Continued Use Of Medication Research Articles

Factors affecting ageism and depression levels in individuals aged 65 and over living in society

Abstract Background The aging process is perceived negatively by some people. This perception prevents/reduces the happiness that can be gained from the aging process. As a result, depressive symptoms may occur. Therefore, this study aimed to examine the factors affecting ageism and depression levels in individuals aged 65 and over living in society. Methods The sample of the research, which was conducted with a cross-sectional, descriptive design, consisted of 287 individuals aged 65 and over living in a neighborhood on the Anatolian side of Istanbul. Data were collected with socio-demographic form, Ageism Questionnaire and Yesavage Geriatric Depression Scale-15. T test, variance analysis and chi-square test were used to analyze the data. Ethical permissions were obtained. Results Moderate depression was found in 27.5% of individuals with a mean age of 70.80±5.42. Individuals scored below the average (18.48±8.14) on the ageism survey. Ageism scores were higher for men, those aged 85 and over, those with poor economic conditions, those with chronic diseases, those hospitalized in the last year, those with severe and moderate depression, and those who needed help with daily tasks (p < 0.05). A statistically significant difference was found between age groups, chronic disease, continuous medication use, hospitalization in the last year, working status, need for help with daily tasks, economic status and depression levels (p < 0.05). Ageism scores of those with severe and moderate depression were found to be high (F = 3.43;p=0.017). Conclusions Variables that are effective in ageism and depression are being aged 85 and over, having a poor economic situation, having a chronic disease, needing help with daily tasks, and receiving inpatient treatment in the last year. The results of this study show that more efforts and resources are needed within the scope of political and social services to reduce ageism in society and the level of depression in older individuals. Key messages • As the level of depression in elderly individuals increases, ageism increases. • Advanced age, economic status, chronic disease, hospitalization and dependence on daily tasks affect depression and ageism.

Beliefs surrounding the use of inhaled asthma medication in The Gambia: a qualitative study of asthma patients and healthcare workers

Asthma-related mortality is high in low- and middle-income countries. Little is known about public perceptions of inhaled medicines. We conducted semi-structured interviews with asthma patients and healthcare workers at three secondary care facilities in The Gambia, between August and November 2022. Thematic analysis was used to interpret these data. A total of 20 patients and 15 healthcare workers were interviewed. Both groups noted limited access to inhalers was an issue resulting in continued use of oral medications. Some patients recognised the benefits of inhalers, yet beliefs that inhalers were dangerous were common. Reliance on oral short-acting beta agonists meant patients saw asthma as a recurrent acute condition resulting in an emphasis on hospital management with little awareness of inhaled preventative medicines. Increasing access to inhaled medicines has the potential to reduce costly avoidable admissions, but socio-cultural factors, in addition to medication supply, need addressing.

Does size matter? A single institution's comparison of Aquablation in prostates greater than or less than 150 mL.

Surgical management options for lower urinary tract symptoms due to benign prostatic hypertension have remained limited in prostates of large volume. The advent of the Aquablation has created a potential minimally invasive option for treatment in prostates of all volumes. Thus, this study aims to evaluate outcomes and complications of Aquablation in clinical practice based on prostate volume. Collected variables included adverse events with Clavien-Dindo classifications, transfusion rates, surgical retreatment rates, continued medication use postoperatively, and International Prostate Symptom Score (IPSS) with Quality-of-Life indicator. Aquablations were stratified by preoperative prostate volume. One hundred seventy-four men were included in the study. The average postop decrease in IPSS was 10.28, with a 2.02 point decrease in Quality-of-Life at 1 year. Postop increase in peak urinary flow rate was 7.65 mL/s for an average of 16.44 mL/s. Hemoglobin drop average was 1.78 g/dL, but only 2.3% of patients required a transfusion. 12.9% of patients required surgical retreatment. Six months after Aquablation, 22.9% and 12.9% of patients continued taking Alpha-blockers and Androgen receptor inhibitors, respectively. Adverse events occurred in 33 patients (19.0%). Eighteen patients were excluded from secondary analysis due to unrecorded prostate volume, leaving 123 with volumes <150 mL and 33 with volumes ≥150 mL. Groups were comparable with respect to length of stay, adverse events, blood transfusion, IPSS with Quality-of-Life indicator preoperative and postoperative, postop peak urinary flow, and postop alpha-blocker use. Larger prostates had a higher rate of adverse events, retreatment, postop hemoglobin drop, and postop use of finasteride. Aquablation is a viable treatment option for benign prostatic hyperplasia. Efficacy, safety, subjective outcomes, and adverse event rates were not impacted by prostate volume. However, size does matter as prostates ≥150 mL had higher surgical retreatment rates and postop finasteride use.

