Receiving Drug Therapy Research Articles

Assessment of the impact of medPlan®, a medication reminder mobile application, in glaucoma patients in Benin City, Nigeria

Purpose: To assess the impact of medPlan®, a medication reminder mobile application in glaucoma patients in Benin City, Nigeria.Methods: In a randomized control trial with 2 months follow-up period, 200 patients receiving drug therapy for glaucoma were randomized into either into a control or study group. The study group comprised participants who made use of a medication reminder mobile application, medPlan®, while the control group consisted of those patients who did not use the application. Adherence to medication was measured for all the patients in both groups. Data was collected using a carefully designed questionnaire and statistically analyzed.Results: This study recorded 100 % response rate from the participants. In the study group, 56 % were very adherent while 18 % were moderately adherent, and 26 % were non-adherent respondents as against 45 % very adherent, 13 % moderately adherent and 42 % non-adherent respondents from the control group. In addition, 78 % of those in the study group agreed that there was improvement in their medication adherence since they started using the medication reminder application. This showed a significant positive impact of the medication reminder application (p = 0.0110) on adherence to medication.Conclusion: Medication adherence was improved in glaucoma patients who used medPlan®, a smartphone medication reminder application. This study lays a foundation for further research on medication reminder mobile applications.
 Keywords: Glaucoma, Smartphone, Medication adherence, Impact, Medication reminder, medPlan®

Multicenter point prevalence evaluation of the utilization and safety of drug therapies for COVID-19 at the onset of the pandemic timeline in the United States.

Key pointsIn a multicenter point-prevalence study, we found that the rate of supportive care was high; among those receiving COVID-19 drug therapies, adverse reactions occurred in 12% of patients.PurposeThere are currently no FDA-approved medications for the treatment of coronavirus disease 2019 (COVID-19). At the onset of the pandemic, off-label medication use was supported by limited or no clinical data. We sought to characterize experimental COVID-19 therapies and identify safety signals during this period.MethodsWe conducted a noninterventional, multicenter, point prevalence study of patients hospitalized with suspected/confirmed COVID-19. Clinical and treatment characteristics within a 24-hour window were evaluated in a random sample of up to 30 patients per site. The primary objective was to describe COVID-19–targeted therapies. The secondary objective was to describe adverse drug reactions (ADRs).ResultsA total of 352 patients treated for COVID-19 at 15 US hospitals From April 18 to May 8, 2020, were included in the study. Most patients were treated at academic medical centers (53.4%) or community hospitals (42.6%). Sixty-seven patients (19%) were receiving drug therapy in addition to supportive care. Drug therapies used included hydroxychloroquine (69%), remdesivir (10%), and interleukin-6 antagonists (9%). Five patients (7.5%) were receiving combination therapy. The rate of use of COVID-19–directed drug therapy was higher in patients with vs patients without a history of asthma (14.9% vs 7%, P = 0.037) and in patients enrolled in clinical trials (26.9% vs 3.2%, P < 0.001). Among those receiving drug therapy, 8 patients (12%) experienced an ADR, and ADRs were recognized at a higher rate in patients enrolled in clinical trials (62.5% vs 22%; odds ratio, 5.9; P = 0.028).ConclusionWhile we observed high rates of supportive care for patients with COVID-19, we also found that ADRs were common among patients receiving drug therapy, including those enrolled in clinical trials. Comprehensive systems are needed to identify and mitigate ADRs associated with experimental COVID-19 treatments.

Association Between Sex and Treatment Outcomes of Atrial Fibrillation Ablation Versus Drug Therapy: Results From the CABANA Trial.

