Poor Therapy Compliance Research Articles

A case of syphilis associated with immune reconstitution inflammatory syndrome and review of the literature

BackgroundImmune reconstitution inflammatory syndrome (IRIS) associated with syphilis has rarely been described in HIV-infected patients. Diagnosis can be challenging because it is not always possible to discern it from a recent infection or a worsening of an undiagnosed one.Case presentationAn HIV-positive 42-year-old man with a poor compliance history of antiretroviral therapy presented at our unit and complained of ocular symptoms. Ocular syphilis diagnosis was posed after initial misdiagnosing with cytomegalovirus infection, and antiretroviral therapy compliance improved after switching to a bictegravir-based regimen. Despite intravenous (IV) penicillin, we observed an initial worsening with the appearance of new skin lesions, and IRIS syphilis was suspected. In the literature, 14 cases of IRIS syphilis are described, all regarding male patients. Seven were HIV naïve to therapy, and 7 HIV-experienced with poor therapy compliance. Basal syphilis serology was negative in ten, with subsequent seroconversion after the development of IRIS. IRIS-syphilis development was observed after a median time of 28 days from ART initiation; 10 cases were considered "unmasking-IRIS" and 4 "paradoxical-IRIS". Skin and ocular involvement were the most often reported. In most cases, it was not necessary to use a systemic steroid. A good outcome was reported in 12.ConclusionsSyphilis should be considered in differential diagnosis with other diseases associated with IRIS. A negative syphilis serology before beginning antiretroviral therapy could convey the impression that syphilis has been ruled out. Whereas a high index of suspicion should be maintained when symptoms suggestive of syphilis, such as ocular and skin manifestations, are noticed after therapy has begun.

Celecoxib, ibuprofen, and indomethacin alleviate depression-like behavior induced by interferon-alfa in mice

Background Interferon-α (IFNα) therapy causes psychiatric side effects, including depression that may result in poor compliance of therapy. It is important to find alternative therapies for the prevention of IFNα induced depression. Non-steroidal anti-inflammatory drugs (NSAIDs) have been useful in depressive disorder. Therefore the effects of celecoxib, ibuprofen, and indomethacin were evaluated following IFNα-induced depression in mice. Methods Male albino mice weighing 26 ± 2 g were used. Depression was induced by IFNα (16 × 105 IU/kg, SC) for six consecutive days. Animals were first subject to the locomotor test, then the splash test and finally the forced swimming test (FST) on the 7th day. The NSAIDs were administered (IP) either one single dose before the test, or simultaneously with IFNα. Results locomotor activity was only impaired by ibuprofen high dose (75 mg/kg), thus it was not further evaluated. Following IFNα therapy depression-like behaviors were observed; significant changes during the splash test (grooming time 24 ± 7 sec vs. control 63 ± 7 sec), the FST (immobility time 166 ± 15 sec vs. control 128 ± 6 sec), and sucrose preference reduced to 64 ± 0.8%. The NSAIDs noticeably reduced the immobility time in FST, while grooming time was increased. Celecoxib and indomethacin single doses were effective while ibuprofen showed better antidepressant effects when it was administered along with IFNα. Conclusions The NSAIDs were able to prevent IFNα induced depression in mice. NSAIDs administration with IFNα does not interfere with clinical benefit effects of IFNα and they could also be useful to prevent IFNα psychiatric side effects, thus further clinical trials are suggested.

A Smartphone-based gaming system for vestibular rehabilitation: A usability study

