Poor Compliance Research Articles

An analysis of demographic, socio-economic and clinical variables for mental illness and mental illness relapse in south-east nigeria

Mental health has come into the front burner of development challenges amid declining socio-economic outcomes, especially in developing countries. Insecurity, conflicts and extremely threatening events, which trigger mental disorders, are common in South-East Nigeria, with many military operations, unknown gunmen attacks and kidnapping leading to the cold-blood assassination and kidnap of dear ones. The study aimed to analyze the demographic, socio-economic and clinical variables for mental illness in South-East Nigeria. Consecutive sampling technique was used to obtain a three-year records of the cases of 380 index and 180 post-index points data of mental illness cases that met the inclusion criteria in a purposively selected public mental health hospital. Data were analyzed using both descriptive and inferential statistics, including frequency count, percentages, chi-square and multinomial logistic regression. Results showed that over a half (55.0%) of the patients were males, and 65.27% had post-primary education. The mean age of patients was 39.87 years. Slightly above half of the cases (55.26%) were single and 56.84% were unemployed. Schizophrenia (68.42%) topped the list of the cases. The rate of relapse was 52.1%, with males being in the majority (61.62%). About 61.62% of those who relapsed were unemployed, 9.60% were into business/trading, and 5.05% were professionals. Those with 5 years and above illness duration had a higher percentage of relapse (52.02%) as well as those with poor drug compliance (66.16%). The mean relapse age was 34.23 years. Educational status, employment status/social class, marital status, and age were socio-economic/clinical factors that associated strongly with relapse at p-value of 0.10. Patients with ≥ 5 and ≤ 3 years duration of illness were 1.17 times on the average more likely to have relapse than those with three or less than 3 years. Onset age for illness predicted 2.479 times more likelihood of relapse. Being employed and having more family support, as against being unskilled/unemployed and not having family support, reduce the likelihood of relapse by 1.110 times on the average. The study recommended policy formulation and implementation for protection against mental illness and mental healthcare provision and access; for tackling unemployment head-on; for improvement of the access to effective treatment of mental illness; and mass education, especially among unemployed, uneducated, singles, and under-35 years of age, to help reduce the high rate of relapse of mental illness in South-East Nigeria.

Legal Framework and Issues in Hazardous Waste Management

Background: Environmental protection is crucial for preventing pollution and maintaining balance. Specific background: Hazardous waste (B3) significantly contributes to pollution, especially when mismanaged. Knowledge gap: Despite existing laws like Law No. 32/2009 on Environmental Protection, enforcement remains a challenge. Aims: This study analyzes B3 waste management under Indonesian regulations and assesses local programs and infrastructure developments. Results: While regulations and programs are in place, such as B3 handling policies and a new waste processing plant, poor compliance hampers effectiveness. Novelty: The study highlights evolving local strategies for improving B3 management. Implications: Stronger enforcement and integrated solutions are key to reducing environmental risks and achieving sustainability. Highlights : Local strategies are evolving to improve B3 waste management. Compliance with environmental regulations remains a significant issue. Technological solutions like waste incineration offer promising improvements. Keywords: Environmental protection, hazardous waste, B3 management, regulatory enforcement, sustainability

Conducting 24-hour movement behaviour research with preschool children in middle-income countries: Lessons from the SUNRISE pilot study in Mexico.

