Potential Medication Effects Research Articles

Discussing male sexual and reproductive health in the rheumatology outpatient clinic: a Q-methodology study

ObjectivesInflammatory arthritis (IA) has been associated with various problems related to male sexual and reproductive health (SRH). However, addressing these issues in the clinic remains a challenge. In this study, we aimed to describe the viewpoints of rheumatologists and male patients with IA regarding the aspects that influence their communication about SRH.MethodsRheumatologists and adult men with IA were invited to participate. This study uses Q-methodology, a mixed methods approach to systematically study subjectivity. Participants ranked 32 aspects according to their degree of influence (least-most influence) in addressing SRH and were then interviewed. Factor analysis was used to identify common patterns in the rankings. These patterns were interpreted as the different viewpoints of rheumatologists and male patients, supported by the qualitative data from the interviews. To obtain more generalizable results, the study was conducted in two countries with different socio-cultural backgrounds and healthcare systems, The Netherlands and Mexico.Results30 rheumatologists and 30 men with IA were included in each country. The analysis revealed three viewpoints in each group. Rheumatologists are more likely to be influenced by aspects such as the patient’s desire to become a father or the patients’ (young) age, but patients by a much more diverse pool of aspects, such as potential side effects of medication on their sexual function.ConclusionsThis study identified different viewpoints on the aspects that influence discussing SRH between rheumatologists and male patients, and important differences in viewpoints between both groups. Further research is needed to reach consensus on how and when rheumatologists and male patients should discuss SRH.

GLP-1 receptor agonists and delayed gastric emptying: implications for invasive cardiac interventions and surgery.

Glucagon-like peptide-1 (GLP-1) is a hormone involved in glucose homeostasis and satiety regulation. The review highlights the importance of understanding the interplay between GLP-1 and gastric motility. This paper explores the intricate connection between GLP-1 and delayed gastric emptying, specifically gastroparesis, and its implications in the context of pulmonary aspiration during anesthesia along with the potential effects of GLP-1 medications on absorption of other medications. The findings noted in this paper serve as a catalyst for continued exploration into the intricate dynamics of GLP-1 and its implications in the context of perioperative care, aiming to enhance patient safety and optimize anesthesia practices. The inquiry suggests that an in-depth examination of this relationship is crucial for refining perioperative management strategies. It underscores the need for further research to elucidate the mechanisms involved and to establish guidelines that address the potential risks associated with GLP-1 modulation, particularly in patients undergoing anesthesia for various cardiac surgeries and procedures. Specifically in the context of cardiac interventions understanding the potential for delayed absorption of critical cardiac medications due to the influence of GLP-1 on gastric emptying is particularly important as drug absorption can play a crucial role for ensuring successful outcomes.

Antioxidant and antidiabetic potential of Cystoseira myrica-mediated green metallic zinc nanoparticles using the algal extract: synthesis and characterization

Abstract Cystoseira myrica marine macroalgae (CSR) were used to produce metallic zinc nanoparticle composites by utilizing the phytochemicals naturally found in the algae. This involves homogenizing the residuals of CSR (10 g), zinc nitrate solution (5 M; 100 ml), and methanol liquid extract (100 ml) at 30 °C for 24 h of sonication and stirring, followed by filtration and drying. This resulted in a hybrid bio-composite (Zn/CSR), which demonstrated strong antioxidant and antidiabetic properties when compared to zinc oxide (ZnO) and CSR used separately. The Zn/CSR hybrid showed excellent antioxidant activity against common radicals such as DPPH (91.5 ± 1.66%), nitric oxide (90.4 ± 1.2%), ABTS (92.2 ± 1.9%), and O2 ·− (27.8 ± 1.12%) (p < 0.05), performing better than the standard antioxidant, ascorbic acid. Regarding its antidiabetic properties, the Zn/CSR composite significantly inhibited key enzymes involved in diabetes, including both commercial enzyme forms (α-amylase (80.3 ± 1.65%), α-glucosidase (96.6 ± 1.11%), amyloglucosidase (95.8 ± 1.3%)) and their crude intestinal forms (α-amylase (72.3 ± 1.5%), α-glucosidase (94.2 ± 1.7%)) (p < 0.05). This improvement increases the impact of the green CSR extract in reducing the agglomeration behaviors of the loaded metal and the formation of a capping layer from the phytochemicals on its surface, in addition to the beneficial effects of the CSR as substrate, which enhances the biological functions of the loaded metal and its interaction interfaces. The Zn/CSR composite also outperformed commercial miglitol drugs and slightly surpassed acarbose in effectiveness. Given the high cost and potential side effects of current medications, the Zn/CSR composite could be a cost-effective alternative for antioxidant and antidiabetic treatments. These findings also emphasize the role of CSR-derived phytochemicals and algae residues in enhancing the biological activity of the metal nanoparticles.

