Drug Use Research Articles

Evaluating the budget impact of Empagliflozin in managing heart failure with reduced ejection fraction: Proposing strategic policies for Malaysian public healthcare.

Sodium-glucose co-transporter-2 (SGLT2) inhibitors such as Empagliflozin, are increasingly recommended as part of guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF) in many developed nations. This recommendation is based on robust clinical evidence showing that adding Empagliflozin to GDMT improves heart failure symptoms, clinical outcomes, functional status, and overall quality of life. In Malaysia, where healthcare is predominantly public and heavily subsidized, the introduction of new treatments can significantly impact costs, requiring detailed economic assessments. This study evaluates the budget impact of incorporating Empagliflozin into GDMT for HFrEF from the perspective of the public healthcare system. A five-year budget impact model was developed, integrating local data such as population, drug use, costs, clinical outcomes, and healthcare expenses. In the current scenario (GDMT alone), the projected five-year expenditure is MYR 6.12 billion (USD 3.92 billion). With Empagliflozin, the total cost rises by 0.71% to MYR 6.16 billion (USD 3.95 billion), driven by drug acquisition costs of MYR 160.12 million (USD 102.64 million) and adverse event costs of MYR 211,543 (USD 135,604). However, these costs are offset by savings from reduced HF hospitalizations, fewer cardiovascular deaths, and improved renal outcomes. Sensitivity analysis identified hospitalization costs, the price of Empagliflozin, and cardiovascular deaths in diabetic patients as key factors influencing the budget impact. Policymakers can improve the affordability of Empagliflozin through strategies like price negotiations, cost-sharing, and focusing on high-risk groups to optimize healthcare expenditure while ensuring effective treatment access.

Non-steroidal anti-inflammatory drug use and inflammatory markers associated with gallbladder dysplasia: A case-control analysis within a series of patients undergoing cholecystectomy.

Inflammation has been associated with the development of gallbladder cancer (GBC). However, little is known about the associations of both, inflammation and the use of non-steroidal anti-inflammatory drugs (NSAIDs), with preneoplastic lesions. We analyzed the association of NSAIDs and gallbladder dysplasia in 82 patients with dysplasia and 1843 patients with gallstones among symptomatic patients from a high-risk population. We also analyzed associations for 33 circulating immune-related proteins in a subsample of all 68 dysplasia cases diagnosed at the time of sample selection and 136 gallstone controls. We calculated age- and sex-adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs). Biliary colic was reported among most cases (97.6%) and controls (83.9%). NSAID use was inversely associated with gallbladder dysplasia (OR: 0.48, 95%CI: 0.26-0.83). Comparing the highest versus lowest category of each immune-related protein, eight proteins were inversely associated with dysplasia with sex- and age-adjusted ORs ranging from 0.30 (95%CI: 0.12-0.77) for IL-33 to 0.76 (95%CI: 0.59-0.99) for MIP-1B. Of those, GRO remained associated with dysplasia (OR: 0.64, 95%CI: 0.45-0.91) and BCA-1 was borderline associated (OR: 0.74, 95%CI: 0.54-1.01) after adjusting the logistic regression model for sex, age, and NSAIDs. In conclusion, NSAID users were less likely to have gallbladder dysplasia, suggesting that NSAIDs might be beneficial for symptomatic gallstones patients. The inverse association between immune-related markers and dysplasia requires additional research, ideally in prospective studies with asymptomatic participants, to understand the role of the inflammatory response in the natural history of GBC and to address the biological effect of NSAIDs.

Validity and reliability of the Japanese version of the Substance Use Stigma Mechanism Scale.

