeks of gestation. A total of 136 women were included in this study. Vaginal fluid was collected with a swab for placental alpha microglobulin-1 determination using the PartoSure test, interleukin-6 was assessed by electrochemiluminescence immunoassay, cervical length was measured by transvaginal ultrasound, and obstetrical variables and newborn details were retrieved from clinical records. These characteristics were used to fit univariate binary logistic regression models to predict time to delivery <7 days, time to delivery <14 days, gestational age at delivery ≤34 weeks, and gestational age at delivery ≤37 weeks, and multivariate binary logistic regression models were fitted with imbalanced and balanced data. Performance of models was assessed by their F2-scores and other metrics, and the association of their variables with a risk or a protective factor was studied. A total of 136 women were recruited, of whom 8 were lost to follow-up and 7 were excluded. Of the remaining 121 patients, 22 had a time to delivery <7 days and 31 had a time to delivery <14 days, and 30 deliveries occurred with a gestational age at delivery ≤34 weeks and 55 with a gestational age at delivery ≤37 weeks. Univariate binary logistic regression models fitted with the log transformation of interleukin-6 showed the greatest F2-scores in most studies, which outperformed those of models fitted with placental alpha microglobulin-1 (log[interleukin-6] vs placental alpha microglobulin-1 in time to delivery <7 days: 0.38 vs 0.30; time to delivery <14 days: 0.58 vs 0.29; gestational age at delivery ≤34 weeks: 0.56 vs 0.29; gestational age at delivery ≤37 weeks: 0.61 vs 0.16). Multivariate logistic regression models fitted with imbalanced data sets outperformed most univariate models (F2-score in time to delivery <7 days: 0.63; time to delivery <14 days: 0.54; gestational age at delivery ≤34 weeks: 0.62; gestational age at delivery ≤37 weeks: 0.73). The performance of prediction of multivariate models was drastically improved when data sets were balanced, and was maximum for time to delivery <7 days (F2-score: 0.88±0.2; positive predictive value: 0.86±0.02; negative predictive value: 0.89±0.03). A multivariate assessment including interleukin-6 may lead to more targeted treatment, thus reducing unnecessary hospitalization and avoiding unnecessary maternal-fetal treatment.

Hypertension in Type 2 Diabetes and Its Association with Glycemic Control: A Hospital-Based Study from Pakistan

Objective: To determine the frequency of type 2 diabetic-hypertensive patients who fail to achieve target blood pressure goals despite treatment and to find the association between uncontrolled hypertension and poor glycemic control. Study Design: Descriptive, cross-sectional. Place and Duration: The study was conducted in the Department of Medicine, Pakistan Railways Hospital, Islamic International Medical College/Riphah International University, from 1st August 2022 to 31st January 2023. Methodology: A total of 200 diabetic patients were included. Study variables included age, gender, duration of diabetes/hypertension, glycemic/blood pressure control, target organ damage, compliance to treatment and life style modification, regular follow ups and awareness of target blood pressure goals. Data was recorded on a self-developed proforma. Diabetic patients with hypertension were classified into those with optimally controlled blood pressure (&lt; 140/90 mmHg) and those with uncontrolled hypertension despite treatment (BP &gt; 140/90 mm Hg). Results: Prevalence of hypertension in our diabetic population was 68.5%. Blood pressure was optimally controlled in 50.4%. Poor glycemic control was observed in 56.5% patients. Patients with sub-optimal glycemic control were more likely to be hypertensive (77.8%) as compared to their normoglycemic counterparts (56.3%). There was a significant correlation between uncontrolled hypertension and poor glycemic control (p-Value 0.202). Older age, female gender, duration of hypertension, lack of awareness of target BP goals and non-adherence to pharmacological and non-pharmacological measures were independent predictors for uncontrolled hypertension. Conclusion: Blood pressure is not optimally controlled in half of the diabetic hypertensive patients despite treatment. Uncontrolled hypertension correlates significantly with poor glycemic control. Keywords: Frequency; Diabetes; Blood Pressure; Goals; Association; Hypertension How to Cite This: Burney S, Asad M, Fazal M, Zulfiqar A. Hypertension in Type 2 Diabetes and Its Association with Glycemic Control: A Hospital-Based Study from Pakistan. Isra Med J. 2023; 15(1): 30-34. DOI: https://doi.org/10.55282/imj.oa1392. This is an Open Access article distributed under the terms of the Creative Commons Attribution-Noncommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Safety aspects during treatment with clozapine. : Monitoring and rechallenge - a narrative review

