Continued Use Of Medication Research Articles

Prediction of Carcinogenic, Mutagenic, Hepatotoxic, and LD50 Toxicity of Herbs Euphorbia hirta and Camellia sinensis Leaf Compounds as In Silico Antihypertensive Agents

Hypertension is defined as an increase in systolic blood pressure above 140 mmHg and diastolic blood pressure above 90 mmHg. Treatment for hypertension is lifelong, and continuous use of conventional medications can lead to the accumulation of drugs, potentially cautilizing adverse effects on the body compared to traditional treatments. The herbal tea formulation of Euphorbia hirta herbs and Camellia sinensis leaves can lower blood pressure due to their high antioxidant activity, which is associated with hypertension-related diseases, including compounds like quercetin and myricetin. This research serves as an initial screening to assess safety and minimize side effects of the active compounds in E. hirta and C. sinensis, which are beneficial as antihypertensive agents, through in silico analysis. Toxicity predictions utilizing the ProTox II, pkCSM, and Vega-QSAR platforms, which have been verified to meet the acceptability criteria of Cooper statistics parameters, were conducted. The toxicity assessment parameters include carcinogenicity, mutagenicity, hepatotoxicity, and acute toxicity (LD50). The research results indicate that 9 compounds are carcinogenic and mutagenic, while 2 compounds are hepatotoxic. Based on the toxicity prediction assessment (LD50), it was found that quercetin and myricetin, with moderate toxicity, have LD50 values of 159 mg/kgBW

Pharmacotherapy for attention deficit/hyperactivity disorder in youth with avoidant restrictive food intake disorder: a case series of patients prescribed stimulant medication in a partial hospitalization program for eating disorders

BackgroundAppetite suppression and weight loss are established potential side effects of most medications for attention deficit/hyperactivity disorder (ADHD). These side effects may be especially problematic when using stimulants to treat ADHD in the context of a restrictive eating disorder, such as avoidant restrictive food intake disorder (ARFID), although these diagnoses are often comorbid in children. This paper presents a combined approach to treating ADHD comorbid with ARFID using stimulant medication and behavior management within a partial hospitalization program (PHP) and intensive outpatient program (IOP)for eating disorders. The aim of this paper is to determine if the continued or new use of stimulant medication allows for adequate weight restoration by reviewing a series of cases receiving the combined treatment.Case presentationsConsecutive patients with a historical or new diagnosis of ADHD when presenting for treatment for ARFID were included in this case series. This series included 10 patients (8 male, 2 female) who received pharmacotherapy using stimulants and behavior management interventions involving structured mealtimes and contingency management. All treatment occurred within the context of a PHP/IOP for childhood eating disorders. All youth were able to effectively continue on stimulant medication, show clinical benefit in core ADHD symptoms, and able to gradually restore weight. In all cases, stimulant medications were not discontinued, but in some cases, doses were optimized (increased or decreased), switched to a different stimulant, or augmented with non-ADHD medication, such as mirtazapine, to support the management of ADHD while concurrently assisting in weight gain as necessary for the treatment of ARFID. Only one patient was newly started on a stimulant medication; as this was near the end of her treatment stay, limited conclusions can be drawn from this case.ConclusionsThese findings support the use of pharmacotherapy, including continuing stimulant medication, when combined with behavior management strategies as a potentially effective treatment approach for ADHD in youth with ARFID in the PHP/IOP setting. Future studies using more rigorous methodology, longer follow-up times, and within other treatment settings are needed.

