Previous Medication Use Research Articles

PS-P09-9: DIETARY PATTERNS AND HYPERTENSION AMONG STROKE-FREE AFRICANS IN THE SIREN STUDY

Objective: This study assessed the relationship of dietary patterns (derived from the frequency of food consumption) with hypertension among stroke-free controls recruited from Nigeria and Ghana in the Stroke Investigation Research and Educational Network (SIREN) study. Design and Methods: This study was a matched case-control study with 1500 hypertensives randomly selected and matched for the country of residence, age and sex with 1500 normotensives in the SIREN study. Factor analysis using principal component analysis was used to summarise food information and seven dietary patterns (DP); vegetables, poultry product and organ meat, whole-grain and fruit drinks, fried foods and sweetened drinks, red meat, processed foods and fruits were identified. Hypertension was defined as one of the following conditions; systolic blood pressure of 140mmHg/greater or diastolic blood pressure of 90mmHg/greater or previous diagnosis or use of antihypertensive medications. Multivariable adjusted logistic regression was used to estimate the odds ratio (OR) and 95% confidence interval (CI) for hypertension by the median of factors scores in each DP (adjusting for age, education, income, smoking, alcohol use, physical inactivity, family history of cardiovascular diseases and obesity) at a two-sided P < 0.05. Results: Mean age was 56.2 ± 13.5years and multivariable-adjusted OR (95%CI) for odds of hypertension by the median (with < median of factor score as reference) of DPs revealed higher consumption of whole grains and fruit drinks; 0.83 (0.73, 0.96; P = 0.01) was associated with lower odds of hypertension, but higher consumption of processed foods; 1.18 (1.00, 1.40; P = 0.04) was associated with higher odds of hypertension. Furthermore, multivariable-adjusted OR (95%CI) of hypertension for other DPs include; 0.88 (0.74, 1.04; P = 0.13) for vegetables; 0.89 (0.75, 1.05; P = 0.16) for poultry product and organ meat; 0.90 (0.76, 1.06; P = 0.21) for fruits; 0.90 (0.77, 1.07; P = 0.23) for fried foods and sweetened drinks and 1.03 (0.87, 1.21; P = 0.76) for red meat. Conclusion: Diet rich in whole grains was associated with lower hypertension risk, but higher consumption of processed foods was related to a deleterious hypertension risk. Also, higher consumption of plant-based diets presented a suggestive inverse relationship with hypertension, but diets dense with red meat presented a suggestive deleterious hypertension risk.

Risk factors for and preventability of drug-related hospital revisits in older patients: A post-hoc analysis of a randomized clinical trial.

The aims of this study were (1) to identify older patients' risk factors for drug-related readmissions and (2) to assess the preventability of older patients' drug-related revisits. Post hoc analysis of a randomized clinical trial with patients aged ≥65 years at eight wards within four hospitals in Sweden. (1) The primary outcome was risk factors for drug-related readmission within 12 months post-discharge. A Cox proportional hazards model was made with sociodemographic and clinical baseline characteristics. (2) Four hundred trial participants were randomly selected and their revisits (admissions and emergency department visits) were assessed to identify potentially preventable drug-related revisits, related diseases and causes. (1) Among 2637 patients (median age 81 years), 582 (22%) experienced a drug-related readmission within 12 months. Sixteen risk factors (hazard ratio >1, P< 0.05) related to age, previous hospital visits, medication use, multimorbidity and cardiovascular, liver, lung and peptic ulcer disease were identified. (2) The 400 patients experienced a total of 522 hospital revisits, of which 85 (16%) were potentially preventable drug-related revisits. The two most prevalent related diseases were heart failure (n = 24, 28%) and chronic obstructive pulmonary disease (n = 13, 15%). The two most prevalent causes were inadequate treatment (n = 23, 27%) and insufficient or no follow-up (n = 22, 26%). (1) Risk factors for drug-related readmissions in older hospitalized patients were age, previous hospital visits, medication use and multiple diseases. (2) Potentially preventable drug-related hospital revisits are common and might be prevented through adequate pharmacotherapy and continuity of care in older patients with cardiovascular or lung disease.

Pituitary Volumes Are Reduced in Patients With Alcohol Use Disorder.