Among patients with atrial fibrillation (AF), women are less likely to receive catheter ablation and may have more complications and less durable results. Most information about sex-specific differences after ablation comes from observational data. We prespecified an examination of outcomes by sex in the 2204-patient CABANA trial (Catheter Ablation Versus Antiarrhythmic Drug Therapy for Atrial Fibrillation). CABANA randomized patients with AF age ≥65 years or <65 years with ≥1 risk factor for stroke to a strategy of catheter ablation with pulmonary vein isolation versus drug therapy with rate/rhythm control agents. The primary composite outcome was death, disabling stroke, serious bleeding, or cardiac arrest, and key secondary outcomes included AF recurrence. CABANA randomized 819 (37%) women (ablation 413, drug 406) and 1385 men (ablation 695, drug 690). Compared with men, women were older (median age, 69 years versus 67 years for men), were more symptomatic (48% Canadian Cardiovascular Society AF Severity Class 3 or 4 versus 39% for men), had more symptomatic heart failure (42% with New York Heart Association Class ≥II versus 32% for men), and more often had a paroxysmal AF pattern at enrollment (50% versus 39% for men) (P<0.0001 for all). Women were less likely to have ancillary (nonpulmonary vein) ablation procedures performed during the index procedure (55.7% versus 62.2% in men, P=0.043), and complications from treatment were infrequent in both sexes. For the primary outcome, the hazard ratio for those who underwent ablation versus drug therapy was 1.01 (95% CI, 0.62-1.65) in women and 0.73 (95% CI, 0.51-1.05) in men (interaction P value=0.299). The risk of recurrent AF was significantly reduced in patients undergoing ablation compared with those receiving drug therapy regardless of sex, but the effect was greater in men (hazard ratio, 0.64 [95% CI, 0.51-0.82] for women versus hazard ratio, 0.48 [95% CI, 0.40-0.58] for men; interaction P value=0.060). Clinically relevant treatment-related strategy differences in the primary and secondary clinical outcomes of CABANA were not seen between men and women, and there were no sex differences in adverse events. The CABANA trial results support catheter ablation as an effective treatment strategy for both women and men. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT00911508.

Major adverse cardiovascular events and mortality after catheter ablation in Japanese patients with atrial fibrillation: The Fushimi AF Registry.

The impact of catheter ablation (CA) on the long-term clinical outcomes in atrial fibrillation (AF) are unclear due to limited cohort investigations. The Fushimi AF Registry is a community-based prospective survey of patients with AF in Fushimi-ku, Kyoto, Japan. Of 4465 patients enrolled between March 2011 and July 2019, analyses were performed on 2639 patients (492 patients who underwent CA and 2147 patients who received standard rhythm- and/or rate-control drug therapy at baseline). We compared the baseline characteristics and the incidence of major adverse cardiovascular events (MACE: the composite of cardiovascular death, heart failure hospitalization, myocardial infarction, ischemic stroke or systemic embolism), and all-cause mortality during the follow-up using propensity score matching. After entering 20 covariates in the current matching analysis, 342 patients who underwent CA and 342 matched patients who received drug therapy, with a median follow-up of 1865days, were included. The patients who underwent CA were significantly associated with lower incidence of MACE (hazard ratio (HR) 0.56, 95% confidential interval (CI) 0.36-0.86; P = 0.0077), and all-cause mortality (HR 0.47, 95% CI 0.29-0.75; P = 0.0016). CA was associated with lower incidences of MACE and all-cause mortality for patients with AF as compared with those who received drug therapy. The most common event of MACE in patients who underwent CA was heart failure hospitalization. URL: http://www.umin.ac.jp/ctr/index.htm UNIQUE IDENTIFIER: UMIN000005834.

