Drug Prevention Research Articles

Monitoring of adverse drug reactions during seasonal malaria chemoprevention campaigns in children aged 3–59 months in Burkina Faso

Seasonal malaria chemoprevention (SMC) by mass administration of sulfadoxine pyrimethamine + amodiaquine (SPAQ) reduces the burden of malaria in children aged 3-59 months. The occurrence of adverse drug reaction (ADR) may affect the success of this intervention. There are few studies of SMC adverse event surveillance in sub-Saharan Africa, particularly in Burkina Faso, a highly endemic country. Our main objective was to characterize the ADRs reported during SMC campaigns in Burkina Faso. Secondly, we evaluated the performance of the pharmacovigilance integrated into the SMC program in order to support safe administration of SMC. This was a retrospective descriptive study of SMC individual case safety reports recorded in VigiBase® in Burkina Faso from 2014 to 2021. We used the P-method for the analysis of preventable serious adverse drug reactions and WHO criteria for assessing the performance of pharmacovigilance integrated into the SMC program. A total of 1,105 SMC individual case safety reports were registered in VigiBase® for 23,311,453 doses of SPAQ given between 2014 and 2021. No pharmacovigilance signal was detected. The number of serious cases was 101, of which 23 (22.8%) were preventable. In 38.1% of children, the occurrence of ADRs led to discontinuation of SMC treatment. Vomiting was the most frequently reported adverse drug reaction (48.0%). The proportion of children whose treatment was discontinued due to vomiting was 42.7%, while the proportion of treatment discontinuation for other ADRs was 32.8% (p = 0.01). The SMC program contributed at 46.2% to the national pharmacovigilance database. The reporting rate was 0.03 per 1,000 exposed children in 2021. The median completeness score of the ICSRs was 0.7 (IQR: 0.5-0.7), and the median time to register the ICSRs in VigiBase® was 204 (IQR: 143-333) days. Post-drug administration vomiting may interfere with the purpose of SMC. Measures to manage this adverse drug reaction should be taken to improve the success of the SMC program. Based on the information on reporting time and reporting rate, spontaneous reporting should be supported by active surveillance, including cohort event monitoring, in Burkina Faso.

Atorvastatin exerts dual effects of lesion regression and ovarian protection in the prevention and treatment of endometriosis

Endometriosis is a frequent, chronic, estrogen-dependent and inflammatory gynecological disease leading to pain and infertility. Clinical and metabolic studies reveal that patients with endometriosis are susceptible to hyperlipemia and lipid dysfunction, putting them at ascending risk of cardiovascular diseases. Statins constitute a group of cholesterol-lowering drugs with pleiotropic effects. A plethora of researches have proved their ability to inhibit the growth of ectopic lesions in endometriosis. However, concerns exist about their possible adverse effects on ovarian function. This study aimed to investigate the possible effect of atorvastatin on the ovarian endocrine function and fertility capacity in the prevention and treatment of endometriosis. Here, 5 mg/kg atorvastatin was intraperitoneally injected to the endometriosis mice once a day for consecutive fourteen days during and after the development of endometriotic implants. The results indicated that atorvastatin not only led to regression of the ectopic lesions, but also caused no discernible harm to the ovary for both the preventive and the therapeutic models. In addition, it elicited a protective effect on the ovarian reserve and fertility possibly by reducing inflammation in the ovary. Hence, atorvastatin could be a promising drug for endometriosis prevention and treatment.

Minocycline mitigates tau pathology via modulating the TLR-4/NF-кβ signalling pathway in the hippocampus of neuroinflammation rat model