Potential effects of attention deficit hyperactivity disorder medication on body height and body weight in a longitudinal pediatric cohort study, the LIFE Child study.

Purpose: To investigate the potential impact of drugs for the treatment of attention deficit hyperactivity disorder (ADHD) on body weight and height in children and adolescents from the LIFE ('Leipzig Research Centre for Civilization Diseases', Leipzig, Germany) Child cohort. Methods: We included 2,115 participants aged ≥6 to <18.25 years who attended the LIFE study center between 2011 and 2020 in our analysis, of whom 48 used ADHD drugs. Anthropometric and medication data from baseline to the third follow-up visit were available for 659 participants. Body height and body weight measurements were subsequently converted to z-scores. A repeated measures analysis of variance (ANOVA) was performed on the z-scores of both ADHD drug users and non-users to determine potential trends in body weight and body height from baseline to the 3 rd annual follow-up. Results: At the last visit with ADHD drug use of the 48 ADHD drug users, 40% (19/48) of the children and adolescents were below the 25 th reference percentile for weight. Z-scores for body height declined from baseline to the 3rd annual follow-up in individuals who used ADHD drugs (n=10; Differencemeans =-0.310; p=0.002) compared to non-users (n=649; Differencemeans =0.102; p<0.001). Body weight also decreased from baseline to 3rd follow-up in the ADHD drug group (n=10; Differencemeans =-0.473; p<0.001) compared to the non-user group (n=649; Differencemeans =0.015; p=0.161). Conclusion: We observed a potential tendency towards lower Z-scores for body height and body weight in individuals taking ADHD medication for an extended period compared to the corresponding age- and sex-matched populations.

Asthma and Cardiovascular Diseases: Navigating Mutual Pharmacological Interferences.

Asthma and cardiovascular disease (CVD) often co-exist. When a patient has both conditions, management requires an approach that addresses the unique challenges of each condition separately, while also considering their potential interactions. However, specific guidance on the management of asthma in patients with CVD and on the management of CVD in patients with asthma is still lacking. Nevertheless, health care providers need to adopt a comprehensive approach that includes both respiratory and CVD health. The management of CVD in patients with asthma requires a delicate balance between controlling respiratory symptoms and minimising potential cardiovascular (CV) risks. In the absence of specific guidelines for the management of patients with both conditions, the most prudent approach would be to follow established guidelines for each condition independently. Careful selection of asthma medications is essential to avoid exacerbation of CV symptoms. In addition, optimal management of CV risk factors is essential. However, close monitoring of these patients is important as there is evidence that some asthma medications may have adverse effects on CVD and, conversely, that some CVD medications may worsen asthma symptoms. On the other hand, there is also increasing evidence of the potential beneficial effects of asthma medications on CVD and, conversely, that some CVD medications may reduce the severity of asthma symptoms. We aim to elucidate the potential risks and benefits associated with the use of asthma medications in patients with CVD, and the potential pulmonary risks and benefits for patients with asthma who are prescribed CVD medications.