Premenstrual Disorders (PMS and PMDD) Incidence, and its Predictors in Iranian Medical University Students; An Exploratory Cross Sectional Study

Introduction: Premenstrual disorders are a wide range of physical, behavioral, and psychological symptoms which emergence before menstruation and in the first initial days of menstruation which repeat in several cycle. This study aimed to evaluate the Premenstrual syndrome (PMS) and Premenstrual dysphoric disorder (PMDD) incidence and its related factors among Iranian medical students. Materials and Methods: In a is cross sectional study 264 students of Qom university of Medical Sciences were selected by stratified proportional to size and simple random sampling method. Demographic form, Premenstrual Symptoms Screening Tool (PSST) and Daily Record of Severity of Problems (DRSP) questionnaires were used for data collection and evaluation of subjects for PMS and PMMD according to the DSM-IV criteria. Data analysis conducted using SPSS version 20 (SPSS Inc., Chicago, IL, USA) by Chi square, independent t-test and multivariable logistic regression. P value lower 0.05 was considered as significant. Results: The mean age of subjects was 21.05±2.20 years and 102 students (38.6%) were diagnosed as PMS that 8% (21 subjects) were labeled as PMMD. Decreased interest in daily activities (60.6%), depressed mood (60.2%), fatigue/lack of energy (52.3%), physical symptoms and difficulty concentrating (51.1%) were the most common PMS symptoms. Bivariate analysis showed that BMI, marital status, chronic disease history, and continuous use of medication have significant relationship with PMS morbidity. Marriage 2.1 (OR=2.1, 95% CI: 1.12-4.42) and stress in the last 3 months (OR=2.38, 95% CI: 1.23-4.63) were two most important predictors of PMS in medical students based on multivariate logistic regression. Conclusion: Decreasing the students stress, especially in students with chronic disease history that have continuous medication consumption could be effective factors for control the PMS symptoms. Moreover, educational stress beside higher familial stress in married students due to socioeconomic and cultural factors, are the related predictive determinants of PMS. Change in life style by rest taking and enough sleeping, and counseling could be help the affected subjects.

Caring for Families in Vulnerable Situations: Welcoming Families and Survivors of the Tragedy of Santa Maria

Objective: to describe the experiences of students and teachers in welcoming families and survivors of the tragedy of Santa Maria. Method: experience report based on the Nursing As Caring Theory of Boykin and Schoenhofer. Results: Nursing students offered active and solidary listening, verification of vital signs, guidance in relation to the continuous use of medications, and singing and playing guitar with family members were carried out to reduce the suffering of family members. Conclusions: the importance of solidary actions in complementing clinical education was highlighted, emphasizing the development of critical and holistic thinking, humanized and solidary care.

Herbal Medicines: A Potent Approach to Human Diseases, Their Chief Compounds, Formulations, Present Status, and Future Aspects

Humans have relied on herbal medicines in health care and the treatment of numerous diseases since the very early stages of civilization. Herbal medicines or phytomedicines not only treat sickness but also guard against its complications simultaneously. The continuous use of synthetic medications is not safe for health because of their extreme negative impacts. So now a days, we can estimate that in some developing countries, such as the USA and England, herbal drugs make up to 25% of all consumption; on the other hand, in a few nations that are rapidly developing, like India and China, it comprises up to 80%. All over the world, more than ten thousand medicinal species are present. India is a well known producer of herbal plants that have a history of being used medicinally. As per the data of the International Union for Conservation of Nature (IUCN) and the World Wide Fund for Nature (WWF), there are 50000-80000 types of flowering plants that have medicinal value globally. Because they are less expensive, more acceptable in society and culture, better compatible with the human body, and cause less adverse effects, herbal medicines are currently in considerable need for primary healthcare in developing countries. Scientific understanding of plants advanced over the 19th and 20th centuries, and active chemicals that are utilized to create new medicines were isolated. However, there are other issues with using phytomedicines that need to be resolved. This time period also saw the rise of herbal pharmacopoeias, standardized herbal preparations, and larger-scale production of herbal medicines for the future development of not only this field but also for the 80% of the world's population that belongs to the extreme limit of poverty. This study attempts to review different potent approach of herbal medicines, their current status and their future aspects.

Factors Associated with Adherence to the Brazilian Food Guide in Food Service Workers.