BACKGROUNDVestibular dysfunctions result in a wide range of impairments and can have debilitating consequences on a person's day-to-day activities. Conventional vestibular rehabilitation is effective but suffers from poor therapy compliance due to boredom. Virtual reality technology can make training more engaging and allow precise quantification of the training process. However, most existing technologies for vestibular rehabilitation are expensive and not suitable for use in patients' homes and most clinics. In this pilot study, we developed and evaluated the usability of a smartphone-based head-mounted display (HMD) for vestibular rehabilitation and quantified the simulator sickness induced by the system.METHODSTwo adaptive training games were developed to train discrete and rhythmic head movements in the pitch and yaw planes. The usability and simulator sickness associated with the system were evaluated in a single testing session on healthy subjects and patients with unilateral vestibular dysfunction. Additionally, the head movement kinematics measured during training was also analyzed using different movement quality measures.RESULTSA total of 15 healthy subjects and 15 patients underwent testing with the system. Both groups found the system to be highly usable (>80 score on the system usability scale). Following 20-30 min training with the system, healthy subjects reported minimal simulator sickness symptoms. On the other hand, patients reported a higher incidence rate for symptoms, which could have been the result of their vestibular condition.CONCLUSIONThe current study demonstrated the usability and safety of a smartphone-based system for vestibular rehabilitation. The system is compact, and affordable thus has the potential to become an excellent tool for home-based vestibular rehabilitation.

Pharmacological Interactions on Blood Pressure Control in Arterial Hypertension, An Issue not to be Overlooked.

Our vision of long-term treatment strategies for the prevention of target organ damage and eventually cardiovascular morbidity and mortality in essential arterial hypertension needs to be continually monitored and updated for at least three issues: 1--the achievement of target pressure required to obtain the expected benefit needs continuous monitoring, a dose adjustment of the drug and, often, the use of combination therapies; 2--the chronic use of certain drugs, even in combination, is associated with the possible onset of side effects; 3--increasing of population life expectancy is inevitably associated with in an increase in drugs use with the unavoidable occurrence of adverse drug reactions, some of which can interfere with blood pressure control. These issues, still poorly studied, pose considerable problems in applying proper strategies for prevention. In this review, we will evaluate the goals of antihypertensive therapy, and its weak spots, such as the frequent side effects, that lead to poor therapy compliance. Moreover, we will review the interactions between antihypertensive and drugs used for other common disease, and their importance in not achieving the expected blood pressure reduction.

Grounding psychological help for adolescents with atopic dermatitis

Uskov O., Markova M. Grounding psychological help for adolescents with atopic dermatitis. Journal of Education , Health and Sport . 2015;5(5): 138-150 . ISSN 2391-8306 . DOI 10.5281/zenodo.17465 http://ojs.ukw.edu.pl/index.php/johs/article/view/2015%3B5%285%29%3A138-150 https://pbn.nauka.gov.pl/works/559212 http://dx.doi.org/10.5281/zenodo.17465 Formerly Journal of Health Sciences. ISSN 1429-9623 / 2300-665X. Archives 2011 – 2014 http://journal.rsw.edu.pl/index.php/JHS/issue/archive Deklaracja. Specyfika i zawartośc merytoryczna czasopisma nie ulega zmianie. Zgodnie z informacją MNiSW z dnia 2 czerwca 2014 r., ze w roku 2014 nie bedzie przeprowadzana ocena czasopism naukowych; czasopismo o zmienionym tytule otrzymuje tyle samo punktow co na wykazie czasopism naukowych z dnia 31 grudnia 2014 r. The journal has had 5 points in Ministry of Science and Higher Education of Poland parametric evaluation. Part B item 1089. (31.12.2014). © The Author (s) 2015; This article is published with open access at Licensee Open Journal Systems of Kazimierz Wielki University in Bydgoszcz, Poland and Radom University in Radom, Poland Open Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. This is an open access article licensed under the terms of the Creative Commons Attribution Non Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. The authors declare that there is no conflict of interests regarding the publication of this paper. Received: 15.02.2015. Revised 27.04.2015. Accepted: 08.05.2015. UDC 616.89: 616.5-009 GROUNDING psychological help for adolescents with atopic dermatitis O. Uskov, M. Markova Kharkiv Medical Academy of Post-graduate Education Abstract. The article addresses some information about psychological problems, emotional state, personal, behavioral and family-associated patterns in adolescents with atopic dermatitis, which served a basis for differentiation of targets and measures of psychological help. There were defined such targets of psychological interventions as follows: physical discomfort, self-perception of the appearance, poor therapy compliance, reduced mental activity, high levels of anxiety, depressive manifestations, disharmonious personal features, a destabilizing profile of coping strategies, distancing and avoidance strategies, problems in child-parent relationships, imbalanced marital relationships, affected self-acceptance, imbalanced in the internality-externality axis, high escapism. As psychological interventions there were used some techniques of Gestalt therapy, rational therapy, art therapy, cognitive-behavioral therapy, psychological training. Family therapy was an important component of psychological help for adolescents with atopic dermatitis. Key words: atopic dermatitis, adolescents, psychological help.

