Regular Medication Use Research Articles

304 IMPLEMENTING A FRAILTY SPECIFIC PHARMACY PRIORITISATION TOOLKIT IN AN OLDER PERSONS’ REHABILITATION UNIT

Abstract Background Standardised identification of patients for medication review using nurse-delivered, frailty-specific pharmacy prioritisation toolkits should maximise effective use of limited pharmacy resources. A frailty-specific pharmacy prioritisation toolkit was introduced in a 21 bed older persons’ rehabilitation unit to standardise pharmacy referrals and categorise the interventions made. Methods The frailty-specific pharmacy prioritisation toolkit was applied to consecutive patients by upskilled rehabilitation nurses to identify patients for weekly senior pharmacist review over a 5-month period from 18th Jan 2022 to 24th May 2022. Regular use of high-risk medication, greater than 10 medications, patients with specific pharmaceutical concerns such as a desire to reduce their medication burden, acute or chronic kidney injury and admission potentially related to medications or admission with non-mechanical falls are included in this toolkit. Pharmacist interventions included recommendations on medications to be weaned or stopped, dose-adjusted, started or restarted and identification of prescribing errors. Age, gender and interventions were recorded onto Excel and data was analysed using descriptive statistics. Results The total number of patients screened was 82. Eighty five percent (n=70) fulfilled criteria for a medication review. Mean age (SD) was 77(10.9) years. Female:male ratio was 1.5:1. Review was completed in 50% (n=35) of these cases. In total there were 228 interventions, with a mean (SD) of 6.5 (2.4) per patient. Eighty-four recommendations were made to wean or stop medication and thirty to dose adjust, of which 60% (n=18) were proton pump inhibitor dose reduction. Thirty-eight were to start or restart a medication, 34% (n=13) of which were for bone protection. Eleven prescribing errors were identified. Conclusion The pharmacy prioritisation toolkit applied by existing rehabilitation nurses successfully identified patients for medication review. The review rate reflects a need for a twice-weekly senior pharmacy resource.

Medication adherence among community-dwelling schizophrenia patients during the COVID-19 pandemic: A cross-sectional study

ObjectivesThis study aims to investigate medication adherence during the COVID-19 pandemic among community-dwelling schizophrenia patients, and to explore the role of social support in improving medication adherence in a rural community sample in China. MethodsA cross-sectional sample of 800 patients was recruited using a cluster random sampling method in Yingshan County, Sichuan Province. Information on participant demographic characteristics, social support and medication adherence was collected through face-to-face interviews. The data analysis was performed using SAS9.4. Two binary logistic regression models were employed to identify the association between regular medication use and social support. ResultsThe rate of regular medication adherence among community-dwelling patients with schizophrenia was 41.5%,which was lower than that indicated by recent research(Li et al., 2020) before COVID-19 in western rural China. The mean scores and standard deviation of the patient's objective support, subjective support, and support utilization were 4.94 ± 1.57, 17.03 ± 5.24, and 5.25 ± 2.75, respectively. The social support standard deviation was 27.22 ± 6.32. The crude odds ratio of objective support, subjective support, and support utilization were 0.790 (95%CI:0.713–0.876), 0.999 (95%CI:0.971–1.027), and 1.049 (95%CI:0.995–1.105) respectively. After adjusting for potential factors, the adjusted odds ratio of objective support, subjective support, and support utilization were 0.758 (95%CI:0.673–0.853), 1.030 (95%CI:0.994–1.068), and 1.043 (95%CI:0.985–1.105), respectively. ConclusionsDuring the COVID-19 pandemic, community-dwelling schizophrenia patients had a low rate of regular medication adherence. This was particularly true of those who were older adults, less educated and living in rural areas. The results of this study suggest that strengthening social support may effectively improve medication adherence for those patients.