ObjectivesMovement behaviour research among preschoolers is nascent in low- and middle-income countries, where levels of physical activity, sleep, and sedentary time in children are largely unknown. This study aimed to adapt and assess the acceptability and feasibility of the International Study of Movement Behaviours in the Early Years (SUNRISE) in Mexico, and report on challenges and solutions while implementing the protocol. Study designPilot study of the SUNRISE protocol in Mexico. MethodsSafety, logistic challenges, local dynamics, and population needs were considered to adapt the SUNRISE protocol. A gender-balanced sample of 100 children aged 3-4 years from urban and rural communities were recruited through early childcare and education centres (ECECs). Measures on children’s movement behaviours, anthropometry, gross and fine motor skills, and executive functions were collected. Challenges and solutions for implementing the protocol were documented. ResultsThe protocol was well accepted by the school community (School response rate: 83.3%). Data were collected from 132 children (response rate: 44.4%); 88 children had valid accelerometer data (average wear time: 766.8 min/d).Challenges faced included: stringent regulations to access ECECs, low confidence in the research team and protocol, low literacy levels among parents, lack of basic services in rural areas (e.g., electricity, transportation, accommodation), and poor compliance with accelerometer wear time. To overcome them, changes to the protocol considered: adaptions to meet ECECs dynamics, strategies to enhance trust in the research team and protocols (face-to-face communication, demonstrations, and encouraging parental engagement), seeking community leaders to facilitate access to rural areas and ensure the research team’s safety and access to basic facilities, and strategies to improve accelerometer adherence. ConclusionsThis study demonstrates the feasibility of conducting movement behavior research among preschool children through ECECs in Mexico and provides relevant lessons learned that may hold relevance for researchers in settings with similar contexts to Mexico.

Left atrioventricular valve regurgitation repair with concomitant outflow obstruction release on repaired atrioventricular septal defect case

BackgroundLeft ventricular outflow tract stenosis and atrioventricular valve regurgitation are often problems encountered in adulthood after complete atrioventricular septal defect repair. The surgical approach and indications for managing long-term outcomes such as left atrioventricular valve regurgitation and left ventricular outflow tract stenosis after complete atrioventricular septal defect repair have been discussed.Case presentationA 23-year-old woman with intellectual disability was diagnosed with complete atrioventricular septal defect and underwent two-patch repair without cleft closure in childhood. Follow-up examination in adulthood demonstrated moderate left-sided atrioventricular valve regurgitation and left ventricular outflow tract stenosis with a circumferential ridge (peak velocity, 3.7 m/s; pressure gradient, 54 mmHg). Intraoperative findings showed a circumferential ridge under the aortic valve, and we removed the ridge. In addition, a cleft was present at the anterior leaflet, and we completely closed the cleft. Anticoagulation therapy was not initiated, and no embolic complications occurred. Follow-up echocardiography demonstrated no ridge under the aortic valve and only mild-range left AVVR.ConclusionsWe successfully performed surgical treatment without valve replacement or anticoagulation therapy in a patient with poor medical compliance. Delayed reoperation leads to degeneration of the valve structure and makes more difficult to repair. Atrioventricular valve regurgitation should be evaluated in combination with based on the etiology of the regurgitation especially cleft related or not, in addition to the dilatation annulus, cleft size, and depth of the leaflet coaptation depth, and associated other valve diseases.

Poor compliance with germline testing recommendations in colorectal cancer patients undergoing molecular residual disease testing.

Approximately 15% of colorectal cancers (CRCs) are associated with germline mutations. There is increasing adoption of DNA-based assays for molecular residual disease (MRD) and growing evidence supporting its clinical utility, particularly for CRC by oncologists in the U.S. We assessed the uptake of germline multi-gene panel testing (MGPT) for hereditary cancer in CRC patients receiving MRD analyses in community oncology settings. This retrospective study included 80 patients receiving care for CRC through community oncology practices who were referred for MRD testing at a commercial laboratory (January-March 2022). Clinical data, including test requisition forms, pathology reports, and clinical notes were reviewed. Documentation of tumor microsatellite instability and/or immunohistochemical (IHC) testing for mismatch repair (MMR) deficiency, age of CRC diagnosis, family history of cancer, and any order or recommendation for MGPT were assessed. Overall, 5/80 (6.3%) patients in the study have documented germline MGPT; 65/80 (81.3%) patients have documented MMR testing of their colorectal tumor. Among the 5 cases with abnormal MMR IHC, 2 have MGPT. Of the 33 patients meeting the 2021 National Comprehensive Cancer Network (NCCN) criteria for genetic/familial high-risk assessment, only 2 have MGPT. Our real-world data suggest that many CRC patients receiving MRD testing and meeting NCCN (v. 2021) criteria for germline MGPT may not be receiving evaluation beyond routine MMR status. Process and educational improvements are needed in community health settings to increase access and uptake of germline testing among CRC patients regardless of age at diagnosis or MMR status.