Real-life comparison of severe vascular events and other non-hematological complications in patients with chronic myeloid leukemia undergoing second-line nilotinib or dasatinib treatment

We retrospectively analyzed the rates of significant non-hematological adverse events (AEs) in 105 patients with chronic myeloid leukemia (CML) treated with second-generation tyrosine kinase inhibitor (TKIs) dasatinib or nilotinib used as second-line therapy in Polish tertiary care centers. Our analysis revealed that in a “real life setting,” nearly half of patients with CML on second-generation TKIs suffer from therapy complications. Grade 2–5 non-hematological AEs were observed in 40% of patients treated with nilotinib and in 42% treated with dasatinib (p = 0.83). Severe vascular events including peripheral artery occlusive disease (PAOD) occurred in 11% of patients on nilotinib and 4% on dasatinib (p = 0.16). Pleural effusion occurred more often in the dasatinib group (26%) than in the nilotinib group (2%) (p = 0.003). Importantly, most AEs occurred late, after more than 1 year of treatment. Since AEs are most often the reason for poor therapy compliance, careful monitoring of tolerability is crucial for an optimal treatment response in CML.

Combination of coenzyme Q10 with methotrexate suppresses Freund's complete adjuvant-induced synovial inflammation with reduced hepatotoxicity in rats: Effect on oxidative stress and inflammation.

Methotrexate (MTX) is a cornerstone disease modifying anti-rheumatic drug. One of its major drawbacks is hepatotoxicity, resulting in poor compliance of therapy. Coenzyme Q10 (CoQ10) is an antioxidant and anti-inflammatory compound, possessing both anti-arthritic and hepatoprotective potential. The present study was carried out to evaluate the effect of CoQ10 (10mg/kg) alone and in combination with MTX (2mg/kg) on the progression of adjuvant-induced arthritis in rats, and to elucidate the potential properties of CoQ10 in ameliorating MTX-induced liver damage in rats. Rats were assigned to; normal, arthritic, MTX treated, CoQ10 treated or a combination of MTX and CoQ10. CoQ10 administration potentiated the antiarthritic effect of MTX. Moreover, the combination therapy was effective in attenuating the severity of MTX-induced liver damage displayed by the improvement in hepatospecific serum markers and confirmed by the histo-pathological evaluation. Additionally, it attenuated the hepatic oxidative stress and the intensity of inflammatory mediators associated with MTX administration as evident by the regulation of oxidant/anti-oxidant balance and the inhibitory effects on TNF-α and IL-6 levels. These results revealed that CoQ10 can serve as a useful adjuvant and promote the safe use of MTX in the management of arthritis, not only by potentiating the antiarthritic effect of MTX, but also by alleviating MTX-induced hepatocellular injury.

Phase 2 Study of Concurrent Cetuximab Plus Definitive Thoracic Radiation Therapy Followed by Consolidation Docetaxel Plus Cetuximab in Poor Prognosis or Elderly Patients With Locally Advanced Non-Small Cell Lung Cancer

Recursive partitioning analysis has shown that Eastern Cooperative Oncology Group (ECOG) Performance Status (PS) ≥2, male sex, and age ≥70 years are prognostic of poor outcome in locally advanced non-small cell lung cancer (LA-NSCLC) patients. Concurrent chemoradiation therapy (CRT) improves survival, but toxicity is a concern in this frail patient cohort. We therefore opened this trial of concurrent definitive thoracic radiation therapy (XRT) and cetuximab, followed by consolidation docetaxel plus cetuximab. Eligible patients had pathologically proven, unresectable LA-NSCLC (stage IIA-"dry" IIIB). They had ECOG PS 2 or weight loss ≥5% in 3 months or were aged ≥70 years. The primary objective was progression-free survival (PFS). Secondary objectives included overall survival (OS) and overall response rate (ORR). From May 2008 to November 2010, a total of 32 patients were evaluated in our single-institution, institutional review board-approved prospective clinical trial. Three patients were screen failures and 2 more withdrew consent before treatment, leaving 27 evaluable patients. One was removed because of poor therapy compliance, and 2 were taken off trial because of grade 3 cetuximab-related toxicities but were followed up under intent-to-treat analysis. The median follow-up and OS were 10.5 months. The median PFS was 7.5 months. The ORR was 59.3%. Eight early/sudden deaths were reported. Upon review, 6 patients developed severe pulmonary complications. Patients enrolled in this trial had improved OS compared with poor-PS historical controls (10.5 vs 6.4 months) and comparable OS to good-PS historical controls (10.5 vs 11.9 months) treated with XRT alone. However, pulmonary toxicity is a concern. Consolidative cetuximab/docetaxel, in conjunction with high-dose radiation therapy, is a putative cause.