Cryoballoon Ablation as Initial Therapy for Atrial Fibrillation

BackgroundIn patients with symptomatic paroxysmal atrial fibrillation that has not responded to medication, catheter ablation is more effective than antiarrhythmic drug therapy for maintaining sinus rhythm. However, the safety and efficacy of cryoballoon ablation as initial first-line therapy have not been established.MethodsWe performed a multicenter trial in which patients 18 to 80 years of age who had paroxysmal atrial fibrillation for which they had not previously received rhythm-control therapy were randomly assigned (1:1) to receive treatment with antiarrhythmic drugs (class I or III agents) or pulmonary vein isolation with a cryoballoon. Arrhythmia monitoring included 12-lead electrocardiography conducted at baseline and at 1, 3, 6, and 12 months; patient-activated telephone monitoring conducted weekly and when symptoms were present during months 3 through 12; and 24-hour ambulatory monitoring conducted at 6 and 12 months. The primary efficacy end point was treatment success (defined as freedom from initial failure of the procedure or atrial arrhythmia recurrence after a 90-day blanking period to allow recovery from the procedure or drug dose adjustment, evaluated in a Kaplan–Meier analysis). The primary safety end point was assessed in the ablation group only and was a composite of several procedure-related and cryoballoon system–related serious adverse events.ResultsOf the 203 participants who underwent randomization and received treatment, 104 underwent ablation, and 99 initially received drug therapy. In the ablation group, initial success of the procedure was achieved in 97% of patients. The Kaplan–Meier estimate of the percentage of patients with treatment success at 12 months was 74.6% (95% confidence interval [CI], 65.0 to 82.0) in the ablation group and 45.0% (95% CI, 34.6 to 54.7) in the drug-therapy group (P<0.001 by log-rank test). Two primary safety end-point events occurred in the ablation group (Kaplan–Meier estimate of the percentage of patients with an event within 12 months, 1.9%; 95% CI, 0.5 to 7.5).ConclusionsCryoballoon ablation as initial therapy was superior to drug therapy for the prevention of atrial arrhythmia recurrence in patients with paroxysmal atrial fibrillation. Serious procedure-related adverse events were uncommon. (Supported by Medtronic; STOP AF First ClinicalTrials.gov number, NCT03118518.)

Long-Term Effect of Microwave Ablation on Patients Undergoing Hemodialysis for Moderate Secondary Hyperparathyroidism: A Retrospective Cohort Study.

ObjectivesA previous 12‐month study confirmed that microwave ablation (MWA) was effective for moderate secondary hyperparathyroidism (SHPT). A further analysis was performed in this study to evaluate the efficacy of MWA for moderate SHPT over an observational follow‐up period of up to 60 months.MethodsThis was a retrospective cohort study of patients involved in a previous randomized controlled trial. Patients were divided into an MWA group (those who underwent MWA followed by drug therapy according to the patient's clinical situation) and a control group (those who received drug therapy only). The primary outcome was the composite endpoint. During the efficacy assessment phase, the two groups were compared in terms of the proportion of patients with intact parathyroid hormone (iPTH) levels <300 pg/ml and the differences in iPTH levels.ResultsTwenty‐seven patients were included in this study: 13 in the MWA group and 14 in the control group. The median (interquartile range) follow‐up periods of the MWA and control groups were 58 (54–60) and 58 (49–60) months, respectively. The proportion of patients with iPTH levels <300 pg/ml in the MWA group was slightly higher than that in the control group (6/13 [46.2%] versus 2/14 [14.3%], respectively; p = .08). Furthermore, iPTH levels in the MWA group were lower than in the control group during the efficacy assessment phase (411 ± 299 pg/ml versus 516 ± 369 pg/ml, respectively; p <.01).ConclusionsMWA helped to contain the necessary iPTH levels in patients undergoing hemodialysis for moderate SHPT in a 60‐month timeframe.

Additional value of deep learning computed tomographic angiography-based fractional flow reserve in detecting coronary stenosis and predicting outcomes.

Deep learning (DL) has achieved great success in medical imaging and could be utilized for the non-invasive calculation of fractional flow reserve (FFR) from coronary computed tomographic angiography (CCTA) (CT-FFR). To examine the ability of a DL-based CT-FFR in detecting hemodynamic changes of stenosis. This study included 73 patients (85 vessels) who were suspected of coronary artery disease (CAD) and received CCTA followed by invasive FFR measurements within 90 days. The diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the receiver operating characteristics curve (AUC) were compared between CT-FFR and CCTA. Thirty-nine patients who received drug therapy instead of revascularization were followed for up to 31 months. Major adverse cardiac events (MACE), unstable angina, and rehospitalization were evaluated and compared between the study groups. At the patient level, CT-FFR achieved 90.4%, 93.6%, 88.1%, 85.3%, and 94.9% in accuracy, sensitivity, specificity, PPV, and NPV, respectively. At the vessel level, CT-FFR achieved 91.8%, 93.9%, 90.4%, 86.1%, and 95.9%, respectively. CT-FFR exceeded CCTA in these measurements at both levels. The vessel-level AUC for CT-FFR also outperformed that for CCTA (0.957 vs. 0.599, P < 0.0001). Patients with CT-FFR ≤0.8 had higher rates of rehospitalization (hazard ratio [HR] 4.51, 95% confidence interval [CI] 1.08-18.9) and MACE (HR 7.26, 95% CI 0.88-59.8), as well as a lower rate of unstable angina (HR 0.46, 95% CI 0.07-2.91). CT-FFR is superior to conventional CCTA in differentiating functional myocardial ischemia. In addition, it has the potential to differentiate prognoses of patients with CAD.