To determine whether there is a difference in pituitary gland volumes in patients with alcohol use disorder compared to healthy people. The subjects included in the study consisted of 15 individuals who met the criteria for alcohol use disorder according to the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM 5) diagnostic criteria based on the Structured Clinical Interview for DSM 5 and were admitted to Firat University School of Medicine, Department of Psychiatry, or were hospitalized, and 17 healthy controls. The volumes of pituitary were measured in subjects. Absolute pituitary gland volumes of patients with alcohol use disorder and healthy controls were compared in the analysis performed using the independent samples t-test. The mean volume of the patient group was significantly smaller than the healthy controls (58.02 ± 7.24mm3 in patients with alcohol use disorder vs. 83.08 ± 12.11mm3, P < 0.01), a difference which persisted after controlling for age, gender and total brain size. Patients with alcohol use disorder in this study had smaller pituitary gland volumes compared to those of healthy control subjects. However, this study has limitations including small sample size and not adjusting for previous or current medication use or current anxiety and depression.

Frequent vegetable consumption is inversely associated with hypertension among indigenous Africans.

The relationship between vegetable consumption and hypertension occurrence remains poorly characterized in sub-Saharan Africa. This study assessed the association of vegetable consumption with odds of hypertension among indigenous Africans. We harmonized data on prior vegetable consumption and hypertension occurrence (defined as one of the following conditions; systolic blood pressure ≥140 or diastolic blood pressure ≥90 mmHg or previous diagnosis or use of antihypertensive medications) from 16 445 participants across five African countries (Nigeria, South Africa, Kenya, Ghana and Burkina Faso) in the Stroke Investigative Research and Educational Network and Africa Wits-INDEPTH partnership for Genomic studies. Vegetable consumption (in servings/week) was classified as 'low' (<6). 'moderate' (6-11), 'sufficient' (12-29), and 'high' (≥30). Odds ratios (ORs) and 95% confidence interval (CI) of hypertension were estimated by categories of vegetable consumption (using 'low' consumption as reference), adjusting for sex, age in years, family history of cardiovascular diseases, education, smoking, alcohol use, physical inactivity, body mass index, diabetes mellitus and dyslipidaemia using logistic regressions at P < 0.05. The mean age of participants was 53.0 ( ± 10.7) years, and 7552 (45.9%) were males, whereas 7070 (42.9%) had hypertension. In addition, 6672(40.6%) participants had 'low' vegetable consumption, and 1758(10.7%) had 'high' vegetable consumption. Multivariable-adjusted OR for hypertension by distribution of vegetable consumption (using 'low' consumption as reference) were 1.03 (95% CI: 0.95, 1.12) for 'moderate' consumption; 0.80 (0.73, 0.88) for 'sufficient', and 0.81 (0.72, 0.92) for 'high' consumption, P-for-trend <0.0001. Indigenous Africans who consumed at least 12 servings of vegetables per week were less likely to be found hypertensive, particularly among males and young adults.

Abstract P069: Vegetable Consumption And Hypertension Among 16,445 Africans

Background: The association of vegetable consumption with hypertension remains poorly described in sub-Saharan Africa. This study assessed the relationship between vegetable consumption and hypertension among indigenous Africans. Methods: We harmonized data on the frequency of vegetable consumption (servings/week) and hypertension (defined as systolic blood pressure ≥ 140mmHg or diastolic blood pressure ≥ 90mmHg or previous diagnosis or use of antihypertensive medications) from 16,445 participants across five African countries (Ghana, Burkina Faso, Kenya, Nigeria and South Africa) from the SIREN and AWI-Gen studies. Using the recommendation of at least five servings/day (35 servings/week) adapted from the World Health Organization recommendations, and vegetable consumption was classified as 'inadequate' (&lt;35 servings/week) or 'adequate' (≥35 servings/week). The odds ratio (OR) and 95% confidence interval (CI) for hypertension risk was estimated for adequate vegetable consumption using multivariable-adjusted logistic regressions at a two-sided P &lt;0.05. Results: The mean age of participants was 53.0±10.7years, 45.9% (7,552 of 16,445) were males, and 42.9% (7,070 of 16,445) were hypertensives. Adequate vegetable consumption was associated with lower odds of hypertension; OR: 0.86 (95%CI: 0.76, 0.97). The sex-stratified odds was; OR: 0.87 (95%CI: 0.73, 1.02) for females and 0.84 (95%CI: 0.71, 1.00) for males. Conclusion: These findings provide new evidence for promoting regular vegetable consumption in the guidelines for the primary prevention of hypertension among Africans.

