Caregiver Practices and Knowledge Regarding Leftover Prescription Medications in Homes With Children.

OBJECTIVES: The aims of the study were to determine the frequency of and factors associated with leftover or expired prescription medication ("leftover medication") presence in homes with children and to assess caregivers' reported behaviors and knowledge regarding disposal of leftover medications in the home. METHODS: This study is a planned secondary analysis from a survey of primary caregivers of children aged 1 to 17 years presenting to an emergency department. The survey assessed leftover medications in the home and medication disposal practices, knowledge, and guidance. The survey was developed iteratively and pilot tested. Multivariable logistic regression was used to identify factors associated with leftover medication presence in the home. RESULTS: We enrolled 550 primary caregivers; 97 of the 538 analyzed (18.0%; 95% confidence interval [CI], 14.8-21.5) reported having leftover medications in their home, most commonly antibiotics and opioids. Of respondents, 217/536 (40.5%) reported not knowing how to properly dispose of medications and only 88/535 (16.4%) reported receiving guidance regarding medication disposal. Most caregivers reported throwing leftover medications in the trash (55.7%) or flushing them down the toilet (38.5%). Caregivers with private insurance for their child were more likely to have leftover medications (adjusted odds ratio [aOR], 1.99; CI, 1.15-3.44), whereas Hispanic caregivers (aOR, 0.24; CI, 0.14-0.42) and those who received guidance on leftover medications (aOR, 0.30; CI, 0.11-0.81) were less likely to have leftover medications in the home. CONCLUSIONS: Leftover medications are commonly stored in homes with children and most caregivers do not receive guidance on medication disposal. Improved education and targeted interventions are needed to ensure proper medication disposal practices.

Frequency of and Factors Associated With Prescription Medication Sharing Within Families.

OBJECTIVES: Limited literature has investigated caregiver sharing of prescription medications with children. Our primary aim was to determine the frequency of and factors associated with prescription medication sharing within families. Our secondary aim was to determine the source and type of medications shared. METHODS: We conducted a survey of a convenience sample of caregivers of children 1 to 17 years in a pediatric emergency department. The survey was developed through literature review, iterative feedback, and pilot testing on caregivers. We used logistic regression to identify factors associated with any history of medication sharing with a child in the home (primary outcome). RESULTS: We enrolled 550 primary caregivers; 68 of the 535 analyzed (12.7%; 95% confidence interval [CI], 10.0-15.8) reported prescription medication sharing with their child/children. Of those who shared, 50 (73.5%) shared asthma medications and 14 (20.6%) shared antibiotics. Of the caregivers who shared prescription medications, 70.6% shared a medication for one child with another child, whereas 33.8% of caregivers shared their own or another adult's medication with their child. A child in the home with asthma (adjusted odds ratio [aOR], 3.35; CI, 1.82-6.17), a greater number of children in the household (aOR, 1.29; CI, 1.04-1.60), and a caregiver who previously shared medications with other family members and/or friends (aOR, 4.10; CI, 1.84-9.15) were factors independently associated with medication sharing. CONCLUSIONS: Prescription medication sharing within families is common and most often involves asthma medications. We identified several factors associated with prescription medication sharing that could be used to target caregivers for preventative interventions.

Role of environmental factors & oxidative stress with respect to in vitro fertilization outcome.

Background & objectives: Oxidative stress, lifestyle factors as also exposure to certain environmental factors are known to affect the fertility status in human beings. The aim of this study was to evaluate the role of OS and lifestyle and environmental factors affecting IVF outcome. Methods: A total of 253 couples were included, and biological samples such as blood, follicular fluid (FF), cumulus cells and semen were collected. Relevant biochemical parameters and metals namely lead (Pb), cadmium (Cd), copper (Cu) and zinc (Zn) were determined in the biological samples. ß-human chorionic gonadotropin levels ≥100 IU/l were considered to predict viable pregnancy on the 15th day of embryo transfer (ET). Results: The mean body mass index (BMI) was significantly lower in females with positive IVF outcome compared to those with negative outcome. Couples residing in the residential area showed more percentage of positive IVF outcomes as compared to couples residing in industrial/agricultural area. FF Zn level was significantly higher (P<0.001) among the females' participants who have undergone ET as compared to those who have not undergone ET. FF MDA and serum Cu levels were significantly higher (P<0.05) in the female participants with negative IVF outcome as compared to positive IVF outcome. Logistic regression revealed that maternal BMI (P=0.034) and FF MDA level (P=0.047) were significantly associated with the IVF outcome. Interpretation & conclusions: The success rate of IVF was about 31.8 per cent, and BMI was significantly lower in females with positive outcome. The higher levels of MDA in FF and SP might have a negative impact on IVF outcome, higher Zn level in SP, FF and serum might have a positive role in embryo transfer as well as IVF outcome. The role of stress management and nutrition supplementation during the IVF treatment may be explored.