Study of the effectiveness of neuroprotective therapy in restoring motor function in patients during the acute period of ischemic stroke

The purpose of the work was to study the effect of neuroprotective therapy with Cellex on the features of recovery of movement disorders in patients in the acute period of ischemic stroke. A single-center randomized study was conducted to assess the efficacy and safety of the use of neuroprotective therapy with Cellex in patients in the acute period of ischemic stroke. The study included 60 patients with a stroke duration of no more than 3 days in the middle cerebral artery area and vertebrobasillar area with moderate and severe central hemiparesis. Patients of the study group received 1 ml of Cellex. subcutaneously 1 time per day for 10 days. All patients received drug therapy and rehabilitation measures within the framework of the standard of care for patients with ischemic stroke. Against the background of the therapy, by the end of the study on days 14-21, the study and control groups showed a significant improvement according to clinical scales: NIHSS, mRS, RMI. The patients of the study group showed a more pronounced recovery of motor function, relative to the comparison group, according to motor scales: «A-D» FMA (54 [53; 62] and 42 [34; 51], p=0.03), «E-F» FMA (29 [28; 33] and 25 [18; 27], p=0.03), ARAT (47 [48; 57], 32 [24; 48], p=0.046). Among the patients of the study group, by the end of the study, the severity of mild stroke was 67%, relative to the comparison group 11% (χ21df=6.48; p=0.01). The use of neuroprotective therapy in the form of Cellex had a positive effect on both the prognostic score and the long-term assessment according to the SSS scale, due to the regression of motor disorders of the upper and lower extremities. The study has demonstrated the effectiveness of the use of neuroprotective therapy in the treatment of movement disorders in patients in the acute period of ischemic stroke. Therapy with Cellex helped to reduce the severity of stroke, and had a positive effect on the prognosis of the disease.

Population with high cardiovascular risk receiving drug therapy and counseling: Brazil's status regarding the global goal, 2014-2015.

To estimate the prevalence of high cardiovascular risk (CVR), the proportion of people with high CVR who receive treatment and counseling, and to investigate the sociodemographic factors associated with this outcome, in Brazil. This was a cross-sectional study, using subsample data from the National Health Survey, collected via biochemical tests, in 2014-2015. Poisson regression was used. The proportion of high CVR in men was 11.2% (95%CI 9.6;12.9), and 10.4% (95%CI 9.2;11.8%) in women. In the group with high CVR, 68.8% (95%CI 63.7;73.4%) received counseling, 59.3% (95%CI 54.2;64.3%) received medication, and 55.6% (95%CI 50.4;60.7%) received both. In the multivariate analysis, receiving treatment and counseling was associated with being aged 50 years and over, and poor/very poor self-rated health (PR=1.26 - 95%CI 1.06;1.51). The proportion of people with high CVR who had received treatment and counseling was over 50%.

Efficacy and Safety of Citicoline to Prevent Cognitive Deficiency Progression in First-Degree Relatives of Patients with Alzheimer’s Disease: Prospective Study

Objective: study of the prolonged effects of a three-month course of therapy with citicoline, carried out three times for three years, to prevent the progression of cognitive deficit in 1st-degree relatives of patients with Alzheimer’s disease (AD).Study participants: the study involved first-degree relatives of patients with an established diagnosis of AD.Study design: an openlabel comparative three-year prospective study of the dynamics of cognitive status in two groups of relatives, one of whom received citicoline therapy (1st group), and the other did not (2nd group). The 1st group made up 48 relatives (11 — with mild cognitive impairment syndrome and 37 — with signs of minimal cognitive dysfunction). 32 relatives who had not received drug treatment for 3 years (8 of them had objectively confirmed signs of minimal cognitive dysfunction, in 24 people — cognitive functioning corresponded to the normal aging) were included to 2nd group. The groups did not have significant differences in demographic characteristics and distribution of the ApoE4(+) genotype carriers.Methods: clinical and psychological, psychometric, ApoE genotyping, statistical.Results: in the therapeutic group, a significant improvement in the cognitive status was found in 75.0% of the treated relatives with cognitive disfunction on most scales and tests, with the exception of the clock drawing test. In the group of relatives who did not receive drug therapy, there was a significant deterioration of cognitive functioning — in 2 cases with the formation of mild cognitive impairment syndrome, in 21 cases — with the appearance of minimal cognitive signs.Conclusion: the results of a three-year preventive course of citicoline therapy showed a significant positive effect of the drug on the cognitive status of the 1st degree relatives of AD patients who had signs of cognitive impairment that did not reach the level of dementia.