Retention of brivaracetam in adults with drug-resistant epilepsy at a single tertiary care center

IntroductionBrivaracetam (BRV) is licensed as an adjunctive treatment for focal epilepsy. We describe our clinical experience with BRV at a large UK tertiary center. MethodsAdults initiated on BRV between July 2015 and July 2020 were followed up until they discontinued BRV or September 2021. Data on epilepsy syndrome, duration, seizure types, concomitant and previous antiseizure medication (ASM) use, BRV dosing, efficacy, and side effects were recorded. Efficacy was categorized as temporary (minimum three months) or ongoing (at last follow-up) seizure freedom, ≥50% seizure reduction, or other benefits (e.g., no convulsions or daytime seizures). Brivaracetam retention was estimated using Kaplan–Meier survival analysis. ResultsTwo-hundred people were treated with BRV, of whom 81% had focal epilepsy. The mean (interquartile range [IQR]) follow-up time was 707 (688) days, and the dose range was 50–600 mg daily. The mean (IQR) of the previous number of used ASMs was 6.9 (6.0), and concomitant use was 2.2 (1.0). One-hundred and eighty-eight people (94%) had previously discontinued levetiracetam (LEV), mainly due to side effects. 13/200 (6.5%) were seizure free for a minimum of six months during treatment, and 46/200 (23%) had a ≥50% reduction in seizure frequency for six months or more. Retention rates were 83% at six months, 71% at 12 months, and 57% at 36 months. Brivaracetam was mostly discontinued due to side effects (38/75, 51%) or lack of efficacy (28/75, 37%). Concomitant use of carbamazepine significantly increased the hazard ratio of discontinuing BRV due to side effects (p = 0.006). The most commonly reported side effects were low mood (20.5%), fatigue (18%) and aggressive behavior (8.5%). These side effects were less prevalent than when the same individuals took LEV (low mood, 59%; aggressive behavior, 43%). Intellectual disability was a risk factor for behavioral side effects (p = 0.004), and a pre-existing mood disorder significantly increased the likelihood of further episodes of low mood (p = 0.019). ConclusionsBrivaracetam was effective at a broad range of doses in managing drug-resistant epilepsy across various phenotypes, but less effective than LEV in those who switched due to poor tolerability on LEV. There were no new tolerability issues, but 77% of the individuals experiencing side effects on BRV also experienced similar side effects on LEV.

Use of Non-pharmacological Therapies in Individuals With Migraine Eligible for Treatment With Monoclonal Antibodies Targeting Calcitonin Gene-Related Peptide (CGRP)-Signaling: A Single-Center Cross-Sectional Observational Study.

IntroductionAccessibility of treatment with monoclonal antibodies targeting the calcitonin gene-related peptide (CGRP) signaling pathway is impeded by regulatory restrictions. Affected individuals may seek out other services including non-pharmacological therapies. Thus, we found it timely to ascertain the use of non-pharmacological therapies in individuals with treatment-resistant migraine eligible for and naïve to treatment with CGRP-signaling targeting monoclonal antibodies.MethodsWe conducted a single-center cross-sectional observational study of patients eligible for and naïve to treatment with monoclonal antibodies targeting CGRP or its receptor. We recorded demographical information (gender, age, educational level, employment status, and income), disease burden (frequency of headache days and migraine days), previous use of preventive pharmacological medications for migraine, and use of non-pharmacological therapies over the past 3 months including frequency of interventions, costs, and patient-reported assessment of efficacy on a 6-point scale (0: no efficacy, 5: best possible efficacy).ResultsWe included 122 patients between 17 June 2019 and 6 January 2020; 101 (83%) were women and the mean age was 45.2 ± 13.3 years. One-third (n = 41 [34%]) had used non-pharmacological therapy within the past 3 months. Among these participants, the median frequency of different interventions was 1 (IQR: 1–2), the median number of monthly visits was 2.3 (IQR: 1.3–4), mean and median monthly costs were 1,086 ± 1471, and 600 (IQR: 0–1200) DKK (1 EUR = ~7.5 DKK), respectively, and median patient-reported assessment of the efficacy of interventions was 2 (IQR: 0–3).ConclusionEven in a high-income country with freely accessible headache services and universal healthcare coverage, there was a non-negligible direct cost in parallel with low satisfaction for non-pharmacological therapies among patients at a tertiary headache center.