Stigma against people who have alcohol and drug problems severely affects their health and well-being. An instrument based on stigma theory assessing individual-level stigma is essential for a comprehensive understanding of their stigma. We evaluated the validity and reliability of the Japanese version of the Substance Use Stigma Mechanism Scale (SU-SMS-J) among a population who had alcohol or drug use problems. Adults with experience in substance use disorders from psychiatry outpatient departments and rehabilitation facilities participated in the self-administered questionnaire survey. Confirmatory factor analysis was conducted to test the structural validity of the 5-factor model proposed in other language versions, and factor loadings and correlation between the subscales were confirmed. The correlations between the SU-SMS-J and psychometric properties related to substance use (e.g., severity of substance use, motivation to change) were investigated to assess concurrent validity. Internal consistency was assessed using Cronbach's alpha coefficients. Data from 126 participants were analyzed. The 5-factor model was acceptable with good or reasonable model fit indices. The correlations between subscales were weak to moderate, and this result suggested the SU-SMS-J assessed different but related components of stigma: enacted, anticipated, and internalized stigma from different stigma sources (family and healthcare workers). The SU-SMS-J and subscales showed moderate concurrent validity. Internal consistency was mostly sufficient, with Cronbach's alpha coefficients of 0.86 for all items and 0.66-0.93 for subscales. The SU-SMS-J is valid and reliable for use among populations with substance use problems in various settings in Japan.

Drug Survival and Clinical Course of Patients with Cancer Treated with Biologic Therapy for Psoriasis.

Background/Objectives: Patients with treated solid tumors (TST) are a highly heterogeneous and difficult-to-treat population due to the risk of disease progression/recurrence or infection. Methods: We conducted an observational, retrospective, single-center study at the Dermatology Clinic of Turin with a focus on the special population of cancer patients with psoriasis treated with biologics. Results: As of July 2023, 52 psoriatic patients with a prior/concomitant history of malignancy had taken biologic drugs. The median age was 67 years, and the median age of cancer onset was 55 years. The most common tumors were gastrointestinal cancer and melanoma. After the tumor diagnosis, 61% received an anti-IL17 drug; 37 patients continued the initiated biologic therapy, while 12 switched drugs due to secondary inefficacy. The estimated biologic DS was 55.6% at 50 months. Evidence suggests that IL-17 is a key pathogenic factor involved in tumorigenesis, resulting in a lower risk of malignancies in subjects managed with IL-17 inhibitors. Similarly, IL-23 plays a role in suppressing innate immunity and promoting tumor and metastases development. This is a consistent real-life case series that support the use of biologic drugs in patients with TST. Conclusions: IL-23 and IL-17 inhibitors, being immunomodulators rather than immunosuppressants, may be a safe option for patients in an active oncological setting and for immune-correlated adverse events.

Psycho-spatial predictors of drug use among Inner City Youths in Uyo

This study examined psycho-spaal predictors (psychological – opmisc bias and stress: spaal-drug availability, neighborhood density and proximity) of drug use among inner city youths of Uyo. A descripve cross-seconal survey design was used to interview 228 youths in Uyo, Akwa Ibom State. Parcipants, with an average age of 31.46, were 75% male. A standardized quesonnaire, consisng of Drug Use Disorder Idenficaon Test (DUDIT), the Perceived Stress Scale (PSS-10), and the Revised Life Orientaon Test-Revised (LOT-R) were used for data collecon. Drug availability was assessed in this study in terms of ease of difficulty in obtaining the drug ranging from very easy to very difficult. Environmental proximity was assessed by asking the respondents the proximity between their residence and where the drug they used are sold- ranging from “On the same street” to “not available in my neighborhood”. Neighborhood density was assessed by asking the respondents their area of residence in Uyo – as high density or low density. Result showed that drug availability [β= -4.23; t = - 4.22; p < 0.05] stress level [β=0.33; t =2.96; p < 0.05] and opmisc bias [β= - 0.52; t=-3.18; p< 0.05] predicted drug use. The study concluded that these psychospaal variables are very important in understanding drug use among young persons and the need to situate intervenon within this psychospaal domain was emphasized.