Management of delirium in a medical and surgical intensive care unit.

Delirium has been associated with increased mortality and prolonged hospital length of stay among critical care patients. Furthermore, treatment of delirium remains variable amongst clinicians due to limited evidence. The objective of this study was to determine the local incidence of delirium and to characterize the effectiveness and safety of pharmacological therapy used to treat delirium. A retrospective chart review evaluated patients diagnosed with delirium (Intensive Care Delirium Screening Checklist score ≥4) and requiring mechanical ventilation for ≥48hours from January 2016 to June 2017. The primary outcomes included comparison of resolution, the time to first resolution and recurrence of delirium in patients prescribed pharmacological and/or pre-emptive therapy versus those who did not. Secondary outcomes included incidence of adverse effects of drug therapy and delirium attributable adverse events. The incidence of delirium during our defined study period was 49%. Of the 178 patients included in the study, 136 (76%) received drug therapy for delirium. Agents used for treatment of delirium included dexmedetomidine (n=90 [66%]), haloperidol (n=77 [57%]), and quetiapine (n=74 [54%]). Resolution of delirium occurred in 94 (52%) of patients and the difference was statistically significant favoring patients who did not receive pharmacological therapy. There was no difference in the median time to resolution of delirium (3days) for patients who received pharmacological and/or pre-emptive therapy versus those who did not. Bradycardia and hypotension were the most frequently documented medication-related adverse events. Self-removal of an invasive line/catheter, was reported in 36 (26%) patients despite receiving pharmacological treatment. Despite unclear evidence that pharmacological interventions help with delirium management, the majority of our patients received such interventions. To improve patient outcomes, we should shift focus towards non-pharmacological interventions for delirium.

Pathogenesis of pelvic pain syndrome associated with endometriosis in patients resistant to surgical treatment

Aim Endometriosis is one of the most common gynecological diseases diagnosed in almost 70% of patients with chronic pelvic pain (CPP). However, a quarter of women with pelvic pain is diagnosed with external genital endometriosis (EGE) during laparoscopy. A special group is represented by patients with PP that did not stop after the removal of endometrial foci. The mechanisms of the pathogenesis of the formation of pain syndrome are not completely explored yet. According to several authors, a significant role in the pathogenesis of pelvic pain recurrence after surgical treatment of EGE is played by active neuroangiogenesis, both in ectopic and eutopic endometrium. The aim of the study was to expand the understanding of the pathogenesis of pelvic pain that did not stop (recurrence) after surgical treatment of external genital endometriosis. Material and Methods The study involved 2 stages. At the first stage (algological), data from B&B, NRS and VRS algological questionnaires, which were completed by patients with recurrent PP after surgical treatment of EGE, were analyzed (n = 130, aged 18–45 years old, average age 32.5 ± 7.6 years). All women were operated on for EGE no later than 3–6 months after assessing the patients by the algological questionnaires; they did not receive drug therapy after surgical treatment and sought medical attention for recurrent pelvic pain. Materials for the study of the endometrium were obtained by the pipelle biopsymethod. The control group was formed from a number of women with EGE without PP, who applied for surgical treatment of infertility (n = 30). Results The results of the study have shown that the basis of pathogenesis of pelvic pain recurrence in patients who did not receive medical therapy after surgical treatment of EGE is the activation of neuro-angiogenesis processes and reduction of apoptosis. The results show a statistically significant 1.6 times increasing expression of NGF in eutopic endometrium (57.9 ± 2.5 vs 35.3 ± 2.1% of patients with the silent form of the gene and its receptor NTRK1 1.8 times (2.78 ± 0.25 versus 1.56 ± 0.21.e. respectively). Conclusion: The pathogenesis of pelvic pain in patients who did not receive medical therapy after surgical treatment of endometriosis compared to no pain form of the disease is the activation of the processes of neurogenesis in the eutopic endometrium.