ABSTRACT Introduction The neuroinflammatory response was seen to impact the formation of phosphorylated tau protein in Alzheimer’s disease (AD). This study aims to investigate the molecular mechanism of minocycline in reducing phosphorylated tau protein formation in the hippocampus of lipopolysaccharide (LPS)-induced rats. Methods Fifty adult male Sprague Dawley (SD) rats were randomly allocated to 1 of 5 groups: control, LPS (5 mg/kg), LPS + minocycline (25 mg/kg), LPS + minocycline (50 mg/kg) and LPS + memantine (10 mg/kg). Minocycline and memantine were administered intraperitoneally (i.p) for two weeks, and LPS was injected i.p. once on day 5. ELISA was used to determine the level of phosphorylated tau protein in SD rats’ hippocampal tissue. The density and expression of Toll-like receptor-4 (TLR-4), nuclear factor kappa-light-chain-enhancer of activated B cells (NF-кβ), tumour necrosis factor-alpha (TNF-α), and cyclooxygenase (COX)-2 were determined using Western blot and immunohistochemistry. Results Minocycline, like memantine, prevented LPS-induced increasein phosphorylated tau protein level suggested via reduced density and expression of TLR-4, NF-кβ, TNF-αand COX-2 proteins in rat hippocampal tissue. Interestingly, higher doses were shown to be more neuroprotective than lower doses. Conclusion This study suggests that minocycline suppresses the neuroinflammation signalling pathway and decreased phosphorylated tau protein formation induced by LPS in a dose-dependent manner. Minocycline can be used as a preventative and therapeutic drug for neuroinflammatory diseases such as AD.

Effectiveness of buffered acetylsalicylic acid compared to other drugs in diseases patients in clinical practice: results of the CARDINAL observational retrospective study

Aim. To evaluate the effectiveness of acetylsalicylic acid (ASA) drugs for secondary prevention of atherosclerotic cardiovascular disease (ASCVD) in clinical practice and compare the effectiveness of the Cardiomagnyl with other ASA drugs.Material and methods. This observational, non-interventional, retrospective study included data from electronic medical records of 18199 patients with ASCVD who were divided into 2 following groups: patients who received ASA 75-100 mg (n=9784) and patients who did not receive ASA (n=8325). The prescription rate of ASA, the choice of the first drug, the duration of ASA therapy, the frequency of switching ASA during treatment, and the choice of the second ASA drug when changing therapy were assessed. Due to the heterogeneity of patients in the above groups, to assess the clinical outcomes, propensity score matching was performed and comparable groups were selected to evaluate the effectiveness of ASA drugs 75-100 mg in patients with ASCVD (n= 427) in comparison with patients not receiving ASA (n=427) and to assess the effectiveness of Cardiomagnyl 75 mg (n=1308) in comparison with enterosoluble ASA 100 mg (CRA) (n=1308) taking into account 24 parameters.Results. The average proportion of patients with ASCVD taking ASA drugs was 58%. During treatment, 54% of patients underwent a change in drug therapy from one ASA drug to another. The prescription rate of Cardiomagnyl as a first-choice drug was 33%, and as a second drug when changing therapy — 21%. The duration of Cardiomagnyl therapy was the longest compared to other ASA drugs and amounted to 16,3 months. The incidence of ischemic stroke, myocardial infarction and major adverse cardiovascular events in the group of patients who received ACS 75-100 mg was significantly lower than in patients who did not take ASA drugs and amounted to 4,7% vs 8,7%, 0,9% vs 3,3%, 5,6% vs 11,9%, respectively. Significantly lower incidence of unstable angina (0,8% vs 2,0%), myocardial infarction (1,5% vs 3,9%) and major adverse cardiovascular events (5,4% vs 7,8%) in group of patients who received Cardiomagnyl 75 mg as opposed to enterosoluble ASA.Conclusion. Significant advantages of buffered ASA (Cardiomagnyl) were revealed in comparison with enterosoluble ASA in clinical practice.

Bioinformatics analyses of infiltrating immune cell participation on pancreatic ductal adenocarcinoma progression and in vivo experiment of the therapeutic effect of Shuangshen granules