A spectrum of altered non-rapid eye movement sleep in schizophrenia.

Multiple facets of sleep neurophysiology, including electroencephalography (EEG) metrics such as non-rapid eye movement (NREM) spindles and slow oscillations, are altered in individuals with schizophrenia (SCZ). However, beyond group-level analyses, the extent to which NREM deficits vary among patients is unclear, as are their relationships to other sources of heterogeneity including clinical factors, ageing, cognitive profiles and medication regimens. Using newly collected high-density sleep EEG data on 103 individuals with SCZ and 68 controls, we first sought to replicate our previously reported group-level differences between patients and controls (original N=130) during N2 stage. Then in the combined sample (N=301 including 175 patients), we characterized patient-to-patient variability. We replicated all group-level mean differences and confirmed the high accuracy of our predictive model (AUC=0.93 for diagnosis). Compared to controls, patients showed significantly increased between-individual variability across many (26%) sleep metrics. Although multiple clinical and cognitive factors were associated with NREM metrics, collectively they did not account for much of the general increase in patient-to-patient variability. Medication regimen was a greater contributor to variability. Some sleep metrics including fast spindle density showed exaggerated age-related effects in SCZ, and patients exhibited older predicted biological ages based on the sleep EEG; further, among patients, certain medications exacerbated these effects, in particular olanzapine. Collectively, our results point to a spectrum of N2 sleep deficits among SCZ patients that can be measured objectively and at scale, with relevance to both the etiological heterogeneity of SCZ as well as potential iatrogenic effects of antipsychotic medication.

Multimodal deep learning models utilizing chest X-ray and electronic health record data for predictive screening of acute heart failure in emergency department

Background and ObjectivesAmbiguity in diagnosing acute heart failure (AHF) leads to inappropriate treatment and potential side effects of rescue medications. To address this issue, this study aimed to use multimodality deep learning models combining chest X-ray (CXR) and electronic health record (EHR) data to screen patients with abnormal N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels in emergency departments. MethodsUsing the open-source dataset MIMIC-IV and MIMICCXR, the study population consisted of 1,432 patients and 1,833 pairs of CXRs and EHRs. We processed the CXRs, extracted relevant features through lung-heart masks, and combined these with the vital signs at triage to predict corresponding NT-proBNP levels. ResultsThe proposed method achieved a 0.89 area under the receiver operating characteristic curve by fusing predictions from single-modality models of heart size ratio, radiomic features, CXR, and the region of interest in the CXR. The model can accurately predict dyspneic patients with abnormal NT-proBNP concentrations, allowing physicians to reduce the risks associated with inappropriate treatment. ConclusionThe study provided new image features related to AHF and offered insights into future research directions. Overall, these models have great potential to improve patient outcomes and reduce risks in emergency departments.

A Longitudinal Analysis of Black Box Warnings: Trends and Implications for Drug Safety.

A black box warning, signaling potential life-threatening adverse effects of medications or medical devices, is crucial for public and healthcare professional awareness. Comprehending and adhering to these warnings can prevent serious harm. This review aims to elucidate their significance. Data on drugs with black box warnings were collected from the Food and Drug Administration's (FDA's) official website using the search term 'Boxed warnings' from January 1, 2015, to January 31, 2024. A MicrosoftExcel spreadsheet (Microsoft Corporation, Redmond, WA, USA) containing black box warnings for this period was downloaded from the FDA's website. Additional parameters, such as drug class and whether the warnings were new or existing, were added to the downloaded spreadsheet. The collected data were organized by year, categorizing new and existing warnings, along with details on the evidence source, system-wise classification, and black box warnings for commonly used drugs, including their clinical significance. Results show that in the past decade, 40% of black box warnings were issued in 2023, followed by 12% in 2022. Most warnings (67%) comprised existing ones with minor revisionswhile 29% were new. Nine existing warnings were removed during the period. Post-marketing studies predominantly provided evidence for these warnings. Neuropsychiatric concerns like addiction potential (31%), suicidal tendency (7%), and hypersensitivity reactions (12%) were the frequently encountered black box warnings. Black box warnings play a crucial role in highlighting the serious adverse effects of medications. Neuropsychiatric warnings have been frequent over the past decade. Awareness of these warnings is essential to prevent adverse effects and enhance patient care, especially concerning drugs like guaifenesin/hydrocodone bitartrate, zolpidem, and montelukast commonly encountered in clinical practice.