Baerveldt Aqueous Shunt with or without Mitomycin C Augmentation: A Retrospective Comparison Study.

OBJECTIVE: To evaluate if intraoperative mitomycin C (MMC) influences the success of Baerveldt aqueous shunts. DESIGN: Retrospective comparative case series. PARTICIPANTS: The study population consisted of 88 patients. Fifty-five received intraoperative MMC and 33 did not (controls). METHODS: The medical records of consecutive patients who underwent standalone Baerveldt aqueous shunts at Birmingham Midland Eye Centre, United Kingdom, were retrospectively reviewed. Patients in the MMC group received 0.2 to 0.4 mg/mL of MMC intraoperatively whereas controls did not. MAIN OUTCOME MEASURES: Primary outcome was survival, which was defined as an intraocular pressure (IOP) > 6 mmHg and ≤ 21 mmHg or ≤ 18 mmHg and > 20% IOP reduction from baseline. Further analysis of patients who required medications (qualified) or no medications (complete) was undertaken. Secondary outcomes were IOP, number of glaucoma medications, complications, intraluminal ripcord removal (IRR), and interventions. RESULTS: Average follow-up was 4.7 ± 1.4 years. At year 5, complete success with the ≤ 21 mmHg threshold was significantly higher in MMC vs controls (39.3% vs 17.8%; log rank P = 0.016). Final complete success with the ≤ 18 mmHg threshold was higher in patients with MMC shunts vs controls (38% vs 15.6%; log rank P = 0.0042). Qualified success was not different between patients with MMC shunts and controls with ≤ 21 mmHg (82% vs 93%; log rank P = 0.29) and ≤ 18 mmHg thresholds (70.3% vs 79.3%; log rank P = 0.44). Uveitic patients were also more likely to achieve complete success at both 21 and 18 mmHg thresholds among the patients receiving MMC compared with controls. Mitomycin C was correlated with lower number of medications between month 3 and year 2 post operatively (P < 0.001) and with a lower rate of IRR at all timepoints (P < 0.001). There were no significant differences in the incidence of prolonged hypotony, although MMC cases had higher transient hypotony at year 1 (P = 0.049). CONCLUSIONS: Mitomycin C provides a significant advantage in Baerveldt aqueous shunt survival when considering medication-free success but not in qualified success. Control patients required more medications to control IOP. This study suggests that intraoperative MMC augmentation of Baerveldt aqueous shunt surgery may be advantageous in achieving IOP control without the need for medication but that it may be associated with more transient hypotony episodes. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Therapeutic effects of biochanin A, phloretin, and epigallocatechin-3-gallate in reducing oxidative stress in arsenic-intoxicated mice.

One of the most common toxicant prevailing in our environment is the arsenic. The present study is an attempt to investigate the effects of some of the common flavonoids, such as biochanin A (BCA), phloretin, and epigallocatechin-3-gallate (EGCG), on arsenic toxicity in the Swiss albino mice. For this purpose, mice were orally treated with sodium meta-arsenite (20 mg/kg bw/day), along with co-administration of BCA (50 mg/kg bw/day), phloretin (50 mg/kg bw/day), and EGCG (40 mg/kg bw/day) for the 2-week duration. All the mice were euthanized at the end of the treatment period, and the observations were made in the following parameters. Arsenic reduced the sperm motility as compared with the control (p < 0.05) and was restored back to the normal status with the flavonoids treatment significantly (p < 0.05). The arsenic concentrations in the kidney and liver tissues were found significantly reduced with all the flavonoids co-treatment (p < 0.001). There was a reduction in the levels of superoxide dismutase (SOD), reduced glutathione (GSH), and glutathione S-transferase (GST) antioxidant markers, with the increased lipid peroxidation (LPO), protein carbonyl content (PCC), and catalase (CAT) levels in the arsenic-intoxicated mice performed in the different tissues. The biochemical homeostasis alterations were well correlated with the estimations of cholinesterase enzyme levels in the brain tissues (p < 0.05) along with DNA damage analysis (Comet) carried out in the blood cells (p < 0.05). These above results are well corroborated with the histopathological findings performed in the brain tissue, along with the increased upregulation seen in the Nrf2 signalling, with all the flavonoid co-treatment carried in the kidney tissue. The administration of BCA, phloretin, and EGCG, in a major way, reversed the alterations in the abovementioned parameters in the arsenic-intoxicated mice. Our findings revealed the beneficial effects of the flavonoids against the arsenic-induced toxicity, due to their ability to enhance the intracellular antioxidant response system by modulating the Nrf2 signaling pathway.

