Steroid-induced glaucoma: an avoidable cause of irreversible blindness.

A man in his 70s on regular follow-up with an ophthalmologist for 10 years presented with blurry vision in his right eye for 4 days. He was diagnosed with elevated intraocular pressure (IOP) bilaterally 18 months earlier and treated with antiglaucoma eye-drops. On direct questioning, he admitted to using fixed combination tobramycin 0.3%/dexamethasone 0.1% eye-drops frequently to relieve ocular redness and discomfort in both eyes for 3.5 years without his ophthalmologist's knowledge. Examination disclosed markedly elevated IOP, advanced optic disc cupping and tunnel vision due to steroid-induced glaucoma bilaterally. After cessation of the eye-drops and 2 weeks of antiglaucoma therapy, his IOP returned to normal and his visual field remained stable for 4 years.Our case highlights the danger of habitual self-treatment of prescription medications containing corticosteroids and the importance of taking a detailed medication history in the diagnosis and management of steroid-induced glaucoma.

Self-Medication for Toothache Causing Chemical Burn of Oral Mucosa and Alveolar Bone Loss in a Child.

Chemical burn of the oral mucosa can occur as a result of the inadvertent, intentional or iatrogenic use of chemicals. Self-treatment for toothache relief with nonpharma ceutical substances can result in a chemical burn. A detailed history is paramount in such cases to identify the etiologic agent to proceed with appropriate treatment. The purpose of this report is to describe the case of an eight-year-old with a complaint of toothache who rinsed his mouth with potassium aluminium sulfate solution to achieve pain relief. This caused ulceration of the attached gingiva and oral mucosa and necrosis of the alveolar bone surrounding the offending tooth, leading to its mobility. This case highlights the disastrous consequences of inappropriate self-treatment to achieve pain relief from toothache.

Determinants of antibiotic self-medication: A systematic review and meta-analysis.

BACKGROUND: Decreasing the prevalence of antibiotic self-medication among the public requires proper understanding of the risk factors involved. However, the determinants of antibiotic self-medication are not well defined. OBJECTIVES: To identify patient and health system-related determinants of antibiotic self-medication among the public. METHODS: A systematic review of quantitative observational studies and qualitative studies was undertaken. PubMed, Embase, and Web of Science were searched to identify studies on determinants of antibiotic self-medication. The data were analyzed using meta-analysis, descriptive analysis, and thematic analysis. RESULTS: Sixty-eight studies were included in the review. From meta-analyses, male sex (pooled odds ratio [POR]: 1.52, 95% confidence interval [CI]: 1.19-1.75), lack of satisfaction with healthcare services/physicians (POR: 3.53, 95% CI: 2.26-4.75) were associated with antibiotic self-medication. In subgroup analysis, lower age was directly associated with self-medication in high-income countries (POR: 1.61, 95% CI: 1.10-2.36). In low- and middle-income countries, people with greater knowledge of antibiotics were less likely to self-medicate (POR: 0.2, 95% CI: 0.08-0.47). Patient-related determinants identified from descriptive and qualitative studies included previous experience with antibiotics and similar symptoms, perceived low severity of disease, intention to save time and get better quickly, cultural beliefs about curative power of antibiotics, advice from family/friends, and having home stock of antibiotics. Health system-related determinants included high cost of consulting physicians and low cost of self-medication, lack of access to physician/medical care, lack of trust/confidence in physicians, greater trust in pharmacists, long distance of physicians/healthcare facilities, long waiting time at healthcare facilities, easy access to antibiotics from pharmacies, and convenience associated with self-medication. CONCLUSIONS: Patient and health system-related determinants are associated with antibiotic self-medication. Interventions to decrease antibiotic self-medication should incorporate community programs along with appropriate policies and healthcare reforms targeting these determinants with specific attention to population at high risk of self-medication.

Systematic Review and Meta-Analysis of Factors Influencing Self-Medication in Children.