Lacosamide and pregnancy: Data from spontaneous and solicited reports.

In pregnancy, it is important to balance the risks of uncontrolled epileptic seizures to the mother and fetus against the potential teratogenic effects of antiseizure medications. Data are limited on pregnancy outcomes among patients taking lacosamide (LCM), particularly when taken as monotherapy. The objective of this analysis was to evaluate the pregnancy outcomes of LCM-exposed pregnancies. This analysis included all reports in the UCB Pharma pharmacovigilance database of exposure to LCM during pregnancy from spontaneous sources (routine clinical settings) or solicited reports from interventional clinical studies and noninterventional postmarketing studies. Prospective and retrospective reports were analyzed separately. At the data cutoff (August 31, 2021), there were 202 prospective pregnancy cases with maternal exposure to LCM and known outcomes. Among these cases, 44 (21.8%) patients received LCM monotherapy and 158 (78.2%) received LCM polytherapy. Most patients received LCM during the first trimester (LCM monotherapy: 39 [88.6%]; LCM polytherapy: 143 [90.5%]). From the prospective pregnancy cases with maternal LCM exposure, there were 204 reported outcomes (two twin pregnancies occurred in the polytherapy group). The proportion of live births was 84.1% (37/44) in patients who received LCM as monotherapy, and 76.3% (122/160) for LCM polytherapy. The overall proportion of abortions (for any reason) was 15.9% (7/44) with LCM monotherapy, and 22.5% (36/160) with LCM polytherapy. Congenital malformations were reported in 2.3% (1/44) of known pregnancy outcomes with maternal exposure to LCM monotherapy, and 6.9% (11/160) with polytherapy. Our preliminary data do not raise major concerns on the use of LCM during pregnancy. Most pregnancies with LCM exposure resulted in healthy live births, and no new safety issues were identified. These findings should be interpreted with caution, as additional data are needed to fully evaluate the safety profile of LCM in pregnancy.

2033 ``Polyclinics'' - a concept of multiple clinic attendance. A pilot quantitative and qualitative review

Abstract Introduction The concept of “polypharmacy” is a well-recognised phenomenon, forming a keystone of any comprehensive geriatric assessment. We considered whether a similar concept could be applied to the number of outpatient clinics that patients may attend - a concept we have coined “polyclinic”. We recognise that older populations may have a greater number of comorbidities and, as a result, have more healthcare professionals inputting into their care. Similar to the potential detrimental effects of multiple medications, we were interested to explore if a similar detrimental effect may apply to patients attending multiple clinics. We also attempted to consider environmental and financial impacts. We approached this in both a quantitative and qualitative manner. Method A cohort was selected from all admissions to a subacute Geriatrics ward at University Hospital of Wales during the month of April 2023. National records were used to review the last decade of clinic attendances. For interviews every 4th patient was contacted Results 66 patients (75% female) were identified with 3 exclusions. The average number of clinics attended was 18.4 with 0.36 new diagnoses being made per clinic and 0.69 interventions per attendance. Geriatric clinic attendance yielded both a higher average number of diagnoses and interventions (0.93 and 1.4 respectively). Patient feedback was limited to 8 patients and 7 next of kin. Feedback regarding ‘worthwhileness’ was very positive with ratings &amp;gt;8/10. Feelings about possible cutting back on clinics or virtual clinic attendance were mixed with concerns regarding suitability and access to technology Conclusions We identified several limitations to this pilot project but overall feedback was positive. This study does not have the scope to suggest that attending multiple clinics are detrimental but aims to raise the concept of “polyclinic” that may be overlooked, particularly in a comorbid population and considers potential patient impact and concerns.