Adherence to vitamin and mineral supplementation after bariatric surgery – A two-year cohort study

BackgroundLifelong vitamin and mineral supplementation is recommended after bariatric surgery to prevent nutritional deficiencies, but it is not clear to which extent patients adhere to the recommended medication. The aim of this study was to assess adherence to supplementation. Additionally, we assessed predictors of low adherence and biochemical deficiencies. Methods263 adults were followed two years post bariatric surgery (89.4 % Roux-en-Y gastric bypass, 10.6 % sleeve gastrectomy) regarding adherence to calcium-vitamin D, vitamin B12 and iron. Pharmacy refill data was used to objectively capture adherence-rate. Predictors of low adherence were assessed via questionnaires and medical records. Blood sampling was performed preoperatively, and 1- and 2-years post-surgery. ResultsAbout 60 % of the study participants had high adherence-rate (≥ 80 %) two years post-surgery, but a significant proportion had discontinued the intended lifelong supplementation: 15 % for calcium-vitamin D and 12 % for B12. Biochemical deficiencies were uncommon two years after surgery, both in adherent and non-persistent subjects, except for a 10 % prevalence of anemia. Younger age, experience of side effects, mental health problems and no regular use of medication before surgery, were factors associated with low adherence. ConclusionSubstantial variation existed in adherence to supplementation regimens after bariatric surgery during the first two years after bariatric surgery, but biochemical deficiencies were rare. The results indicate need for tailored follow-up and strategies to support long-term persistence.

Hoarseness Among Young Children in Day-Care Centers

Chronic respiratory symptoms among toddlers are assumed to be due to allergies and common respiratory infections. Because symptoms and respiratory disease in this age group often continue on to school age and later life, it is important to know the possible risk factors for prevention of the chronic hoarseness. We aimed to determine the current prevalence of hoarseness and other chronic respiratory symptoms among toddlers and young children. Another aim was to examine the risk factors for hoarseness in the building environments of day-care centers (DCC). An electronic symptom survey was sent to all parents of children in day-care centers of a large city in southern Finland. In all, 3721 individuals completed the questionnaire (38%), 53.4% were the parents of boys and 46.6% girls. The prevalence of hoarseness was 5.6%. The boy's parents reported hoarseness more often than the girls, but no significant difference was observed. Risk factors for hoarseness in a built environment in this age group were noise, visible dust and dirt, mold and a cellar like odor, a sewer smell, other unpleasant smells, stuffiness of the indoor air, a too high or too low temperatures, a cold floor, insufficient ventilation, the age of the DCC building, and wood as the bearing construction of the building. The lifestyle factors that correlated with the prevalence of hoarseness were the amount of time spent outdoors; however, passive smoking, the number of siblings and pets at home did not correlate with hoarseness. Hoarseness was significantly correlated with other chronic respiratory symptoms such as rhinitis, coughs, eye irritation, tiredness, headaches, and stomach problems and also with the regular or periodic use of medication. Hoarseness was also significantly correlated with asthma and allergic rhinitis and also with repeated infections, such as a common cold, cold with a fever, laryngitis, otitis media and acute bronchitis, but not with tonsillitis or pneumonia. When potential confounders had been controlled for with a logistic regression model, the following risk factors in the built environment remained statistically significant: noise, high room temperature, insufficient ventilation and the stuffiness of the indoor air, a solvent odor, wood as the bearing construction and the age of the building. We conclude that in day-care centers, buildings should be maintained, cleaned and ventilated properly. Concrete and brick used in the construction were protective compared with wood. The acoustic environment should be planned to reduce noise indoors and solvent based chemicals should be avoided. Neither having pets at home or the number of siblings were risk factors, but they were also not found to be protective in this material. All measures that reduce the occurrence of respiratory infections probably also reduce chronic voice problems.

Predictors of blood pressure and hypertension long-term after treatment of isolated coarctation of the aorta in children-a population-based study.