Atrial Fibrillation Prevalence In Ischemic Strokes In An Irish Hospital. Spotlight On Anticoagulation Failure In Patients On Direct Oral Anticoagulants

Abstract Background Global atrial fibrillation (AF) burden in acute ischemic stroke patients approximates at 30%. An Audit in 2022, in the concerned hospital identified lack of compliance and under-dosing as major causes of ischemic strokes whilst on direct acting anticoagulants (DOACs). This year, we sought repeat the audit of process with focus on ischemic strokes with pre-existing AF patients established on DOACs, to study trends related to anticoagulation failure. Methods The study was a retrospective observational audit study of all patients admitted with a diagnosis of acute ischemic stroke to the concerned hospital from January 2023 to December 2023 who had known diagnosis of atrial fibrillation and were prescribed a DOAC prior to their admission in the concerned hospital with an ischemic stroke. Patients were identified via HIPE coding and in-hospital stroke registry. Data was collected via charts review, compiled via flow charts, graphs and excel sheets, and studied. Results 143 patients were admitted to the hospital’s stroke service with ischemic stroke in the set time frame. 46 (32%) had Atrial Fibrillation (AF) which was deemed to be the cause of their stroke. 29 (20.2%) had pre-existing diagnosed AF, and 22 of those patients were prescribed DOACs. In all patients already on DOACs, compliance was found questionable or lack of in 11 (50%). 8 (36.3%) patients were on low dose (adjusted dose DOACs). 3 patients were diagnosed with DOAC failure without cause. All new and existing AF patients not anticoagulated, were commenced on anticoagulation. Conclusion The audit showed under dosage and poor compliance were major causes of anticoagulation failure in stroke patients who were anticoagulated with DOACs. Similar results were noted as secondary results in last year’s audit in the concerned hospital. As part of quality improvement process, a specialist DOAC clinic was being set up with further audit process planned for the coming year.

The Development And Implementation Of A Multi-Factorial Falls Assessment Tool In A Pathfinder Service

Abstract Background Falls are a common complaint of older adults who present to the Pathfinder service. Pathfinder offers alternative care pathways to older adults when they phone 999 for low acuity concerns. As part of the service, Occupational Therapists and Physiotherapists provide home-based assessments and interventions. The aims of this project were firstly, to develop a falls assessment tool to assist therapists’ compliance with guidelines relating to older adults who have fallen and secondly, to ensure consistency of assessment and intervention among therapists on the team. Methods A falls assessment tool was created in line with the most recent world falls guidelines (Montero-Odasso et al., 2022). The initial roll out began on October 1st, 2024, when the tool was used to assess older adults who presented to the Pathfinder service following a fall. After three months, areas of poor compliance and barriers with usability of the tool were highlighted from a chart review and stakeholder engagement. The document was then revised based on this feedback. From February 1st, 2024, the tool was then used with all older adults who presented to the service. Compliance was re-audited at the end of April 2024 and therapists on the team were surveyed to gather user feedback. Results As a result of the falls assessment tool, compliance with the World Falls Guidelines increased initially from 54% to 86% but continued to improve when reviewed seven months post implementation. Qualitative data was universally positive when stakeholders were surveyed with benefits identified as: improving patient care, consistency across the therapy team and a useful means of communication. Conclusion The development and implementation of a falls assessment tool into the practice of a Pathfinder service increased compliance with the most recent world falls guidelines and received positive feedback from all key stakeholders.