Targeting TNF-α and NF-κB Activation by Bee Venom: Role in Suppressing Adjuvant Induced Arthritis and Methotrexate Hepatotoxicity in Rats

Low dose methotrexate is the cornerstone for the treatment of rheumatoid arthritis. One of its major drawbacks is hepatotoxicity, resulting in poor compliance of therapy. Dissatisfied arthritis patients are likely to seek the option of complementary and alternative medicine such as bee venom. The combination of natural products with modern medicine poses the possibility of potential interaction between the two groups and needs investigation. The present study was aimed to investigate the modulatory effect of bee venom acupuncture on efficacy, toxicity, and pharmacokinetics and tissue disposition of methotrexate. Complete Freund's adjuvant induced arthritic rats were treated for 3 weeks with methotrexate and/or bee venom. Arthritic score, ankle diameter, paw volume and tissue expression of NF-κB and TNF-α were determined to assess anti-arthritic effects, while anti-nociceptive effects were assessed by gait score and thermal hyperalgesia. Methotrexate toxicity was assessed by measuring serum TNF-α, liver enzymes and expression of NF-κB in liver. Combination therapy of bee venom with methotrexate significantly improved arthritic parameters and analgesic effect as compared to methotrexate alone. Bee venom ameliorated serum TNF-α and liver enzymes elevations as well as over expression of NF-κB in liver induced by methotrexate. Histological examination supported the results. And for the first time bee venom acupuncture was approved to increase methotrexate bioavailability with a significant decrease in its elimination. Conclusion: bee venom potentiates the anti-arthritic effects of methotrexate, possibly by increasing its bioavailability. Also, it provides a potent anti-nociceptive effect. Furthermore, bee venom protects against methotrexate induced hepatotoxicity mostly due to its inhibitory effect on TNF-α and NF-κB.

Long-term effects of a combination of D-penicillamine and zinc salts in the treatment of Wilson’s disease in children

The aim of this study was to investigate the effectiveness of a high-dose zinc sulfate and low-dose D-penicillamine combination in the treatment of pediatric Wilson’s disease (WD). A retropective chart review of 65 patients with WD was conducted. These patients received D-penicillamine (8–10 mg/kg/day) and zinc sulfate as the primary treatment. The pediatric dose of elemental zinc is 68–85 mg/day until 6 years of age, 85–136 mg/day until 8 years of age, 136–170 mg/day until 10 years of age and then 170 mg/day, in 3 divided doses 1 h before meals. After clinical and biochemical improvement or stabilization, zinc sulfate alone was administered as the maintenance therapy. Under treatment, the majority of patients (89.2%) had a favourable outcome and 3 patients succumbed due to poor therapy compliance. No penicillamine-induced neurological deterioration was noted and side-effects were observed in <11% of patients over the entire follow-up period. Benefical results on the liver and neurological symptoms were reported following extremely long-term treatment with a combination of low-dose D-penicillamine and high-dose zinc sulfate. Therefore, this regimen is an effective and safe treatment for children with WD.

Phase II study of concurrent cetuximab (C225) plus definitive thoracic radiotherapy (XRT) followed by adjuvant docetaxel in poor prognosis patients with locally advanced non-small cell lung cancer (LA-NSCLC).