A comparative study of cognitive function in young patients with bipolar disorder with and without non-suicidal self-injury

ObjectiveBipolar disorder (BD) is a chronic mental disorder characterized by alternating or mixed episodes of mania or hypomania and depression. Cognitive function impairment is a frequent associated feature of the disease. While many BD patients also engage in non-suicidal self-injury (NSSI), there is a lack of studies on the cognitive function of BD patients with NSSI. This study aimed to evaluate cognitive functioning of BD patients with NSSI and provide a clinical basis for the differential diagnosis and treatment of BD and NSSI. MethodsA total of 60 BD patients with NSSI, 60 BD patients without NSSI, and 60 healthy controls (HC) were selected for the study. All participants met the inclusion criteria and were not taking any medications, excluding the potential effects of medication on cognitive functions. The following neurocognitive tests were used to measure the cognitive functions in areas such as speed of processing, reasoning and problem solving, attention/vigilance, working memory, visual learning, and verbal learning: The Trail Making Test (TMT), Category Fluency, Digit Symbol Coding Test (DSCT), Brief Visuospatial Memory Test-Revised (BVMT-R), The Neuropsychological Assessment Battery Mazes (NABM), Wechsler Memory Scale Third Edition Spatial Span Test (WMS III-SST), Hopkins Verbal Learning Test-Revised (HVLTR) and Continuous Performance Test and Identical Prs (CPT-IP). ResultsThe findings indicated that BD patients with NSSI exhibited cognitive impairment in all measured cognitive domains. On the other hand, BD patients without NSSI showed less pronounced impairment in terms of speed of processing, but exhibited significant cognitive impairment in the remaining five areas compared to the HC group. ConclusionThe study underscores the presence of cognitive impairment in BD, and the cognitive impairment is more severe in BD patients with NSSI compared to those without NSSI. In conclusion, both individuals with NSSI and those without NSSI in BD exhibit cognitive impairment, which provides ideas and strategies for using cognitive-behavioral therapy to treat BD and NSSI.

Recent Trends of AI in Pharmaceutical Industries: A Review

Artificial intelligence (AI) algorithms have been used to evaluate actual knowledge, reports on unfavourable occurrences, and publications to monitor post-marketing medication safety and detect possible safety concerns concerning security and respect to standards. AI has also been helpful in signal verification, adverse event prediction, and pharmacovigilance. AI is additionally implemented in streamlining pharmaceutical supply chains, guaranteeing effective distribution, management of inventory, and output. The possibilities of AI in PKPD studies are being recognized by pharmaceutical firms more and more. AI includes significant tools and techniques that help improve the processes involved in medication development and discovery. GNS Medical Care, AstraZeneca, Atom wise, Recursion Pharmaceuticals, and Insilico Medicines are a few instances. AI has been useful in the advancement of strategies for the rapid and perfect manufacture of dosage forms. AI possesses the possibility to completely overhaul the medical industry in the future by driving up the process of medication creation and discovery. With the use of virtual screening techniques, large chemical libraries will be effectively assessed to determine therapeutic candidates with the necessary lead compound identification time. By reviewing genomes, proteomes, and health data, AI-enabled precision nursing may be able to divide up patients, determine the results of treatment, and personalize medications. Using generative models and deep learning, scientists can produce novel molecules with targetbinding properties that increase drug efficacy and decrease side effects. AI will also enable dosage formulations tailored to individual patients. AI algorithms will improve drug formulations as well as delivery systems for improving health service outcomes by accounting for factors unique to each patient, such as size, age, heritage, and medical condition disease. Security evaluations he transform as a result of AI algorithms' ability to predict the toxicity and potential negative effects of medications.