Special Needs in Substance Use Treatment for Women Who Use Drugs: Social and Mental Health Factors

Women who receive substance use treatment have a particular classification of sensitivity to European drugs and drug use (according to the EMCDDA). The average level of women’s treatment is lower than men’s across Europe, while women’s abandonment is higher than men’s. The purpose of this study was to examine the factors associated with problems for women who use drugs, analyzing several psychological and social factors (gender, substance use, mental health, source of economic support, legal status, and abuse). Methodology: This was a quantitative study. Data on 2179 people receiving rehabilitation treatment were obtained from the EuropASI survey. The dependent variables in this study were (1) a patient’s known history of addiction and mental illness; (2) primary drug use; (3) drug use in their lifetime and the past month; (4) mood in their lifetime and the past month, physical condition, and sexual abuse history; (5) mental illness in their lifetime and the past month (including suicide attempts); (6) legal status in their lifetime and the past month; (7) and source of income in the past month and (8) and the number of patients. The factor of gender was taken as a dichotomous variable (male–female). The confidence interval used was 95%. Results: In summary, we found that women had consumed more alcohol, used more drugs, and suffered more from depression, anxiety, and suicidal ideation than men, both during their lifetimes and in the past month. In addition, women were more likely than men to be stigmatized for prostitution because their financial support came mainly from colleagues, friends, and family, as well as from prostitution. Finally, women had experienced more violence (emotional, physical, and sexual) during their lifetimes and in the last month than men. Conclusion: There appears to be a need to develop a comprehensive treatment network for addictive behaviors from a multifactorial perspective, including harm reduction, psychosocial support, and recovery programs; furthermore, targeting specific groups with special needs, such as women, especially those with mental health problems, women with alcoholism, and abused women, it also seems important to develop adaptive recovery programs within addictive behavior treatment networks.

Drug use and divorce rates in Bayelsa State, Nigeria

This study examines the relaonship between drug use and divorce rates in Bayelsa State Nigeria, it ulized survey design, using quesonnaire to obtain data with a purposive sample size of 420. The data was analyzed using the Logisc and the Probit regression techniques. It was found that drug consumpon, frequency of drug consumpon and misuse of drug had a posive and insignificant impact on divorce among drug consumers. 2 The Pseudo R presented in column (1) shows that the variables in the model explain approximately 68.56% change in the divorce rate. The likelihood chi-square value of 30.53 (p = 0.0000) means that the variables jointly significantly affect the rate of divorce. The pvalue for hats is 0.239. The non-significant hatsq means good regression model adequacy. Also, the insignificant Hosmer-Lemeshow goodness of fit test is evidence of the overall goodness of fit of the regression model. Sensizaon of the dangers associated with the abuse of drug, frequent consumpon of drug and the use of drug without a medical doctor's prescripon is recommended.

The effect of drug abuse among adolescents in Nigeria: A case study of Gwagwalada, Area Council, Abuja, Nigeria

With a focus on drug addiction in teenagers, this study explores the prevalence, causes, and effects of drug addiction in Gwagwalada, Abuja, Nigeria. It provides a thorough understanding of the factors that influence drug misuse among adolescents in the area. The project intends to determine the precise chemicals being misused and investigate the social and environmental factors that contribute to drug use by looking over previous studies, consulting with experts, and gathering information from local stakeholders. Peer pressure, broken families, easy access to drugs, and a lack of opportunities are major contributing factors. The study also looks at how interpersonal violence, criminality, and economic instability are made worse in communities by teen drug use. An extensive literature review, qualitative interviews, and statistical tools like trend analysis and frequency distribution were all combined in a mixed-methods approach to determine the degree of substance abuse. The results show that drug addiction severely compromises the physical, psychological, and social well-being of youth; the main initiators of this damage are peer pressure, familial problems, and financial difficulty. The report recommends quick, comprehensive efforts to reduce drug availability, such as drug education, public awareness campaigns, and increased law enforcement. It also places a strong emphasis on improving preventative measures, addressing underlying socioeconomic issues, and giving young people the tools they need to resist peer pressure and make better decisions in life. The report urges the development of a comprehensive plan to lower drug usage among teenagers and ensure that Nigerian kids have a better future.