Air pollutants and impairments of male reproductive health-an overview.

Excessive air pollution, both ambient and indoor are might be detrimental to human wellbeing and are related to morbidity and mortality, it may also affect the reproductive function and its outcome. It is a recognized fact that air pollution contains several toxicants, gases, particulate matter, toxic metals etc. Some of them might affect reproductive and developmental process and a few are persistent. The information accessible on air pollution to human male reproduction is stated to affect semen quality by diminishing one or more sperm quality parameters i.e., sperm morphology, concentration, motility etc. and may causes sperm DNA damage, these might alter the fertility potential which in turn affect pregnancy or its outcome. The impact might be related to the pollutant's concentration and duration of exposure. The data on impact of air contamination on endocrine function are inadequate, inconsistence and the diversity of existence of air contaminants in area to area and multiplicity in semen quality parameters assessed in various studies as well as study design variables complicated the problem of evaluation of impact of air pollution on male reproduction. The data available suggests the air pollution is might be injurious to human male reproductive health, which depends upon amounts of air pollutants in the air, duration of exposure etc. but more comprehensive data are needed to substantiate the findings. The data are also needed on indoor air pollution on reproduction as people are might be subjected to greater quantities of some of the indoor air pollutants as compared to ambient air pollution.

The Association of Circulatory Cytokines (IL-6 and IL-10) Level with Spontaneous Abortion-a Preliminary Observation.

Successful pregnancy or its outcome depends upon various endogenous and exogenous determinants including immune status, and cytokines are one of the regulators which might play a vital role in the maintenance of pregnancy. The study was carried out to determine the role of cytokines, i.e., interleukin-6 (IL-6) and interleukin-10 (IL-10), in spontaneous abortion (SAb) cases with reference to control (women without SAb). One hundred twenty-six subjects (63 women with SAb cases and 63 control women without SAb and bearing at least one child) were enrolled. Out of the 63 SAb cases, 31 women from Outpatient Department (with history of SAb cases, i.e., one, two, or more) and 32 from the Gynecology ward (current SAb cases) were enrolled. The cytokines (IL-6 and IL-10) were measured by ELISA method using commercially available kit. The mean IL-6 level was higher among women with SAb cases, recent SAb and recurrent SAb cases versus controls, history of SAb and less than 2 SAb cases respectively, while an inverse pattern of variations was observed for IL-10 level. The Spearman's correlation revealed that the IL-6 was positively correlated while IL-10 was negatively correlated with number of incidences of SAbs. The data of women with recent SAb and childbirth were categorized into four IL quartiles and found that the highest % of control and lowest % of SAb subjects were in second quartile of IL-6 while highest % of control and lowest % of SAb subjects were in the fourth (high) quartile of IL-10 level group. A multiple regression model showed that with elevation in IL-6, there was an elevation in number of SAb cases and an inverse relationship was observed with regard to IL-10. The results indicate positive role of IL-10 and undesirable role of IL-6 on pregnancy outcomes. Further, quartiles' distribution suggests that high levels of IL-10 might be necessary for the effective pregnancy outcome, but more data are needed to substantiate the present findings.

Prophylactic Use of Nonsteroidal Anti-Inflammatory Drugs after Cataract Surgery and Corneal Melt.

PURPOSE: To describe a case where prophylactic use of nonsteroidal anti-inflammatory drugs (NSAID) eye drops lead to recurrent corneal melt with loss of vision and a brief literature review. METHODS: This is a case report of an 84-year-old diabetic female with chronic dry eye, operated by two different surgeons on each eye at different time intervals. She received topical NSAID prophylaxis after the second surgery only, which led to blindness due to recurrent corneal melt and chronic choroidal effusions. We also present a brief literature review. RESULTS: This lady presented with corneal melt and perforation 5 days following the use of topical NSAIDs prophylaxis after a routine cataract surgery in the second eye. Unfortunately, all efforts to save her vision and eye were unsuccessful as she developed repeated complications in spite of corneal gluing, amniotic membrane, penetrating keratoplasty, and tarsorrhaphy. She also had chronic choroidal effusions. She ended up with an opaque cornea and a subtotal tarsorrhaphy, with no other option to improve her vision as she did not qualify for sedation or general anesthesia due to her poor systemic health. CONCLUSION: Although it is a common practice for diabetic patients to have topical NSAIDs prophylaxis in combination with steroid eye drops to reduce the risk of cystoid macular edema after cataract surgery, the elderly diabetic patients with concomitant dry eyes should be considered high risk for corneal melt and should be closely monitored. This case highlights the rare but serious complication of topical NSAIDs prophylaxis in the vulnerable cornea, which warrants careful consideration.