OBJECTIVESThe aim of this study was to assess predictors of BP and hypertension and relations between BP and LV mass in a population-based retrospective study of repaired isolated coarctation of aorta.METHODSWe collected follow-up data until 2018 of 284/304 (93%) patients with coarctation treated by surgery (n = 235) or balloon angioplasty/stent (n = 37/12) in our unit 2000–2012. Systolic hypertension was defined as systolic BP (SBP) z-score ≥+2 standard deviation (SD) or regular use of BP medication. LV hypertrophy was defined as LV mass z-score ≥+2 SD or LV mass index g/m2.7 ≥95th percentile.RESULTSThe median (25–75th percentiles) follow-up time and age at follow-up were 9.7 years (6.9–13.2) and 11.8 years (7.9–16.0), respectively. Age at first procedure (P = 0.011) and systolic arm-leg-gradient (P = 0.007) were positively and transverse arch (P = 0.007) and isthmus diameter (P = 0.001) z-scores at follow-up were negatively associated with SBP z-score adjusted for age at follow-up and need for reintervention for coarctation. Systolic hypertension was present in 53/284 (18.7%) and related with increasing age at first procedure (median 33.2 vs 0.6 months; P < 0.001) and arm-leg-gradient at follow-up (mean ± SD, −0.3 ± 14.6 vs −6.4 ± 11.6 mmHg; P = 0.047) adjusted for reintervention for coarctation and age at follow-up. LV hypertrophy was present in 20/227 (9.3%) and related with SBP z-score.CONCLUSIONSHigher SBP and hypertension in repaired coarctation of aorta are related with increasing age at first procedure and arm-leg-gradient at follow-up. Transverse arch and isthmus diameters at follow-up are inversely related with SBP.

Financial burden among cancer patients: A national-level perspective.

This research study aimed to evaluate the financial burden among older cancer patients and its corresponding risk factors. Factors such as increasing treatment costs and work limitations often lead cancer patients to bankruptcy and poor quality of life. These consequences, in turn, can cause higher mortality rates among these patients. This retrospective cohort study utilized data from the Health Retirement Study (HRS), conducted by the University of Michigan (N= 18,109). Eligible participants had responses captured from years 2002 to 2016. Participants were classified according to any self-reported cancer diagnosis (yes or no) and were compared on the basis of financial, work, and health-related outcomes. Propensity score (PS) matching was applied to reduce the effects of potential confounding factors. Also only, individuals with an age ≥50 and ≤85 during Wave 6 were retained. Multivariate analysis with random effects revealed several indicators of financial burden when comparing participants with a cancer diagnosis to those with no history of cancer. Mean out-of-pocket costs associated with a cancer diagnosis were $1058 higher when compared to participants with no history of cancer, suggesting that even cancer patients with insurance coverage faced out-of-pocket costs. Respondents with cancer patients had higher odds of encountering financial hardship if they are facing Work Limitations (OR = 2.714), Regular use of Medications (OR = 2.518), Hospital Stays (OR = 2.858), Declining Health (OR = 2.349), or were being covered under government health insurance (OR = 5.803) than respondents who did not have cancer, or suffered from mental health issues such as Depression (OR = 0.901). Cancer patients contend with increasing financial costs during their treatment. However, most newly diagnosed patients are not aware of these costs and are given few resources to handle them.

Asymptomatic COVID-19 Infection Induced First Episode Psychosis: A Case Series

Aims: We presented 3 similar cases of 1st episode psychosis that occurred after Corona Virus Disease -2019 (COVID-19) infection which we treated at our institute’s on going post-COVID-19 mental health clinic, to provide more evidence to the existing literature and to describe whether an asymptomatic COVID-19 infection can also induce psychosis in previously healthy individuals and tried to elaborate the probable etiology and nature of the psychotic symptoms.&#x0D; Presentation of the Cases: All the 3 cases had COVID-19 infection, few days before their psychotic symptoms started for the 1st time. They didn’t have any history of regular substance or medication use that are known to induce psychosis or any previous history of psychiatric disease or family history of psychiatric disease, without any abnormality in physical examinations and laboratory investigations. All the cases had history of stress which were not overwhelming (except the 3rd case) and were mostly related to COVID-19 infection and pandemic associated social and financial stress. 1st case (54 years, married male) developed delusion of persecution, delusion of reference, 2nd and 3rd person auditory hallucinations, 2nd case (61 years, widower male) developed delusion of persecution, 2nd person auditory hallucination (commanding type), disinhibited behaviour (disrobing in public) and the 3rd case (32 years, unmarried male) developed delusion of persecution and delusional misidentification (Intermetamorphosis). All of them responded well to commonly used antipsychotics within 4 weeks that prompted a diagnosis of Acute and Transient Psychotic disorder according to ICD-10 criteria.&#x0D; Discussion: This study points out that even an asymptomatic COVID-19 can induce psychosis for the first time in life, where the etiology most probably is the direct effect of the virus itself on brain or the COVID-19 and pandemic related stress which is supported by the fact that factors like family history of psychiatric disease, substance use or medication use or any comorbidity that can induce psychosis were also absent. The psychopathological findings were persecutory delusion and auditory hallucinations with one case having Intermetamorphosis phenomenon which is a rare finding and perhaps a novel finding in post-COVID-19 Psychosis.&#x0D; Conclusion: All COVID-19 infected individuals should be screened early for appearance of any symptom that raises the suspicion of psychosis. Large studies are needed to ascertain the etiology of post-COVID-19 psychosis.