Ethnopharmacological relevanceShuangshen granules (SSG), a nationally patented Chinese medicinal formula, including Panax quinquefolium L., Panax notoginseng (Burkill) F. H. Chen, and Cordyceps sinensis (Berk.) Sacc., has demonstrated remarkable therapeutic effects on pancreatic cancer in clinical treatment for nearly 10 years. Previous pharmacological researches have found that its main components, including ginsenosides and cordycepin have anticancer or preventive effects on pancreatic ductal adenocarcinoma (PDAC), which may be associated with immune metabolism. However, the underlying pharmacological mechanism of SSG in the truncation effect of PDAC progression is still unclear. Aim of the studyTo comprehensively understand the infiltrating immune cells during the different stages of the PDAC development chain and search for immune-related biomarkers that could potentially serve as drug targets through bioinformatic analysis. Meanwhile, the truncation effect of SSG on PDAC progression was also investigated. Materials and methodsThe gene expression profiles at different PDAC developmental stages, including normal pancreas, pancreatic intraepithelial neoplasia (PanIN), and PDAC, were retrieved from the GEO database. The GEO2R tool was used to identify differentially expressed genes among the three groups. Functional enrichment analysis was performed with the GSEA software and Metascape platform. The CIBERSORT algorithm evaluated immune cell infiltration in the three groups, and immune-related biomarkers were identified. Correlation analysis was employed to examine the association between immune cells and the biomarkers. One of these biomarkers was selected for immunohistochemistry validation in human samples. Lastly, the effectiveness of SSG against PDAC progression and the influence on the selected biomarker were validated in vivo. The underlying pharmacological mechanisms were also explored. ResultsOne dataset was obtained, where the functional enrichment of DEGs primarily involved immune effector processes and cytokine production of immune cells. The differential immune cells reflected during the progression from PanIN to PDAC were B memory cells, monocytes, M2 macrophages, and activated dendritic cells. The upregulation of ACTA2 was closely associated with M2 macrophage regulation. The immunohistochemistry on human samples validated significant differences in ACTA2 expression levels as the PDAC progressed. Moreover, animal experiments revealed that the national patented drug SSG ameliorated the pathological changes, decreased the expression of ACTA2 and its functional protein α-smooth muscle actin during PDAC progression. The underlying pharmacological mechanism was related to the regulation of macrophage polarization and downregulation of TGF-β/Smad signaling pathway. ConclusionsThe immunosuppressive environment changes during the PDAC progression. ACTA2 is a potential immuned-target for drug prevention of PDAC, while SSG could be a promising drug candidate.

Prevention better than cure: expanding on pharmacists’ role in prescription opioid overdose and addiction management

As prescription opioid misuse and abuse increases in prevalence, pharmacists continue to be in frontlines of prevention and therapeutic management. Pharmacists as public health practitioners should be aware of new and relevant paradigms of substance abuse research and prevention and how they can further contribute to mitigation of opioid and other substance use disorders (SUDs). Screening, brief intervention, and referral to treatment (SBIRT) is a prevention tool that has been used to identify, reduce and misuse, abuse, and dependence on substances, including drugs and alcohol. The screening and brief intervention aspects of SBIRT have been shown to be adaptable across multiple health-care settings. Techniques to conduct applicable stages of SBIRT can be learned and used by pharmacists across multiple practice areas as they engage with the public. SBIRT can be used in conjunction or as a supplementary tool to other prevention and management strategies such as the use of prescription drug monitoring programs and naloxone prescription and distribution. We make a case that pharmacists, particularly those in the community setting, who act as the entry points for many patient engagement encounters, can incorporate SBIRT into their counseling and medication therapy management workflows. As pharmacists continue the move toward codifying provider status, their expertise along with expansion of services, such as the application of SBIRT called for in this article, should be continually leveraged to increase access to treatment and services for at-risk patients with SUDs.

Sosialisai Produk Hukum Undang-Undang Nomor 35 Tahun 2009 tentang Narkotika dan P4GN (Pencegahan, Pemberantasan, Penyalahgunaan dan Peredaran Gelap Narkoba) Dewan Pengurus Cabang Pengajian Ahad Wage Perempuan Bangsa Kota Kediri