Quality Improvements in Dementia Care in an Acute Hospital Setting

Abstract Background Dementia care in acute hospital settings requires targeted quality improvement initiatives based on national standards. This poster highlights key interventions to enhance care, aligning with local hospital group key performance indicators (KPIs), in one large teaching hospital. Methods Delirium screening (4AT) was implemented in the Emergency Department and geriatric ward, with education to increase staff awareness of delirium screening, prevention, and management. Audits assessed compliance with the 4AT tool. An audit evaluated the geriatric ward environment, including dementia-friendly painting, decorating, and signage, at baseline. Psychotropic prescribing practices were audited in 20 inpatient charts. A Life story Information tool (Sunflower Tool) was implemented to display personalized patient information at the end of the bed. Semi-annual audits assessed usage and effectiveness in the geriatric ward. Results The initial audit showed 85% compliance with the 4AT tool, dropping to 40% in a repeat audit after 6 months. Initially, 17 of 20 charts had complete 4AT scores; in the re-audit, 11 of 20 had scores recorded, with only 8 fully completed. The first environmental audit revealed poor compliance with dementia-friendly standards, especially in signage, clutter, and bedroom colour contrasts. Best compliance was seen with colour contrast in bathroom toilets and handrails. A quality improvement plan was developed to address gaps. The adoption and impact of the Sunflower tool improved patient-staff interactions and personalized care. All ward staff were trained in using the Sunflower tool. Conclusion A robust quality improvement plan, with measurable, achievable, relevant, and time-defined actions, aligned with national standards and local KPIs, is crucial to achieve and sustain positive audit results. Continuous education, resource allocation, and regular audits are required to ensure high-quality care for patients with dementia. Future efforts will focus on addressing identified challenges, refining interventions based on audit feedback, and maintaining care improvements.

Audit of Lithium Monitoring in a Mental Health for Older Persons (Dublin North City Central) Service

Abstract Background Lithium is a psychotropic medication used for the treatment of bipolar affective disorder and augmentation for treatment resistant depression. Lithium monitoring is essential due to the narrow therapeutic range of serum lithium and the potential for toxicity. Other medications with similar risk profiles, such as warfarin, have established monitoring programmes. Older adults receiving lithium therapy are at an increased risk of adverse events, given the prevalence of medical co-morbidities and changing pharmacokinetics. The authors of this audit identified the lack of formalized lithium monitoring programme in the Mental Health Service for Older Persons (MHSOP). The aim of this audit to compare monitoring practices in the MHSOP against the current gold standard Irish Medication Safety Network (IMSN) for Prescribing and Monitoring of Lithium Therapy. Methods A survey of all community medical charts identifying patients attending the service receiving lithium therapy was completed. Data collected pertained to diagnosis, treating consultant, lithium dose, if the patient received educational material, compliance with ECG and blood monitoring. Results The MHSOP active case load was 682 patients, 14 patients were prescribed lithium therapy. Cycle 1 of the audit demonstrated poor compliance of lithium monitoring against the gold standard. A lithium pack was inserted in patient files to prompt all clinicians to follow the recommended standardized monitoring of lithium therapy as per the IMSN guidelines. In cycle 2 of the audit there was an improvement in recording blood monitoring across the patient group. Conclusion The audit demonstrated improvement in compliance with international guidelines following the intervention. It was recommended that a formalized Lithium Clinic was a needed resource for the MHSOP. The lithium monitoring pack will continue to be added to clinical files, included in Non-Hospital Consultant (NCHD) induction and multi - disciplinary teaching sessions. It is proposed that the audit be repeated in one year to longitudinally assess compliance.

Multiphase soft metal enabled high-performance fabric-based wearable energy harvesting