The present study aimed to evaluate factors associated with adherence to the Food Guide for the Brazilian Population (GAPB) among food service workers. A cross-sectional study was conducted with 421 employees from 43 food service establishments located in a capital of Brazil. Health and lifestyle data were collected, including the continuous use of medication, smoking, physical activity, and alcohol consumption. An instrument based on the GAPB was utilized, covering the domains of planning, household organization, eating habits, and food choices, according to GAPB recommendations. The findings revealed a direct association between the quality of life scores and the total GAPB adherence score (β = 1.17; p < 0.001), as well as the domains of planning (β = 0.53; p < 0.001), household organization (β = 0.22; p = 0.001), and eating habits (β = 0.38; p < 0.001). Adherence to the GAPB among food service workers was strongly linked to their perception of quality of life, in addition to other factors such as gender, age, education, type of work activity, and variables of lifestyle. Therefore, the eating practices of these employees need to be assessed comprehensively, and enhancing their quality of life can encourage proper and healthy eating.

Study on the associations of meeting intensive systolic blood pressure control goals with risk for incident cardiovascular and cerebrovascular diseases among the adult hypertensive patients in China

Objective: To evaluate the associations of meeting intensive systolic blood pressure (SBP) control goals with risk for incident cardiovascular and cerebrovascular diseases among the adult hypertensive patients in China. Methods: We used data from adult hypertensive patients from the China Kadoorie Biobank. logistic regression models evaluated the influencing factors of meeting intensive and standard SBP control goals. Cox proportional hazard models evaluated the associations between meeting intensive vs. standard SBP control goals and risk for incident cardiovascular and cerebrovascular diseases. Results: A total of 3 628 hypertensive patients who reported continuous medication use were included in this study, of which 5.0% of the participants met the goals of intensive SBP control (≤130 mmHg). Participants with higher educational attainment (OR=2.36,95%CI: 1.32-4.04), healthier diet (OR=2.09,95%CI: 1.45-2.96), daily intake of fresh fruit (OR=1.67,95%CI: 1.17-2.36) and combination treatment (OR=1.82,95%CI: 1.03-3.09) were more likely to meet intensive SBP control goal after adjustment of age, sex and urban/rural areas. During an average follow-up of (10.0±3.7) years, 1 278 cases of composite cardiovascular outcome were recorded. This study did not find a statistical correlation between achieving the goal of enhanced SBP control and the occurrence of composite cardiovascular and cerebrovascular outcomes (HR=0.89, 95%CI: 0.63-1.25). For major adverse cardiovascular events (MACE), cerebrovascular diseases, stroke, and ischemic stroke, we observed a trend of decrease in risk of outcomes with more intensive SBP control (trend test P<0.05). Conclusions: We observed decreased risk for MACE and cerebrovascular diseases with more intensive SBP control. However, there was no significant risk reduction for cardiovascular and cerebrovascular diseases when meeting the intensive SBP control goal, compared to the standard SBP control goal.

Patients With Depression and/or Anxiety Having Arthroscopic Rotator Cuff Repair Show Decreased Number of Prescriptions and Number of Psychotherapy Sessions in the Year After Surgery

To determine whether the utilization of psychological treatments changes after arthroscopic rotator cuff repair (RCR) for patients with preoperative depression and/or anxiety. The Truven Healthcare Marketscan database was used to identify patients who underwent arthroscopic RCR between January 2009 and December 2016. We included all patients with diagnosis codes associated with either depression or anxiety before RCR. Patients were excluded if they did not have complete insurance coverage for 1 year before or after surgery, or if they had arthroscopic RCR in the year before the index surgical procedure. We compared the proportion of patients with preoperative depression or anxiety who filled a prescription and had psychotherapy procedural codes in the year before and the year after arthroscopic RCR. A total of 170,406 patients who underwent RCR were identified, of which depression and/or anxiety was found in 46,737 patients (43.7% male). Of the 46,737 patients, 19.6% filled a prescription for a depression/anxiety medication at least once in the year before surgery. Of this subset of patients, 41.5% did not fill a prescription for depression or anxiety medication after surgery, whereas 32.6% continued medication use but demonstrated a median 30-day reduction in the number of days' worth of medication. Similarly, 13.1% of patients were attending psychotherapy sessions preoperatively, but 76.6% of those patients either stopped or reduced the amount of psychotherapy sessions in the year following RCR. The number of prescriptions and psychotherapy sessions decreased in the year after RCR for patients with preoperative diagnoses of depression and/or anxiety. Level IV, case series.