Socialization of legal products in the form of Law No. 35 of 2009 on narcotics and socialization of P4GN (Prevention, eradication, abuse and illicit drug trafficking). This activity is a form of community service as an effort to know and understand the consequences of punishment for drug addicts, abuse and illicit drug trafficking contained in Law No. 35 of 2009 on narcotics. In order to prevent the eradication, abuse and illicit circulation of drugs that can harm, endanger the joint life of society, nation, and state. It requires knowledge, understanding related to the dangers of drugs. The form of this activity is the socialization of legal products in the form of socialization of Law No. 35 of 2009 on narcotics and socialization of P4GN (Prevention, eradication, abuse and illicit drug trafficking). This form of service activity provides an understanding to the community, about narcotics, narcotics precursors, production, import, export, illicit circulation of narcotics and Narcotics precursors, import and export approval letters, transportation, pharmaceutical wholesalers, narcotics transito, narcotics addicts, narcotics dependence, abusers, medical rehabilitation, social rehabilitation, conspiracy, wiretapping, organized crime, corporations and ministers. Participants of the socialization were mothers from the National Women's Branch Board of Kediri City. The purpose of this community service is to convey and provide understanding to mothers regarding the law on narcotics. Ensure narcotics security for the needs of health services and/or the development of Science and Technology, prevent, protect and save the Indonesian nation from narcotics abuse, eradicate illicit trafficking of narcotics and narcotics precursors. So Ibu2 as the first and main madrasah able to prevent early on the dangers of drugs for his family and the community around him. So that the realization of families and communities that Shine is clean from drugs.

Demographic Insights into Migraine Prevalence and a Cost-Effective Analysis of Various Prophylactic Medications

Headache, a common human experience, has been classified since antiquity. Migraine, a prevalent disabling primary headache condition, has significant personal and societal consequences. Understanding its demography is critical for creating effective prevention and treatment methods. An observational study of 387 persons with chronic migraine was conducted over a six-month period. They were divided into three groups and given a separate prophylactic drug. Demographic information was collected at the outset, and patients were assessed at 4, 8, and 12 weeks. The study population had an average age of 38.20 ±12.78 years, with 90% of the participants being female. Migraine was most common in those under 30 (37%), followed by those between 31 and 40 (28%). The most common co-morbidity (43.5%) was anxiety. Propranolol alone was the most cost-effective preventative medication, followed by propranolol plus escitalopram. This study sheds light on the intricate relationship between migraine and demographic characteristics, underlining the significance of individualized care. Because females are more vulnerable, age-specific therapies are critical, as are gender-sensitive approaches. The potential benefits of preventative drugs in decreasing both personal and society burdens are highlighted by socioeconomic factors and cost-effectiveness analyses. To optimize outcomes and cost allocation, this study advocates for a patient-centered, comprehensive approach to migraine care. Keywords Migraine, Prevalence, Prophylactic Medications, Demographics, Cost­effectiveness Analysis

Analisis Metode Pendidikan Kesehatan Berbasis Online dalam Peningkatan Pengetahuan dan Sikap Pencegahan Narkoba pada Anak Usia Remaja

The results of a survey by the National Narcotics Agency (BNN) in 2018 stated that the prevalence of drug abuse in students reached 4.7 percent of the total number of students in Indonesia or around 921,695 people. This requires serious attention from health practitioners and education to make prevention efforts. The programs that are being promoted include, among others, effective online health education, through cellphones, whatsapp groups and other online facilities. The purpose of the study was to analyze the effect of online-based health education on the level of knowledge and attitudes of adolescents in drug prevention. This study is a quantitative study with a quasi-experimental design using a pre-posttest design without a control group. The research sample was 30 respondents from SMPN 2 Sumberlawang, which was held in July-September 2020. Data collection was by giving a questionnaire via an online g-form. The data were tested using the Wilcoxon test. Results: there was a significant effect (p-value = 0.000 < 0.005) of providing health education interventions through whatsapp groups using voice notes and videos about drug prevention on the level of knowledge and attitudes of SMPN 2 Sumberlawang students.

Antiepileptic therapy algorithms in patients with primary and metastatic brain tumors

Up to date the brain tumors incidence keeps growing worldwide. Epilepsy and epileptic seizures are one of the most common clinical features of brain tumors. The aim of the study was to invent the algorithms antiepileptic treatment of patients with primary and metastatic brain tumors based on literature data. We searched eLIBRARY, PubMed databases by keywords. We concluded, that preventive antiepileptic drugs administration in patients with primary or metastatic brain lesions does not lower the risk of acute symptomatic postoperative seizures or epilepsy incidence, and therefore should not be recommended. Experts’ opinion states that in patients with brain tumors even one unprovoked seizure makes it feasible to initiate antiepileptic drugs therapy as soon as possible. In case of two or more unprovoked episodes (with over 24 hours difference) the diagnosis of “epilepsy” is legitimate and antiepileptic therapy should be started. The treating physician’s choice of antiepileptic therapy is based on type of seizures, age and sex of the patient, the comorbidity and potential antiepileptic drugs pharmacokinetic interactions with other drugs (including chemotherapy), in particular, one should avoid the use of liver microsomal-inducing antiepileptic drugs. The presented algorithms provide the decision-making guidelines in case of intraoperative focal seizures, acute symptomatic seizures and status epilepticus occurrence in early postoperative period.