The effect of ARBs and ACEIs on SARS-CoV-2: Exploring the controversy

As the COVID-19 pandemic spread quickly across the world, one of the largest emerging debates in the science community was surrounding the risk of COVID-19 (also referred to as SARS-CoV-2) as an effect of the regular use of anti-hypertensive medications. In this article, this debate and the controversy that followed will be analyzed by outlining the elements of the biological system involved, then analyzing its importance, the implicated arguments, and the controversy itself.

Prospective preference assessment for the Comparison of Analgesic Regimen Effectiveness and Safety in Surgery (CARES) trial

BackgroundClinical trials face major barriers such as under-enrollment and selective enrollment, which threaten study completion and undermine validity and generalizability. Thus, we conducted a prospective preference assessment (PPA) prior to commencing the Comparison of Analgesic Regimen Effectiveness and Safety in Surgery (CARES) trial—a randomized controlled study comparing the outcomes of managing acute postoperative pain between opioid-sparing and opioid-based therapies. This PPA aimed to (1) determine the patients’ willingness to participate in the CARES trial, (2) identify the areas for improvement, and (3) assess the differences between willing and unwilling patients.MethodsPatients undergoing elective laparoscopic cholecystectomy were recruited between August 2019 and February 2020 from two academic hospitals. A survey was administered to each patient consisting of (1) a vignette describing the trial, (2) an assessment of the patients’ understanding of the trial, (3) open-ended questions assessing the attitudes towards the trial, and (4) patient-completed questionnaires. Data were analyzed qualitatively with thematic analysis and quantitatively with the Wilcoxon signed-rank and chi-square tests.ResultsForty-two patients were enrolled and grouped based on the 6-point Likert scale into willing (4–6, 71%) and not willing (1–3, 29%) to participate in the CARES trial. There were no significant differences with respect to all variables: age, education, sex, visible minority status, previous research, previous surgery, regular use of pain medications, surgical concerns, previous discussions on pain management, significant pain within the past 3 months, and significant use of pain medication within the past month. Factors that motivated participation were contributing to scientific research (45%), altruism (29%), and improving personal pain (24%). Common discouraging factors were negative perceptions of opioids (29%), side effects (21%), being blinded to the study medication (21%), and poor pain management (19%).ConclusionsThis PPA revealed that two key discouraging factors for patients were being blinded to the type of pain medication being taken and the potential for poor pain management as a consequence of participation. Modifications to improve patient acceptance of the CARES trial include ensuring sufficient rescue medicine and follow-up visits consistent with current standards of care for all patients, as well as patient education surrounding safe administration and side effects of the study medications.

EFFECTS OF OCCUPATIONAL EXPOSURE TO IONIZING RADIATION ON OXIDATIVE STRESS AND INFLAMMATORY MARKERS IN HEALTHCARE WORKERS OF A UNIVERSITY HOSPITAL IN KONYA, TURKEY