To evaluate the prevalence, influencing factors, and behavior rules of self-medication in children. Articles on self-medication in children from various electronic databases (PubMed, Cochrane Library, Web of Science, the WHO website (https://www.who.int/), ABI, CNKI, and Wanfang), were searched to August 2022. The single-group meta-analyses of the prevalence, influencing factors, and behavior rules of self-medication in children were performed using Revman 5.3 and Stata 16.0. The overall pooled prevalence of self-medication in children was 57% (95% CI: 0.39-0.75, I² = 100%, P < .00001 Z = 6.22). The pooled prevalence for main influencing factors, in terms of caregivers, was: 73% (95% CI: 0.72-0.75, I² = 100%, P < .00001, Z = 111.18) for those in rural areas; 55% (95% CI: 0.51-0.59, P = .04, Z = 26.92, I² = 68%, P < .00001) for females; 75% (95% CI: 0.74-0.76, I² = 68%, P < .00001, Z = 106.66) for those whose income was less than 716 dollars; 77% (95% CI: 0.75-0.79, I² = 99%, P < .000001, Z = 92.59) for the middle-aged and elderly; and 72% (95% CI: 0.58-87, I² = 99%, P < .00001, Z = 9.82) for those with a degree below bachelor. In the process of self-medication for children, 19% (95% CI: 0.06-0.32, I² = 99%, P < .00001, Z = 2.82) of the caregivers did not read the instructions, 28% (95% CI: -0.03-0.60, I² = 100%, P < .000001, Z = 1.77) neglected adverse effects, 49% (95% CI: 0.11-0.87, I² = 100%, P = .01, Z = 2.51) spontaneously increased or decreased the dosages, 49% (95% CI: 0.48-0.55, I² = 65%, P < .00001, Z = 16.51) had an awareness of over-the-counter (OTC) drugs, and 41% (95% CI: 0.18-0.64, I² = 99%, P < .00001, Z = 3.49) misrecognized the antibiotics. Self-medication for children was common, although the overall prevalence was not very high. The prevalence of self-medication in children was relatively higher among those caregivers who were female, rural, had low-income, were elder, or had a degree below bachelor. Common behaviors during self-medication in children included spontaneous dose increase or decrease, a lack of awareness of OTC drugs, and misconception of antibiotics. Government departments should formulate corresponding policies to provide quality health education resources for the caregivers of children.

Automedicación y riesgo de abuso con benzodiacepinas en pacientes adultos Lima-Perú, 2019 / Self-medication and risk of abuse with benzodiazepines in adults patients Lima-Peru, 2019

RESUMEN: Introducción: Las benzodiacepinas tienen potencial para generar abuso, por lo que, un consumo indiscriminado, a través de la venta sin prescripción y la práctica de automedicación, significaría un alto riesgo, producto de su abuso. Objetivo: Establecer la relación entre la automedicación con benzodiacepinas y el riesgo de abuso en pacientes de un hospital de Lima-Perú. Metodología: Estudio transversal analítico. Se encuestó a 874 participantes, se usó una encuesta para determinar datos demográficos, uso de benzodiacepinas y preguntas de la prueba de detección de consumo de alcohol, tabaco y sustancias (ASSIST, por sus siglas en inglés); se obtuvo estadística descriptiva y analítica. Resultados: Hubo más encuestadas del sexo femenino (74,5%), la mediana de edades fue de 52 años (rango intercuartílico: 40-62 años). De los adultos estudiados, 485 fueron considerados como consumidores de benzodiacepinas con receta médica y 389 sin receta médica. Los consumidores con receta médica y sin receta médica que necesitaron tratamiento fueron 129 (26,6%) y 245 (63,0%), respectivamente (p<0.001). Conclusión: Hay una mayor prevalencia de personas que necesitan tratamiento por abuso en consumidores sin receta médica que en el grupo de consumidores con receta médica, por lo que, existe una relación significativa entre la automedicación con benzodiacepinas y el riesgo de abuso; lo que requiere tratamiento en la población estudiada.