Development of a predictive model for the side effects of liraglutide

Background: Liraglutide, a drug used for the management of obesity, has many known side effects. In this study, we developed a predictive model for the occurrence of liraglutide-related side effects using data from electronic medical records (EMRs).Methods: This study included 237 patients from Seoul St. Mary's Hospital and Eunpyeong St. Mary's Hospital who were prescribed liraglutide. An endocrinologist obtained medical data through an EMR chart review. Model performance was evaluated using the mean of the area under the receiver operating characteristic curve (AUROC) with a 95% confidence interval (CI).Results: A predictive model was developed for patients who were prescribed liraglutide. However, 37.1% to 75.5% of many variables were missing, and the AUROC of the developed predictive model was 0.630 (95% CI, 0.551–0.708). Patients who had previously taken antiobesity medication had significantly fewer side effects than those without previous antiobesity medication use (20.7% vs. 41.4%, P&lt;0.003). The risk of side effect occurrence was significantly higher in patients with diabetes than in patients without diabetes by 2.389 times (odds ratio, 2.389; 95% CI, 1.115–5.174).Conclusions: This study did not successfully develop a predictive model for liraglutide-related side effects, primarily due to issues related to missing data. When prescribing antiobesity drugs, detailed records and basic blood tests are expected to be essential. Further large-scale studies on liraglutide-related side effects are needed after obtaining high-quality data.

Patient and Clinical Demographics of New Users to Single-Inhaler Triple Therapy in Patients with Chronic Obstructive Pulmonary Disease.

IntroductionSingle-inhaler fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) triple therapy was approved by the United States Food and Drug Administration in 2017 as a maintenance therapy for chronic obstructive pulmonary disease (COPD). Patient characteristics and treatment patterns prior to initiating FF/UMEC/VI are currently unknown. This study assessed patient characteristics, exacerbation, and medication history in patients with COPD before the initiation of FF/UMEC/VI or multiple-inhaler triple therapy (MITT).MethodsThis was a retrospective study using the Optum Clinformatics® Data Mart. Patients who initiated FF/UMEC/VI triple therapy or MITT (consisting of a long-acting muscarinic antagonist [LAMA], long-acting β2-agonist [LABA], and inhaled corticosteroid [ICS]) between October 2017 and September 2018, were enrolled in commercial or Medicare Advantage Prescription Drug plans, were aged > 40 years, and had a COPD diagnosis were eligible. Patient characteristics, comorbidities, COPD medication use, exacerbations, and eosinophil counts were assessed in the 12-month baseline period prior to initiation of FF/UMEC/VI triple therapy or MITT.ResultsThe study population included 3933 FF/UMEC/VI users and 18,244 MITT users. Mean (standard deviation) patient age was 72.2 (8.6) years in FF/UMEC/VI users and 70.7 (9.7) years in MITT users. Prior to initiating triple therapy, the majority of FF/UMEC/VI (89.1%) and MITT (93.8%) users experienced a moderate or severe exacerbation or used a COPD maintenance therapy during the baseline period. In addition, 41.2% of FF/UMEC/VI users received overlapping ICS/LAMA/LABA, 20.3% received ICS/LABA, and 9.7% received LAMA/LABA.ConclusionIn this population of COPD patients, triple therapy was frequently initiated after previous maintenance medication use or an exacerbation, in line with treatment guideline recommendations.

Clinical profile and treatment outcomes of Fusarium keratitis.

Purpose:To determine the seasonality, clinical profile, and treatment outcome of Fusarium keratitis.Methods:A retrospective medical chart review of 97 patients with culture-proven Fusarium keratitis at a tertiary eye care institution from January 2018 to December 2019.Results:The median (SD) age at enrollment was 44.6 (16) years; 75 (79.8%) of them were male. Presence of infiltrate less than 4 mm2 at baseline indicated 4.4 times the odds of achieving final BCVA more than 20/60 (95% CI: 1.4–13.3; P = 0.008). The absence of surgical management indicated 8.1 times the odds of achieving final BCVA of more than 20/60 (95% CI: 0.9–71.5; P = 0.06). The visual acuity at presentation, duration between symptoms and presentation, history of ocular trauma, previous use of topical medications, and presence of hypopyon were not identified as significant predictors of final BCVA in the multivariable regression analysis.Conclusion:Smaller infiltrate size and absence of surgical management are the significant predictors of good visual outcome. Visual outcome of Fusarium keratitis is poor, and a significant number of patients did not respond to anti-fungal therapy and had to undergo surgeries. To the best of our knowledge, this is the largest case series on Fusarium keratitis to date.