Multimorbidity patterns: obesity as the main modifiable risk factor in adult women in Southern Brazil.

To identify multimorbidity patterns in women in southern Brazil, and its relationship with sociodemographic, lifestyle characteristics, and nutritional status, as well as to explore the main independent risk factor for the identified patterns. This is a cross-sectional, population-based study with 1,128 women (20-69 years), southern Brazil. Chronic conditions were identified using the therapeutic and chemical anatomical classification of continuous use of medications. Multimorbidity was assessed as ≥2 or ≥3 chronic conditions to identify dyads and triads. Poisson regression was used to explore risk factors in the different adjustment models. As independent variables evaluated, in addition to sociodemographic characteristics, lifestyle variables were included: consumption of fruits and vegetables, physical activity, alcohol consumption, smoking and nutritional status. Eleven dyads (frequencies between 2.0% and 6.4%) and three triads (frequencies between 1.9% and 2.1%) of morbidities were identified in the study. Aging was related to a higher prevalence of all patterns, and obesity was a risk factor for multimorbidity patterns that contained conditions related to the cardiovascular and metabolic system and mental health. After adjustment, obesity increased the probability of "hypertension + common mental disorders (CMD)" (PR 3.63; 95% CI 1.94-6.78) and "dyslipidemia + CMD" (PR 3.69; 95% CI 1.08-12.65) by more than three times. This study identified common and important diseases in the patterns, associated with a common risk factor, obesity, that must be addressed by public health policies to prevent multimorbidity.

Survival rate of dental implants installed by postgraduate students attending an implantology program in Brazil: A 52-month retrospective analysis

ObjectivesThe aim of this study was to assess the survival rate and identify possible risk factors for failure of dental implants placed by postgraduate students in Implantology at a Brazilian Dental School.Materials &amp;amp; methodsA retrospective observational study was conducted to evaluate 1,164 dental implants placed by postgraduate students in Implantology at São Leopoldo Mandic Dental School (Brazil) during a 3-year time period (2018–2020). Data collected from the patients' medical charts included the following: implant loss, gender, diabetes, smoking, continuous use of medication, type of implant connection system, implant position (maxilla or mandible), previous bone grafting and type of prosthetic provisioning (temporary prosthesis, immediate prosthesis or permanent prosthesis). The association between all the independent variables and implant loss was run using χ2 and G tests (α = 5%). The implant survival rate was estimated using Kaplan-Meier curve.ResultsGender, diabetes, smoking, continuous use of medication, type of implant connection system, implant position, previous bone grafting and type of prosthetic provisioning showed no statistically significant association with implant loss. Of the 1,164 implants installed, 29 (2.5%) failed. The overall survival rate of dental implants placed by postgraduate students up to 52 months was 90.5% (IC95%: 74.5%–96.7%).ConclusionsImplants placed by postgraduate students in Implantology at São Leopoldo Mandic Dental School showed a high survival rate, with gender, diabetes, smoking, continuous use of medication, type of implant connection system, implant position, previous bone grafting and type of prosthetic provisioning not accounting for the risk of implant failure.

Innate immune cellular therapeutics in transplantation.