Due to its unique efficacy in treatment-resistant schizophrenia, discontinuation of treatment with clozapine is frequently associated with asignificant worsening of symptoms, but also with an increased risk of suicide. Based on the literature, this review aims at summarizing different monitoring recommendations in order to be able to continue this therapy despite the occurrence of side effects. In addition, we provide recommendations when rechallenge of apreviously stopped treatment with clozapine can be considered and when adefinite discontinuation must take place. Medline, the Guideline for the use of clozapine 2013 of the Netherlands Clozapine Collaboration Group, and the S3Guideline for Schizophrenia of the German Association of Psychiatry, Psychotherapy and Psychosomatics were searched for relevant literature, the last query dating from April28th, 2023. If agranulocytosis or cardiomyopathy develops, treatment with clozapine must be discontinued and should not be resumed thereafter. In contrast, treatment with clozapine which had to be discontinued due to myocarditis or prolongation of the QTc interval may be continued if left ventricular function is normal or after normalization of the QTc interval. Other side effects are usually not absolute contraindications for rechallenge but often require the adjunctive use of additional pharmacologic and non-pharmacologic measures. Taking into consideration various monitoring recommendations, cessation of treatment with clozapine can often be prevented or treatment with clozapine that has been discontinued due to side effects can be resumed.

Hypertension in Type 2 Diabetes and Its Association with Glycemic Control: A Hospital-Based Study from Pakistan

Objective: To determine the frequency of type 2 diabetic-hypertensive patients who fail to achieve target blood pressure goals despite treatment and to find the association between uncontrolled hypertension and poor glycemic control. Study Design: Descriptive, cross-sectional. Place and Duration: The study was conducted in the Department of Medicine, Pakistan Railways Hospital, Islamic International Medical College/Riphah International University, from 1st August 2022 to 31st January 2023. Methodology: A total of 200 diabetic patients were included. Study variables included age, gender, duration of diabetes/hypertension, glycemic/blood pressure control, target organ damage, compliance to treatment and life style modification, regular follow ups and awareness of target blood pressure goals. Data was recorded on a self-developed proforma. Diabetic patients with hypertension were classified into those with optimally controlled blood pressure (&lt; 140/90 mmHg) and those with uncontrolled hypertension despite treatment (BP &gt; 140/90 mm Hg). Results: Prevalence of hypertension in our diabetic population was 68.5%. Blood pressure was optimally controlled in 50.4%. Poor glycemic control was observed in 56.5% patients. Patients with sub-optimal glycemic control were more likely to be hypertensive (77.8%) as compared to their normoglycemic counterparts (56.3%). There was a significant correlation between uncontrolled hypertension and poor glycemic control (p-Value 0.202). Older age, female gender, duration of hypertension, lack of awareness of target BP goals and non-adherence to pharmacological and non-pharmacological measures were independent predictors for uncontrolled hypertension. Conclusion: Blood pressure is not optimally controlled in half of the diabetic hypertensive patients despite treatment. Uncontrolled hypertension correlates significantly with poor glycemic control. Keywords: Frequency; Diabetes; Blood Pressure; Goals; Association; Hypertension How to Cite This: Burney S, Asad M, Fazal M, Zulfiqar A. Hypertension in Type 2 Diabetes and Its Association with Glycemic Control: A Hospital-Based Study from Pakistan. Isra Med J. 2023; 15(1): 30-34. DOI: https://doi.org/10.55282/imj.oa1392. This is an Open Access article distributed under the terms of the Creative Commons Attribution-Noncommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

The Influence of Family Intervention on the Treatment of Adolescent Patients With Borderline Personality Disorder: A Literature Review.