Impact of Hypertension History and Blood Pressure at Presentation on Cardiac Remodeling and Mortality in Aortic Dissection.

ObjectiveThis study compared clinical, echocardiographic, and prognostic characteristics among patients with aortic dissection (AD) with (HypHist) and without (No-HypHist) hypertension history and evaluated the association of blood pressure (BP) at presentation with 1-year mortality, left ventricular (LV) remodeling and renal dysfunction.MethodsWe investigated clinical and echocardiographic characteristics and 1-year mortality among 367 patients with AD (81% HypHist, 66% Type-A) from three Brazilian centers.ResultsPatients with No-HypHist were more likely to have Marfan syndrome, bicuspid aortic valve, to undergo surgical therapy, were less likely to have LV hypertrophy and concentricity, and had similar mortality compared with HypHist patients. Adjusted restricted cubic spline analysis showed that systolic BP (SBP) and diastolic BP (DBP) at presentation had a J-curve association with mortality among patients with No-HypHist, but did not associate with death among patients with HypHist (p for interaction = 0.001 for SBP and = 0.022 for DBP). Conversely, the association between SBP at presentation and mortality was influenced by previous use of antihypertensive medications in the HypHist group (p for interaction = 0.002). Results of multivariable logistic regression analysis comprising the whole sample showed direct associations of SBP and DBP at presentation with LV hypertrophy (p = 0.009) and LV concentricity (p = 0.015), respectively, and an inverse association between pulse pressure at presentation and estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2 (p = 0.008).ConclusionCombined information on BP at presentation, previous diagnosis of hypertension, and use of antihypertensive medications might be useful to predict mortality risk and to estimate extra-aortic end-organ damage among patients with AD.

A Case-Control of Patients with COVID-19 to Explore the Association of Previous Hospitalisation Use of Medication on the Mortality of COVID-19 Disease: A Propensity Score Matching Analysis.

Data from several cohorts of coronavirus disease 2019 (COVID-19) suggest that the most common comorbidities for severe COVID-19 disease are the elderly, high blood pressure, and diabetes; however, it is not currently known whether the previous use of certain drugs help or hinder recovery. This study aims to explore the association of previous hospitalisation use of medication on the mortality of COVID-19 disease. A retrospective case-control from two hospitals in Madrid, Spain, included all patients aged 18 years or above hospitalised with a diagnosis of COVID-19. A Propensity Score matching (PSM) analysis was performed. Confounding variables were considered to be age, sex, and the number of comorbidities. Finally, 3712 patients were included. Of these, 687 (18.5%) patients died (cases). The 22,446 medicine trademarks used previous to admission were classified according to the ATC, obtaining 689 final drugs; all of them were included in PSM analysis. Eleven drugs displayed a reduction in mortality: azithromycin, bemiparine, budesonide-formoterol fumarate, cefuroxime, colchicine, enoxaparin, ipratropium bromide, loratadine, mepyramine theophylline acetate, oral rehydration salts, and salbutamol sulphate. Eight final drugs displayed an increase in mortality: acetylsalicylic acid, digoxin, folic acid, mirtazapine, linagliptin, enalapril, atorvastatin, and allopurinol. Medication associated with survival (anticoagulants, antihistamines, azithromycin, bronchodilators, cefuroxime, colchicine, and inhaled corticosteroids) may be candidates for future clinical trials. Drugs associated with mortality show an interaction with the underlying conditions.

The Use of Over-the-Counter Sleep Aid Containing Diphenhydramine Hydrochloride Among Saudis.