Patient Background Factors Affecting Prescription Drugs for Male Lower Urinary Tract Symptoms: The Multicenter Study of Miyazaki Urological-Network Group

The present multicenter study performed by the MIYAZAKI UROLOGICAL-NETWORK GROUP involving patients from 32 hospitals in Miyazaki Prefecture demonstrates that an association exists between the use of prescription drugs for male lower urinary tract symptoms (MLUTS) and patient characteristics. Men aged ≥40 years who were prescribed at least one drug for MLUTS between April 1, 2014 and March 31, 2015 were prospectively recruited. In total, 2,295 patients with a median age of 72 years were enrolled. The median prostate volume was 33 ml, the median International Prostate Symptom Score (IPSS) was 15, and the median quality-of-life score was 5. Prescribed drugs were α1-blockers alone in 1,661 patients, tamsulosin hydrochloride in 702, silodosin in 481, and naftopidil in 477. Multivariate analysis of the associations between use of α1-blockers and patient characteristics revealed use of tamsulosin hydrochloride to be more significantly associated with higher age (P=0.02), higher prostate volume (P=0.048), and higher IPSS score (P=0. 01) than silodosin. No significant associations between patient characteristics and naftopidil or tamsulosin hydrochloride ware revealed. We found that 369 patients received drug therapy for MLUTS plus overactive bladder (OAB). Multivariate analysis of the associations between patient characteristics and use of drugs for MLUTS or MLUTS plus OAB revealed higher age (P=0.001) and lower PSA value (P=0.04), lower prostate volume (P=0.01), and higher storage symptom score of IPSS (P< 0.001) to be more strongly associated with use of drugs for MLUTS plus OAB than drugs for MLUTS alone.

A Review on Pediatric Adverse Effects of First Line Anti-Tubercular Drugs

Tuberculosis is a potentially serious communicable disease caused by mycobacterium tuberculosis. That mainly affects lungs. Tricky mitigation and diagnosis cause the childhood tuberculosis a growing burden for society. Directly Observed Treatment Short course (DOTS) strategy is one of the largest public health programmes found to be beneficial against tuberculosis. Anti-tubercular treatment shows greater level of efficacy high degree of toxicity; however combination treatment, especially during the intensive phase of therapy may produce severe adverse events. First line therapy of Tuberculosis leads to serious adverse effects. Serious adverse effects are less in children receiving drug therapy. Major adverse event associated with anti TB drugs is hepatotoxicity. Keywords: Tuberculosis, DOTS, isoniazid, rifampicin, pyrazinamide, ethambutol and streptomycin

Untapped Possibilities of Antiischemic Therapy after Acute Myocardial Infarction: Data from the PROFILE-IM Register

Aim. To evaluate the practice of prescribing antianginal/antiischemic therapy in patients who, after acute myocardial infarction (AMI), retained typical clinical manifestations of stable angina.Material and methods. The registry includes 160 patients who applied to the polyclinic from March 01, 2014 to June 30, 2015 after suffering an AMI. Anti-ischemic therapy was evaluated in patients with typical angina pectoris.Results. Based on the survey, typical angina attacks were detected in almost a quarter of patients (38 patients – 23.8%). According to the main indicators, patients with typical angina pectoris practically did not differ from the rest of the group of patients, with the exception of a significantly larger proportion of patients with diagnosed ischemic heart disease before AMI and patients under dispensary supervision. Almost all patients received beta-blockers (97.4%), about a third of patients received calcium antagonists (28.9%) or long-acting nitrates (34,2%). During the first year after AMI, second-line drugs were practically not prescribed to enhance antianginal therapy. According to international non-proprietary names, the choice of doctors tended to prescribe bisoprolol, amlodipine, and isosorbide dinitrate. Exacerbation of the disease course with hospitalization for unstable angina pectoris was recorded in 9 (23.7%) patients from the group with typical angina pectoris and in 5 (4.1%) patients in the rest of the group (p&lt;0.001).Conclusion. In real clinical practice, only a small part of patients with typical angina pectoris receive drug therapy that corresponds to evidence-based medicine; therefore, the unique possibilities of antianginal (anti-ischemic) therapy often remain unrealized.