UnDerstandIng the cauSes of mediCation errOrs and adVerse drug evEnts for patients with mental illness in community caRe (DISCOVER): a qualitative study.

It is estimated that 237 million medication errors occur in England each year with a significant number occurring in the community. Our understanding of the causes of preventable medication errors and adverse drug events (ADE) affecting patients with mental illness is limited in this setting. Better understanding of the factors that contribute to errors can support the development of theory-driven improvement interventions. Remote qualitative semi-structured interviews with 26 community-based healthcare professionals in England and Wales were undertaken between June-November 2022. Recruitment was undertaken using purposive sampling via professional networks. Interviews were guided by the critical incident technique and analysed using the framework method. Any data that involved speculation was not included in the analysis. Independent analysis was carried out by the research team to extract themes guided by the London Protocol. A total of 43 medication errors and 12 preventable ADEs were discussed, with two ADEs having an unknown error origin. Prescribing errors were discussed most commonly (n = 24), followed by monitoring errors (n = 8). Six contributory factor themes were identified: the individual (staff); the work environment; the teams/interfaces; the organisation and management; the patient; and the task and technology. The individual (staff) factors were involved in just over 80% of all errors discussed. Participants reported a lack of knowledge regarding psychotropic medication and mental illnesses which accompanied diffusion of responsibility. There were difficulties with team communication, particularly across care interfaces, such as ambiguity/brevity of information being communicated and uncertainty concerning roles which created confusion amongst staff. Unique patient social/behavioural contributory factors were identified such as presenting with challenging behaviour and complex lifestyles, which caused difficulties attending appointments as well as affecting overall clinical management. These findings highlight that the causes of errors are multifactorial with some unique to this patient group. Key areas to target for improvement include the education/training of healthcare professionals regarding neuropharmacology/mental illnesses and enhancing communication across care interfaces. Future research should explore patient perspectives regarding this topic to help develop a holistic picture. These findings can be used to guide future intervention research to ameliorate medication safety challenges for this patient group.

GW1929 (an agonist of PPARγ) inhibits excessive production of reactive oxygen species in cisplatin-stimulated renal tubular epithelial cells, hampers cell apoptosis, and ameliorates renal injury

ABSTRACT Cisplatin-induced nephrotoxicity has long been explored for development of preventative and therapeutic drugs. The current investigation focused on the renal protective effect of GW1929, an agonist for peroxisome proliferator-activated receptors gamma (PPARγ), on cisplatin-induced kidney injury. HK2 cells treated with 20 μM cisplatin and C57BL/6 mice injected with 20 mg/kg cisplatin were used as the cell model and animal model for acute kidney injury. HK2 cell viability after cisplatin or GW1929 (0–80 μM) treatment was tested using methyl thiazolyl tetrazolium assays. Flow cytometry analysis and TUNEL assays were used to measure cell apoptosis. Intracellular reactive oxygen species (ROS) level was measured through fluorescence intensities. Levels of blood urea nitrogen (BUN) and serum creatinine (SCr) were measured to evaluate the renal function of mice. For renal morphology observation and cell apoptosis assessment in vivo, hematoxylin-eosin staining and TUNEL assays were conducted. The concentrations of oxidative stress markers in renal samples were measured using colorimetric tests. It was found that GW1929 dose-dependently enhanced protein levels of PPARγ, PGC-1α and TFEB in HK2 cells. Meanwhile, intracellular ROS overproduction, the decrease in cell viability and excessive cell apoptosis mediated by cisplatin were reversed by GW1929. For in vivo experiments, GW1929 notably attenuated cisplatin-stimulated nephrotoxicity and oxidative stress while reducing BUN and Scr levels in cisplatin-challenged model mice. Moreover, GW1929 significantly dampened renal cell apoptosis in vivo. GW1929 mitigates renal tubular epithelial cell injury and renal damage by inhibiting oxidative stress and renal cell apoptosis.