BackgroundDiphenhydramine is a first-generation H1 receptor antihistamine that is usually used for the treatment of allergy, insect bites such as mosquitos, bee stings, and some types of skin rashes. However, it possesses antiparkinsonian, antitussive, antiemetic, and most importantly hypnotic properties. This study aimed to assess the prevalence, frequency of use, and dosage of over-the-counter (OTC) sleep aid containing diphenhydramine hydrochloride used among Saudis.Material and MethodsThe study used a descriptive cross-sectional design conducted among the Saudi population. An online self-administered questionnaire was distributed among the selected Saudi nationality using social media platforms. The subjects included were Saudis aged 15 years or older, literate in using social media. The questionnaire included basic demographic characteristics, previous and current history of medication use that contains diphenhydramine hydrochloride, its side effects, and other related behavior of using, such as frequency of use and dosage.ResultsA total of 414 respondents were recruited (51% males and 49% females). Previous and current use of medications that contain diphenhydramine hydrochloride constituted 87.2% and 31.9%, respectively. The most common reason for using sleep aid was insomnia (52.1%). Dizziness or imbalance was the most commonly reported side effect. The Chi-square test revealed that the age group of ≤25 years (p = 0.044), female gender (p = 0.040), being a student (p = 0.015), current use of sleeping aid medications (p < 0.001), and the use of other medications (p < 0.001) were significantly associated with increased use of sleep aid medications.ConclusionThe excessive use of over-the-counter (OTC) sleep aid medications containing diphenhydramine hydrochloride was widely prevalent among the Saudi population. Younger female students constitute the majority of OTC sleep aid medication users.

Predictors of Anxiolytic Requirement During Radiation Therapy With Thermoplastic Mask Immobilization

<h3>Purpose/Objective(s)</h3> Anxiety during radiation simulation and/or treatments is common in cancer patients and is frequently treated with anxiolytic medications. Specifically, mask anxiety has been documented in patients requiring a thermoplastic mask for immobilization and has the potential to disrupt the safety and efficacy of treatments. We sought to identify factors that predict for anxiolytic requirement (AR) during mask immobilization. <h3>Materials/Methods</h3> Patients who received radiation therapy with a thermoplastic mask covering their entire face (including eyes, nose, and mouth) at a single institution from 2019-2020 were identified and charts were retrospectively reviewed. The use of anxiolytic medications during simulation/treatments, possible predictive factors, and absolute number and percentage of missed treatment days were recorded. If patients underwent multiple radiation treatments, only the first was evaluated. Factors analyzed include gender, spoken language, ECOG performance status, smoking history, past psychiatric history (anxiety, depression, panic attacks, dementia, alcohol abuse, claustrophobia, or post-traumatic stress disorder), previous use of anxiety-related medications, treatment site, mask type, treatment modality, and dexamethasone use. Regression analysis using a generalized linear model was used to create predictive models for AR and for missed radiation treatments. <h3>Results</h3> A total of 250 patients were evaluated, of whom 124 were female and 126 were male. Median age was 63 years and median ECOG performance status was 1. Thirty-nine percent of patients had a history of anxiety, 4% of claustrophobia, 30% of depression, and 41% were previously prescribed at least one outpatient anxiety-related medication. Thirty patients (12%) required an anxiolytic medication during radiation simulation and/or treatments and 67 patients (27%) missed at least one planned treatment fraction. On multivariate analysis, history of anxiety (<i>P</i> = 0.0002, OR = 5.6) and claustrophobia (<i>P</i> = 0.003, OR = 7.7) were independently predictive of AR. Additionally, AR and head and neck treatment site were independently predictive of percentage of missed radiation fractions (<i>P</i> < 0.01) and AR and IMRT were independently predictive of absolute missed radiation fractions (<i>P</i> < 0.01). <h3>Conclusion</h3> History of anxiety and claustrophobia were independently predictive of AR during radiation simulation/treatments with a thermoplastic mask. These factors can be detected in patient charts prior to consultation and therefore have the potential to allow for early identification of individuals who may be at higher risk for anxiety during their radiation experience. Furthermore, patients who required anxiolytics during radiation therapy tended to miss more treatment days, possibly indicating that optimal anxiety management has not yet been achieved.