Effects of medication on dopamine transporter imaging using [123I]I-FP-CIT SPECT in routine practice.

Dopamine transporter (DAT) imaging is used to support the diagnosis of neurodegenerative parkinsonian disorders. Specific medications have been reported to confound the interpretation of[123I]I-FP-CIT SPECT scans, but there is limited data. The aim of the current study is to identify potential medication effects on the interpretation of[123I]I-FP-CIT SPECT scans in routine practice. Consecutive patients undergoing a[123I]I-FP-CIT SPECT/CT scan on a 360° CZT camera between September 2019 and December 2022 were included. An exhaustive review of patient medications (antidepressants, antipsychotics, anti-epileptics, anti-parkinsonians, benzodiazepines, lithium, opioids, and stimulants) was performed. Two experienced nuclear physicians, blinded to the medication reports, interpreted the[123I]I-FP-CIT SPECT scans visually and a semi-quantitative analysis was performed using a local normal database. The study included 305 patients (71.0 ± 10.4, 135 women) and 145 (47.5%) visually interpreted normal scans. In normal scans, the striatum/occiput radioligand uptake ratio was decreased by noradrenergic and specific serotonergic antidepressants (NASSAs) (n = 15, z-score of - 0.93) and opioid medication (tramadol, n = 6, z-score of - 0.85) and was associated with a younger age in the multivariate analysis. In the overall population, the striatum/occiput ratio was influenced by NASSAs and associated with consensual visual analysis, age, sex, and anti-parkinsonian medications related to the status of the disease. Our study confirms the potential impact of antidepressant (NASSA) and opioid (tramadol) medications on the semi-quantitative analysis of[123I]I-FP-CIT SPECT scans. However, when performing a visual analysis, only NASSAs significantly impacted the interpretation of[123I]I-FP-CIT SPECT scans.

A Scoping Review on Interventions for Chronic Pelvic Pain

Chronic pelvic pain (CPP) is a complex and debilitating condition affecting a significant portion of the global population, predominantly women. This review dwells on various interventions to alleviate the burden of CPP and improve patients’ quality of life. Traditional approaches have included patient education, pharmacotherapy, physical therapy, and cognitive behavioral therapy. However, the limited efficacy and potential side effects of long-term medications necessitate a multidisciplinary approach. The review lists a comprehensive tabulation of results from systematic reviews and meta-analyses on CPP interventions published in the past 5 years.

A preliminary study of the effects of stimulant medications on estimates of psycholinguistic abilities for children with attention-deficit/hyperactivity disorder

ABSTRACT Underlying deficits in inattention, hyperactivity, and/or impulsivity might contribute to suboptimal test-taking behaviours during language assessments that can lead to diagnostic errors. Considerations of potential medication effects on estimates of children’s nonword repetition, sentence recall, tense-marking, and narrative abilities are warranted given long-standing enthusiasm for these indices to serve as clinical markers for developmental language disorder (DLD). A battery consisting of 1 nonverbal, 1 reading, and 6 verbal measures was administered twice to 26 children (6–9 years) with independently diagnosed combined-type attention-deficit/hyperactivity disorder (ADHD). All participants had been prescribed stimulant medications for the management of their ADHD symptoms and were assessed off- and on-medication, with order counter-balanced across participants. Half of the participants had concomitant DLD. Examiners were unaware of children’s clinical status during assessments or when they were testing children who had received medication. Effect sizes were calculated for each measure. Significant score differences indicating a beneficial impact of stimulant medications on children’s performances were observed on the recalling sentences subtest of the Clinical Evaluation of Language Fundamentals and the Picture Peabody Vocabulary Test. Adjustments may be needed when speech language pathologists use sentence recall or receptive vocabulary measures to make diagnostic decisions with children who have ADHD.

Assessment of the Chemical Profile and Potential Medical Effects of a Flavonoid-Rich Extract of Eclipta prostrata L. Collected in the Central Highlands of Vietnam.