Anxiety, depression and post-traumatic stress disorder management after critical illness: a UK multi-centre prospective cohort study

BackgroundSurvivors of critical illness have significant psychopathological comorbidity. The treatments offered by primary health care professionals to affected patients are unstudied.AimTo report the psychological interventions after GPs received notification of patients who showed severe symptoms of anxiety, depression or Post-Traumatic Stress Disorder.MethodsDesign: Multi-centre prospective cohort sub-study of the ICON study. Setting: NHS primary care in the United Kingdom. Participants: Adult patients, November 2006–October 2010 who had received at least 24 h of intensive care, where the general practitioner recorded notification that the patient had reported severe symptoms or caseness using the Hospital Anxiety and Depression Scale (HADS) or the Post-Traumatic Stress Disorder Check List-Civilian (PCL-C). Interventions: We notified general practitioners (GPs) by post if a patient reported severe symptoms or caseness and sent a postal questionnaire to determine interventions after notification. Main outcome measure: Primary or secondary healthcare interventions instigated by general practitioners following notification of a patient’s caseness.ResultsOf the 11,726 patients, sent questionnaire packs containing HADS and PCL-C, 4361 (37%) responded. A notification of severe symptoms was sent to their GP in 25% (1112) of cases. Of notified GPs, 65% (725) responded to our postal questionnaire. Of these 37% (266) had no record of receipt of the original notification. Of the 459 patients where GPs had record of notification (the study group for this analysis), 21% (98) had pre-existing psychopathology. Of those without a pre-existing diagnosis 45% (162) received further psychological assessment or treatment. GP screening or follow-up alone occurred in 18% (64) whilst 27% (98) were referred to mental health services or received drug therapy following notification.ConclusionsPostal questionnaire identifies a burden of psychopathology in survivors of critical illness that have otherwise gone undiagnosed following discharge from an intensive care unit (ICU). After being alerted to the presence of psychological symptoms, GPs instigate treatment in 27% and augmented surveillance in 18% of cases.Trial registrationISRCTN69112866 (assigned 02/05/2006).

The Effect of Multi-Vitamin/Multi-Mineral Supplementation on Nutritional Status in Older Adults Receiving Drug Therapies: A Double-Blind, Placebo-Controlled Trial

Polypharmacy regimens may increase the susceptibility of older adults to micronutrient inadequacy and deficiency via impairment of nutritional status. We hypothesized that a multi-vitamin-mineral supplement (MVMS) could improve nutritional status in older adults prescribed diuretics, metformin, and/or proton pump inhibitors (PPIs). We conducted a randomized, double-blind, placebo controlled, parallel clinical trial in which eligible subjects were instructed to consume either a MVMS or placebo for 16 wk. Fasting blood was collected at baseline, 8, and 16 wk and the status of selected vitamins and minerals determined. Thirty-five and 19 men and women aged 45–75 yrs in the in MVMS and placebo arms, respectively, completed the trial. The mean total number of medications among the three drug classes taken by participants did not differ between two groups. The status of vitamins B1, B12, C and folate and calcium, copper, magnesium and zinc at baseline were within normal ranges. The MVMS group had a greater change in nutrient status after 16 wk compared to the placebo group for serum folate (7.5 vs. –1.6 ng/mL, p < 0.0001), vitamin B12 (159.2 vs. –33.9 pg/mL, p = 0.007), and plasma vitamin C (0.2 vs. 0.0 mg/dL, p = 0.004). Other measured vitamins and minerals were not significantly changed during the intervention. In conclusion, the status of vitamins B12, C and folate improved with MVMS but remained within normal ranges in older adults taking diuretics, metformin, and/or PPIs.