Common Presenting Complaints and Predisposing Factors among Adult Ophthalmic Patients with Low Vision and Blindness in Aba

Aim: To determine the common complaints and predisposing factors of low vision and blindness among adult ophthalmic patients in Abia State University Teaching Hospital, (ABSUTH), Aba, Nigeria.&#x0D; Study Design: A retrospective, descriptive study.&#x0D; Methodology: An institutional-based study involving 457 patients who attended Abia State University Teaching Hospital eye clinic between April and September 2018 was undertaken. The patients’ biodata, clinical history, ophthalmic examination findings, and results of ancillary investigations were obtained from patients’ hospital records within the period under study and analyzed using IBM SPSS version 25.0. AP-value of &lt; 0.05 was taken to be statistical significant.&#x0D; Result: A total of 457 patients comprising of 206 males and 251 females, aged 18-85 years were seen in the study period. Based on World Health Organization (WHO)’s definition of low vision and blindness, two hundred and eighty-four (62.1%) patients had normal vision, 25(5.5%) patients had low vision while 32(7%) patients were blind. The most common complaint was blurring of vision, 136 (23.5%) followed by itching of the eye, 91 (15.7%) and tearing, 86 (14.9%). Forty percent of the respondents’ complaints had lasted for over 12 months before presentation at the clinic. Common predisposing factors for low vision and blindness observed in this study were hypertension (24.1%), previous drug use (5%), previous use of traditional medication (1.3%) and family ocular history (3.7%). No statistically significant association was found between diagnostic data and family ocular history, previous use of traditional medication and previous drug use. Statistically, significant relationship was found between diagnostic data and blood pressure (P&lt; 0.001).&#x0D; Conclusion: There are various presentations of low vision and blindness in Aba. Routine eye check, early referral and appropriate treatment is advocated for the populace.

Impact of COVID-19 Pandemic on Sleep Quality, Stress Level and Health-Related Quality of Life-A Large Prospective Cohort Study on Adult Danes.

The everyday lives of Danish inhabitants have been affected by the COVID-19 pandemic, e.g., by social distancing, which was employed by the government in March 2020 to prevent the spread of SARS-CoV-2. Moreover, the pandemic has entailed economic consequences for many people. This study aims to assess changes in physical and mental health-related quality of life (MCS, PCS), in stress levels, and quality of sleep during the COVID-19 pandemic and to identify factors that impact such changes, using a prospective national cohort study including 26,453 participants from the Danish Blood Donor Study who answered a health questionnaire before the pandemic and during the pandemic. Descriptive statistics, multivariable linear and multinomial logistic regression analyses were applied. A worsening of MCS and quality of sleep was found, and an overall decrease in stress levels was observed. PCS was decreased in men and slightly increased in women. The extent of health changes was mainly affected by changes in job situation, type of job, previous use of anti-depressive medication and the participants’ level of personal stamina. Thus, living under the unusual circumstances that persisted during the COVID-19 pandemic has had a negative impact on the health of the general population. This may, in time, constitute a public health problem.

Is sedentary lifestyle a critical driver for hypertension burden in Sub-Saharan Africa?: evidence from a community-based population in Ghana and Nigeria

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): National Institute of Health (NIH) OnBehalf SIREN as part of the H3 Africa Consortium Background Hypertension is the principal risk factor for stroke events in Sub-Saharan Africa (SSA). However, international evidence on the significance of physical inactivity as a critical driver of hypertension risk in SSA is sparse. Purpose This study assessed determinants of hypertension risk among a stroke-free population in Ghana and Nigeria. Methods Participants were 4,267 stroke-free individuals recruited in the Stroke Investigative Research and Education Network study from Nigeria and Ghana. Data on sociodemographic, lifestyle, cardiovascular risk and blood pressure were collected using standard protocols. Hypertension was defined as systolic blood pressure (SBP) ≥ 140mmHg or diastolic blood pressure (DBP) ≥ 90mmHg or a previous diagnosis or current use of antihypertensive medications. Odds ratio (OR) and 95% confidence interval (CI) for hypertension risk was estimated using logistic regression at P &amp;lt; 0.05. Results Mean age was 55.9 ± 14.7 and 1.8% were physically inactive. Mean SBP and DBP were 135.8 ± 24.2mmHg and 82.7 ± 14.3mmHg respectively, and 56.7% had hypertension. Factors associated with hypertension were physical inactivity (OR: 9.09; 95%CI: 4.03, 20.53), being diabetic (OR: 2.70; 95%CI: 1.91, 3.82), being older than 60years (OR: 2.22; 95%CI: 1.78, 2.77) and family history of cardiovascular diseases (OR: 2.02; 95%CI: 1.59, 2.56) and elevated waist circumference (OR: 1.01; 95%CI: 1.00, 1.02). Conclusion(s): Physical inactivity was the leading risk factor for hypertension in this population. Community-oriented interventions promoting physical activity should help in the control of hypertension among sub-Saharan African population.