Exploring Botanical Innovations in Fish Aquaculture: A Review of Biological Impacts and Industry Prospects

Culture fisheries play a crucial role in providing protein-rich sustenance for the expanding global population. However, the intensification of fish farming comes with a downside – heightened stress among fish, which subsequently escalates the risk of disease transmission. The emergence of resilient bacterial populations and the accumulation of residues in body tissues due to the use of drugs and chemicals have underscored the necessity for the development of environmentally friendly and durable solutions. Notably, there has been a recent upsurge in interest regarding the use of botanical products to enhance aquaculture practices. Plant derived secondary metabolites have demonstrated their efficacy in stimulating appetite, facilitating growth, boosting immune responses, and exhibiting antibacterial as well as anti-parasitic properties within the realm of aquaculture. This article aims to comprehensively examine the body of research on the application of plant-derived products in pisciculture, elucidating their effects on various biological aspects of fish, including growth patterns, immune system functionality, pigmentation, blood composition, and reproductive parameters. Furthermore, the article also delivers inputs into an assessment of the current status of these practices, the methodologies deployed, and the challenges encountered in integrating plant-based solutions into the aquaculture industry.

Perioperative intravenous lidocaine infusion for postsurgical pain management in bariatric surgery patients

IntroductionObesity is one of the biggest modern health issues worldwide. Owing to the failure of both behavioral and pharmacological measures, the surgical approach has been established as the main conduct to follow, with bariatric surgery being one of the most effective and safe procedures. One of the bases for the optimal analgesic strategy is the use of adjuvants during the perioperative period. One of the main drugs in use is lidocaine.AimTo evaluate postoperative pain after perioperative lidocaine infusion in patients undergoing bariatric surgery and describe the presence of nausea and vomiting during the first 24 h.MethodsThis was a retrospective study of patients who underwent laparoscopic bariatric surgery at ABC Medical Center. Two study arms were established: a group of patients who received lidocaine infusion and a control group. The presence of pain, nausea, or vomiting was evaluated upon admission to the recovery area and 1 h and 24 h after the intervention. The normal distribution of the data was first verified via the Shapiro–Wilk test. The data are presented as medians for quantitative variables and as frequencies for qualitative variables.ResultsA total of 50 surgeries were performed, with a significant correlation between lidocaine infusion and lower pain values at 1 h (p = 0.04). Similarly, there was a marked trend in the presence of nausea in control group 4 (18.6%) vs. 15 (53.5%).ConclusionsOur data suggest that the use of intraoperative lidocaine infusion is limited in postoperative pain management; nonetheless, it significantly improves the incidence of postoperative nausea.

The relative contributions of genetic and non‐genetic factors to the risk of neuroblastoma

ABSTRACTPrevious literature has well‐established genetic factors as being associated with neuroblastoma (NB). About 1%–2% of NB cases are familial, with 85% of these cases predisposed to mutations in the PHOX2B and ALK genes. The genetic basis of sporadic NB has been studied through genome‐wide association studies and next‐generation sequencing approaches. Particularly, germline variants, as well as copy number variations, confer increased risks of NB, often with effect estimates ≥1.5, underscoring the strong genetic contributions to NB. However, the strength of the association varied in non‐genetic factors. Some risk factors, such as birth defects, maternal illicit drug use, and early infections, had relatively stronger associations (effect estimates ≥1.5 or ≤0.67), while some other factors remain inconclusive. This suggests that certain non‐genetic factors may play a more prominent role in NB risk, while further research is needed to clarify the impact of others. We synthesized and critically evaluated existing literature on the risk factors of NB to provide an overview, analyze the current state of knowledge, and outline a research path to address the relative contributions of genetic and non‐genetic factors in NB. Future epidemiologic studies should incorporate novel methods for measuring genetic and non‐genetic factors to comprehensively assess the full extent of factors contributing to NB. Furthermore, the utilization of dried blood spots holds promise to overcome technical and recruitment challenges for future studies. These strategies will contribute to a more holistic understanding of NB etiology and potentially lead to improved prevention strategies.

First report on human T-lymphotropic virus 1 infection in a group of transgender women.