8043 IgG4-related disease with isolated involvement of the pituitary gland: case report

Abstract Disclosure: J.M. Ramos: None. Female patient, 36 years old, presented to our service complaining of a headache lasting five weeks, mainly in the frontal and left periorbital region, radiating to the occipital region. The pain was intense and intermittent, lasting about 40 minutes. No nausea or vomiting was reported, but the patient experienced dizziness and double vision. During the symptomatic interview, the patient mentioned increased thirst and urinary volume. In her medical history, she denied comorbidities, with only frequent episodes of tension-type headaches. She had no continuous medication use and no known drug allergies. The patient had undergone two cesarean sections, with the last one in December 2021. On physical examination, she had horizontal binocular double vision in all three gazes to the left, accompanied by pain during eye movement. Increased facial sensitivity on the left in branches V1 and V2 was observed. The rest of the physical examination showed no abnormalities. Initial general laboratory tests were normal. Evaluation of pituitary function was mostly normal, except for slightly elevated prolactin. A cranial MRI revealed an expansive lesion with sellar and suprasellar components measuring 1.2x1.1x1.2cm. Additional imaging of the sella turcica showed an intra- and suprasellar expansive lesion, predominantly isointense on T1, hyperintense on T2, with discreetly heterogeneous enhancement with gadolinium. In consultation with the neuroradiology team, a hypointensity on T2 at the left margin of the pituitary was noted, suggesting an inflammatory etiology. Based on this, laboratory tests were conducted, and treatment with methylprednisolone 1g per day for 7 days was initiated. After treatment completion, the IgG4 level was found to be 146.7 mg/dL (upper limit of reference: 86 mg/dL). A follow-up MRI, five days after the steroid pulse therapy, showed a reduction in lesion size to 0.8 cm in the cranio-caudal dimension, with a preserved appearance of the optic chiasm. The patient experienced considerable symptom improvement and was discharged with oral corticosteroids and a scheduled initiation of rituximab. The patient meets criteria confirming the diagnosis of IgG4-related hypophysitis, a rare condition representing 30% of hypophysitis cases. Isolated pituitary involvement is even rarer, and its association with diabetes insipidus has been described. Treatment involves corticosteroids, and rituximab can be considered, especially in recurrent cases. Presentation: 6/3/2024

Prevalence and Risk Factors of Pressure Injury in Home Care Patients

The present study aimed to determine the prevalence of pressure injury in home care patients and the risk factors that affected its occurrence. The study was conducted in a descriptive-cross-sectional design to 6 months between November 2021 and May 2022 with 170 home care patients who were registered to the Home Health Care Service at a public hospital a city western in Turkey and met the inclusion criteria. The data were collected with the in-person interview method by using the investigator-created Patient Evaluation Form, National Pressure Injury Advisory Panel (NPIAP) Pressure Injury Staging System, and Glasgow Coma Scale (GCS). The prevalence of pressure injury was found to be 33.5% in the study. The prevalence of pressure injury was statistically and significantly higher in the patients younger than 75 years of age ( p = .043), underweight, and with normal Body Mass Index (BMI) ( p = .009). The prevalence of pressure injury was found to be lower in those who were oriented according to GCS ( p = .000). No statistically significant differences were detected between the presence of pressure injury and gender, education levels, marital status, income status, presence of systemic or chronic disease, continuous medication use, type of medication used, and duration of receiving home care services ( p &gt; .05). The results of the present study showed that the prevalence of pressure injury was high in home care patients and that age, BMI, and level of consciousness variables were factors that influenced the development of pressure injury.