OBJECTIVE Ionizing radiation (IR) has a wide area of use and its effects on human health have been discussed since its discovery. This study aimed to show oxidative stress and inflammation due to ionizing radiation exposure based on biomarkers in healthcare workers.&#x0D; METHOD This study was conducted with 172 people, who were exposed to IR in the work environment and those who did not have exposure to radiation. In this cross-sectional study, a data collection form was used to obtain data from the participants. In addition, 6 ml of blood was taken to measure their tumor necrosis factor (TNF)-alpha, total oxidant status (TOS), interleukin (IL)-10 and total antioxidant status (TAS) levels, and calculate their oxidative stress index (OSI) values.&#x0D; RESULTS In the ionizing radiation group, 50% of the participants were men, the mean age was 35.91±7.07 years, and the mean duration of employment was 9.80±7.1 years. The TOS, OSI, TNF-α and IL-10 values were higher and TAS was lower in the ionizing radiation group compared to the participants without exposure to ionizing radiation. Gender, smoking, alcohol use, presence of chronic diseases, regular medication use, antioxidant supplement use, and exposure to radiation for medical diagnosis and treatment within the last year did not affect oxidative stress and inflammation in the radiation workers. The cut-off values of the TOS, TAS, OSI, TNF-α and IL-10 biomarkers were also determined.&#x0D; CONCLUSION Occupational low-dose long-term exposure to ionizing radiation was found to increase oxidative stress and inflammation.

Predictive factors of non-adherence to asthma medication in pregnancy.

Background. Adherence to asthma medications is a significant problem among pregnant women. Objective. To evaluate asthma medication adherence in pregnant women and to determine the factors that may predict non-adherence in a real-life setting. Methods. A cross-sectional study was performed with pregnant women with asthma followed in a specialized asthma consultation at the Pulmonology Department, between 2014 and 2019. Sociodemographic and clinical variables were collected. Structured telephone interviews were conducted to determine regular medication use during pregnancy. Multiple logistic regression was used to identify predictive factors of asthma medication non-adherence (cessation or dose reduction). Results. A total of 82 pregnant women were included: mean age of 31.3 ± 6.5 years, non-adherence was detected in 29% (n = 24). Multivariable logistic regression analysis revealed that mild asthma during pregnancy (OR, 4.8; 95% CI 1.4-17.1, p = 0.015) and single, separated or divorced mothers (OR, 4.0; 95% CI 1.3-11.8, p = 0.014) were independent predictors of poor adherence to asthma medications. Conclusions. Asthma severity and marital status can strongly predict the asthma medication non-adherence in pregnant females. These findings may help improve asthma education strategies to promote.

Dietary Supplement Use in Middle-aged and Older Adults.

Despite limited evidence of clinical benefits, dietary supplement use is increasingly common among older adults. The aim of this study was to characterise the prevalence of dietary supplement use in a national sample of community-dwelling middle-aged and older adults and investigate factors associated with its use. This was a cross-sectional study using data from the Health and Retirement Study (HRS), a biennial, nationally representative survey of individuals aged 50 years and older in the United States. This study combined data from the 2013/14 Health Care and Nutrition Survey (HCNS) and 2012 Core Survey. The primary outcome was the use of any dietary supplement at least once a week. Secondary outcomes were the use of multivitamins and specific vitamin and supplement types. Multivariable regression models were used to identify factors associated with any dietary supplement use. A total of 6045 participants (weighted n = 71,268,015) were included in the final analytical sample (mean age 67.7 years, 59.3% female). Of these, 84.6% (n=60,292,704) were regular dietary supplement users, with participants taking a mean of 3.2±0.1 different dietary supplements and 41.9% taking four or more. Multivitamins were the most common, used by 57.5% (n=41,147,146) of participants. Other commonly used dietary supplements were vitamin D, fish oil, calcium, vitamin C, and vitamin B12. Older age (75+ years), female sex, higher education, daily alcohol use, vigorous physical activity, regular medication use, and arthritis were associated with higher odds of dietary supplement use. In this sample of middle-aged and older Americans, more than 4 out of 5 used a dietary supplement. Certain demographic, behavioural, and clinical factors were associated with their use. Given the lack of evidence for improving health outcomes, our findings suggest potential overuse of dietary supplements in people over the age of 50.