There is a lack of data on human T-lymphotropic virus 1 (HTLV-1) infection among transgender women (TGW). Therefore, this study estimated the prevalence of HTLV-1 infection in a group of TGW in Brazil. A cross-sectional study was conducted with 235 TGW in Goiânia City, Central Brazil. Respondent-driven sampling was used for recruitment. All participants were interviewed, and serum samples were tested for anti-HTLV-1/2 using an enzyme-linked immunosorbent assay (ELISA; Murex HTLV-I + II, DiaSorin, Dartford, United Kingdom). Seropositive samples were submitted for confirmation by Western blot (WB; MP Diagnostics HTLV BLOT 2.4 test, MP Biomedicals, Germany). The majority of participants were young (≤ 25 years old), self-declared mixed or brown ethnicity, single, had attended high school, and had a monthly income above US$ 255 (R$ 1,000,00; nearly the minimum wage in Brazil at the time). Most reported earlier age at first sex and various risk behaviors for sexually transmitted infections (STIs). Three TGW were anti-HTLV-1/2 positive by ELISA and were subsequently positive for HTLV-1 by WB, giving a crude HTLV-1 seroprevalence of 1.3%; 1.0% (95% CI: 0.0-1.9) after being weighted by RDS Analysis Tool (RDSAT). The HTLV-1 seropositive TGW reported high-risk sexual behaviors. In addition, one of them also engaged in injecting drug use. These data indicate the circulation of HTLV-1 in TGW in Goiânia City, Central Brazil. Given the alarming estimates of high-risk sexual behaviors, there is an urgent need to intensify health programs targeting this population to control and prevent HTLV-1 and other STIs effectively.

Assessment of drug therapy problems in pediatric patients using Cipolle/Morley/strand classification: A hospital based study

Drug plays an important role in treating diseases and improving health. However, inappropriate drug use can lead to the occurrence of drug-Therapy problems (DTPs). According to Cipolle/Morley/Strand classification DTPs are any undesirable event experienced by the patient that involves or is suspected to involve drug therapy and that actually or potentially interferes with a desired patient outcome. The purpose of this study was to assess the drug therapy problems in a pediatric ward of Srinivas institute of medical science and research centre and to identify associated factors for drug therapy problems. A retrospective observational study was carried out to assess drug therapy problems (DTPs) in paediatric patients using Cipolle/Morley/Strand classification from January to June 2024. Ethical approval was obtained, and informed consent was signed by each study participant's parent before the commencement of the study. All paediatric out patients and patients admitted to the paediatric ward during the study period were included in the study. Data were collected through medical record reviews of patients and using semi structured questionnaire. Data was analysed using Microsoft Excel. The participants mean age was 2.32 years. Among 150 patients, 116 (77.33%) of them had at least one drug therapy problem per patient which indicates that the prevalence of the drug therapy problem was substantially high. On the other hand, Adverse drug reaction was the least 4 (3.38%) drug therapy problem. Hence to ensure optimum care in paediatric patients, a targeted approach is essential. Thus, the present study concluded that pharmacists can be helpful in the identification of the drug therapy problems, their causes and the risk factors involved and thus lead to a better health care outcome.

Characteristics of attrition within the SuperMIX cohort of people who inject drugs: a multiple event discrete-time survival analysis