Successful organ transplantation provides an opportunity to extend the lives of patients with end-stage organ failure. Selectively suppressing the donor-specific alloimmune response, however, remains challenging without the continuous use of non-specific immunosuppressive medications, which have multiple adverse effects including elevated risks of infection, chronic kidney injury, cardiovascular disease, and cancer. Efforts to promote allograft tolerance have focused on manipulating the adaptive immune response, but long-term allograft survival rates remain disappointing. In recent years, the innate immune system has become an attractive therapeutic target for the prevention and treatment of transplant organ rejection. Indeed, contemporary studies demonstrate that innate immune cells participate in both the initial alloimmune response and chronic allograft rejection and undergo non-permanent functional reprogramming in a phenomenon termed "trained immunity." Several types of innate immune cells are currently under investigation as potential therapeutics in transplantation, including myeloid-derived suppressor cells, dendritic cells, regulatory macrophages, natural killer cells, and innate lymphoid cells. In this review, we discuss the features and functions of these cell types, with a focus on their role in the alloimmune response. We examine their potential application as therapeutics to prevent or treat allograft rejection, as well as challenges in their clinical translation and future directions for investigation.

Continuous use of antithrombotic medications during peri-endoscopic submucosal dissection period for colorectal lesions: A propensity score matched study.

The aim of this study was to elucidate the continuous use of antithrombotic medications during the peri-colorectal endoscopic submucosal dissection (ESD) period. This study included 468 patients with colorectal epithelial neoplasms treated by ESD, consisting of 82 under antithrombotic medications and 386 patients without the medications. Among patients taking antithrombotic medications, antithrombotic agents were continued during the peri-ESD period. Clinical characteristics and adverse events were compared after propensity score matching. Before and after propensity score matching, post-colorectal ESD bleeding rate was higher in patients continuing antithrombotic medications (19.5% and 21.6%, respectively) than in those not taking antithrombotic medications (2.9% and 5.4%, respectively). In the Cox regression analysis, continuation of antithrombotic medications was associated with post-ESD bleeding risk (hazard ratio, 3.73; 95% confidence interval, 1.2-11.6; P<0.05) compared with patients without antithrombotic therapy. All patients who experienced post-ESD bleeding were successfully treated by endoscopic hemostasis procedure or conservative therapy. Continuation of antithrombotic medications during the peri-colorectal ESD period increases the risk of bleeding. However, the continuation may be acceptable under careful monitoring for post-ESD bleeding.

Shock Wave Therapy in Patients with Erectile Dysfunction

Erectile dysfunction is a serious medical problem because it directly affects the sex life of a man, but it also has an overall effect on his self-esteem and social behaviour.&#x0D; Pathophysiologically, erectile dysfunction may be due to factors of vascular origin, anatomical and structural features, neurological disorders, hormonal problems, drug-induced disorders, or iatrogenic trauma. The so-called psychogenic erectile dysfunction is not uncommon. In addition to the establishedtherapy with phosphodiesterase inhibitors, there are a number of publications that focus on the effect of Shock wave therapy as an alternative for treating erectile dysfunction. However, this issue remains debatable. Extracorporeal shockwave therapy is used as a method of treating erection problems, as itinduces neovascularization and improves blood flow to the cavernous tissue.&#x0D; Our goal is to test the efficacy and safety of Shock Wave therapy and to determine its place in the treatment of patients with erectile dysfunction.&#x0D; Clinical follow-up included 120 men between the ages of 30 and 75 (mean 55.68) diagnosed with erectile dysfunction. Patients were treated and monitored for a period of two years (January 2017 to April 2019). Detailed anamnestic data was taken, including sexual history, and full laboratory tests were performed.We used the following questionnaires to evaluate the extent of erectile dysfunction: International Index of Erectile Function (IIEF-5), Erection Hardness Score (EHS). All patients underwent shockwave therapy. Course duration was ten weeks, one procedure per week. Extracorporeal shock wave therapy equipment (BTL-5000) was used.&#x0D; With regard to the Erection Hardness Score (EHS), there was a significant improvement in penis firmness, immediately after the first procedure, which persisted after the end of treatment until the third month after therapy. Improvement in firmness was mainly observed in patients with moderate and mild erectile dysfunction, while no significant improvement was observed in patients with complete inability to achieve erection.&#x0D; With respect to the International Index of Erectile Function (IIEF-5), there is a significant improvement in erectile function, mainly in the groups with mild and moderate erectile dysfunction. The effect of therapy is maintained until the third month of treatment. No improvement in the condition was observed in patients with severe erectile dysfunction.&#x0D; The mean value of IIEF-5 increased significantly from 14.54 to 18.85 after the end of treatment, and this value was sustained until the third month after the treatment – 18.55. The procedure was well tolerated by patients, with no side effects reported during and after the procedure.&#x0D; The developments in modern technology and in the pharmaceutical industry have fundamentally changed the understanding of erectile dysfunction and the methods of treating it. More and more young people are rejecting the continued use of medication and looking for an alternative to effective treatment. Thus, there is a need for new methods of treating patients with erectile dysfunction. Based on publications in world literature, and on our own results, we have come to the conclusion that extracorporeal shock wave therapy may be an alternative to therapy with Phosphodiesterase 5 inhibitors (PDE5). Following the course of treatment, there was a significant increase in the number of patients without erectile dysfunction, and an increase in the total IIEF-5 score from 14.54 before treatment to 18.55 3 months after the end of therapy. This confirms the assumption of a lasting effect of the therapy 3 months after the end of treatment.