7065 Background: Recursive partitioning analysis has shown that ECOG PS ≥ 2, male gender, or age &gt; 70 are prognostic of poor outcome in LA-NSCLC pts. Concurrent chemoradiotherapy improves survival, but toxicity is concerning in this frail pt cohort. We therefore opened this trial of concurrent definitive-dose XRT (70 Gy in 35 fractions) and C225 (250 mg/m2/dose), followed by adjuvant C225 and docetaxel (60 mg/m2 q3weeks x 3 cycles). Methods: Eligible patients had pathologically-proven LA-NSCLC (stage IIA – “dry” IIIB), not surgically resectable. They had ECOG PS 2 OR weight loss ≥5% in 3 months OR age &gt;70. The primary objective was progression-free survival (PFS). Secondary objectives included overall survival (OS) and overall response rate (ORR). Results: From 5/2008 to 11/2010, 32 pts were evaluated for our single-institution, IRB-approved prospective clinical trial. 3 pts were screen-failures and 2 more withdrew consent prior to treatment, leaving 27 evaluable patients. 1 was removed due to poor therapy compliance and 2 were taken off trial due to grade 3 toxicity from the C225 loading dose, but were followed under intent-to-treat analysis. Median follow-up and OS was 10.5 months. Median PFS was 7.8 months. ORR = 59.3%. 8 early/sudden deaths were reported, so the trial closed early: radiation pneumonitis (RP) was the apparent cause in 1 and probably/possibly in 4 others, with insufficient information in 2 additional pts; 1 pt died of failure to thrive. Of the remaining pts, 3 developed grade 3+ RP and 2 had grade 2 RP. Conclusions: Pts enrolled on this trial had improved OS compared with poor-PS historical controls (10.5 vs 6.3 months) and comparable OS compared with good-PS historical controls (10.5 vs 11.9 months) treated with RT (Werner-Wasik M et al. Int J Radiat Oncol Biol Phys. 2000;48:1475-82). However, pulmonary toxicity is a concern. Analysis of RP events is ongoing. Updated results will be presented at the meeting.

Hypertension and sexual dysfunction

Hypertension is a major independent cardiovascular risk factor, and also a marker of survival risk. Quality of life during the treatment of hypertension is an important health issue, as one in every five treated patients with hypertension will discontinue their therapy due to sideeffects. 1 Discontinuation of therapy, and poor compliance with therapy, will eventually lead to a poorer outcome. The appearance of treatment-related side- effects may actually make patients feel worse than they did prior to treatment, when most hypertensive patients are asymptomatic. Sexual dysfunction is a potential side-effect of therapy, and may lead to poor therapy compliance.

Synergistic activity of curcumin with methotrexate in ameliorating Freund's Complete Adjuvant induced arthritis with reduced hepatotoxicity in experimental animals

Methotrexate is employed in low doses for the treatment of rheumatoid arthritis. One of the major drawbacks with methotrexate is hepatotoxicity resulting in poor compliance of therapy. Curcumin is an extensively used spice possessing both anti-arthritic and hepatoprotective potential. The present study was aimed at investigating the effect of curcumin (30 and 100mg/kg) in combination with subtherapeutic dose of methotrexate (1mg/kg) is salvaging hepatotoxicity, oxidative stress and producing synergistic anti-arthritic action with methotrexate. Wistar albino rats were induced with arthritis by subplantar injection of Freund's Complete Adjuvant and pronounced arthritis was seen after 9days of injection. Groups of animals were treated with subtherapeutic dose of methotrexate followed half an hour later with 30 and 100mg/kg of curcumin from day 9 up to days 45 by intraperitoneal route. Methotrexate treatment in Freund's Complete Adjuvant induced arthritic animals produced elevation in the levels of aminotransferases, alkaline phosphatase, total and direct bilirubin. Enhanced oxidative stress in terms of measured lipid peroxides was observed in the methotrexate treated group. Curcumin significantly circumvented hepatotoxicity induced by methotrexate as evidenced by a change in biochemical markers possibly due to its strong anti-oxidant action. Hepatoprotective potential of curcumin was also confirmed from histological evaluation. Sub-therapeutic dose of methotrexate elicited substantial anti-arthritic action when used in combination with curcumin implying that the latter potentiated its action. Concomitant administration of curcumin with methotrexate was also found to minimize liver damage.