Association of parental factors and delayed dental care for children

There is a general perception that majority of parents delay seeking oral health care services for their children. However,the reasons for this health seeking behaviour and the related contributing factors are poorly understood. Aims To investigate the parental factors that influence delayed dental care for their children. Methodology A descriptive cross-sectional survey that was conducted at MEDUNSA Oral Health Centre and other oral health facilities within Tshwane oral health district. Parents of children 12 year and younger participated in the study. Results The average age of 350 parents and children in the study was 36.94 (±9.40) and 6.31 (±2.38) years respectively. Most parents were female 315 (90.0%), unemployed 281 (80.3%) and reached high school education 281 (80.3%). The association between gender, age, employment and dmft with delayed dental treatment for children was not statistically significant. Parents considered acute medical conditions as urgent compared to dental pain and conditions (OR =1.27). Regular use of home remedies and medications exacerbated delayed dental visits for children, irrespective of the problem. Conclusion Parental attitude and perception of oral health contribute delayed dental visits by children. Majority of parents resorted to alternative remedies such as self-medication in managing children`s oral health pain and conditions instead of seeking oral health care for their children.

Attitudes towards influenza and pneumococcal vaccines in parents of asthmatic children during the COVID-19 pandemic.

This study aimed to determine the differences in attitudes and views towards influenza and pneumococcal vaccines in parents of children with asthma during the COVID-19 pandemic. Asthmatic children in the 6-18 age group who were admitted to the pediatric allergy clinic of our hospital between October 1, 2020 and February 31, 2021 were included in the study. The parents were given a questionnaire asking about their demographics and medical history. Their attitudes and thoughts towards these two vaccines, both before and during the pandemic, and their COVID-19 stories were questioned. A total of 78 patients diagnosed with asthma were included in this study. While the rate of influenza vaccination before the pandemic was 29.5%, the rate of those who received or wanted to receive influenza vaccine during the pandemic was 71.8% (p = 0.001). It was observed that the rate of influenza vaccination during the pandemic increased with the regular use of asthma medication, the presence of atopy, and a history of COVID-19 infection in the family/close environment. In total, 69.2% of the parents stated that their child's pneumococcal vaccination was incomplete or they were unaware of their child's vaccination status. This study demonstrated that there was an increase in the rate and willingness of parents of asthmatic children to have their children vaccinated against influenza during the COVID-19 pandemic. As for the pneumococcal vaccine, the majority of the parents did not have enough information or they were unaware of the vaccination status of their children.

Prototyping neural networks to evaluate the risk of adverse cardiovascular outcomes in the population

Aim. To develop a neural network basis for the design of artificial intelligence software to predict adverse cardiovascular outcomes in the population.Materials and Methods. Neural networks were designed using the database of 1,525 participants of PURE (Prospective Urban Rural Epidemiology Study), an international, multi-center, prospective study investigating disease risk factors in the urban and rural areas. As this study is still ongoing, we analysed only baseline data, therefore switching prognosis and diagnosis task. Because of its leading prevalence among other cardiovascular diseases, arterial hypertension was selected as an adverse outcome. Neural networks were designed employing STATISTICA Automated Neural Networks (SANN) software, manually selected, cross-validated, and transferred to the original graphical user interface software.Results. Input risk factors were gender, age, place of residence, concomitant diseases (i.e., coronary artery disease, chronic heart failure, diabetes mellitus, chronic obstructive pulmonary disease, and asthma), active or passive smoking, regular use of medications, family history of arterial hypertension, coronary artery disease or stroke, heart rate, body mass index, fasting blood glucose and cholesterol, high- and low-density lipoprotein cholesterol, and serum creatinine levels. Our neural networks showed a moderate efficacy in the virtual diagnostics of arterial hypertension (84.5%, or 1,289 successfully predicted outcomes out of 1,525, area under the ROC curve = 0.88), with almost equal sensitivity (83.6%) and specificity (85.3%), and were successfully integrated into graphical user interface that is necessary for the development of the commercial prognostication software. Cross-validation of this neural network on bootstrapped samples of virtual patients demonstrated sensitivity of 82.7 – 84.7%, specificity of 84.5 – 87.3%, and area under the ROC curve of 0.88 – 0.89.Conclusion. The artificial intelligence prognostication software to predict adverse cardiovascular outcomes in the population can be developed by a combination of automated neural network generation and analysis followed by manual selection, cross-validation, and integration into graphical user interface.

