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Medical influences,surgical outcomes: Role of common medications on the risk of perforation from untreated diverticular disease

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World Journal of Gastroenterology 2013年第36期19卷 5947-5952页

作者： Gianpiero Gravante Shuker Yahia Department of Colorectal SurgeryGeorge Eliot Hospital

Numerous drugs,largely used in the wards or at home,have a significant influence on patients with untreated diverticular *** consequences can be disastrous,may require an emergency operation,postoperative intensive care,and overall influence the patient’s length of stay and the final *** these considerations in mind the routine or chronic administration of pain-killers,steroids and non-steroidal anti-inflammatory should be balanced in patients with known diverticular disease as it normally happens with other conditions potentially affected by these drugs(i.e.,peptic ulcer disease or chronic obstructive pulmonary disease).This is even more important in the old and frail patient where an eventual surgical treatment may not always be possible.

关键词： Perforation Diverticular disease medications Drugs Risk factor

Prevention of macrovascular complications in patients with type 2 diabetes mellitus: Review of cardiovascular safety and efficacy of newer diabetes medications

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World Journal of Diabetes 2019年第6期10卷 324-332页

作者： Ravi Kant Kashif M Munir Arshpreet Kaur Vipin Verma Division of Endocrinology Diabetes and Nutrition Medical University of South Carolina/Anmed Campus Anderson SC 29621 United States Division of Endocrinology Diabetes and Nutrition University of Maryland School of Medicine Baltimore MD 21201 United States Division of Endocrinology Diabetes and Nutrition Sinai Hospital Baltimore MD 21215 United States Department of Medicine Medical University of South Carolina/Anmed Campus Anderson SC 29621 United States

Lack of conclusive beneficial effects of strict glycemic control on macrovascular complications has been very frustrating for clinicians involved in care of patients with diabetes mellitus (DM). Highly publicized controversy surrounding cardiovascular (CV) safety of rosiglitazone resulted in major changes in United States Food and Drug Administration policy in 2008 regarding approval process of new antidiabetic medications, which has resulted in revolutionary data from several large CV outcome trials over the last few years. All drugs in glucagon-like peptide-1 receptor agonist (GLP-1 RA) and sodium-glucose cotransporter-2 (SGLT-2) inhibitor classes have shown to be CV safe with heterogeneous results on CV efficacy. Given twofold higher CV disease mortality in patients with DM than without DM, GLP-1 RAs and SGLT-2-inhibitors are important additions to clinician’s armamentarium and should be second line-therapy particularly in patients with T2DM and established atherosclerotic CV disease or high risks for CV disease. Abundance of data and heterogeneity in CV outcome trials results can make it difficult for clinicians, particularly primary care physicians, to stay updated with all the recent evidence. The scope of this comprehensive review will focus on all major CV outcome studies evaluating CV safety and efficacy of GLP-1 RAs and SGLT-2 inhibitors.

关键词： Newer antidiabetic medications Glucagon-like peptide-1 receptor agonist Sodium-glucose cotransporter-2 inhibitors Type 2 diabetes mellitus Macrovascular complications Cardiovascular outcome trials Major cardiovascular events Heart failure Prevention of heart disease

Improving Adherence to Prescribed Antidiabetics and Cardiovascular medications in Primary Health Care Centers in Nyala City, South Darfur State-Sudan

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Pharmacology & Pharmacy 2013年第9期4卷 701-709页

作者： Ahmed Dahab Ahmed Asim Ahmed Elnour Mirghani Abd Elrahman Yousif Farah Hamad Farah Hasab Alrasoul Akasha Ahmed Osman Abobakr Abasaeed College of Pharmacy and Health Sciences Ajman University of Sciences and Technology Ajman UAE College of Pharmacy Clinical Pharmacy Taif University Taif KSA Consultant Clinical Pharmacist Al Ain Hospital Abu Dhabi Health Services Company (SEHA) Al Ain UAE Department of Pharmacology College of Medicine and Health Sciences UAE University Al Ain UAE Revolving Drug Fund (RDF) Ministry of Health (MOH) Nyala Sudan Department of Pharmaceutics Faculty of Pharmacy Gezira University Medani Sudan Social and Clinical Pharmacy Department Faculty of Pharmacy Charles University Hradec Kralove Czech Republic Registration and Drug Control Department Ministry of Health Abu Dhabi UAE. The Epidemiological Laboratory (Epi-Lab) Khartoum Sudan