Borderline personality disorder (BPD) is a widespread mental disorder linked to functional impairment and a high suicide rate. Adolescent BPD is now recognized as a reliable and valid diagnosis in psychiatric classification systems and national treatment guidelines. Family issues, such as parental underinvolvement or neglect, may affect the mentalization process and attachment styles. Thus, the family is crucial to understanding the etiology of BPD in adolescents. Family intervention was primarily used as a component of the psychotherapy strategy in the current treatment of BPD, including pharmacological and psychotherapy measures. The primary objective of this study is to review previous research on the effectiveness of family intervention in treating adolescents with BPD.Although there is currently little data, studies in this paper show that family intervention is a realistic treatment option for adolescents with BPD.

Measuring ART Adherence Among Young Adults with Perinatally Acquired HIV: Comparison Between Self-report, Telephone-Based Pill Count, and Objective Pharmacologic Measures.

Tenofovir diphosphate (TVF-DP) can be quantified in red blood cells (RBCs) and dried blood spots (DBS) and can objectively measure ART adherence and predict viral suppression. Data on the association of TFV-DP with viral load are very limited in adolescents and young adults (AYA) living with perinatally-acquired HIV (PHIV), as are data comparing TFV-DP to other measures of ART adherence, such as self-report and unannounced telephone pill count. Viral load and ART adherence (self-report, TFV-DP and unannounced telephone pill count) were assessed and compared among 61 AYAPHIV recruited from an ongoing longitudinal study (CASAH) in New York City.

THERAPEUTIC METHODS FOR BURNING MOUTH SYNDROME: AN OVERVIEW

Objective To perform an overview of available systematic reviews (SR) on therapeutic methods used to alleviate Burning Mouth Syndrome (BMS) symptomatology. Study Design The study was conducted following the PRISMA and is registered with PROSPERO under number (CRD42021268587). The databases searched were PubMed, The Cochrane Library, Scopus, Embase, and Web of Science. The PICO question was "For the relief of symptomatology, discomfort, and burning sensation caused by BMS, what is the best strategy?". 212 articles were retrieved, 113 studies were evaluated for inclusion, and eight SR were included. The quality of SR was analyzed through the evaluation of SR in dentistry (Glenny Scale) and the Assessment of the Methodological Quality of SR (AMSTAR2). Results The most indicated pharmacological measure was clonazepam with short- and long-term effects on symptomatology relief. However, a standardized BMS treatment protocol is not described in the literature. According to Glenny scale, the studies had moderate to high quality, but according to AMSTAR 2, only two studies showed a high-quality level, while the others were classified as critically low. Conclusion The use of pharmacological and non-pharmacological measures reduces the symptomatology of BMS, but new randomized clinical trials are suggested to investigate treatment protocols for BMS. To perform an overview of available systematic reviews (SR) on therapeutic methods used to alleviate Burning Mouth Syndrome (BMS) symptomatology. The study was conducted following the PRISMA and is registered with PROSPERO under number (CRD42021268587). The databases searched were PubMed, The Cochrane Library, Scopus, Embase, and Web of Science. The PICO question was "For the relief of symptomatology, discomfort, and burning sensation caused by BMS, what is the best strategy?". 212 articles were retrieved, 113 studies were evaluated for inclusion, and eight SR were included. The quality of SR was analyzed through the evaluation of SR in dentistry (Glenny Scale) and the Assessment of the Methodological Quality of SR (AMSTAR2). The most indicated pharmacological measure was clonazepam with short- and long-term effects on symptomatology relief. However, a standardized BMS treatment protocol is not described in the literature. According to Glenny scale, the studies had moderate to high quality, but according to AMSTAR 2, only two studies showed a high-quality level, while the others were classified as critically low. The use of pharmacological and non-pharmacological measures reduces the symptomatology of BMS, but new randomized clinical trials are suggested to investigate treatment protocols for BMS.