Lifestyle and health vulnerabilities of people with disabilities in the COVID-19 pandemic

Objective: To analyze the vulnerabilities related to lifestyle and health of people with disabilities in the COVID-19 pandemic. Methods: This cross-sectional study analyzed the characteristics and health perceptions of 250 people with disabilities based on home visits using the reference network or snowball sampling strategy. A questionnaire was used to collect data on type of disability, cause, duration, physical activity, smoking and alcohol consumption, use of continuous medication, and pre-existing diseases. The chi-square test was used to analyze the data for compliance, frequency, percentages and p-values. Results: People with motor disabilities, acquired over the course of their lives and related to disease complications, predominated. With regard to health vulnerabilities, lack of physical exercise and continuous medication use were predominant. However, most respondents reported that they did not smoke or drink alcohol. Conclusion: The health and lifestyle vulnerabilities of people with disabilities identified in this study could help in the development of actions aimed at promoting the quality of life and health of this population, as well as in the identification of risk factors to be considered when designing health policies.

Improved Health Care Utilization Among Men With Depression Undergoing Inflatable Penile Prosthesis in a U.S. Commercial Population.

We evaluated depression-related health care resource utilization and antidepressant prescription medication utilization among commercially insured men in the United States who underwent inflatable penile prosthesis (IPP) implantation between January 1, 2007 and December 31, 2020, and who received a depression diagnosis in the year preceding the IPP procedure. A total of 11,177 patients received an IPP during the index period, 808 of whom were diagnosed with depression. A statistically significant reduction in overall depression-related health care visits occurred from pre- to post-IPP, decreasing from 4.9 to 3.8, p < .001. In addition, there was a significant reduction in depression-related inpatient visits (0.07 vs. 0.03, p = .02) and office visits (4.25 vs. 3.29, p < .001) from pre- to post-IPP. Of the 678 men who received an antidepressant medication within 1 year prior to their IPP date, 15% stopped antidepressant medication use entirely post-IPP. Among patients with continued antidepressant medication use post-IPP (n = 574), there was a significant decrease in the number of prescriptions (7.55 vs. 8.09, p < .0001) and refills (7.52 vs. 8.11, p = .0015), with a higher likelihood of discontinuation (17.6% vs. 10.5%, p < .0001) and a lower proportion of days covered (0.79 vs. 0.83, p = .0004) post-IPP compared with pre-IPP. In conclusion, IPP was associated with reduced depression-related health care utilization and antidepressant medication use among recipients. This suggests potential mental health benefits for IPP recipients beyond restoration of erectile function. Comprehensive insurance coverage for IPP, especially for men with depression, may be beneficial to both patients and insurers.

What comes next? A cross-sectional study on post-discharge referrals of adolescents treated in emergency services following a suicide attempt.

To assess the proportions and associated factors of different post-discharge referrals among adolescents treated in the emergency department after a suicide attempt. Observational, cross-sectional retrospective study. We conducted a study using the medical records of 140 adolescents treated for a suicide attempt between January 2015 and May 2023 in a Brazilian emergency department, focusing on post-discharge referrals, defined as discharge without referral, unaddressed referral and referral addressed to the network. Associations between the outcomes and other variables were analysed using a Poisson regression model. Discharges without referrals prevailed, followed by addressed and unaddressed referrals. Regression models showed associations between post-discharge and age, prior continuous use of psychotropic medications, location of care, continued suicidal ideation at discharge and evaluation by a multi-professional team. A high number of adolescents were discharged from emergency departments without co-ordination with the mental health network, and the involvement of the multi-professional team was positively associated with addressed referrals. This study informs healthcare professionals by raising awareness of their practices in discharging adolescents after suicide attempts in emergency departments, with the possibility of improving care quality and reducing the likelihood of readmission. STrengthening the Reporting of OBservational studies in Epidemiology (STROBE). No patient or public contribution.

Antidepressant Medication Use for Treatment of Chronic Ocular Pain.

Chronic ocular pain (COP) is a leading cause of eye care visits in the US and has a substantial impact on quality of life and visual functioning. Although many conditions underlie COP, such as dry eye disease or post-herpetic neuralgia, some people experience pain without significant ocular signs on examination or known risk factors (eg, traumatic injury). Antidepressant medications that act primarily on the central nervous system, such as tricyclic antidepressants and serotonin and norepinephrine reuptake inhibitors, are often used to treat patients with COP, but a recent Cochrane review and network meta-analysis investigating 25 different antidepressants concluded that only two serotonin and norepinephrine reuptake inhibitors, have sufficient data to support their use in chronic pain. For all other medications, the evidence was of low certainty. We contend that while these medications are not a cure-all for chronic pain or COP, it is premature to conclude that these medications have no role in their treatment. We provide a rationale for continued use of antidepressant medications as part of a multimodal targeted treatment for patients with COP.