Wilson's disease: long-term follow-up of a cohort of 24 patients treated with D-penicillamine

Detailed data on long-term effectiveness of various drug therapies in Wilson's disease (WD) are lacking. Therefore, we retrospectively reviewed our patient cohort treated with D-penicillamine. This study reports on the clinical presentation, the diagnostic evaluation, and the disease course in 24 WD patients treated long-term (15+/-12 years, between 1969 and 2009) with D-penicillamine. The overall survival in our cohort was 91.6%. Twenty-two of 24 patients had liver disease at presentation, 17 of 24 patients (71%) had cirrhosis, 11 of whom had complications of cirrhosis. Six of 11 of these patients showed hepatological improvement (five of six) or stabilization (one of six), three of 11 were transplanted, one of 11 died, one of 11 discontinued follow-up. In the six of 17 cirrhotic patients without complications, improvement (four of six) or stabilization (two of six) occurred. Of all other patients (seven of 24), five of seven showed improvement (three of five) or stabilization (two of five), hepatological deterioration occurred only in one patient due to poor therapy compliance and one of seven discontinued follow-up. Neuropsychiatric symptoms were present in 13 of 24 at presentation and resolved in one of 13, decreased in seven of 13, stabilized in four of 13 and worsened in one of 13 patients (due to poor compliance). In general, we observed a favorable hepatological and neurological evolution with D-penicillamine. Despite the presence of liver disease or neuropsychiatric symptoms at baseline in all but one of the patients, we report beneficial results on liver and neurological disease after very long-term treatment with D-penicillamine, thereby adding to its reputation as 'first-line' therapy in WD.

Acupuntura para niños y adolescentes con asma bronquial: Estudio aleatorizado y controlado

Background During rehabilitation children and adolescents with bronchial asthma suff er from physical and mental stress in spite of receiving their asthma medication, or demonstrate poor therapy compliance. The randomized controlled trial evaluates the eff ectiveness of acupuncture in the course of inpatient rehabilitation of children and adolescents with mild to severe persistent bronchial asthma. Patients and methods In a longitudinal study design (pre-, post-, 4 month-follow-up) the eff ects of additional acupuncture on symptom frequency and severity, lung function, medication, quality of life (PAQLQ), general and asthma specific level of anxiety (STAIK) were examined in 43 acupuncture and 42 control patients. Apart from asthma sport, climate therapy and behavioral training, the acupuncture group was given acupuncture treatment according to a standardized needle pattern (12 × 30 min). Results After acupuncture the frequency of morning breathlessness and inhalation difficulty decreased signifi-cantly (p < 0.05) with equal or reduced medication. Patients treated with acupuncture also showed a tendency towards reduced anxiety levels. Patients of the acupuncture group with moderately persistent asthma demonstrated an additional decline of workload-induced obstruction (FEV 1 Diff. %). Conclusion Add-on acupuncture was able to achieve signifi cant improvements in lung function, especially in severe asthma, as well as a sustained reduction of anxiety scores.

Akupunktur bei Kindern und Jugendlichen mit Asthma bronchiale: Eine randomisierte kontrollierte Studie

Background During rehabilitation children and adolescents with bronchial asthma suffer from physical and mental stress in spite of receiving their asthma medication, or demonstrate poor therapy compliance. The randomized controlled trial evaluates the effectiveness of acupuncture in the course of inpatient rehabilitation of children and adolescents with mild to severe persistent bronchial asthma. Patients and methods In a longitudinal study design (pre-, post-, 4 month-follow-up) the effects of additional acupuncture on symptom frequency and severity, lung function, medication, quality of life (PAQLQ), general and asthma specific level of anxiety (STAIK) were examined in 43 acupuncture and 42 control patients. Apart from asthma sport, climate therapy and behavioural training, the acupuncture group was given acupuncture treatment according to a standardized needle pattern (12 × 30′). Results After acupuncture the frequency of morning breathlessness and inhalation difficulty decreased significantly (p < .05) with equal or reduced medication. Patients treated with acupuncture also showed a tendency towards reduced anxiety levels . Patients of the acupuncture group with moderately persistent asthma demonstrated an additional decline of workload-induced obstruction (FEV 1 Diff. %). Conclusion Add-on acupuncture was able to achieve significant improvements in lung function, especially in severe asthma, as well as a sustained reduction of anxiety scores.