The role of stimulation protocol, number of oocytes retrieved with respect to follicular fluid oxidative stress and IVF outcome.

The study was conducted on a population of 203 women attending the IVF clinic, Ahmedabad, India, to explore the role of stimulation protocol and the number of oocytes retrieved on oxidative stress in follicular fluid and IVF outcome. Follicular fluid was collected during ovum pick-up to determine the oxidative stress markers: superoxide dismutase (SOD), malondialdehyde (MDA), glutathione (GSH), total thiols (TT), l-ascorbic acid (AA), total protein, glutathione S-transferase (GST) and glutathione reductase (GRD). The average number of oocytes retrieved was significantly higher in the women receiving a long GnRH agonist protocol compared to GnRH antagonist protocol while the percentage of women with positive IVF outcome was lower in the long agonist protocol. The level of total thiols was significantly lower in the group of women administered a short agonist protocol. The proportion of ETs carried out and positive IVF outcome were higher following retrieval of an intermediate number of oocytes (6-10 oocytes) compared to a lower (0-5 oocytes) and higher (>10 oocytes) number. Mean glutathione reductase (GRD) activity in follicular fluid was significantly elevated in the intermediate (6-10) and higher (>10) oocyte retrieval groups compared to the lower oocyte retrieval group. Positive IVF outcomes were highest when oocyte retrieval was in the range of 6-10 oocytes, and the level of MDA was lower (1.76 ± 0.13 nmol/ml) as compared to 0-5 and >10 oocytes retrieved groups.

Correlation of Copper and Zinc in Spontaneous Abortion.

BACKGROUND: Humans require minute amounts of trace metals to maintain body's normal growth and physiological functions; such elements may also play a vital role in pregnancy and pregnancy outcome. The present study was conducted to assess the role of two trace metals, zinc (Zn) and copper (Cu) in women with history of spontaneous abortion (SAb cases) in comparison to women without such history (controls). MATERIALS AND METHODS: In this retrospective study, a total of 277 subjects were enrolled from the Obstetrics and Gynecology Department, Civil Hospital, Ahmedabad, India. Personal demographic information, medical history, reproductive history especially details of number of SAb, duration of last SAb, number of children, etc. were recorded using predesigned and pre-tested proforma. Serum Zn and Cu levels were measured by an atomic absorption spectrophotometer. RESULTS: The data indicated that the serum level of Cu (P<0.01) and Zn was lower in SAb cases as compared to controls. Correlation between the number of SAbs and trace metals levels showed a significant negative correlation between Cu and Cu/Zn and the number of SAbs. Cu/Zn was higher in controls and women having at least one child as compared cases and women without child, respectively. Pregnant women had higher levels of trace elements as compared to non-pregnant women at the time of enrollment. CONCLUSION: The data revealed that trace metals such as Zn and Cu have a positive role in pregnancy outcome and optimum levels of Zn and Cu might be able to decline the chances of SAb occurrence in addition to other factors. The ratio of Cu/Zn has a positive role in reproductive outcomes.

Occupational, Environmental, and Lifestyle Factors and their Contribution to Preterm Birth - An Overview.

Preterm birth (PTB) is a significant public health concern and a leading cause of infant mortality and morbidity worldwide and often contributes to various health complications later in life. More than 60% of PTBs occur in Africa and south Asia. This overview discusses the available information on occupational, environmental, and lifestyle factors and their contribution to PTB and proposes new etiological explanations that underlie this devastating pregnancy complication. Several factors such as emotional, stress, social, racial, maternal anxiety, multiple pregnancies, infections during pregnancy, diabetes and high blood pressure, and in-vitro fertilization pregnancy have been shown to be associated with PTB. Data are emerging that occupational, environmental exposure and lifestyle factors might also be associated in part with PTB, however, they are at best limited and inconclusive. Nevertheless, data on heavy metals such as lead, air pollutants and particulate matters, bisphenol A, phthalate compounds, and environmental tobacco smoke (ETS) are promising and point to higher incidence of PTB associated with exposure to them. Thus, these observations can be used to advise pregnant women or women of reproductive age to avoid such exposures and adopt positive lifestyle to protect pregnancy and normal fetal development. There is a need to conduct well-planned epidemiological studies that include all the pathology causing factors that may contribute to adverse pregnancy outcomes, including PTB.