Impact on Cardiovascular Health of Using Phentermine/Topiramate in Combination With Laparoscopic Sleeve Gastrectomy in Super Obesity

IntroductionManagement of patients with BMI≥50 kg/m2 is challenging. In previous work, pre and postoperative pharmacotherapy with phentermine/topiramate plus laparoscopic sleeve gastrectomy (PT + SG) promoted greater weight loss than sleeve gastrectomy (SG) alone at 24 mo postoperatively. This current secondary analysis studied the impact of PT + SG on blood pressure (BP), heart rate, and antihypertensive usage. MethodsPatients with BMI≥50 kg/m2 planning to have SG (n = 13) were recruited from 2014 to 2016, at an academic medical center in Winston–Salem, North Carolina, for this open-label trial. Participants took phentermine/topiramate (PT; 7.5/46–15/92 mg/d) for ≥3 mo preoperatively and 24 mo postoperatively. The control group (n = 40) underwent SG during the same time frame. We used mixed models for BP and heart rate to compare PT + SG versus SG alone over time, adjusted for age, sex, and initial BP. ResultsBy 24 mo postoperatively the model adjusted changes in systolic blood pressure/diastolic blood pressure (SBP/DBP) (mm Hg) were −24.44 (−34.46,−14.43)/−28.60 (−40.74,−16.46) in the PT + SG group versus −11.81 (−17.58,−6.05)/−13.89 (−21.32,−6.46) in the control group (SBP P = 0.02; DBP P = 0.03). At baseline 8 (61.5%) participants in the PT + SG arm and 22 (55.0%) in the control group used antihypertensives. Excluding patients lost to follow-up (n = 3), by 24 mo postoperatively, none of the PT + SG participants were on antihypertensives compared to 14 (41.2%) in the control group (P = 0.01). ConclusionsPatients with BMI≥50 kg/m2 treated with PT + SG had greater improvement in BP with no use of antihypertensive medication at 24 mo postoperatively versus SG alone, where 41% continued medication use. Larger trials are required to evaluate this.

Difficulties in the use of medications by elderly people followed up in a cohort study in Southern Brazil.

This study aimed to assess the need for help by elderly people to take their medications, the difficulties related to this activity, the frequency of forgotten doses, and factors associated. Cross-sectional study conducted with a cohort of elderly people (60 years and over - "COMO VAI?" [How do you do?] study), where the need for help to properly take medication and the difficulties faced in using them were evaluated. The Poisson regression model was used to estimate the crude and adjusted prevalence ratios (PR) of the outcomes and respective 95% confidence intervals according to the characteristics of the sample. In total, 1,161 elderly people were followed up. The prevalence of participants who reported requiring help with medication was 15.5% (95%CI 13.5-17.8), and the oldest subjects, with lower educational levels, in worse economic situations, on four or more medications and in bad self-rated health were the ones who needed help the most. Continuous use of medication was reported by 83.0% (95%CI 80.7-85.1) of the sample and most participants (74.9%; 95%CI 72.0-77.5) never forgot to take their medications. The need for help to use medications was shown to be influenced by social and economic determinants. Studies assessing the difficulties in medication use by the elderly are important to support policies and practices to improve adherence to treatment and the rational use of medications.