ABSTRACT Introduction: Benzodiazepines have the potential to generate abuse, so an indiscriminate consumption, through the sale without prescription and the practice of self-medication, would mean a high risk due to their abuse. Objective: To establish the relationship between self-medication with benzodiazepines and the risk of abuse that requires treatment in adult patients of Hospital San Juan de Lurigancho, 2019. Methodology: It was an observational, correlational descriptive, transversal and prospective study. The sample size was 874 participants (95.0% confidence level; 80% power). Sampling was performed non-randomly. A survey was used to determine demographics, benzodiazepine use, and questions of Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). Results: Of the study population, the most prevalent demographic data were female sex (74.5%), the median age was 52 years (interquartile range: 40-62 years), the age range 50-59 years (26.43%), married marital status (31.6%), secondary education level (48.4%) and occupation as a housewife (47.3%). Of adults studied, 485 were considered as consumers of benzodiazepines with prescription and 389 consumers without a prescription. Prescription and non-prescription consumers needing treatment were 129 (26.60%) and 245 (62.98%), respectively (p <0.001). Conclusion: There is a higher prevalence of people who need treatment for abuse in consumers without a prescription than in the group of consumers with a prescription so there is a significant relationship between self-medication with benzodiazepines and the risk of abuse that requires treatment in study population.

A Case of Phenibut Directed Detoxification Leading to Toxicity During the COVID-19 Pandemic.

BACKGROUND: Phenibut is a non-Food and Drug Administration-approved gamma-aminobutyric acid analog marketed in the United States as an anxiolytic, cognitive enhancer, and alcohol withdrawal treatment through online supplement vendors. In this case report, we describe a woman's self-directed detoxification with phenibut used to manage withdrawal symptoms from fentanyl and benzodiazepines in March 2020 during the height of the COVID-19 pandemic. CASE: A 38-year-old woman with severe opioid, benzodiazepine, gabapentin, stimulant use disorders developed altered mental status after oral phenibut ingestion intended to help self-manage opioid and benzodiazepine withdrawal. She chose self-directed detoxification as she feared COVID-19 exposure in detoxification facilities. Her altered mental status drove her to jump out a third-story window causing multiple spinal fractures. After a long hospitalization, she self-directed her discharge home due to concerns about COVID-19. Her premature discharge disrupted opioid and benzodiazepine use disorder treatment plans. CONCLUSION: This case highlights the risks of phenibut use for selfdirected detoxification. With COVID-19 related changes in the drug supply, people may be more likely to use online pharmaceuticals, therefore, substance use assessments should inquire about the online acquisition of new psychoactive drugs. Public health messaging regarding the risks of infectious disease transmission in addiction care settings is needed to guide addiction treatment choices among people who use substances.

Tinea pseudoimbricata: observations from a clinicoepidemiological and mycological study from eastern India.

The characteristic ring with ring appearance in patients with dermatophytosis should raise the suspicion of application of topical corticosteroids (alone or in combination with topical antifungals). Such patients be counselled about the harmful effects applying such inappropriate combinaiton.

Bleeding associated with self-medication in warfarin users: A prospective observational study in Ijuí (Brazil)