Highly efficient and flexible power sources have always been the focus and goal in the field of wearable electronics. However, the existing wearable power sources are limited by their large size, high weight, electrolyte leakage, and poor mechanical compliance, which seriously hinders their practical applications. Herein, we propose a novel strategy to achieve and demonstrate a fabric-based high-performance wearable triboelectric nanogenerator (TENG) structure. The metals of gallium (Ga), bismuth (Bi), indium (In), and tin (Sn) are mixed according to specific mass ratios, and then they are transformed in liquid phase to form room-temperature multiphase soft metals of GaBiInSn. The material exhibits both metallic and fluidic properties, and possesses a characteristic of multiphase structure. The GaBiInSn material is directly deposited between polytetrafluoroethylene (PTFE) layers and nonwoven fabrics to establish multi-level conductive and frictional interfaces, creating charge transfer and solid-liquid hybrid dielectric layers. Therefore, the thin film-type triboelectric nanogenerators with a structure of PTFE/GaBiInSn/nonwoven fabric (LM-P-TENGs) is manufactured. The LM-P-TENGs can be integrated onto fabrics without compromising their breathability, comfortableness, and flexibility. Particularly, LM-P-TENGs efficiently convert the mechanical energy of human limb movements into sustainable electrical energy output. Under the human limb mechanical triggering conditions, LM-P-TENG achieves a champion specific open-circuit voltage up to 900 V, peak short-circuit current density of 43.3 mA/m2, and high power density of 12.56 W/m2. This work demonstrates the application potential of room-temperature multiphase soft materials in flexible wearable power sources, while introducing a novel power supply mode for wearable electronics. Additionally, the LM-P-TENGs also present applications in self-powered wearables, medical biosensing systems, human-machine interaction systems, near-eye display systems, etc. for the flexible electronics.

QSAR Modeling, Molecular Docking and ADMET Study of Aryl Fluorosulfate Derivatives as Potential Anti-TB Agents

Tuberculosis (TB), caused by Mycobacterium tuberculosis (Mtb) infection, stands as a global infectious disease presenting substantial public health challenges due to its high incidence and mortality rates. The prolonged use of conventional anti-TB therapies has led to the emergence of severe drug resistance in Mtb, resulting in extended treatment durations, increased costs, poor patient compliance, and reduced cure rates. This phenomenon has posed a significant burden on global TB prevention and control efforts, necessitating a shift in research focus toward the exploration of novel anti-TB drugs. In this context, utilizing QSAR modeling methods, our study systematically investigated the relationship between the chemical structures of 36 aryl fluorosulfate derivatives and their inhibitory activity against Mtb. Robust and predictive Topomer CoMFA and HQSAR models were developed, featuring Topomer CoMFA model parameters: q 2 = 0.659, r 2 = 0.969, F = 102.877, N = 6, SEE = 0.138; HQSAR model parameters: q 2 = 0.705, r 2 = 0.873, SEE = 0.264, HL = 199, N = 4. Leveraging these models, structural modifications were applied to the compounds using the ZINC15 database, leading to the successful design and screening of three novel compounds with desirable inhibitory activity. Molecular docking and ADMET performance prediction results indicated that these three new compounds exhibit strong binding capabilities and promising pharmaceutical potential. This study provides valuable insights and research directions for the development of aryl fluorosulfate derivatives as potential agents for tuberculosis treatment and as novel drugs.

Pseudo-outbreak of Bacillaceae species associated with poor compliance with blood culture collection recommendations.

This study describes a pseudo-outbreak of Bacillaceae spp. bloodstream infections that spanned five months starting in May 2023 and the infection prevention measures implemented to control it. This retrospective study was conducted at a tertiary infectious disease hospital in Bucharest, Romania. An observational audit of the blood culture collection practice in our hospital was performed, and the materials used during blood culture collection were sampled. Bacterial colonies were identified using MALDI Biotyper. The Bacillaceae blood culture positivity rates in the previous four years were compared using the Kruskal‒Wallis rank test. Bacillaceae spp.-positive blood cultures were recovered from 60 patients over a five-month period. In the case of 58 patients, Bacillaceae spp.-positive blood cultures were considered contaminated. Two patients were treated for Bacillus spp. bacteraemia. The audit revealed significant variation during the preparation of the venipuncture site step and the use of nonsterile medical cotton wool. Medical cotton wool contaminated with species of Bacillaceae was found in 10 out of 12 wards. The control measures included repeated training on the blood culture collection procedure and the removal of Bacillaceae spp.-contaminated cotton wool. The pseudo-outbreak was caused by the unjustified use of medical cotton wool for disinfection of the skin and blood culture bottle septums. The investigation of this pseudo-outbreak highlighted a gap in blood culture collection practices at our facility and thus allowed for its improvement.

Naturalistic outcomes of patients discharged from a community treatment order: QA project.