Aims: Prospective pharmacist’s interventions aimed to improve patient’s knowledge and behaviors to adhere to medications in patients with type 2 diabetes with or without cardiovascular medical conditions in primary health care (PHCs) centers in Nyala city, South Darfur State, Sudan. Methodology and Materials: 300 patients were enrolled for assessing adherence with the Brief Medication Questionnaire (BMQ) in ten PHCs in Nyala city. We assessed patients’ responses to BMQ pre-and post-interventions plan by: complex interventions, humanitarianism and disease outcomes determined by health-related outcomes (SF-36), glycosylated hemoglobin (HbA1c) and blood pressure. Results: BMQ scores have improved significantly in four screens (pre-and post-interventions): regimen [4.6 ± 0.2 to 1.8 ± 0.1;P = 0.001], belief [1.6 ± 0.3 to 0.3 ± 0.3;P = 0.007], recall [1.7 ± 0.2 to 0.6 ± 0.2;P = 0.043] and access screens [1.8 ± 0.1 to 0.4 ± 0.1;P = 0.005];which have indicated an improved patients’ adherence to medications. Percentage of subjects reaching target of post prandial blood glucose (PPBG) have increased from 28.0% to 49.3%;[P = 0.02] post interventions. PPBG mean values have decreased significantly from [11.1 ± 0.6 mmol/L to 8.1 ± 0.8 mmol/L;

关键词： Adherence Darfur medications Nyala PHCs Sudan

Adherence to Drug medications amongst Tuberculosis Patients in a Tertiary Health Institution in South East Nigeria

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International Journal of Clinical Medicine 2015年第6期6卷 399-406页

作者： Chika F. Ubajaka Emmanuel C. Azuike John O. Ugoji Onyema E. Nwibo Obiorah C. Ejiofor Ifeoma A. Modebe Uche M. Umeh Department of Community Medicine Nnamdi Azikiwe University Teaching Hospital Nnewi Nigeria Department of Pharmacy Nnamdi Azikiwe University Teaching Hospital Nnewi Nigeria Department of Surgery Nnamdi Azikiwe University Teaching Hospital Nnewi Nigeria Department of Paediatrics Anambra State University Teaching Hospital Amaku Nigeria

Tuberculosis remains one of the major health problems in many tropical countries. An estimated eight to ten million people develop overt tuberculosis annually worldwide as a result of primary infection, endogenous reactivation or exogenous re-infection. About half of all patients with TB do not complete treatment and this contributes to prolonged infectiousness, drug resistance, relapse and death. This study is aimed at assessing the adherence of TB patients to anti-TB medications as well as the factors influencing drug adherence in a tertiary health care institution in South-Eastern Nigeria. A descriptive cross-sectional study was conducted among 217 TB patients in Nnamdi Azi-kiwe University Teaching Hospital, Nnewi. Information was obtained using a self-administered and interviewer administered semi-structured questionnaire. The mean age of the respondents is 36.1 ± 13.3 years. More of the respondents were females (58.1%), while 41.9% were males. It was observed that 74.2% had never failed to take their anti-TB drugs while 24.2% agreed they had failed to take their drugs. The major reasons for failure to take drugs were no money for transport to collect new drugs and forgetfulness by 32.7% of the respondents respectively. The factors which influenced drug adherence were educational qualification, average monthly income, ill-health as a financial burden and receiving HIV drugs

关键词： Adherence Drug medications Tuberculosis

Impact of preterm birth and low birth weight on medical conditions, medication use and mortality among neonates: a prospective observational cohort study

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World Journal of Pediatrics 2019年第3期15卷 281-288页

作者： Krishna Undela Bashar Talal Saad Mohammed Parthasarathi Gurumurthy Srinivasa Murthy Doreswamy Department of Pharmacy Practice JSS College of Pharmacy.JSS Academy of Higher Education and ResearchSS NagaraMysuru.Karnataka 570 015.India Department of Pediatrics JSS Medical College and Hospital.JSS Academy of Higher Education and ResearchMahatma Gandhi RoadMysuruKarnataka 570 004India