Screening for antenatal depression and its determinants among pregnant women in Qatar: revisiting the biopsychosocial model

BackgroundScreening for antenatal depression and its determinants is highly recommended. However, there is no consensus on a standard conceptual framework to approach pregnant women in a primary health care setting. The prevalence of antenatal depression and significant determinants are unknown in Qatar, a gap that we propose to fill.MethodsAn analytical cross-sectional study with a probability sampling technique was employed. Enrolling eight-hundred participants from primary health care centers. The screening was performed through a valid and reliable screening instrument ‘Edinburgh Postpartum Depression Scale.’ In addition to the proposed Comprehensive Biopsychosocial Model, participants were asked about their predisposing profile, biological risk, and other suggested modifiable variables.ResultsTwenty-one percent reported minor depressive episodes (n = 167, 20.9%) at a 95% confidence interval [18.2–23.8]. Previous use of mental health medications, fear of giving birth, concern about appearance, low perceived social support, and low resilience level showed to be associated with antenatal depression. The logistic regression analyses revealed that the Comprehensive Biopsychosocial model forecast 89% of antenatal depression predictors provided Area Under the Receiver Operating Characteristic Curve of 0.89 at a 95% confidence interval [0.85 to 0.92].ConclusionsAntenatal depression is common among pregnant women in Qatar, and preventive interventions must target the determinants revealed. From a clinical perspective, the use of the proposed model may aid in the standardization of the screening process.

Atypical femur fractures associated with chronic bisphosphonates use: A case series with 66 patients.

Objective The present study aims to describe outcomes from a series of surgically treated patients with atypical femoral fracture due to bisphosphonates use, in addition to correlate the time of previous medication use with fracture consolidation time, and to compare the consolidation time of complete and incomplete fractures. Methods This is an observational, retrospective study with 66 patients diagnosed with atypical femur fractures associated with chronic bisphosphonates use. The patients underwent orthopedic surgical treatment at a referral hospital from January 2018 to March 2020. Results All patients were females, with two bilateral cases. Fracture consolidation occurred in all cases, with an average time of 2.3 months and a follow-up time of 5.8 months. The average time of bisphosphonates use was 7.8 years. There was no correlation between the time of previous bisphosphonates use and the time for fracture consolidation. Consolidation time differed in complete and incomplete fractures. Conclusion Surgical treatment with a long cephalomedullary nail resulted in consolidation in all patients. The consolidation time was longer in complete fractures when compared with incomplete lesions, and there was no correlation between the time of previous bisphosphonates use and the consolidation time . Level of evidence Level IV, case series

Hydroxychloroquine with azithromycin in patients hospitalized for mild and moderate COVID-19

ObjectivesTo assess the efficacy of hydroxychloroquine in combination with azithromycin in terms of clinical and biochemical outcomes in adult patients with COVID-19 hospitalized for acute respiratory distress syndrome (ARDS), and to describe the occurrence of adverse events. MethodRetrospective comparative study, based in a quaternary private hospital in Rio de Janeiro, Brazil, involving 193 adult patients hospitalized for mild and moderate COVID-19 related ARSD, analyzing treatment efficacy based on clinical and biochemical outcomes. ResultsThe active group comprised 101 (52.3%) patients using hydroxychloroquine associated with azithromycin and the control group 92 (47.7%) patients who did not take these medications. Median age was 59 (47–70) in the active group and 65 (47−77) in the control group (p < 0.05). Patients in the control group had greater extent of pulmonary involvement on baseline chest CT scans (p < 0.05). All other baseline variables (BMI, comorbidities, previous use of medications and biochemical assessments) were similar between groups. In the medication group, 25% (25 out of 101) were admitted to the ICU, compared to 21% (19 out of 92) in the control group (p > 0.05). No difference in mortality, duration of non-invasive oxygen use or duration of hospitalization was seen between groups. The therapeutic regimen was well tolerated, with only eight (7.9%) patients presenting gastrointestinal symptoms and eight (7.9%) patients withdrawn treatment due to QTc prolongation. ConclusionsPatients treated with hydroxychloroquine combined with azithromycin and the control group had similar clinical outcomes. This therapeutic regimen was considered ineffective in hospitalized patients with mild to moderate COVID-19 related ARDS and was associated with few non-severe adverse events.