To study outcomes for patients after they are discharged from Community treatment orders (CTO) including rate of relapse, median time to relapse and to identify the risk factors associated with relapse. The study population included patients discharged from CTO from July 2017 to December 2021, managed by a major metropolitan* case management team (CMT). The data were collected from electronic medical records (EMR). Descriptive analysis was conducted to study the sample characteristics. Logistic regression using univariate and multivariate analysis was performed to examine the associations between factors related to relapse. A total of 128 patients were studied. The relapse rate was 27.4% with median time to relapse of 72 days. Poor insight, poor treatment compliance, duration of CTO and number of CMT contacts were significantly associated with relapse while substance use, psychiatric comorbidities and psychosocial factors were not. The findings suggest that people who relapsed had poor insight and poor medication adherence, had CTO for a longer period and had frequent contact from CMT even after discharge from CTO.

The role and mechanism of dapagliflozin in Alzheimer disease: A review.

Alzheimer disease (AD), as the main type of dementia, is primarily characterized by cognitive dysfunction across multiple domains. Current drugs for AD have not achieved the desired clinical efficacy due to potential risks, inapplicability, high costs, significant side effects, and poor patient compliance. However, recent findings offer new hope by suggesting that sodium-glucose cotransporter 2 inhibitors (SGLT-2i) may possess neuroprotective properties, potentially opening up novel avenues for the treatment of AD. This review delves deeply into the multifaceted mechanisms of action of SGLT-2i in AD, encompassing antioxidative stress, antineuroinflammation, upregulation of autophagy, antiapoptosis, acetylcholinesterase inhibitor activity, and protection of endothelial cells against atherosclerosis and damage to the blood-brain barrier, among others. Furthermore, it provides an overview of recent advances in clinical research on this drug. These findings suggest that SGLT-2i is poised to emerge as a pivotal candidate for the treatment of AD, given its diverse functional effects.

Formulation and Development of Nanoparticulate Drug Delivery System in the Treatment of Cancer.

Cancer is a leading cause of death worldwide. Owing to increased prevalence of cancer globally, it has posed a major challenge to healthcare professionals. The main types of cancer that account for high mortality are lung, stomach, liver, colon, and breast cancer. For many decades and even today, the major portion of chemotherapy is based on intravenous administration of drugs, which has its limitations including lack of safety, inconvenience, and poor patient compliance. In present study, formulated a novel nanoparticulate drug delivery system for the treatment of cancer. Pre- formulation is the initial stage in drug development where the physical and chemical properties of a drug candidate are studied. This phase involves characterizing solubility, stability, pH, and compatibility with excipients to guide the formulation of a safe, effective, and stable dosage form. Pre-formulation studies are crucial for optimizing drug delivery, bioavailability, and shelf-life.

Advancing Glaucoma Therapy by Exploring the Efficacy and Potential of Brimonidine Niosomal Gel

Glaucoma is a leading cause of permanent vision loss worldwide and is characterised by progressive optic neuropathy with elevated intraocular pressure (IOP) as a major risk factor. Although successful, the current therapeutic strategies are often severely limited by their need for chronic dosing, systemic side effects and poor patient compliance. Brimonidine, an alpha-2 adrenergic receptor agonist which acts selectively, has been beneficial through its IOP-lowering effects by diminishing aqueous humor production and improving uveoscleral outflow. A novel medication delivery technology to enhance ocular bioavailability and extended drug release is brimonidine, formulated as a niosomal gel. The aim of this study is to highlight its clinical efficacy, formulation strategies and mechanism of action that significantly improved glaucoma therapy. Key studies illuminate its potential benefits in reducing dosing frequency, avoiding side effects and increasing patient compliance. Additional study and optimization required to scale-up manufacturing or ensure long-term stability. Possible future directions: combination medications and delivery systems personalized medicine possible future directions in the treatment of glaucoma might include combination medicines and personalized medicine techniques tailored to patient-specific needs. Brimonidine niosomal gel may be a new approach for glaucoma management and it can change the concept of intraocular drug delivery in the future.