Cerebrovascular risk factors and their time-dependent effects on stroke survival in the EMMA cohort study.

To investigate the time-dependent effects of traditional risk factors on functional disability in all-cause mortality post-stroke, we evaluated data from a long-term stroke cohort. Baseline cerebrovascular risk factors (CVRF) and functionality at 1 and 6 months were evaluated in survivors from a prospective stroke cohort using the modified Rankin scale (m-RS), which classifies participants as improvement of disability, unchanged disability (at least moderate), and worsening disability. Cox regression models considering baseline risk factors, medication use, and functionality 6 months after stroke were fitted to identify their time-dependent effects up to 12 years of follow-up. Adjusted hazard ratios (HR) with 95% confidence intervals (CI) are presented. Among 632 survivors (median age 68, 54% male, 71% first-ever episode), age and functional disability (unchanged and worsening) 6 months after ischemic stroke had time-dependent effects on all-cause mortality risk up to 12 years of follow-up. The most impacting risk factors were unchanged (at least moderate) (HR, 2.99; 95%CI: 1.98-4.52) and worsening disability (HR, 2.85; 95%CI: 1.26-6.44), particularly in the first two years after a stroke event (Time 1: ≥6 mo to <2.5 y). Worsening disability also impacted mortality in the period from ≥2.5 to <7.5 years (Time 2) of follow-up (HR, 2.43 (95%CI: 1.03-5.73). Other baseline factors had a fixed high-risk effect on mortality during follow-up. Post-stroke and continuous medication use had a fixed protective effect on mortality. Functional disability was the main contributor with differential risks of mortality up to 12 years of follow-up.

Management of Anti-Seizure Medications during Pregnancy: Advancements in The Past Decade.

Management of seizures often involves continuous medication use throughout a patient's life, including when a patient is pregnant. The physiological changes during pregnancy can lead to altered drug exposure to anti-seizure medications, increasing patient response variability. In addition, subtherapeutic anti-seizure medication concentrations in the mother may increase seizure frequency, raising the risk of miscarriage and preterm labor. On the other hand, drug exposure increases can lead to differences in neurodevelopmental outcomes in the developing fetus. Established pregnancy registries provide insight into the teratogenicity potential of anti-seizure medication use. In addition, some anti-seizure medications are associated with an increased risk of major congenital malformations, and their use has declined over the last decade. Although newer anti-seizure medications are thought to have more favorable pharmacokinetics in general, they are not without risk, as they may undergo significant pharmacokinetic changes when an individual becomes pregnant. With known changes in metabolism and kidney function during pregnancy, therapeutic monitoring of drug concentrations helps to determine if and when doses should be changed to maintain similar seizure control as observed pre-pregnancy. This review concentrates on the results from research in the past decade (2010-2022) regarding risks of major congenital malformations, changes in prescribing patterns, and pharmacokinetics of the anti-seizure medications that are prescribed to pregnant patients with epilepsy.