Clinical effectiveness of pharmacological interventions for managing chronic migraine in adults: a systematic review and network meta-analysis

BackgroundChronic migraine can be a profoundly disabling disorder that may be treated with preventive medications. However, uncertainty remains as to which preventive medication is the most effective. We present a network meta-analysis to determine the effectiveness and rank of preventive drugs for chronic migraine in adults.MethodsWe identified, reviewed, and extracted data from randomised controlled trials (RCTs) of preventive drugs for chronic migraine with at least 200 participants. Data were analysed using network meta-analysis.FindingsWe included 12 RCTs of six medications (Eptinezumab, Erenumab, Fremanezumab, Galcanezumab, Onabotulinumtoxin A, and Topiramate) compared to placebo or each other. All drugs effectively reduced monthly headache and migraine days compared with placebo. The most effective drug for monthly headache days was Eptinezumab 300mg, with a mean difference of -2.46 days, 95% Credible Interval (CrI): -3.23 to -1.69. On the Surface Under the Cumulative Ranking Area (SUCRA) analysis, the probability that Eptinezumab 300mg was ranked highest was 0.82. For monthly migraine days, the most effective medication was Fremanezumab-monthly, with a mean difference: -2.77 days, 95% CrI: -3.36 to -2.17, and 0.98 probability of being ranked the highest. All included drugs, except Topiramate, improved headache-related quality of life. No eligible studies were identified for the other common preventive oral medications such as Amitriptyline, Candesartan, and Propranolol. The main reasons were that the studies did not define chronic migraine, were undertaken before the definition of chronic migraine, or were too small.InterpretationAll six medications were more effective than the placebo on monthly headache and migraine days. The absolute differences in the number of headache/migraine days are, at best, modest. No evidence was found to determine the relative effectiveness of the six included drugs with other oral preventive medications.RegistrationPROSPERO (number CRD42021265990).

Competing treatments for migraine: a headache for decision-makers

BackgroundMigraine is the world’s second most common disabling disorder, affecting 15% of UK adults and costing the UK over £1.5 billion per year. Several costly new drugs have been approved by National Institute for Health and Care Excellence.AimTo assess the cost-effectiveness of drugs used to treat adults with chronic migraine.MethodsWe did a systematic review of placebo-controlled trials of preventive drugs for chronic migraine. We then assessed the cost-effectiveness of the currently prescribable drugs included in the review: Onabotulinum toxin A (BTA), Eptinezumab (100mg or 300mg), Fremanezumab (monthly or quarterly dose), Galcanezumab or Topiramate, each compared to placebo, and we evaluated them jointly. We developed a Markov (state-transition) model with a three-month cycle length to estimate the costs and quality-adjusted life years (QALYs) for the different medications from a UK NHS and Personal Social Services perspective. We used a two-year time horizon with a starting age of 30 years for the patient cohort. We estimated transition probabilities based on monthly headache days using a network meta-analysis (NMA) developed by us, and from published literature. We obtained costs from published sources and applied discount rates of 3.5% to both costs and outcomes.ResultsDeterministic results suggest Topiramate was the least costly option and generated slightly more QALYs than the placebo, whereas Eptinezumab 300mg was the more costly option and generated the most QALYs. After excluding dominated options, the incremental cost-effectiveness ratio (ICER) between BTA and Topiramate was £68,000 per QALY gained and the ICER between Eptinezumab 300mg and BTA was not within plausible cost-effectiveness thresholds. The cost-effectiveness acceptability frontier showed that Topiramate is the most cost-effective medication for any amount the decision maker is willing-to-pay per QALY.ConclusionsAmong the various prophylactic medications for managing chronic migraine, only Topiramate was within typical cost-effectiveness threshold ranges. Further research is needed, ideally an economic evaluation alongside a randomised trial, to compare these newer, expensive CGRP MAbs with the cheaper oral medications.