Factors influencing deprescribing in primary care for those towards the end of life: A qualitative interview study with patients and healthcare practitioners.

For people with limited lifetime expectancy, the benefit of many medications may be outweighed by their potential harms. Despite the relevance of reducing unnecessary medication use, deprescribing is poorly enacted in primary care practice. This study aims to describe factors, as identified by primary care professionals and patients, that influence deprescribing in the last phase of life. Semi-structured interviews were conducted and analysed using a thematic approach. This study was performed in primary care settings, including general practices, hospices and community care teams in The Netherlands. Purposefully identified primary care professionals (general practitioners, pharmacists, nurses) and patients with limited lifetime expectancy due to advanced chronic illness or cancer and their caretakers were interviewed. Three themes emerged detailing factors influencing deprescribing in the last phase of life in primary care: (1) non-maleficence, the wish to avoid additional psychological or physical distress; (2) reactive care, the lack of priority and awareness of eligible patients; and (3) discontinuity of care within primary care and between primary care and specialty care. Deprescribing is an incremental process, complicated by the unpredictability of life expectancy and attitudes of patients and health care professionals that associate continued medication use with clinical stability. Opportunities to facilitate the deprescribing process and its acceptance include the routinely systematic identification of patients with limited life expectancy and potentially inappropriate medications, and normalisation of deprescribing as component of regular primary care, occurring for all patients and continuing into end-of-life care.

Physical activity level and quality of life in older women during the pandemic

The aim of the study was to identify the level of physical activity and quality of life in elderly women during the pandemic. A total of 2,269 women took part (X= 66.46 ± 5.73 years). A sociodemographic questionnaire, the WHOQOL-Old for quality of life and the Baecke questionnaire for level of physical activity were used. The study population was 57.14% mulatto; 35.71% single; 40% literate; 50% retired; 60% with a monthly income ≤ 2 salaries (≤ US$200.00). 77.14% reported having some pre-established illness or continuous use of medication, and 86% had a sick parent. The results show that 90% of the participants had a low physical activity index (PAI) (X= 4.44 ± 3.79; PAI ≤ 9.11) and 61.4% had an average overall quality of life (OHQoL) (X= 13.56 ± 1.75; OHQoL between 10 - 14). It was concluded that the pandemic has a negative effect on the physical activity of elderly women, causing a decline in quality of life.

The Effect of Hyperemesis Gravidarum on Macular Thickness, Corneal Thickness, and Intraocular Pressure in Pregnancy.

Physiological changes in intraocular pressure as well as in the cornea and macula may occur during pregnancy. Therefore, we decided to investigate the effect of hyperemesis gravidarum on macular thickness, corneal thickness and intraocular pressure (IOP). A total of 110 people, 55 of whom were diagnosed with hyperemesis gravidarum and 55 of whom were in the control group, were included in the study. The inclusion criteria for the study were as follows: first trimester (8-14 weeks of gestation) pregnancy with positive fetal heartbeat and no history of systemic disease, no continuous use of medication, diagnosis of hyperemesis gravidarum (ketonuria and weight loss of more than 3 kilograms or 5% of body weight), body mass index (BMI) within normal limits, age between 18 and 40, no alcohol use or smoking. In the HG group compared to the control group, there was a difference between the CCT values of both the right and left eyes (p<0.01). There was a difference in both right and left IOP values in patients in the HG group compared to the control group (p<0.05), and there was no correlation between ketonuria scores and right and left eye CCT values, right and left eye macular thickness, and right and left eye pressure in patients diagnosed with HG (p>0.05). In hyperemesis gravidarum, changes occur in IOP, corneal thickness, and macular thickness. In ophthalmic examinations in the pregestational period, especially for women with systemic disease, it may be important for clinicians to take the necessary precautions in this regard.

Initiation and continuation of pharmacological therapies in patients hospitalized for heart failure in Japan.