BackgroundCompared to the general population, people who inject drugs have poor health and wellbeing. Longitudinal studies can provide insight into factors driving these worse health outcomes but are subject to methodological challenges, such as cohort attrition. The aim of this study was to assess and characterise attrition in a prospective cohort of people who inject drugs in Victoria, Australia.MethodsUsing annually collected self-reported data from The Melbourne Injecting Drug User Cohort Study (SuperMIX) from September 2008 to January 2021, we estimated the incidence of participants being lost-to-follow-up (LTFU), with an episode of being LTFU defined as participants not undertaking a follow-up interview within two years of their last interview. We utilised a multiple event discrete-time survival analysis on participant period-observation data to estimate the associations between key factors and LTFU. Key areas of exposure measurement in analyses were sociodemographic, drug use and mental health.ResultsA total of n = 1328 SuperMIX participants completed a baseline interview, with n = 489 (36.8%) LTFU, i.e. not completing a follow-up interview in the following two years. Increased attrition was observed among SuperMIX participants who were: born outside Australia, younger than 30 years, reporting having completed fewer years of education, not residing in stable accommodation, not in stable employment and not on opioid agonist therapy (OAT).ConclusionsThe attrition rate of the SuperMIX cohort has largely been stable throughout the duration of the study. Higher attrition rates among individuals at greater sociodemographic disadvantage and not on OAT suggest that additional efforts are required to retain these participants. Findings also suggest that SuperMIX might not be capturing data on adverse health and wellbeing outcomes among subpopulations at high risk of harm.

Lifetime Adversity and Risky Substance Use among Transgender Emerging Adults: Selected Interventions and Clinical Social Work Practice

AbstractThis study investigated multivariate relations between indicators of lifetime adversity and past year risky substance use reported by an Internet-recruited sample of transgender emerging adults from the United States (N = 248, age M = 22.61 years). Canonical correlation analysis (CCA) documented the canonical correlation between canonical variates in this sample (.362), as well as the amount of shared variance (13.1%) between set of variables representing lifetime adversity and past year risky substance use. Examination of the standardized canonical coefficients and structure coefficients highlighted the important contributions of (a) past year drug use and negative consequences of substance use to the synthetic criterion variable and (b) lifetime intimate partner violence to the synthetic predictor variable. Information generated in this study about how specific observed variables contributed to canonical variates may be used to tailor trauma-informed selected interventions in clinical socialwork practice with transgender emerging adults who report substance use problems.

Development of a Physiologically Based Pharmacokinetic Model for Flunixin in Cattle and Swine Following Dermal Exposure.

Flunixin meglumine is a nonsteroidal anti-inflammatory drug (NSAID). Banamine® Transdermal is a pour-on formulation of flunixin approved for pain control in beef and dairy cattle, but not for calves and some classes of dairy cattle or swine. Violative flunixin residues in edible tissues in cattle and swine have been reported and are usually attributed to non-compliant drug use or failure to observe an appropriate withdrawal time. This project aimed to develop a physiologically based pharmacokinetic (PBPK) model for flunixin in cattle and swine to predict withdrawal intervals (WDI) after exposures to different therapeutic regimens of Banamine® Transdermal. Due to the lack of comprehensive skin physiological data in cattle, the model was initially developed for swine and then adapted for cattle. Monte Carlo simulation was employed for population variability analysis. The model predicted WDIs were rounded to 1 and 2 days for liver and muscle in cattle, respectively, under FDA tolerance levels, while under EU maximum residue limits (MRLs), the WDIs were rounded to 1, 3, 2, and 2 days for liver, kidney, muscle, and fat, respectively, following a labeled single transdermal 3.3 mg/kg dose in cattle. The model was converted into a user-friendly interactive PBPK (iPBPK) interface. This study reports the first transdermal absorption model for drugs in cattle. This iPBPK model provides a scientifically based tool for the prediction of WDIs in cattle and swine administered with flunixin in an extra-label manner, especially by the transdermal route.

"I Didn't Have a Choice": Experiences, Responses and Perceived Motivations for Reproductive Coercion and Abuse in Australian Women.

This study explored reproductive coercion and abuse (RCA) experiences of community-based victim/survivors, their responses to RCA, and perceived motivations for RCA. One hundred and one female RCA victim/survivors completed an online questionnaire. Intimate partners, family, friends, cultural/religious leaders, and health professionals were RCA perpetrators. Victim/survivors' RCA experiences were heterogeneous, incorporating a range of pregnancy-preventing and pregnancy-promoting RCA tactics. Women's response to RCA depended on how it was experienced; victim/survivors were more likely to reassert control when RCA was verbal and not physical. Finally, control was the primary motivator for RCA, followed by contextual factors, drug use, and religion/culture.