Harmine ameliorates steroid-induced osteonecrosis of the femoral head by modulating metabolism and ferroptosis via HIF1-α

Steroid-induced osteonecrosis of the femoral head (SONFH) often leads to disability in the terminal stage, and there are still no effective drugs for prevention. Harmine (Hm), which is extracted from Peganum harmala L., is a β-carboline alkaloid with a number of biological and pharmacological properties. In this study, we discovered the protective effect of Hm on SONFH in rats. In vitro studies showed that Hm could ameliorate oxidative stress and facilitate osteogenic differentiation in bone mesenchymal stem cells (BMSCs), which play an important role in bone development and repair. Bioinformatics analysis revealed that ferroptosis and the HIF1-α pathway played an important role in SONFH pathogenesis. Mechanistically, Hm treatment alleviated ferroptosis by promoting HIF1-α expression in BMSCs. When shHif1a was used to inhibit HIF1-α expression, the protective effects of Hm disappeared. Meanwhile, we further found that Hm intervention promoted HIF1-α expression to increase GSH production and the GSH/GSSG ratio, which further promoted the scavenging of free radicals. In summary, Hm may be a promising candidate for the treatment of SONFH.

Prescription patterns of antidiabetic and cardiovascular preventive medications in community-dwelling older adults with type 2 diabetes mellitus: a cross-sectional study.

To describe trends in antidiabetics drug prescription patterns in community-dwelling older adults with type 2 diabetes mellitus (T2DM) and to evaluate the use of cardiovascular preventive medications among those diagnosed with atherosclerotic cardiovascular disease (ASCVD). This cross-sectional, face-to-face interview study that comprised community-dwelling older adults (≥ 65 years) diagnosed with T2DM. The study questionnaire included the patients' demographics, clinical data, and current medication use. Patients with established ASCVD were further classified into low (i.e., not receiving evidence-based therapy or only one) and high (i.e., receiving at least two evidence-based therapies) composite score groups. Bivariate analysis followed by multivariable logistic regression analysis were performed to evaluate the demographic/clinical characteristics associated with the use of antidiabetic monotherapy/polytherapy and evidence-based pharmacotherapy. A total of 500 older adults were enrolled. The mean age of included participants was 73 ± 7 years, 310 participants (62%) were males, and 385 participants (77.0%) had established ASCVD. Antidiabetic monotherapy was reported in 251 participants (50.2%), with metformin followed by sulfonylureas being the most commonly prescribed drugs as monotherapy. The results of the multivariable analysis showed that age [odds ratio (OR) = 0.89, 95% CI: 0.85-0.94, P < 0.001], obesity (OR = 4.18, 95% CI: 1.63-10.36, P = 0.003), hypertension (OR = 4.2, 95% CI: 1.22-7.66, P = 0.04), and dyslipidemia (OR = 4.1, 95% CI: 1.28-8.30, P = 0.01), were significantly associated with the prescription of cardiovascular preventive medications. Only one in twenty-one participant with T2DM and ASCVD collectively received three guideline-recommended therapies, indicating a deficiency of utilization of cardiovascular preventive drugs.

Understanding the causes of preventable medication incidents for patients with mental illness in primary care