Currently, the utilization patterns of medications for heart failure (HF) after worsening HF events remain unelucidated in Japan. Here, we conducted a retrospective cohort study evaluating the changes in HF drug utilization patterns in 6 months before and after hospitalizations for HF. The adherence to newly initiated HF medications was evaluated based on the proportion of days covered (PDC) and persistence as continuous treatment episodes among new users. The study included 9091 patients hospitalized for HF between January 2016 and September 2019, including 2735 (30.1%) patients who were newly prescribed at least one HF medication after hospitalization. Despite increases in the use of foundational HF therapy (beta-blockers, angiotensin-converting-enzyme inhibitors/angiotensin receptor blockers, or mineralocorticoid receptor antagonists), 35.6% and 7.6% of patients were treated with the HF foundational monotherapy or diuretics alone after hospitalization, respectively. The mean PDC of newly initiated HF medications ranged from 0.57 for thiazide diuretics to 0.77 for sodium-glucose cotransporter-2 inhibitors. Continuous use of HF medications during the first year after initiation was observed in 30-60% of patients. The mean PDC and one-year continuous HF medication use were consistently lower in patients aged ≥ 75years and in patients with a history of HF hospitalization for all HF medication classes except for tolvaptan and digoxin. Despite the guideline recommendations of HF pharmacotherapy, both treatment and adherence were suboptimal after HF hospitalization, especially in vulnerable populations such as older patients and those with prior HF hospitalizations.

Chemical ciliary body ablation in dogs with chronic glaucoma and anterior lens luxation: A retrospective review from 2017 to 2022.

To evaluate the clinical outcomes of chemical ciliary body ablation (CBA) in dogs with chronic glaucoma and concurrent anterior lens luxation and to investigate adverse ocular effects of this procedure. Retrospective review of 17 dogs (18 eyes) with chronic glaucoma and concurrent anterior lens luxation treated with intravitreal gentamicin with or without dexamethasone sodium phosphate or triamcinolone acetonide. Data collected included signalment, concurrent ocular disease, topical medications prescribed, follow-up duration, and intraocular pressure (IOP) pretreatment, posttreatment, and at the last follow-up visit. Success was defined as an IOP <25 mmHg with no additional procedures or ocular hypotensive medications at the last examination to date. The success rate for CBA in dogs with chronic glaucoma and concurrent anterior lens luxation was 88.9% without the need of additional surgical or ocular hypotensive therapies. Glaucoma was suspected to be secondary to lens luxation in 72.2% of cases. The most common postoperative complications were phthisis bulbi (50.0%), keratoconjunctivitis sicca (27.8%), and uveitis (27.8%). Long-term management with topical nonsteroidal anti-inflammatories, corticosteroids, and/or immunomodulators was needed in 70.6% of cases. CBA with intravitreal injection of gentamicin is effective at maintaining an IOP <25 mmHg in dogs with chronic glaucoma and concurrent anterior lens luxation. Management of postoperative sequelae commonly requires continued use of topical medications.

Dermatologists' and Rheumatologists' Adherence to the Latest Recommendations for Screening of Hydroxychloroquine Retinopathy in Saudi Arabia: A Cross-Sectional Study.

Hydroxychloroquine (HCQ) is used to manage the symptoms of inflammatory rheumatic and dermatologic disorders. However, HCQ retinopathy is aserious side effect becauseeven after the drug is discontinued, irreversible vision loss may occur and may continue to progress.According to the American Academy of Ophthalmology (AAO),the recent recommendation for HCQ dosing is ≤5 mg/kg of real body weight, with baseline ophthalmologic screening during the first year of HCQ treatment and yearly screening after five years of continuous use of HCQ medication, unless the patient is at high risk or symptoms have developed.Nonetheless, this study aims to assess dermatologists' and rheumatologists' adherence in Saudi Arabia to the 2016 AAO HCQ retinal toxicity guidelines. A questionnaire-based cross-sectional study was conducted on dermatologists and rheumatologists in Saudi Arabia. It was conducted between August and September 2022 and questionnaires were sent to dermatologists and rheumatologists via their professional emails or accounts. The collected sample consisted of 635 participants; males and females represented 54% and 46%, respectively; 47.6% were consultants; 50.1% were rheumatologists; and 49.9% were dermatologists. Approximately 28.2% of the participants reported treating one to three patients with HCQ in the previous year. Only 45.4% of the respondents stated that the ideal recommended HCQ dose for reducing the risk of retinopathy is "≤ 5 mg/kg of the real body weight." More than 50% of the respondents stated that systemic lupus erythematosus was the most common disease for which they used HCQ. Additionally, 36.5% of the physicians screened patients during the first year of HCQ treatment. We found significant associations between practice levels and specialty practice-related questions with a p-value of less than 0.05, except for the specialty practice-related question, "What is the most common disease for which you use HCQ?" with a p-value of 0.074. Also, we found significant associations between all demographic variables and screening-related variables with a p-value of less than 0.05, with two exceptions: no significant associations were found between specialty area and the screening-related question, "Do you recommend screening tests for all patients starting treatment with HCQ?" at p = 0.270, and gender and the screening-related question, "When would you recommend screening tests for a patient without risk?" at p = 0.142. Dermatologists and rheumatologists in Saudi Arabia have shown poor adherence to the most recent AAO recommendations. Educating physicians and patients about the AAO guidelines is needed for HCQ to be used in a way that is both effective and safe.