Abstract Warfarin has been associated with bleeding and venous thromboembolism. Objective: This study aimed to estimate the association between bleeding and concomitant self-medication, and the incidence of adverse drug reactions in patients using warfarin. Setting: the public health network of Ijuí, a municipality in southern Brazil. This was an open prospective cohort, conducted for a period of 18 months with users of warfarin, treated at the public health service. The association between bleeding and self-medication was evaluated by means of the Cox Model with left truncation, using the time variable. Main outcome measurement: bleeding reported in the follow-up. Cases of thromboembolism and death were also registered. All patients treated with warfarin in the public health system of the municipality (98) were identified. Sixty-eight were interviewed and followed up, of whom 63 completed follow-up and five died during the study. Bleeding rates of 37.7 /100 patients/year, thromboembolism of 4.8/100 patients / year and deaths of 4.8 /100 patients / year were observed. The results showed that patients, who take warfarin and self-medicated present a two-fold increased bleeding, compared with those who do not self-medicate. The bleeding risk associated with self-medication ranged from 2.001 to 2.685; those values maintained their significance even when adjusted for number of interactions, CYP polymorphism, TTR and age in COX analysis. These results greatly suggest the need for providing greater assistance to patients who take anticoagulant medications with the purpose of reducing self-medication and consequently, adverse reactions.

Consecuencias derivadas de la automedicación con benzodiacepinas en personas adultas: revisión exploratoria / Consequences derived from self-medication with benzodiazepines in adults: scoping review

Introducción: Revisar la evidencia científica sobre las consecuencias derivadas de la automedicación con benzodiacepinas (BZD) en personas adultas. Método: Revisión exploratoria de los artículos recuperados de las bases de datos MEDLINE (PubMed), Embase, Cochrane Library, Scopus y Web of Science hasta octubre de 2020. La búsqueda se formuló́ mediante los descriptores “Self Medication” y “Benzodiazepines”, utilizando los Entry Terms relacionados y los filtros: «Humans» y «Adult: 19+years». La calidad de los artículos se evaluó́ mediante STROBE. Resultados: De las 388 referencias recuperadas, tras aplicar los criterios de inclusión y exclusión, se seleccionaron 14 artículos. Las puntuaciones STROBE oscilaron entre mínimo de 8,7 y máximo de 17,7, con mediana de 14,3. En 8 artículos se estudió la automedicación; en 2 el abuso; en otros 2 la automedicación o el abuso con la finalidad de tratar las emociones, el estrés o, directamente, drogarse. Otros resultados fueron la sobredosificación y el consumo previo y posterior de BZD al ingreso en programa de metadona. Conclusiones: Los artículos revisados reportaron elevada prevalencia de automedicación y auto-manipulación de BZD. Es necesario conocer el patrón de uso en cada grupo poblacional para establecer medidas que garanticen una adecuada prescripción y uso racional. Mejorando la atención farmacéutica en el proceso de dispensación de BZD (alertando sobre las consecuencias de un tratamiento crónico y la exclusividad de las recetas) y la validación farmacéutica (detección de prescripciones inadecuadas), se podría actuar contra la automedicación de las BZD y las consecuencias derivadas. (AU)

Introduction: To review the scientific evidence on the consequences of self-medication with benzodiazepines (BZD) in adults. Method: Exploratory review of the articles retrieved from the bibliographic databases MEDLINE (PubMed), Embase, Cochrane Library, Scopus and Web of Science until October 2020. The search query was formulated using the de-scriptors “Self Medication” and “Benzodiazepines”, also using the related Entry Terms and filters: «Humans» and «Adult: 19+years». The quality of the articles was evaluated using the STROBE questionnaire. Results: From the 388 references retrieved, after applying the inclusion and exclusion criteria, 14 articles were se-lected. Once the articles were evaluated by means of the STROBE questionnaire for this review the scores ranged from a minimum of 8.7 to a maximum of 17.7, with median equal to 14.3. Self-medication was studied in 8 articles; overuse was researched in 2 of them; 2 other articles’ aim was to examine self-medication or overuse with the pur-pose of treating emotions, stress or, directly, using them as drug. Other observed outcomes were overdosage, in addition to their previous and subsequent consumption to joining the methadone program. Conclusions: The revised articles have documented a high prevalence of self-medication and self-manipulation of BZD. It is essential to know the use pattern of each population branch in order to establish measures which guaran-tee both suitable prescription and rational use. By improving pharmaceutical care in the process of dispensing BZD (warning of the effects of chronic treatment and the exclusivity of prescriptions) and pharmaceutical validation (de-tection of unsuitable prescriptions) BZD self-medication and its derived consequences could be actively prevented. (AU)

Gaps in the implementation of COVID-19 mitigation measures could lead to development of new strains of antimicrobial resistant pathogens: Nigerian perspective.

The severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) is a new virus that is responsible for COVID-19, a disease that complicate health conditions and results in death. The total diversion of attention of government and health care workers (HCWs) to prevent the escalation of the pandemic disease has placed a great barrier to diagnosis and treatment of other illnesses that share common symptoms with COVID-19, and that has consequently enabled the endemic practice of self-antimicrobial medication to increase in Nigeria. Development of secondary infections in COVID-19 and in other conditions, caused by antibiotic resistant pathogens could make them more deadly now or in the future. The mitigation strategies adopted in Nigeria and its States, which include enforcing social distancing, partial or total lockdown, and restricting access to health care facilities for non COVID-19 patients, have further increased the demand of antimicrobial agents from unauthorized outlets in communities for inappropriate use. A cross-sectional survey of 162 randomly selected individuals that visited medical stores and 170 medical store owners to evaluates the level of self-medication with five oral broad spectrum antibiotics and antimalaria during the lockdown revealed an increase (68.5%) in practice of self-medication with at least one of the antimicrobial and emergence of new abusers. Blind treatment of symptoms of malaria and common cold without diagnosis and health care consultation was nearly 100%. Irrational use of sanitizers, disinfectants and other cidal agents that can fuel antimicrobial resistance has drastically increased in communities. Exposure of microorganisms in the environment without caution to large volume of fumigants is increasing on daily basis. We strongly recommend that while mitigating SARS-CoV-2 virus spread, efficacious and feasible technological, social, economic and behavioral interventions that will also control the evolution and spread antimicrobial resistant microorganisms should be applied.

Prevalence and factors associated with self medication with antibiotics among University students in Moshi Kilimanjaro Tanzania.

BACKGROUND: Self medication is a common practice of using medicines without a medical supervision by the people themselves. Self medication is likely to happen when people feel unwell, it is worse in the population with poor helth seeking behavior. Therefore it is important to assess the prevalence and factors associated with self medication with antibiotics among University students in Moshi, Kilimanjaro Tanzania. METHODS: A cross sectional study was conducted from April-August 2019 at two Universities in Moshi, including one medical and one non medical. The study population were undergraduate students aged 18 and above, A self-filled questionnaire was used for data collection and data analyzed using the SPSS version 16 and association was tested using chi square. RESULTS: Out 374 students enrolled 187 from each University, 126 were female and 248 were male with age ranging from 19 to 35 years with mean age of 23.91 years. The prevalence of self medication with antibiotics was 57% and the most common used antibiotics was amoxicillin with prevalence of 32.08%. The common reported symptoms/diseases were headache (31.02%) followed by malaria and coughing with prevalence of 15.24% and 10.96% respectively. The commonest reasons of self medication reported to be emergency illness (38.77%) and delaying of hospital services (24.33%). The commonest effects reported among respondents which practiced self medication with antibiotics were worsening of the condition that they were suffering in (4.55%) and body rashes (2.67). There was no significant difference between self medication practices among medical and non medical students(p = 0.676). CONCLUSION: The prevalence of self medication with antibiotics was high among University students and there is no significant difference in both medical and non medical students. The most feared outcome on self medication with antibiotics is antibiotic drug resistance which leads to treatment failure along with high financial costs and increase mortality rate following microbial infections.

Impact of the COVID-19 outbreak on the reporting of adverse drug reactions associated with self-medication.