Comprehensive approach for the treatment of medication-overuse headache

Background: Medication-overuse headache (MOH) is defined by the International Classification of Headache Disorders as a headache in patients with a pre-existing primary headache disorder that occurs on 15 or more days per month for more than 3 months. It is caused by overuse of medication for acute or symptomatic headache treatment. Regular and frequent use of acute or symptomatic medications can worsen headaches and lead to chronic headache or MOH. MOH is a burdensome medical condition that is difficult to treat, and the frequent recurrence of headaches may result in disability in individuals and impair socioeconomic outcomes.Current Concepts: Awareness of MOH and the education of patients, the general population, and healthcare providers are important for the first step of treatment. Scientific research regarding the treatment of MOH has been published in the past few years.Discussion and Conclusion: Physicians should educate and counsel patients to stop or at least reduce the intake of acute or symptomatic medications that can be discontinued abruptly or tapered slowly. During the period after the discontinuation of the overused medications, some withdrawal symptoms including headache might be manageable with bridging therapy. Evidence-based preventive therapies including anticonvulsants (topiramate and divalproex sodium), botulinum toxin A, and medications acting by antagonism of the calcitonin generelated peptide pathway might be helpful in patients with MOH for both avoiding the overused medication and preventing the relapse of overuse. A comprehensive and multidisciplinary approach may improve the outcomes of patients with MOH.

The Peripheral Blood Inflammatory Patterns in the Control Levels of Asthma in Children

To evaluate the role of white blood cell count, platelet count (PLT), mean platelet volume (MPV), and eosinophil percentage as objective markers of asthma control in pediatric patients.The study included 348 patients between the ages of 4 and 18 years diagnosed with asthma from January 2011 through September 2015 at the University of Health Sciences in Ankara, Turkey. Within the cohort, 63.2% were male, and 43.1% had controlled asthma.This was a retrospective and cross-sectional study in which subjects with asthma were separated into 2 groups: controlled and uncontrolled asthma (by using the Asthma Control Test). Subjects were further subdivided into groups on the basis of medication use (regular versus irregular) and atopic status (atopic versus nonatopic). The white blood cell count, PLT, MPV, eosinophil percentage, forced expiratory volume in 1 second (%), FVC (%), and forced expiratory volume in 1 second to FVC (%) were extracted from each subject’s medical record. Laboratory data were compared between patients in the controlled and uncontrolled asthma groups. The effect of medication use and atopic status on laboratory data were further analyzed.The eosinophil percentage was significantly higher in the uncontrolled asthma group (4.992 ± 3.43), compared with that of the controlled asthma group (3.493 ± 2.24) independent of atopic status. There were no significant differences in the PLT, MPV, or eosinophil percentages between asthmatics with and without atopy. The eosinophil percentage was significantly higher among asthmatics with regular medication use (4.788 ± 3.007) versus that of those with irregular medication use (3.986 ± 3.077).Eosinophil percentage may be an effective marker to monitor asthma control in the pediatric population.Monitoring asthma control can be difficult in pediatric patients who are too young or unable to perform pulmonary function tests. With this study, the authors suggest a role for biomarkers, such as eosinophil percentage, in the monitoring of pediatric asthma. Eosinophil percentage could be used in the follow-up and treatment of asthma in pediatric patients who are unable to perform other objective tests. Randomized controlled trials are needed to confirm that eosinophil percentage is a reliable parameter.

HIV Pre-Exposure Prophylaxis (PrEP) purchase patterns and STI occurrence among Israeli men: A cohort analysis.