Background There is a paucity of studies conducted in India on neonatal outcomes of preterm birth and low birth ***,we aimed to assess the impact of preterm birth and low birth weight on medical conditions,medication use and mortality among *** A prospective observational cohort study was conducted at the neonatal intensive care unit (NICU) over a period of 9 *** of either sex,admitted to NICU and who received at least one medication were enrolled in the *** and demographic data,reason(s) for NICU admission,diagnoses,medications prescribed,medication-related problems,discharge status and the direct medical cost were documented and *** Four hundred and five neonates Were included in the study:60.5% were boys,32.7% were preterm and 44.2% were born *** sepsis (n =125,16.7%),unconjugated hyperbilirubinemia (n =83,11.1%) and respiratory distress syndrome (n =62,8.3%) were the most common medical conditions and were significantly more common among preterm and underweight *** half of the medications prescribed were anti-infectives for systemic use (n =1310,47.4%).The mean number of medications received by neonates increased from term to extremely preterm (5.2-15.0) and normal birth weight to extremely low birth weight (5.0-14.9).Mortality rate was significantly higher among extremely preterm (66.7%),and very preterm (15.2%) neonates compared to term (2.9%) *** median direct medical cost for NICU admission was INR 21,430 (USD 331).Conclusion Medical conditions,medications prescribed and mortality rate were significantly higher among preterm and underweight neonates admitted to NICU.

关键词： Low birth weight Medical conditions medications Mortality Preterm birth

Clinical characteristics, treatment and prognosis of patients with idiopathic dilated cardiomyopathy: a tertiary center experience

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Journal of Geriatric Cardiology 2019年第4期16卷 320-328页

作者： Abdullah Hagar Xiao-Bo PU Shi-Jian CHEN Jageshwar-Prasad Shah Mao CHEN Department of Cardiology West China HospitalSichuan UniversitySichuanChina Department of Cardiology Affiliated Minda Hospital of Hubei Institute for NationalitiesHubeiChina

Background Contemporary heart failure medications have led to considerable improvement in the survival of patients with heart failure. However,limited evidence is available regarding the effect of those medications in patients with idiopathic dilated cardiomyopathy (IDCM),particularly in China. We sought to analyze the trends in clinical characteristics and the prescription rate of recommended therapies and its prognostic impact in patients with IDCM. Methods From 2009 to 2016,1441 consecutive patients (age: 55±14 years,68% men,LVEF: 33%± 12%) fulfilling World Health Organization criteria for IDCM were enrolled in the current retrospective cohort study. Temporal trends of baseline clinical characteristics,treatment and prognosis were analyzed,and potential influential factors were explored. Results Rates of patients receiving angiotensin-converting enzyme inhibitors/angiotensin II receptors blockers,β-blockers,aldosterone receptor antagonists and diuretics increased from 55%,45%,58%,51% in 2009 to 67%,69%,71%,64% in 2016,respectively (P medications in IDCM patients was observed. However,it remains suboptimal,and there is still some room for improvement. The prognosis of patients with optimal GDMT was better than those without. Moreover,the following patient

关键词： Dilated cardiomyopathy Heart failure medications Prognosis

Efficacy of the vaccination in inflammatory bowel disease

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World Journal of Gastroenterology 2013年第9期19卷 1349-1353页

作者： Elisa Carrera Rebeca Manzano Elena Garrido Department of Gastroenterology University Hospital of Guadalajara 19002 Guadalajara Spain Department of Gastroenterology Sureste Hospital Arganda 28500 Madrid Spain Inflammatory Bowel Disease Clinic Department of Gastroenterology University Hospital Ramón y Cajal 28034 Madrid Spain