Eclipta prostrata L. (EPL), a medicinal plant, is widely utilized in the central highlands of Vietnam. This study aims to assess the chemical profile and potential medical effects of an EPL extract rich in flavonoids. A total of 36 secondary metabolites were identified from the EPL extract through GC-MS and UHPLC-UV analysis. Among them, 15 volatile compounds and several phenolic and flavonoid chemicals, including salicylic acid, epicatechin gallate, isovitexin, and apigetrin, were reported in EPL extract for the first time. This herbal extract demonstrated moderate inhibition against α-amylase and α-glucosidase, and high anti-oxidant and anti-acetylcholinesterase activities (IC50 = 76.8 ± 0.8 μg/mL). These promising attributes can be likely attributed to the high levels of major compounds, including wedelolactone (1), chlorogenic acid (3), epicatechin gallate (6), salicylic acid (8), isovitexin (9), apigetrin (11), and myricetin (12). These findings align with the traditional use of EPL for enhancing memory and cognitive function, as well as its potential benefits in diabetes management. The results of the molecular docking study reveal that the major identified compounds (1, 6, 9, and 11) showed a more effective acetylcholinesterase inhibitory effect than berberine chloride, with good binding energy (DS values, -12.3 to -14.3 kcal/mol) and acceptable values of RMSD (1.02-1.67 Å). Additionally, almost all the identified major compounds exhibited good ADMET properties within the required limits.

A Laboratory Medicine Perspective on the Investigation of Phaeochromocytoma and Paraganglioma.

Phaeochromocytomas (PC) and sympathetic paragangliomas (PGL) are potentially malignant tumours arising from the adrenal medulla (PC) or elsewhere in the sympathetic nervous system (PGL). These tumours usually secrete catecholamines and are associated with significant morbidity and mortality, so accurate and timely diagnosis is essential. The initial diagnosis of phaeochromocytoma/paraganglioma (PPGL) is often dependent on biochemical testing. There is a range of pre-analytical, analytical and post-analytical factors influencing the analytical and diagnostic performance of biochemical tests for PPGL. Pre-analytical factors include patient preparation, sample handling and choice of test. Analytical factors include choice of methodology and the potential for analytical interference from medications and other compounds. Important factors in the post-analytical phase include provision of appropriate reference ranges, an understanding of the potential effects of various medications on metanephrine concentrations in urine and plasma and a consideration of PPGL prevalence in the patient population being tested. This article reviews these pre-analytical, analytical and post-analytical factors that must be understood in order to provide effective laboratory services for biochemical testing in the diagnosis of PPGL.

Fetoplacental vascular effects of maternal adrenergic antihypertensive and cardioprotective medications in pregnancy.

Maternal cardiovascular diseases, including hypertension and cardiac conditions, are associated with poor fetal outcomes. A range of adrenergic antihypertensive and cardioprotective medications are often prescribed to pregnant women to reduce major maternal complications during pregnancy. Although these treatments are not considered teratogenic, they may have detrimental effects on fetal growth and development, as they cross the fetoplacental barrier, and may contribute to placental vascular dysregulation. Medication risk assessment sheets do not include specific advice to clinicians and women regarding the safety of these therapies for use in pregnancy and the potential off-target effects of adrenergic medications on fetal growth have not been rigorously conducted. Little is known of their effects on the fetoplacental vasculature. There is also a dearth of knowledge on adrenergic receptor activation and signalling within the endothelium and vascular smooth muscle cells of the human placenta, a vital organ in the maintenance of adequate blood flow to satisfy fetal growth and development. The fetoplacental circulation, absent of sympathetic innervation, and unique in its reliance on endocrine, paracrine and autocrine influence in the regulation of vascular tone, appears vulnerable to dysregulation by adrenergic antihypertensive and cardioprotective medications compared with the adult peripheral circulation. This semi-systematic review focuses on fetoplacental vascular expression of adrenergic receptors, associated cell signalling mechanisms and predictive consequences of receptor activation/deactivation by antihypertensive and cardioprotective medications.