EFEITO DO EXERCÍCIO AERÓBICO SOBRE A FUNÇÃO MOTORA DOS MEMBROS EM PACIENTES DIABÉTICOS

ABSTRACT Introduction: Gestational Diabetes is a group of metabolic disorders that result in glucose intolerance during pregnancy. Among the range of treatments are diet, continuous use of medication, and psychological monitoring. Since it is a multidisciplinary treatment, a proper protocol is vital for a favorable outcome. In addition, there are questions about the benefits of physical activity as a complementary therapy. Objective: To verify the impact of adding exercise to the hospital protocol for patients with gestational diabetes, both on the risks of type 2 diabetes in pregnant women and on the obesity of their offspring. Methods: Sixty pregnant women diagnosed with Gestational Diabetes were randomly divided into control and intervention groups. Both groups received specific treatment and intervention, and the experimental group practiced controlled moderate-intensity physical activity (125-146bpm). Morning blood samples were collected from both groups to check fasting glucose and insulin levels, indicators of lipid metabolism, low and high-density lipoprotein cholesterol, apolipoprotein B. The Brog scale measured the fatigue level. In addition, the premature rupture of membranes, postpartum hemorrhage, neonatal asphyxia, macrosomia, and others was checked. Results: The peripheral blood total cholesterol levels were 5.93, 5. 38, low-density lipoprotein cholesterol levels were 2.95 before versus 2.64 after, and apolipoprotein B levels were 1.84 versus 1.59 in the control group, high-density lipoprotein cholesterol content increased from 1.74 to 1.88, blood cholesterol, and apolipoprotein B levels after the intervention in the experimental group were lower than those in the control group, with an elevation of high-density lipoprotein cholesterol. Conclusion: Aerobic exercise proved to be more appropriate for patients with gestational diabetes in the later stages of pregnancy and may also be adapted for bedridden patients refractory to traditional drugs. Evidence Level II; Therapeutic Studies - Investigating the result.

People living with HIV, LGBT people and intersectional experiences: Young adults' conceptions of old age and aging

Objective: This study aims to understand the social representations of old age LGBT (lesbians, gays, bisexuals, transvestites, and transgenders) among adults living with human immunodeficiency virus (HIV) in Brazil. Method: 111 people from 21 Brazilian states participated in the study, with a mean age of 42 years, most of the men (85%), homosexuals (75%), single (85%), and without religion (34%). For data collection, a sociodemographic questionnaire was used; a structured interview was also used; both instruments were applied online. Results: The classes of representations shared by the investigated group are structured in three main axes: Old age of LGBT people; Old age of people living with HIV; Intersectionality, and commonalities between groups. Conclusions: The representations directed to the specificities of each group were: Older LGBT people, connected to loneliness and discrimination; People living with HIV, related to the continuous use of medication. The common and intersectoral experiences for both groups are those related to the experience of stigma and social exclusion. Thus, based on the representations expressed, one can see the need for an intersectional understanding of the groups being investigated and the importance of countering the negative stereotypes to which these people are subjected.

Cardiovascular medications and long-term mortality among stroke survivors in the Brazilian Study of Stroke Mortality and Morbidity (EMMA).

To investigate the association between medication use and long-term all-cause mortality in a Brazilian stroke cohort. Both ischemic and hemorrhagic stroke were evaluated. Medication use was assessed as: never, only pre-stroke, only post-stroke, and continuous use. We evaluated anti-hypertensives, anti-diabetics, lipid-lowering drugs, anti-platelets, and anti-coagulants. Cox regression models were adjusted for sociodemographic and cardiovascular risk factors. Among 1173 incident stroke cases (median age: 68; 86.8% were ischemic, 70% first-ever stroke), medication use was low (overall: 17.5% pre-stroke, 26.4% post-stroke, and 40% were under continuous use). Anti-hypertensives and anti-platelets (aspirin) were the continuous cardiovascular medications used most often, at 83.5% and 72%, respectively, while statins (39.7%) and anti-diabetics (31.3%) were the least used. Medication use (pre-stroke, post-stroke and continuous use) was associated with a reduction in all-cause mortality risk, particularly among those under continuous use (multivariable hazard ratio, 0.52; 95% confidence interval (CI), 0.46-0.66) compared with never-users. Among ischemic stroke patients, this effect was similar (multivariable hazard ratio, 0.52; 95% CI, 0.40-0.68). No significant associations were evident among hemorrhagic stroke patients. The risk of all-cause mortality was reduced by 48% among those with ischemic stroke under continuous use of medications. Secondary prevention should be emphasized more strongly in clinical practice. Geriatr Gerontol Int 2022; 22: 715-722.