BackgroundHIV Pre-exposure prophylaxis (PrEP) is the regular use of antiretroviral medication by people who are not infected with HIV to prevent seroconversion. Israel approved PrEP for continuous use in 2017, and Israeli Health Maintenance Organizations (HMO) offered PrEP with a copayment to eligible members.MethodologyThis retrospective cohort study included all people who were dispensed PrEP between September 2017 to June 2019 in the second largest HMO in Israel. Statistical analysis, including Kaplan Meier, was conducted to evaluate user PrEP purchase, adherence to medical follow-up, and clinical outcomes.ResultsIn total, a cohort of 757 PrEP users were followed for 657.8 person-years. All but one user were male; median age was 35 years. At baseline, 0.8% had gonorrhea and 1.5% had chlamydia infections and 4.4% had recent syphilis infection. Continuous use of PrEP (without interruption/discontinuation) was observed in 29.9%, while 39.9% interrupted and 30.3% discontinued use. Median time to first interruption/discontinuation was 4.0 months. At 6–12 months after initiation, 79.8% of users had a documented HIV test, 77.3% a Chlamydia-Gonorrhea panel, and 78.9% a creatinine test. There was one new case of HIV among the cohort, five months after PrEP discontinuation. Estimated first-year infection rates were 5.0%, 8.6% and 6.8% for gonorrhea, chlamydia and first-time syphilis, respectively.ConclusionsThis study shows heterogeneous PrEP purchase patterns and required medical follow-up, and an increase in STIs among consistent PrEP users. Improving adherence to recommended medical follow-up during PrEP use is essential in PrEP’s integration into Israel’s national HIV prevention strategy.

Platelet-rich Plasma for Refractory Coccydynia: A Case Report

Introduction: Coccydynia is a common syndrome characterized by pain localized to the tailbone that radiates into the lower sacrum and perinium. Coccydynia affects female patients more frequently than male patients. It occurs more commonly after direct trauma from fall directly onto the coccyx. The pain is caused commonly by the strain of sacrococcygeal ligament or fracture of the coccyx and less commonly secondary to arthritis. Conservative treatment of coccydynia include simple analgesics and foam donut to prevent irritation to sacrococcygeal ligament. If pain persist, usually ganglion impar block and radiofrequency are alterative options. There are no strong evidence to support coccygectomy.&#x0D; Case Report: A 40-year-old presented with coccygeal pain for more than six months. The patient was seen at the pain clinic in Prince Sultan Military Medical City after failure of conservative and multiple steroid injections followed by radiofrequency therapy. We discussed with the patient a trial of a platelet-rich plasma (PRP) injection into the sacrococcygeal ligament under fluoroscopic guidance with full details endorsed to the patient including the risks and benefits of the procedures and informed consent signed before the injection. Pain severity score was taken before and about one month after each injection. The patient received a total of three PRP injections.&#x0D; Result: The patient reported about 30%, 70%, and 85% pain reduction after the first, second, and third injection, respectively. At six months, the patient continued to experience the same level of reduced pain without the use of regular pain medications.&#x0D; Conclusion: PRP can be considered as an option for the treatment of patients with refractory coccydynia.

Burnout, lifestyle and relaxation among dentists in Lithuania: a cross-sectional study

BackgroundThe aim of this study was to estimate the association of burnout level with lifestyle and relaxation among dentists in Lithuania. A better understanding of this association could help in the development of targeted interventions to prevent burnout among these professionals.MethodsThe survey was conducted among practising dentists (N = 380) using the Maslach Burnout Inventory (MBI) and an authors’ proposed scale to measure lifestyle and relaxation. Poisson regression was applied to examine the association between variables.ResultsRegular cigarette smoking among dentists in Lithuania was 16.8 % and alcohol consumption was 31.3 %. Some forms of active relaxation were also common: regular playing sports (57.9 %), and spending time in nature (61.4 %). Emotional exhaustion (EE) and depersonalization (DP) burnout dimensions were negatively related to the regular use of illegal substances, alcohol, medication and smoking, while personal achievement (PA) was negatively related to smoking only. Dentists who regularly exercised had significantly lower EE and DP sum scores, and better assessments of PA. There were also positive relationships of EE, DP and PA sum scores with the variables of relaxation (e.g., spending time with family or friends, visiting a theatre, engaging in art, listening to music).ConclusionsIt was concluded that the burnout dimensions are negatively associated with unhealthy lifestyle factors and positively associated with active relaxation among dentists in Lithuania. Therefore, burnout prevention should target specific lifestyle and relaxation improvement strategies.