Aspirin and statin use in primary prevention after coronary artery calcium score

Abstract Funding Acknowledgements Type of funding sources: None. Introduction A coronary artery calcium (CAC) score of more than 100 places the 10-year cardiovascular risk above 7.5%, justifying the initiation of pharmacological measures in primary prevention. Purpose The present study explores the level of implementation of a primary prevention strategy after CAC score in patients without obstructive coronary disease. Methods The study cohort included all patients from the health area of our city (Galicia, Spain) who underwent a coronary computed tomography (CT) scan between July 2021 and February 2022. Subjects with obstructive coronary disease (CADRADS 3 or higher), atrial fibrillation patients and inconclusive studies were excluded. The final population of the study consisted of 209 patients. The sample was classified according to Agatston Score into three groups: no calcification (CAC=0), non-significant (CAC 1-100), and significant calcification (CAC &amp;gt;101). Multinomial and binomial logistic regression were performed to identify the predictors associated with the prescription of statin and aspirin, respectively. Results 41 patients (19.62%) had significant calcification (CAC &amp;gt;101). Of those, 16 (39.02%) started aspirin and 21 (51.22%) started statin (Figure 1). The CAC score allowed to increase the percentage of patients who benefited from lipid-lowering treatment, from 31.70% to 82.92% (Figure 2). Significant differences were observed in the proportion of patients who initiated aspirin and statins according to the degree of coronary calcification (Chi2 18.76; p=0.000), (Chi2 48.42; p=0.000) respectively. After multivariate adjustment, a CAC score &amp;gt;100 (OR 5.88 (2.29-15.07; p=0.000) and the presence of vulnerable plaque (OR 6.78 (1.01-47.46; p=0.050) were the only predictos which led clinicians to start antiplatelet therapy. Neither age, nor SIS (segment involvement score) were associated. Regarding to lipid-lowering therapy, CAC score 1-100 (OR 5.87 (1.68-20.51; p=0.006) and CAC score &amp;gt;100 (OR 30.78 (5.08-186.47; p=0.000) were independently associated with statin prescription. Conclusions The use of coronary CT allows optimization of the therapeutic strategy in primary prevention, increasing the percentage of patients who may benefit from statins. In this setting, aspirin is little established in our cohort. Therefore, we should transmit to the clinician the possibility of starting antiplatelet therapy, individualizing the indication.

Evaluation and comparison of the effectiveness of kaleidoscope and virtual reality goggles to reduce dental anxiety in young children undergoing administration of local anesthesia.

Administration of local anesthesia via injection is the main reason for inducing anxiety in children and if not intervened it aggravates the anxiety in subsequent appointments. There are many approaches, including pharmacological and non-pharmacological methods that can be used to reduce children's perception of pain and anxiety. A frequently used non-pharmacological behaviour management method to reduce anxiety and procedure pain is distraction. The rationale of distraction is to shift the attention to avert the brain from receiving unwanted stimulus which induce anxiousness. Many approaches including music, television, portable video games, virtual reality (VR) helmet, and virtual reality audio-visual eyewear, have been implemented so far. Kaleidoscope and virtual reality goggles may help as distraction techniques in reducing the levels of anxiety caused during administration of local anesthesia. By the aid of which the operator may be able to make the dental experience child friendly and ultimately provide quality dental care to anxious children. Non pharmacological measures of reducing pain are cost effective and best means that can be used while performing dental procedures. This is a research protocol for a study aimed to evaluate and compare the effectiveness of kaleidoscope and virtual reality goggles to reduce dental anxiety in young children.

Self-management for sickle cell disease among patients and parents: A qualitative study.

This study aimed to explore self-management practices among patients and parents of children with sickle cell disease (SCD). The qualitative descriptive design was employed. The study involved 19 participants comprising adult SCD patients ≥16 years, and nine parents of SCD children ≤ 15 years. Purposive sampling was conducted to select participants from a teaching hospital and SCD association. Data was collected using one-on-one interviews, transcribed verbatim, and analysed using qualitative content analysis. Self-management was reported through four categories including preventive health, self-monitoring, self-diagnosis, and self-treatment. Hydration, nutrition, activity limitation, avoidance of cold temperatures, and supportive medications were the most common preventive health actions. Regarding self-monitoring and self-diagnosis, the parents emphasized objective indicators such as changes in urine and eye colour compared to the adults who utilize subjective indicators such as feeling unwell and easy fatigue. Pharmacological and non-pharmacological measures were reported by both groups for treating painful episodes, fever, leg ulcers, priapism, and unspecified symptoms. The participants in this study practice several self-management actions with some differences in application between adults and children. Tailored self-management services may be helpful for adults and children when developing services for SCD patients.

Aetiology, pathogenesis and management of neuropathic itch: A narrative review with recent updates.