Care transition for patients admitted to hospital due to COVID-19 and its relationship with clinical characteristics

Objective To analyze care transition (CT) and its relationship with the clinical characteristics of patients admitted to hospital due to COVID-19. Methods This is a cross-sectional study, carried out in a general hospital, with 165 patients admitted to hospital due to COVID-19 and who were discharged home. Participants were those who had been admitted to hospital for at least 24 hours, over 18 years of age, with telephone access after discharge. Those who were discharged by transfer, who died or those without cognitive conditions were excluded. Data collected between March and July 2021, using a sociodemographic and clinical questionnaire as well as Care Transitions Measure-15. Descriptive and inferential statistical analysis was applied. Results The overall mean of Care Transitions Measure-15 was considered satisfactory (71.8±7.45). The Important preferences factor obtained the highest mean (80.5± 9.84) and the Care Plan factor the lowest (57.5± 11.4). Significant statistical differences were found when the CTM-15 factors were associated with the clinical variables: duration of chronic disease (p&lt;0.03); presence of clinical artifact (p&lt;0.040); use of continuous medication (p&lt;0.029). Readmission had a significant difference in the factors Health management preparation (p&lt;0.045), Important preferences (p&lt;0.027) and Care plan (p&lt;0.032). Conclusion Patients admitted to hospital due to COVID-19 assessed the general CT as satisfactory and the clinical variables, length of chronic illness, clinical artifact, continuous medication and readmission interfered in the CT of these patients.

Surgical Aspects of Sleeve Gastrectomy Are Related to Weight Loss and Gastro-esophageal Reflux Symptoms

IntroductionA large variation in outcome has been reported after sleeve gastrectomy (SG) across countries and institutions. We aimed to evaluate the effect of surgical technique on total weight loss (TWL) and gastro-esophageal reflux disease (GERD).MethodsObservational cohort study based on data from the national registries for bariatric surgery in the Netherlands, Norway, and Sweden. A retrospective analysis of prospectively obtained data from surgeries during 2015–2017 was performed based on 2-year follow-up. GERD was defined as continuous use of acid-reducing medication. The relationship between TWL, de novo GERD and operation technical variables were analyzed with regression methods.ResultsA total of 5927 patients were included. The average TWL was 25.6% in Sweden, 28.6% in the Netherlands, and 30.6% in Norway (p < 0.001 pairwise). Bougie size, distance from the resection line to the pylorus and the angle of His differed between hospitals. A minimized sleeve increased the expected total weight loss by 5–10 percentage points. Reducing the distance to the angle of His from 3 to just above 0 cm increased the risk of de novo GERD five-fold (from 3.5 to 17.8%).ConclusionSmaller bougie size, a shorter distance to pylorus and to the angle of His were all associated with greater weight loss, whereas a shorter distance to angle of His was associated with more de novo reflux.Graphical

Self-medication practice and associated factor among adult household members in Gurage Zone, Southern Ethiopia, Ethiopia, 2022: a cross-sectional study