The Outcomes of Liver Transplantation in Highly Dependent Incapacitated Patients with Intellectual and Developmental Disabilities.

Background/Objectives: Data regarding the outcomes of liver transplantation in disabled, highly dependent, and legally incapacitated adults are scarce, likely due to the infrequency of these procedures in such populations. Multicenter studies in adult transplant centers have shown that patients with coexisting intellectual and developmental disabilities (IDDs) may be denied transplantation because of their expected low longevity and the complexities associated with managing post-transplant care. We examined the long-term patient and graft outcomes in highly dependent, incapacitated patients with IDDs who underwent elective transplantation for chronic liver disease. Methods: Six adult patients who underwent liver transplantation for primary biliary cholangitis (n = 2), hepatitis C cirrhosis (n = 2), Wilson's disease (n = 1), and autoimmune hepatitis (n = 1) were included. The main causes of their disability were infantile cerebral palsy, myotonia, and Niemann-Pick disease. Results: Four of the six patients were women, with a median age of 26 (range: 23-36) years. Only one patient died during follow-up. Their 1- and 5-year survival rates were 100 and 75%, respectively, which were not statistically different from those of the general cohort of electively transplanted patients (95.8 and 90.1%, respectively) (p = 0.35). Conclusions: Adult patients who are highly dependent, disabled, or legally incapable should not be denied liver transplantation because of poor long-term survival rates. Physiological disorders and psychiatric comorbidities should not prevent patients from receiving life-saving surgeries due to poor postoperative compliance or low quality of life.

Persistent transmission of soil-transmitted helminths despite 16 years of uninterrupted Mebendazole- and ivermectin-based preventive chemotherapy in the Lomie Health District (East Region, Cameroon): The emergency of complementary control strategies.

The control of the Soil-Transmitted Helminths (STH) infections primarily relies on the school-based Preventive Chemotherapy (PCT) with mebendazole. Given the efficacy of ivermectin on STH, the control of the latter is expected to be potentialized in areas where ivermectin is also distributed for onchocerciasis and/or lymphatic filariasis control/elimination. This study aimed to assess the prevalence and intensity of STH in the Lomie Health District where annual school-based deworming campaigns and community-directed treatments with Ivermectin have been underway for almost two decades. A quantitative cross-sectional study was conducted in 10 schools of the Lomie Health District, East Region, Cameroon. Stool samples were collected from school-aged children and analysed using the Kato-Katz technique. Semi-structured questionnaires were administered to enrolees to assess compliance with water, sanitation, and hygiene (WASH). Of the 491 children (median age: 9 years; IQR: 7-10) enrolled, 83.9% (95% CI: 80.3-87.1) were infected with at least one STH species. Trichuris trichiura was the predominant species (78.5%), and no hookworm was found. The prevalence trend slightly decreased between 1987 and 2010 (~8%) and remained unchanged since 2010 (p-value = 0.05). Overall, 46.8% and 41.8% of children were heavy-to-moderately infected with Ascaris lumbricoides and T. trichiura. Poor hand hygiene (OR: 2.24, 95% IC: 1.4-3.4, p-value = 0.0002) and the use of river as a source of drinking water (OR: 14.8, 95% IC: 6.9-33.3, p-value = 0.0001) were the main risk factors associated with the STH infection in Lomie Health District. The persistent high prevalence and intensity of STH infection despite 16 years of mebendazole-based PCT and expected collateral impact of ivermectin mass distribution, points to plausible implementation gaps, poor compliance to WASH or sub-optimal efficacy of the anthelminthics used. This study highlights the need to further assess the cause of the persistent high prevalence and implement context-adapted control measures in order to curb STH transmission.

Therapeutic Potential of Molsidomine-Loaded Liquid Crystal Nanoparticles for the Treatment and Management of Niacin-Induced Varicose Veins: In Vitro and In Vivo Studies.