Abstract 091: Efficacy Of A Patient-engagement Platform In Reducing Uncontrolled Hypertension In Community Health Clinics

Introduction: Hypertension affects 47% of US adults and can lead to serious sequelae such as myocardial infarction and stroke when uncontrolled. Over 37 million US adults have blood pressure (BP) higher than 140/90 mmHg. Medication to treat hypertension is effective, yet, approximately 50% of patients do not take medication as prescribed and non-adherence to cardioprotective medications increases a patient’s risk of death from 50% to 80%. Objective: To use a novel patient engagement platform to assist federally qualified health centers (FQHCs) in improving BP control. Methods: We enrolled patients treated at FQHCs in a digital hypertension management program. Patients were prompted to submit their BP and responses to questions about medication adherence and potential side effects of medication either daily or weekly in English or Spanish. The responses were prioritized by level of concern. The clinic reviewed these data, in real-time and provided coaching or treatment changes. We analyzed first and last systolic and diastolic BPs of patients who participated for ≥90 days (range 90-721 days) and considered BP &lt;140/90 mmHg to be controlled. Results: The cohort included 2500 patients, 38.6% male, with a mean age of 53.9 years (range 14-100 years) from 43 FQHCs across the US. Of these patients, 30.7% (768 of 2500) had an initial controlled BP and 61.2% (1529 of 2500) demonstrated a final controlled BP measurement. In patients with an initial uncontrolled BP, 55.4% (959 of 1732) had a controlled final BP. The Spanish language version was used by 551 patients, and in this subgroup, 35.2% (194 of 551) and 70.4% (388 of 551) had controlled BPs on initial and final measurements, respectively, with 66.0% (235 of 356) of initially uncontrolled patients having a controlled final BP. Conclusion: This novel hypertension control program, which used technology to gather and prioritize data, facilitating the clinic’s efficient response, improved BP control rates by over 30% in a real-world, underserved population. BP control was higher in the Spanish-speaking population. Remote digital monitoring with intervention improves clinical outcomes without increasing the overall cost of care, thereby promoting value-based care strategies for chronic diseases such as hypertension.

Antisaccade and memory-guided saccade in individuals at ultra-high-risk for bipolar disorder

BackgroundUltra-high-risk for bipolar disorder (UHR-BD) is an important paradigm to investigate the potential early-stage biomarkers of bipolar disorder, including eye-tracking abnormalities and cognitive functions. Antisaccade (AS) described as looking in the opposite direction of the target, and memory-guided saccade (MGS), identified as maintaining fixation, and remembering the location of the target, were used in this study. The aim of this study was to evaluate the differences in saccadic eye movements between UHR-BD and healthy controls (HCs) via AS-MGS. MethodsThe study included 28 UHR-BD and 29 HCs. Participants were selected using a structured clinical interview for prodromal symptoms of BD. AS-MGS were measured with parameters like uncorrected errors, anticipatory saccades, and latency. Eye movements were recorded with the EyeLink 1000-Plus eye-tracker. ResultsIn the AS, the number of correct saccades was significantly decreased in UHR-BD (p = 0.020). Anticipatory (p = 0.009) and express saccades (p = 0.040) were increased in UHR-BD. In the MGS paradigm, the correct saccades were reduced in UHR-BD (p = 0.031). In addition, anticipatory (p = 0.004) and express saccades (p = 0.012) were significantly increased in cue-screen in UHR-BD. ConclusionsTo our knowledge, this is the first study to evaluate cognitive functions with eye movements in individuals at UHR-BD. The current findings showed that eye movement functions, particularly in saccadic parameters related to inhibition and spatial perception, may be affected in the UHR-BD group. Therefore, assessment of oculomotor functions may provide observation of clinical and cognitive functions in the early-stage of bipolar disorder. However, further research is needed because the potential effects of medication may affect saccadic results.