Background: Self-medication refers to the use of medicinal products by the consumers to treat selfrecognized disorders or symptoms, or the intermittent or continued use of medication is not prescribed by a physician for chronic or recurring diseases or symptoms. Globally, the prevalence of selfmedication is estimated to be around 27 – 99.4% according to different studies. Methods: A cross-sectional study was conducted to assess self-medication practice and associated factors among adult household members of Gubre town from April 28 to June 27, 2022. Data collection from 399 households was conducted by means of a systematic random sampling technique using a pre-tested questionnaire. Result: Among 398 respondents, 113 (28.4%) of them were found to practice self-medication. Two hundred and forty-three (61.05%) participants reported to have fallen sick in the 2 weeks before the survey. Being married (adjusted odds ratio [AOR] = 1.599, 95% confidence interval [CI]: 1.09 – 2.621), being literate (AOR = 1.672, 95% CI: 1.032 – 2.01), perceiving self-medication as an acceptable practice (AOR = 1.652, 95% CI: 1.32 – 1.887), peer influence (AOR = 1.54, 95% CI: 1.304 – 2.321), and access to medical information (AOR = 1.452, 95% CI: 1.263 – 1.570) were significantly associated with self-medication practice. Conclusion: Nearly a quarter of the study participants practice self-medication. Being married, being literate, perceiving self-medication as an acceptable practice, peer influence, and access to medical information were significantly associated with self-medication practice. Relevance for Patients: Tailored interventions designed by policymakers, program designer, and implementers should aim to reduce or eliminate non-prescribed drug use among the community through the education on the impact of self-medication on individual health.

Case report: juvenile paracoccidioidomycosis with intestinal involvement

Introduction: Contact of Paracoccidioides sp. with the human organism presents in a variety of clinical forms of the disease. Intestinal clinical manifestation is found in 10 to 30% of cases, commonly in juvenile form. This case report seeks to describe a patient with juvenile paracoccidioidomycosis with atypical intestinal involvement. Case report: A 14 years old woman with an updated vaccination schedule and no reports of chronic diseases, allergies or continued use of medications, presented a diarrheal condition that was characterized by pasty stools, where episodes became gradually more intense, associated with episodes of hematochezia, retroauricular lymphadenopathy on the right, as well as shivering and fever. A colonoscopy revealed multiple polypoid formations, ulcerations and friability throughout the colon. After biopsy results, the diagnosis of Paracoccidioidomycosis with intestinal involvement was established. Due to the wasting syndrome, anemia and persistent diarrhea, the patient was hospitalized for blood transfusion and intravenous treatment with conventional Amphotericin B. Discussion: Unlike what was presented by the patient in this case, involvement of the gastrointestinal tract is uncommon in paracoccidioidomycosis. This disease presents a range of clinical manifestations, which makes diagnosis difficult. Since this type of infection is not always considered, it may result in underdiagnosed cases, especially in women and young adults. The prognosis depends on the initial severity of the disease, the presence of comorbidities and the treatment used. Conclusion: Especially for the intestinal form, earlier treatment will better the results. The disease has a good chance of effective treatment using antifungal therapy.

Case Report of Hemangiopericytoma Development After Prolonged Use of Oclacitinib Maleate in a Dog with Atopic Dermatitis and Iatrogenic Hyperadrenocorticism

The canine atopic dermatitis is a chronic allergic disease that affects dogs genetically predisposed. Clinically, dogs present pruritus symptoms that lead to self-trauma. The most commonly used drugs are glucocorticoids to control pruritus, however, due to the genetic nature of the disease, there is a need for continuous and lifelong use of medication, which can lead to the development of iatrogenic hyperadrenocorticism. Therefore, others drugs such as cyclosporine, oclacitinib maleate and lokivetmab are recommended. The oclacitinib maleate is an inhibitor of the intracellular signaling pathway mediated by enzymes of the Janus kinase family, responsible by the activation of T lymphocytes and synthesis of cytokines with proinflammatory and pruritic activity and cytokines that participate in survival, development, growth and differentiation of T lymphocytes and cytokines that participate in survival, development, growth and Its use is restricted to dogs with atopic dermatitis that do not present an infectious or tumoral condition. This case report describes a 15-year-old female Lhasa Apso dog initially treated with glucocorticoids who developed iatrogenic hyperadrenocorticism. After replacement with oclacitinib maleate and its prolonged use, the dog presented the growth of three large nodules defined by histological analysis as hemangiopericytoma.