OBJECTIVES: The primary objective of the present study was to describe the characteristics of adverse drug reactions (ADRs) linked to self-medication that were notified to the French Pharmacovigilance Database (FPVD) during the COVID-19 outbreak in 2020 first wave. The secondary objective was to compare the characteristics of these ADRs in 2020 with those notified during the same calendar period a year previously. MATERIAL AND METHODS: We analyzed ADRs recorded in the FPVD between March 15th and May 31st, 2020 vs. the same dates in 2019. Only ADRs linked to self-medication were analyzed. Descriptive statistics were used to obtain an overview of the types and characteristics of these ADRs. RESULTS: Of 3114 ADRs notified to the FPVD during the COVID-19 period in 2020, 114 (3.7%) were linked to self-medication. The equivalent proportion in 2019 was 1.6% (113 out of 7097). Half of the ADRs notified in 2020 were "serious". The median age of affected patients was 30.5, and 22% of the ADRs concerned children. Of the 114 ADRs linked to self-medication, 107 (66%) were for prescription-only drugs. The three mostly frequently suspected ATC classes were analgesics, psycholeptics, and antibacterials for systemic use. The most frequent ADRs were general disorders, gastrointestinal disorders, and nervous system disorders. The main difference between the non-COVID-19 period and the COVID-19 period was the higher proportion of medication errors during the latter. CONCLUSION: The present study is the first to have reported on ADRs linked to self-medication and notified during a COVID-19 outbreak. Further studies of self-medication patterns and their consequences in a pandemic context are mandatory and effective information on medication use (including self-medication and its dangers) during a pandemic is essential.

Update on Biotin Therapy in Dermatology: Time for a Change.

Biotin (vitamin B7 or H) is found in milk, nuts, egg yolks, cereals, supplements, synthesized by intestinal bacteria, and is required for gluconeogenesis, fatty acid synthesis and amino acid catabolism.

Potencial abuso y dependencia de tianeptina. Revisión a propósito de un caso / Potential tianeptine abuse and dependence: a case review

OBJETIVO: Señalar, mediante la exposición de un caso clínico, la necesidad de tener en cuenta el riesgo de abuso o dependencia de un antidepresivo de reciente aparición en nuestro país: la tianeptina. CASO CLÍNICO: Se presenta el caso de un varón de 47 años con diagnósticos de trastorno bipolar tipo ii, trastorno límite de personalidad y trastorno por uso sustancias, que presentaba una dependencia a tianeptina, de la que llegó a consumir 1.125mg al día. RESULTADOS: Durante la búsqueda bibliográfica apenas se encontraron revisiones de casos centrados en el potencial abuso o dependencia de tianeptina. Se halló que, por la modulación de los sistemas de neurotransmisión opioidérgico (activación de los receptores μ), su uso a dosis altas se relaciona con un mayor riesgo. CONCLUSIONES: Ciertas características personales y enfermedades, como pueden ser los trastornos de personalidad o un abuso de sustancias previo, implican una mayor probabilidad de abuso o dependencia de tianeptina

OBJECTIVE: Using a clinical case, the aim of this article is to point out the need to take into account the risk of abuse and / or dependence on tianeptine, an antidepressant that has recently appeared in Spain. CLINICAL CASE: The case is presented on a 47-year-old man diagnosed with type II bipolar disorder, borderline personality disorder, and substance use disorder with tianeptine dependency, consuming 1,125mg per day. RESULTS: During the bibliographic search, few reviews were found that focused on the potential abuse or dependence on tianeptine. High-dose use was found to be associated with an increased risk, explained by modulation of opioidergic neurotransmission systems (activation of μ receptors). CONCLUSIONS: Some personal characteristics and pathologies, such as personality disorders or previous substance abuse, imply a greater probability of abuse or dependence on tianeptine

live from UNGA side event on infodemic management with Dr Tedros

COVID-19 y su relación con los antibióticos y medicamentos

Existe un número creciente de productos médicos falsificados que pretenden prevenir, detectar, tratar o curar la COVID-19