Varicose vein therapy has historically relied significantly on invasive surgical procedures, which frequently resulted in poor compliance among patients. The tendency could stem from the past use of abrasive surgical procedures and a lack of documented drug-induced animal models. To address this challenge, we envisaged an innovative approach for animal model development that uses niacin-induced recurrent flushing. And to further treat the condition, we used liquid crystal nanoparticles (LCNPs) as carriers for the antiangiogenic, cardio protective, and anti-inflammatory drug molsidomine. After the successful initiation of reticular perforant varicose veins, the animals were administered and treated with molsidomine-loaded liquid crystal nanoparticles (MD-LCNPs) that were simultaneously synthesized via a straightforward homogenization method. The preparation of MD-LCNPs involved inducing the disruption of a cubic-phase gel of glyceryl monostearate (GMS) by Milli-Q water in the presence of a Tween-80. Characterization of MD-LCNPs encompassed an assessment of their physicochemical properties. Microscopic studies revealed monodispersity with an average size of 195 ± 55.94 nm. In vitro evaluations demonstrated commendable antioxidant potential, excellent swelling behavior, and sustained release behavior of MD-LCNPs. Furthermore, MD-LCNPs exhibited nontoxicity toward cells, with minimal generation of reactive oxygen species (ROS) or nitric oxide (NO). Histopathological and hematological analysis indicated the efficacy of MD-LCNPs in ameliorating niacin-induced varicose veins, the absence of detrimental and toxic effects on blood cells and visceral organs, and safety for intravenous administration. Following the administration of nanoparticles, the formulation demonstrated appropriate levels of prostaglandins (PGDs), vascular cell adhesion molecule-1 (VCAM-1), intercellular adhesion molecule-1 (ICAM-1), and vascular endothelial growth factor (VEGF). This substantiates the formulation's suitability for the treatment and management of varicose veins. In conclusion, our work shows an efficient method that induces varicose veins in rodents, and also a promising nanocarrier-based drug delivery approach using MD-LCNPs for effective and safe varicose vein therapy.

Extended duration linagliptin nanoparticles: a novel, safe and effective future of diabetes treatment?

Dear Editor, Diabetes Mellitus (DM), a chronic disease characterised by hyperglycaemia caused by either underproduction of insulin or defective insulin action, has become more prevalent globally; affecting 1 in every 10 adults over the past years with type 2 diabetes being more common in the low- and middle-income countries and type 1 in high-income countries (1). Pakistan, being a lower-middle-income country, has a 26.7% prevalence of diabetes and age-adjusted comparative prevalence of 30.8% affecting 1 in approximately every 4th adult (2). The current guidelines for the management of diabetes include insulin, metformin, sulfonylureas, and sodium-glucose co-transporters type 2 (SGLT-2) inhibitors. However, hypoglycaemia, weight gain, gastrointestinal problems and contraindication of their use in patients with pre-existing renal diseases pose problems for clinicians. Poor patient compliance in following the regular antidiabetic regimen also make treatment plans ineffective. Thus, newer drugs are constantly being researched (3). Metformin has been an excellent treatment option with only a slight risk for some specific patients to develop lactic acidosis. It is the most commonly prescribed medication for DM. Another drug, Linagliptin (Lina) was approved by the FDA in 2011 as an effective dipeptidyl peptidase inhibitor for the treatment of DM. It has been used as monotherapy and in combination with dapagliflozin, an SGLT2 inhibitor, for the treatment of diabetes in patients with a history of metformin therapy. However, its use was limited due to its low bioavailability (4). Recent research suggests that the extended duration (ED) Lina via the use of poly d, l-lactic-co-glycolic acid (PLGA) polymers in nanoparticle form could be beneficial in the management of type 2 DM. It has an increased bioavailability, fewer reported side effects and a reduced need for regular dosage. Furthermore, the use of nanoparticles facilitates a targeted delivery of the drug which may omit the pain that is caused by the use of implants (5). Lina is also thought to be effective in Type 3 Diabetes which causes Alzheimer’s disease. As dementia can lead to forgetting to take medications regularly, the ED Lina, which is taken once weekly, may be a suitable option. This new formulation is being considered for its better safety profile compared to other antidiabetics and its effectiveness in controlling HbA1C both as monotherapy and in combination therapy (4,6) ---Continue