Neuropathic itch is a relatively common yet under-reported cause of systemic pruritus. It is a debilitating condition often associated with pain, which impairs the patient's quality of life. Although much literature exists about renal and hepatic pruritus, there is a dearth of information and awareness about neuropathic itch. The pathogenesis of neuropathic itch is complex and can result from an insult at any point along the itch pathway, ranging from the peripheral receptors and nerves until the brain. There are several causes of neuropathic itch, many of which do not produce any skin lesions and are thus, often missed. A detailed history and clinical examination are necessary for the diagnosis, while laboratory and radiologic investigations may be needed in select cases. Several therapeutic strategies currently exist involving both non-pharmacological and pharmacological measures, the latter including topical, systemic, and invasive options. Further research is ongoing to clarify its pathogenesis and to design newer targeted therapies with minimal adverse effects. This narrative review highlights the current understanding of this condition, focusing on its causes, pathogenesis, diagnosis, and management, along with newer investigational drugs.

Management of Chronic Truncal Wall Type-I Complex Regional Pain Syndrome in a Patient with Uncontrolled Diabetes Mellitus: Case Report

Complex regional pain syndrome (CRPS) is a chronic pain syndrome associated with sensory, vasomotor, sudomotor, motor and trophic changes commonly affecting the upper and lower extremities; however, we report a case of truncal wall CRPS in an uncontrolled type 2 diabetes mellitus patient. A male in his late fifties presented with right lower chest and upper abdominal wall burning, sharp and stabbing type of pain for 5 years associated with hyperalgesia and allodynia. The extensive evaluation ruled out any underlying pathology and the symptoms were increasing with time. He failed to respond to conservative pharmacological, non-pharmacological treatment and rehabilitation measures. In our institute, he underwent alcohol neurolysis of subcostal transversus abdominis plane and rectus sheath nerves with rehabilitation measures and reported significant relief in his symptoms. It has now been 6 months since the procedure was done and he has complete relief in pain. Hence, if sympathetic block is difficult to do, peripheral nerve block with alcohol and rehabilitation measures provide desirable effect in abdominal wall CRPS.

Lynch syndrome: from detection to treatment.

Lynch syndrome (LS) is an inherited cancer predisposition syndrome associated with high lifetime risk of developing tumours, most notably colorectal and endometrial. It arises in the context of pathogenic germline variants in one of the mismatch repair genes, that are necessary to maintain genomic stability. LS remains underdiagnosed in the population despite national recommendations for empirical testing in all new colorectal and endometrial cancer cases. There are now well-established colorectal cancer surveillance programmes, but the high rate of interval cancers identified, coupled with a paucity of high-quality evidence for extra-colonic cancer surveillance, means there is still much that can be achieved in diagnosis, risk-stratification and management. The widespread adoption of preventative pharmacological measures is on the horizon and there are exciting advances in the role of immunotherapy and anti-cancer vaccines for treatment of these highly immunogenic LS-associated tumours. In this review, we explore the current landscape and future perspectives for the identification, risk stratification and optimised management of LS with a focus on the gastrointestinal system. We highlight the current guidelines on diagnosis, surveillance, prevention and treatment and link molecular disease mechanisms to clinical practice recommendations.

Predictive factors of hesitancy to vaccination against SARS-CoV-2 virus in young adults in Spain: Results from the PSY-COVID study

Widespread population vaccination against the SARS-CoV-2 virus is a matter of great interest to public health as it is the main pharmacological measure to contain the COVID-19 pandemic. Hesitancy/reluctance to vaccination has become a main barrier to containing the pandemic. Young adults are the age group with the greatest resistance to vaccination, even in countries with the highest vaccination rates during this pandemic. The objective of this study was to identify the main predictive factors of vaccination intention and profile people with hesitancy/reluctance to vaccinate against SARS-CoV-2 virus in young adults living in Spain during the pandemic. A cross-sectional study was conducted based on the administration of an online survey (PSY-COVID-2) that evaluated the intention of vaccination together with a wide range of sociodemographic, social, cognitive, behavioral and affective variables in a sample of 2210 young adults. 14% of the sample showed hesitancy/reluctance to vaccination at the beginning of their vaccination campaign. A total of 35 factors were associated (small to medium effect sizes) with the intention to get vaccinated. A reduced set of 4 attitudinal and social variables explained 41% of the variability in vaccination intention: attitude to the vaccination, trust in health staff/scientists, conspiracy beliefs about SARS-CoV-2 and time spent being informed about COVID-19. These variables showed good sensitivity/specificity for classifying people as reluctant/not reluctant to vaccination, properly classifying 86% of people. Psychosocial processes related to attitudes, trust and information are the main predictors of vaccination intention in a highly reluctant group such as the young adult population.