Serum changes in pyridinoline, type II collagen cleavage neoepitope and osteocalcin in early stage male brucellosis patients

Musculoskeletal changes are the most common clinical manifestation of brucellosis. The main objective of this study was to provide a better understanding of this disease, while also attempting to identify potential markers that can identify the early stage musculoskeletal changes associated with human brucellosis. In this case–control study, 41 male early-stage brucellosis patients (within 6 months of diagnosis) who had not received drug therapy and 44 matched controls were examined. Venous blood samples were collected and serum pyridinoline (PYD), type II collagen cleavage neoepitope (C2C) and osteocalcin (OC) levels were quantified using an enzyme-linked immunosorbent assay (ELISA). In the brucellosis group, the median serum levels of PYD (278.53 µg/L), C2C (82.23 µg/L) and OC (8.41 µg/L) were significantly elevated relative to the control group (Z = 5.686, 3.997, 3.579; P = 0.000). Serum PYD, C2C, and OC levels were increased in early-stage male brucellosis patients, and these factors appear to have promise as potential indicator biomarkers that can reflect the osteoarticular changes that occur in the early stage of human brucellosis.

Experience of application of T2-mapping MRI assessment of inflammatory myopathies

Specialized quantitative MRI techniques allow identifying structural changes in individual muscles in inflammatory myopathies.Aim. To evaluate the role of T2 mapping MRI and to evaluate specific changes in T2 relaxation time in patients with inflammatory myopathies at different stages of the disease process.Methods. T2 mapping technique for assessing structural changes in muscle tissues was optimized for the Philips “Ingenia” 3.0T MR scanner. T2 relaxation (T2rt) time of the thigh and lower leg muscles (muscule rectus femoris, m. vastus lateralis, m. adductor magnus, m. soleus, m. tibialis anterior, medial and lateral head of m. gastrocnemius) was assessed in the control group (n = 9) and the study group (n = 6). Patients recruited in the study group suffered from dermatomyositis and polymyositis of various severity.Results. The following values of T2rt were obtained in the control group: m.rectus femoris – 78.2±6.9 ms, m.vastus lateralis – 79.5±4.8 ms, m.adductor magnus – 77.1±4.4 ms, m. soleus – 92.9±4.3 ms, m. tibialis anterior – 89.4±1.3 ms, m.gastrocnemius medial head – 93.7±2.4 ms, m.gastrocnemius lateral head – 92.9±3.5 ms. Patients with polymyositis and dermatomyositis showed an increase in the signal intensity on STIR and PD-SPAIR in the structure of m.soleus, m. gastrocmenius, m.rectus femoris, as well as a significant increase in T2rt of 40–49% (p&lt;0.01). T2rt values did not differ in patients with polymyositis who received drug therapy and had clinical remission. Patients with dermatomyositis who had laboratory remission along with the deterioration reported an increase in T2rt in the structure of long spine muscles, m. rectus femoris and m. vastus lateralis equal to 15–25% (p&lt;0.05). However, none significant changes in the signal characteristics on STIR and PDSPAIR were reported.Conclusion. The sensitivity of the reported technique in the detection of sub-acute swelling of muscle tissue in the absence of significant changes in signal characteristics on routine MR sequences had been shown.

Risk groups for multiple vitamin and mineral deficiencies in the population

Lack of several vitamins, calcium, magnesium, zinc, iodine and other minerals in the diet now is typical for the majority of the adult and childrens population of Russia, regardless of where they live, throughout the year. In addition, population groups that are additionally at risk of developing micronutrient deficiencies exist. Children 23 years old when switching to food from a common table, early puberty, pregnant and lactating women, persons with food intolerances and allergies, persons on elimination diets (vegetarians, vegans, etc.), or enriching the diet with dietary fiber, obese persons (reduced by caloric content of the diet), persons with gastrointestinal diseases (sparing diets, persons receiving drug therapy, persons with increased physical and psycho-emotional stress, the elderly, persons observing long-term religious fasts, athletes controlling body weight are among them. The role of each micronutrient depends on the sufficiency of the body with other micronutrients involved in the metabolism or necessary for the realization of the final function in the body. A recognized and scientifically grounded way to improve micronutrient status is the enrichment of the diet with vitamins and minerals. In the absence of mandatory fortification of mass-market foods the use of vitamin and mineral supplements is a great idea. The selection criterion is a complete set of vitamins and microelements, the deficiency of which is characteristic for a particular group of the population, and in doses close to the physiological needs of the body.