Inflammatory bowel disease (IBD) is associated with conditions that may predispose to infections, such as the lack of an appropriate innate immune response to infectious agents, malnutrition, surgery, and immunosuppressive and biological drugs. Some of these infections may be preventable by vaccination. Therefore, for this particular patient population, the benefits of implementing a well-established immunization protocol in daily clinical practice are potentially even greater than for the general population. In recent years international consensus guidelines have been published, but in spite of theses recommendations, studies have shown that a significant number of patients with IBD remain inadequately immunized. Another important issue regarding immunization in this population is that vaccine efficacy among patients receiving immunosuppressive therapies has been variable. In a healthy population, a humoral immune response to hepatitis B vaccination (HBV) is expected in > 90%, whereas a much lower rate is achieved in the IBD patients. Immunosuppressive, anti-tumor necrosis factor therapy and disease activity have been implicated in the impaired efficacy of the vaccination. The serological response to HBV should be confirmed and patients with an inadequate response should receive a second full series of vaccine. Modified dosing regimens, including doubling the standard antigen dose, might increase the effectiveness. Response to influenza, pneumococcal and tetanus immunization is still not clear, as there are studies that show a normal response to the vaccination while others demonstrate a lack of efficacy. We pose a series of questions on the efficacy of the different vaccinations recommended for IBD patients and attempt to answer them using scientific evidence.

关键词： Vaccination Efficacy Infections Immunization Inflammatory bowel disease Immunosuppressive medications Hepatitis B vaccines Influenza vaccines Pneumococcal vaccines Tetanus vaccines

Clozapine resistant schizophrenia:Newer avenues of management

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World Journal of Psychiatry 2021年第8期11卷 429-448页

作者： Subho Chakrabarti Department of Psychiatry Postgraduate Institute of Medical Education and ResearchChandigarh 160012India

About 40%-70%of the patients with treatment-resistant schizophrenia have a poor response to adequate treatment with *** impact of clozapineresistant schizophrenia(CRS)is even greater than that of treatment resistance in terms of severe and persistent symptoms,relapses and hospitalizations,poorer quality of life,and healthcare *** serious consequences often compel clinicians to try different augmentation strategies to enhance the inadequate clozapine response in ***,a large body of evidence has shown that antipsychotics,antidepressants,mood stabilizers,electroconvulsive therapy,and cognitive-behavioural therapy are mostly ineffective in augmenting clozapine *** beneficial effects of augmentation have been found,they are usually small and of doubtful clinical significance or based on low-quality ***,newer treatment approaches that go beyond the evidence are *** options proposed include developing a clinical consensus about the augmentation strategies that are most likely to be effective and using them sequentially in patients with ***,newer approaches such as augmentation with long-acting antipsychotic injections or multi-component psychosocial interventions could be ***,perhaps the most effective way to deal with CRS would be to optimize clozapine treatment,which might prevent clozapine resistance from *** dosing,adequate treatment durations,management of side effects and non-adherence,collaboration with patients and caregivers,and addressing clinician barriers to clozapine use are the principal ways of ensuring optimal clozapine *** present,these three options could the best way to manage CRS until research provides more firm directions about the effective options for augmenting clozapine response.

关键词： Clozapine-resistance Augmentation medications Electroconvulsive therapy Psychosocial treatments Schizophrenia

Acute onset clozapine-induced hyperglycaemia: A case report

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General Psychiatry 2019年第2期32卷 95-96页

作者： Pradeep Kumar Dheerendra Kumar Mishra Nimisha Mishra Sunil Ahuja Gyanendra Raghuvanshi Vijay Niranjan Department of Psychiatry Shyam Shah Medical College Rewa Rewa India Department of Psychiatry Mahatma Gandhi Memorial Medical College Indore India

Clozapine is an atypical antipsychotic which is described to have higher efficacy among all available antipsychotic medications. Clozapine is reserved especially for resistant schizophrenia due to its side effects. Clozapine-induced metabolic syndrome and hyperglycaemia are common longterm side effects and are responsible for increased mortality in patients with schizophrenia. In this case, a patient with resistant schizophrenia was presented with acute-onset hyperglycaemia and delirium with the use of clozapine within a week. Withdrawal of clozapine in the patient led to the improvement in delirium and hyperglycaemia without the use of any hypoglycaemic agent. This case s叩ports the notion that in certain cases clozapine can induce hyperglycemia through possible direct pathophysiological mechanisms within a shorter time frame.

关键词： Clozapine atypical antipsychotic antipsychotic medications