Hypertension as Cardiovascular Risk Factor in Chronic Kidney Disease

Hypertension is the leading modifiable cause of premature death and hence one of the global targets of World Health Organization for prevention. Hypertension also affects the great majority of patients with chronic kidney disease (CKD). Both hypertension and CKD are intrinsically related, as hypertension is a strong determinant of worse renal and cardiovascular outcomes and renal function decline aggravates hypertension. This bidirectional relationship is well documented by the high prevalence of hypertension across CKD stages and the dual benefits of effective antihypertensive treatments on renal and cardiovascular risk reduction. Achieving an optimal blood pressure (BP) target is mandatory and requires several pharmacological and lifestyle measures. However, it also requires a correct diagnosis based on reliable BP measurements (eg, 24-hour ambulatory BP monitoring, home BP), especially for populations like patients with CKD where reduced or reverse dipping patterns or masked and resistant hypertension are frequent and associated with a poor cardiovascular and renal prognosis. Even after achieving BP targets, which remain debated in CKD, the residual cardiovascular risk remains high. Current antihypertensive options have been enriched with novel agents that enable to lower the existing renal and cardiovascular risks, such as SGLT2 (sodium-glucose cotransporter-2) inhibitors and novel nonsteroidal mineralocorticoid receptor antagonists. Although their beneficial effects may be driven mostly from actions beyond BP control, recent evidence underline potential improvements on abnormal 24-hour BP phenotypes such as nondipping. Other promising novelties are still to come for the management of hypertension in CKD. In the present review, we shall discuss the existing evidence of hypertension as a cardiovascular risk factor in CKD, the importance of identifying hypertension phenotypes among patients with CKD, and the traditional and novel aspects of the management of hypertensives with CKD.

GEDEFO-SEFH management of antineoplastic extravasations survey results.

Extravasation is a potentially severe complication of intravenous administration of antineoplastic drugs. The limited data makes it difficult to develop an optimal management scheme. The objective of this study is to describe the clinical practice in the extravasation management of antineoplastic agents in Spanish centers. An online survey was distributed to oncology pharmacists using the email distribution list of the Spanish Society of Hospital Pharmacists. Respondents were surveyed on the standard operational protocol (SOP) of extravasation, tissue damage risk classification, and specific measures of extravasation management. A total of 68 surveys were completed. A specific extravasation SOP was available in 82.4% centers. The pharmacist participates in the authorship (100%) and actively collaborates in extravasation management (76.5%). A tissue damage risk classification based on the three categories was mostly adopted (48.2%) and 73.2% applied specific criteria based on concentration and/or extravasated volume. Extravasation management was mainly performed with the application of physical measures and/or antidotes (91.2%). High variability in the choices of pharmacological and/or physical measures recommended is outstanding. The results of this study highlight the involvement of Spanish pharmacists in extravasation management, the application of physical measures and/or pharmacological measures as the method of choice in extravasation management, as well as the existing discrepancies in tissue damage risk classification and management recommendations.

Survey peningkatan resiko penyakit DM di masa Pandemi covid-19 Di wilayah Kabupaten Ponorogo tahun 2021

DM is a chronic disease that cannot be cured but can only be reduced and blood sugar levels controlled. Blood sugar levels of DM patients can be controlled and reduced by pharmacological and non-pharmacological measures. The impact of the Covid 19 pandemic that can increase the risk of DM is stress. Stress due to the declining level of the community's economy can be due to losing a job, increasing the burden of living and others. At times of stress can increase levels of the hormone cortisol which can increase blood sugar levels. During the pandemic, people are afraid to leave the house so that activity decreases so that it will reduce the use of blood sugar by cells so that blood sugar increasesThe method used in this research is a survey by distributing a google form questionnaire with the link https://forms.gle/EsCR4qnoj62LZFnv9 via WA Online media to the community in the Ponorogo district from 6-15 October 2021 so that the number of respondents who fit the sample criteria is as much as 122 respondents. Measurement of DM risk factors using the FINDRISC questionnaire is a questionnaire that helps to identify the risk of DM disease.The results of the Survey on Increasing the Risk of DM Disease During the Covid 19 Pandemic in the Ponorogo Regency Region in 2021 it is known that from 122 respondents, 60 (49%) low risk respondents, 45 (36%) risk respondents slightly increased, 8 (7%) risk respondents medium, 8 (7%) high risk respondents and 1 (1%) very high risk respondents.