Management outcome of pulmonary tuberculosis: a nine year review in Ilorin.

This study evaluates the management outcome of patients with pulmonary tuberculosis (PTB) over a nine year period. Essentially the cure rate, rate of default and fatality rate were all estimated. Factors predisposing to poor drug compliance were also reviewed. This was conducted by analysing the medical records of all newly diagnosed cases of PTB. Patients' demographic data, their social and past medical histories were obtained from their records. The extents of the lung lesions were determined from their chest X-rays. Criteria were set to define those that were (a) cured, (b) defaulted (c) transferred (d) had treatment failure and (e) died. The chi-square test of significance was used to estimate the difference between those that were cured and those that defaulted therapy. Multiple regression models were used to determine the level of interplay among the various factors contributing to patients' poor therapy compliance; the best of these was recorded. Out of the 1,741 cases of PTB treated over the studied period, 43.7% were cured, 0.3% had treatment failure, 44.2% defaulted therapy, 0.2% were transferred to other treatment centers while a fatality rate of 11.6% was recorded. Male gender, old age (> or =) 65 years), unmarried status, and previous default from therapy were found associated with poor therapy compliance. Others were unemployment, cigarette smoking and the use of alcohol. The cure rate of PTB in this study was very low, while the rate of default from therapy was quite high. These are in contrast to WHO target for TB control. To improve on these, directly observed therapy short course (DOTS) strategy for treating TB has to be adopted and implemented at all our treatment points for PTB. There should be emphasis on the Primary health Care (PHC) centers, because majority of PTB patients are grass root people and PHC set-ups are closer to them.

Poor therapy compliance accounts for large costs in diabetic ketoacidosis

Poor therapy compliance accounts for large costs in diabetic ketoacidosis

Transient sexual dysfunction observed during antiarrhythmic therapy by long-acting disopyramide in a male Wolff-Parkinson-White patient

Dear Sir, During antiarrhythmic drug therapy for various kinds of cardiac arrhythmias, not only arrhythmogenic effects, but also other minor adverse reactions, such as skin eruption, dry mouth, and urinary retention, have been recognized as causes of discontinuation and poor compliance of therapy. Recently we observed a case of another rare but significant adverse effect of an antiarrhythmic drug. The patient was a 46-year-old intellectual desk worker with intermittent Wolff-Parkinson-White syndrome. He had occasional episodes of paroxysmal supraventricular tachycardia while playing amateur baseball and drinking alcoholic beverages. We prescribed the long-acting disopyramide phosphate, 150 mg once in the morning daily, because of low efficacy of verapamil, 40 mg three times daily. On the first visit after administration of disopyramide, he complained of sexual dysfunction (impotence) without any other anticholinergic side effects. At the second visit (4 weeks after drug administration), he reported the disappearance of that adverse effect. The steady-state serum level of disopyramide in this case was 1.5 ~g/ml. Sexuality is woven into the everyday life of an individual. Sexual dysfunction is a matter of enormous importance and the cause of worry and concern. Several authors [1-4] have itemized and reviewed the characteristics of good sexual functioning and its dysfunction. Papadopoulos [3] described the significance of the actions of cardiovascular drugs as factors in sexual dysfunction of the cardiovascular patient. McHaffie et al. [2] reported a case of a 47-year-old man in whom impotence developed when the plasma concentration of the drug was 14 ~g/ml. There was full recovery of sexual function when the concentration was lowered to 3 ~g/ml. Although the anticholinergic properties of the drug may mainly impair sexual performance [2-4], the present case indicates the dependence on individual organ sensitivity to the anticholinergic action of the drug. Despite the low serum drug concentration, the adverse drug action happened as a first-dose phenomenon at the beginning of drug administration. This case also indicates that such adverse effects of the long-acting disopyramide at a low serum concentration may be transient and reversible with continued intake of the drug.