Abstract Introduction A recent scoping review has highlighted that whilst patients with mental illness are commonly affected by medication errors and preventable adverse drug events in primary care, there were limited data regarding their causes1. By understanding why these preventable events occur, targeted interventions can be developed. Aim To understand the nature and contributory factors that lead to medication errors and preventable adverse drug events amongst patients with mental illness in primary care. Methods This study used a qualitative design. A researcher remotely interviewed 26 healthcare professionals (14 pharmacists, 5 GPs, 5 nurses, 2 psychiatrists) working in primary care between June-November 2022, guided by the critical incident technique. Professionals were recruited via social media, research team networks, and snowballing. Data were analysed using the framework method and any data that involved speculation as to the causes of errors was not included. The data were organised into themes based on the London protocol error framework, which describes the contributory factors leading to care delivery problems2. Themes generated were validated by other members of the research team and a patient advisory group. This study was approved by the University of Manchester Ethics Committee 1 (reference 2022-13735-23555). Results Forty-three medication errors and twelve preventable adverse drug events were discussed during interview. Prescribing errors were discussed most commonly (n=24) and administration errors least commonly (n=4). Six contributory factors were identified which were: the individual (staff) (n=37); the work environment (n=31); the teams/interfaces (n=28); the organisation and management (n=24); the patient (n=23); and the task and technology (n=15). Primary care clinicians reported a lack of knowledge regarding psychotropics and mental illness which accompanied diffusion of responsibility. The responsibilities of staff were also confused by limited clinical information communicated between teams and across care interfaces. Service demand was reported to exceed capacity, creating stress for the staff, as well as limiting the time available for staff to undergo training. Complicated patient lifestyles and behavioural challenges were reported as unique contributory factors. Discussion/Conclusion Lack of knowledge amongst primary care clinicians regarding psychotropics and mental illness was a key issue. This was exacerbated by a mental health service structure placing considerable pressure on primary care leaving clinicians to support patients with needs perceived to be outside their areas of confidence and competence. There is a need to support this workforce by upskilling them to effectively manage patients by addressing the educational needs regarding neuropharmacology and communication skills. These changes may have a positive effect in reducing error rates for this patient group in primary care. Study limitations include recall bias, social desirability bias, as well as the majority errors discussed were made by another clinician within a chain therefore critical details may be missing in the series of events. This is the first study to identify the nature and contributory factors of preventable medication incidents for patients with mental illness in primary care. Future research should focus on exploring this topic from the perspective of patients to better understand the causes of preventable medication incidents.

Correlates of substance misuse among college-going male students in Chandigarh

Background: The World Health Organization (WHO) defines substance misuse as “consistent or occasional use of a drug inconsistent with or unrelated to acceptable medical practice”. The implementation of evidence-based policies, rules, and interventions targeted at preventing substance abuse and promoting healthier campus settings can result from an understanding of the specific issues associated with substance mis-use among children, particularly college students. Methods: A cross-sectional study was conducted among 256 college students in Chandigarh, selected through stratified multi-stage random sampling. A self-administered, semi-structured, and validated questionnaire was used for collecting data. The data was analyzed using SPSS-26.0. Results: Out of 256 respondents, 157 (61.3%) reported not using any substance. The prevalence of substance use among them was found 38.7%. Among substance users, smoking was the most commonly used (82.8%) followed by drinking (75.7%) and chewing (26.2%). Inhaling was also emerging as substance misuse (4.0%). Prevalence rates among different disciplines varied significantly, law students (100.0%) followed by arts (40.0%), commerce (36.4%), medical (34.9%), and engineering (32.3%). Students irrespective of socio-demographic factors were at equal risk of substance misuse based on the logistic regression. Conclusions: Based on the study’s findings in demographics, it was determined that age, discipline, mother’s educational level, and current living situation have a significant association with substance misuse.

Use of antibiotics for prophylaxis in clinical practice

Drug and non-drug prevention of internal organs diseases is an integral part of clinical medicine. However, the question of whether antibiotics can be used for prophylaxis, and if so, when and for how long, remains a subject of lively debate.

Sosialisasi Penyalah Gunaan Narkoba Pesantren Sebagai Benteng Terakhir Mencegah Peredaran Narkoba Di Pesantren Al-MuhajirinDusun Sumberwuluh Desa Lakardowo Kecamatan Jetis Kabupaten Mojokerto Propinsi Jawa Timur

This service was carried out to remind the role of Islamic Boarding Schools as the last bastion in preventing drug trafficking in the community, where the phenomenon of drug trafficking has become a serious problem in various layers of society, so that Islamic Boarding Schools, as Islamic educational institutions that have the potential to contribute to prevention efforts. The methodology of this service was carried out by means of lectures conveying material on the understanding and dangers of drugs / drugs and how to prevent their circulation. In addition, discussions were also held by means of questions and answers and the delivery of the importance of the role of santri and satriwati to understand how Islamic Boarding Schools can implement anti-drug programs, as well as the impact on the behavior of students. The results of this research are expected to provide a deeper insight into the effectiveness of the role of Islamic boarding schools in combating drug trafficking in the community. In a broader context, this dedication has important implications in the development of drug prevention strategies in Indonesia. The results of this research can also be the basis for policy improvement and cooperation between religious educational institutions and the government in addressing the drug problem. Thus, this research is expected to make a positive contribution in the effort to protect the community from the threat of drug trafficking