Successful Management of a Spontaneous Retrobulbar Hematoma After Heart Transplantation. A Case Report

We present a case of a 65-year-old patient who underwent heart transplantation. After the surgery, left proptosis, conjunctival chemosis, and ipsilateral palpebral ecchymosis were found while he was still intubated. A retrobulbar hematoma was suspected, confirmed by a computed tomography scan. Initially, expectant management was considered, but with the appearance of an afferent pupillary defect, the patient underwent orbital decompression and posterior collection drainage, which prevented visual impairment. Spontaneous retrobulbar hematoma after heart transplantation is a rare condition that risks vision. We intend to discuss the importance of postoperative ophthalmologic examination after heart transplantation in intubated patients for early diagnosis and rapid treatment. Spontaneous retrobulbar hematoma (SRH) after heart transplantation is an exceptional condition that risks vision. Bleeding in the retrobulbar space provokes an anterior ocular displacement, extending the vessels and the optic nerve, which can generate ischemic neuropathy and, finally, a loss of vision [1]. A retrobulbar hematoma is usually associated with trauma or eye surgery. Though, in non-traumatic cases, the underlying cause is not evident. An adequate ophthalmologic examination is usually not performed in complex surgeries like heart transplantation. However, this simple measure can prevent permanent vision loss. Non-traumatic risk factors should also be considered, which include vascular malformations, bleeding disorders, use of anticoagulants, and increased central venous pressure usually triggered by a Valsalva maneuver [2]. The clinical presentation of SRH consists of ocular pain, decreased visual acuity, conjunctival chemosis, proptosis, abnormal extraocular movements, and elevated intraocular pressure (IOP). Its diagnosis is often clinical; however, it can be confirmed with computed tomography or magnetic resonance imaging. Treatment aims to reduce IOP with surgical decompression or pharmacologic measures [2]. In the reviewed literature, less than 5 spontaneous ocular hemorrhages related to cardiac surgery have been reported [3-6], of which only one is related to heart transplantation [3]. A clinical challenge of an SRH after heart transplantation is presented below. Surgical management was performed with a favorable result.

Spontaneous Reversal of Vitiligo, a Rare Phenomenon Reported in a Case in Saudi Arabia with an Insight into Metabolic Biochemical Derangements

Background and Objectives: Vitiligo is a skin disorder characterized by hypopigmented macules occurring due to melanocyte destruction. An interplay of several biochemical mechanisms has been proposed to explain the etiopathogenesis of vitiligo, such as genetic, autoimmune responses, generation of inflammatory mediators, oxidative stress, and melanocyte detachment mechanisms. There is no cure for vitiligo; however, pharmacological treatment measures (cosmetic camouflage creams, steroids, psoralen and ultraviolet A (PUVA) therapy, narrowband UVB) are available, but they could have certain side effects. We reported an interesting case of vitiligo in Saudi Arabia that showed reversal of vitiligo, which is an extremely rare phenomenon, with the objective of probing the probable reasons for this reversal. To the best of our knowledge, there is no study on vitiligo that has reported spontaneous reversal of vitiligo in Saudi Arabia so far. Materials and Method: The patient presented to the Family Medicine clinic with a history of restoration of melanin pigment in his lesions after 3 years of the onset of vitiligo. Patients history was taken carefully along with clinical examination, carried out necessary biomedical lab investigations and compiled the data. The data at the time of pigment restoration were compared to the previous data when he developed the lesions. Result: The probable reasons for vitiligo reversal could be markedly decreased psychological stress, regular consumption of an antioxidant-rich herbal drink made of curcumin and honey, and dietary switchover to vegetarianism and an alcohol-free lifestyle. Conclusions: Curcumin-based herbal remedies could be an alternative option to treat vitiligo. These methods must be further explored through clinical trials as they are safer, easily available, and more affordable.