014. Localized Meconium Peritonitis Due to Perforation of Ileum Atresia: Case Report

Background: Ileal atresia is a congenital disorder that can cause serious complications such as intestinal obstruction, intestinal ischemia, and intestinal rupture. The worldwide incidence rate is 1 in 5,000 - 10,000 births, which can be influenced by various factors such as the use of certain drugs during pregnancy, a family history of similar complaints, and premature birth which can increase the risk. One of the rare features is spontaneous walling off of the abdominal wall which resembles a cyst. From this case we found a patient who had this rare clinical presentation. Case: 3 days old baby was referred to Dr. Kariadi Semarang with a greenish lump in the epigastric region since birth, accompanied by the appearance of small intestinal obstruction. The patient was born via vaginal delivery at 39 weeks' gestation with a normal Apgar score and weight. From the history and examination that had been carried out, it was concluded that there was ileal atresia and an exploratory laparotomy was performed. A green mass was obtained which was the walling off of the ileal perforation. During the operation, another finding was found, ileal perforation caused by atresia and severe adhesions (Grade IV). The patient then underwent the Santulli procedure and laceration repair. Conclusion: Ileal atresia is diagnosed from anamnesis taking from baby has signs of obstruction such as flatulence and vomiting. The incidence of ileal atresia associated with perforation and causing peritonitis is still rare due to lack of reporting of these cases. Peritonitis, which occurs due to intestinal perforation in the jejunoileal segment, can cause the release of intestinal products, meconium, into the intra-abdominal cavity. Spontaneous walling off in this case is quite rare, and because the perforation product is sterile, it does not give a picture of inflammation.

Clinical audit on management of Post Operative Nausea and Vomiting

Postoperative nausea and vomiting (PONV) are common complications following surgery, affecting up to 30% of patients despite advances in anaesthesia and surgical techniques. It can be distressing for patients and may lead to complications such as dehydration, electrolyte imbalances, wound dehiscence, and delayed recovery. Several factors contribute to PONV, including patient-related factors (such as age, gender, history of motion sickness, and smoking), anaesthesia-related factors (type and duration of anaesthesia, use of volatile anaesthetics, opioids, and muscle relaxants), and surgical factors (type and duration of surgery, intraoperative hypotension, and use of certain drugs like opioids and nitrous oxide). It can be determined by APFEL score which says that female sex, non-smokers, history of motion sickness and post operative use of opioids have high chances of PONV. Although PONV is a very detrimental disorder, it can last for several hours to days. Not only it depends on the anaesthetic factors it is also affected by surgical stress. PONV is said to the most important factor resulting to delayed recovery and prolonged hospital stay.

Development and validation of an early acute kidney injury risk prediction model for patients with sepsis in emergency departments

In this study, we aimed to develop and validate a nomogram to predicting the risk of sepsis-associated acute kidney injury (SA-AKI) in patients admitted to emergency departments (EDs). We randomly divided a retrospective dataset of 391 patients with sepsis into a 294-person training cohort and a 97-person validation cohort, and developed three predictive models using multivariate logistic regression analysis and clinical insight. No difference was observed between the three models using the DeLong test and Model 3 was selected as the risk prediction model based on the principle of least inclusion indicators. The use of vasopressor drugs, patient age, platelet count, procalcitonin, and D-dimer levels were included. The training and validation cohorts had a consistency index of 0.832 and 0.866, respectively, indicating high accuracy and stability in predicting SA-AKI risk. The area under the receiver operating characteristic curve was 0.832, showing excellent discrimination. The calibration curves for the training and validation cohorts showed excellent calibration. The decision curve and clinical impact curve analyses showed that the net clinical benefit of using the nomogram was greatest over a probability threshold of 0.05–0.90. In addition, the model showed moderate validity in predicting the 30-day survival and the incidence of major adverse renal events within 30 days. The nomogram developed for SA-AKI risk assessment in patients in EDs showed good discriminability and clinical utility. It can provide a theoretical basis for emergency physicians to prevent SA-AKI.