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1.
Medicine (Baltimore) ; 99(38): e22230, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957364

RESUMO

BACKGROUND: Although the efficacy of antihypertensive drugs has been well established for primary hypertension, their effectiveness is always limited by side effects and poor compliance. Heat-sensitive moxibustion is an innovative acupoint stimulation therapy that is promising as a community health care intervention for hypertension. AIMS: This study aims to evaluate the pragmatic effectiveness and safety of heat-sensitive moxibustion self-administration by patients in the community with primary hypertension. METHODS: This study will adopt a multi-center, pragmatic, nonrandomized design. Six hundred patients with primary hypertension will be recruited from 4 communities. Each patient will choose to either receive heat-sensitive moxibustion self-administration + original antihypertensive drugs or maintain their original antihypertensive drugs without heat-sensitive moxibustion for 1 year. EXPECTED OUTCOMES: The primary outcome will be changes in systolic and diastolic blood pressures and the percentage changes in the doses of antihypertensive drugs. The secondary outcomes will be changes in quality of life assessed by a validated patient-reported outcome scale and the levels of fasting blood glucose, glycated hemoglobin, total cholesterol, triglycerides, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, urinary albumin, and serum creatinine. The proportion of patients with poor compliance with the heat-sensitive moxibustion regimen will also be evaluated as a secondary outcome. The safety of heat-sensitive moxibustion will be considered by analyzing the incidence of all and serious adverse events and their correlation with heat-sensitive moxibustion. DISCUSSION: The findings of this study will provide pragmatic evidence for heat-sensitive moxibustion self-administration in patients in the community with primary hypertension and may also establish an ethical basis for further randomized controlled trials. TRIAL REGISTRATION: The protocol of this trial was registered in ClinicalTrials.gov at May 11, 2020 (No. NCT04381520).


Assuntos
Temperatura Alta , Hipertensão/terapia , Moxibustão/métodos , Adolescente , Adulto , Idoso , Anti-Hipertensivos/uso terapêutico , Humanos , Hipertensão/sangue , Hipertensão/tratamento farmacológico , Hipertensão/urina , Adesão à Medicação , Pessoa de Meia-Idade , Moxibustão/efeitos adversos , Medidas de Resultados Relatados pelo Paciente , Qualidade de Vida , Autoadministração , Adulto Jovem
2.
Medicine (Baltimore) ; 99(36): e21998, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32899046

RESUMO

BACKGROUND: As the self-administration of coffee enema is being used as a mean of self-care for detoxication in various indications, it is important that evidence-based public health information is provided for effective and safe use. However, the evidence is so far rare. This systematic review was conducted to investigate the safety and effectiveness of self-administered coffee enema in a wide range of use, and to provide evidence about its benefits and risks. METHODS: Relevant studies were retrieved from Ovid MEDLINE, Ovid Embase, the Cochrane Central Register of Controlled Trials, and the Cumulative Index to Nursing and Allied Health Literature; and also from oriental databases, KoreaMed, Korean Medical Database, Korean Studies Information Service System, National Discovery for Science Leaders, and Korea Institute of Science and Technology Information, Oriental Medicine Advanced Searching Integrated System, China National Knowledge Infrastructure, and Japan Science and Technology Information Aggregator. Considering self-administered coffee enema being used in a various indication, study population was not restricted. Any types of published studies that included outcomes of effectiveness and safety of self-administered coffee enema with or without comparators were eligible for this systematic review. Data on biomedical indications, patient-reported outcomes, and adverse events were collected. Descriptive analyses were planned because diverse health conditions and outcome variables did not allow for quantitative synthesis. RESULTS: Nine case reports that describe adverse events were identified and included in the analysis. Of these, 7 recent ones reported colitis after self-administration, mentioning that the most plausible cause assumed was the coffee fluid itself, which contained numerous chemical substances. Two others reported more critical adverse events. All 9 case reports with acceptable quality of evidence warned against the self-administration of the procedure. No study that reports the effectiveness of coffee enema was found. CONCLUSIONS: Based on the evidences reviewed, this systematic review does not recommend coffee enema self-administration as a complementary and alternative medicine modality that can be adopted as a mean of self-care, given the unsolved issues on its safety and insufficient evidence with regard to the effectiveness.


Assuntos
Café/efeitos adversos , Enema/efeitos adversos , Humanos , Autoadministração
3.
Nat Commun ; 11(1): 4634, 2020 09 14.
Artigo em Inglês | MEDLINE | ID: mdl-32929078

RESUMO

The current opioid epidemic necessitates a better understanding of human addiction neurobiology to develop efficacious treatment approaches. Here, we perform genome-wide assessment of chromatin accessibility of the human striatum in heroin users and matched controls. Our study reveals distinct neuronal and non-neuronal epigenetic signatures, and identifies a locus in the proximity of the gene encoding tyrosine kinase FYN as the most affected region in neurons. FYN expression, kinase activity and the phosphorylation of its target Tau are increased by heroin use in the post-mortem human striatum, as well as in rats trained to self-administer heroin and primary striatal neurons treated with chronic morphine in vitro. Pharmacological or genetic manipulation of FYN activity significantly attenuates heroin self-administration and responding for drug-paired cues in rodents. Our findings suggest that striatal FYN is an important driver of heroin-related neurodegenerative-like pathology and drug-taking behavior, making FYN a promising therapeutic target for heroin use disorder.


Assuntos
Cromatina/metabolismo , Corpo Estriado/enzimologia , Dependência de Heroína/enzimologia , Terapia de Alvo Molecular , Proteínas Proto-Oncogênicas c-fyn/metabolismo , Animais , Sequência de Bases , Comportamento Animal/efeitos dos fármacos , Sinais (Psicologia) , Genoma , Células HEK293 , Heroína/efeitos adversos , Humanos , Masculino , Neurônios/metabolismo , Fosforilação/efeitos dos fármacos , Regiões Promotoras Genéticas/genética , Proteínas Proto-Oncogênicas c-fyn/antagonistas & inibidores , Ratos Long-Evans , Autoadministração , Transcrição Genética/efeitos dos fármacos , Proteínas tau/metabolismo
4.
Afr J AIDS Res ; 19(2): 147-155, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32780676

RESUMO

HIV prevalence among truckers in Africa is high and testing rates suboptimal. With numerous African countries having approved HIV self-testing kits, more information on how to design acceptable and accessible self-testing programs for high-risk populations is necessary. We explored views about self-testing via in-depth interviews with 24 truckers participating in a randomised controlled trial who refused HIV testing. A social-ecological lens was used to guide data analysis and frame study findings. While most participants said that they would use an HIV self-test, perceived barriers and facilitators were identified at multiple levels. Many participants noted lack of time to test or obtain a self-test kit as a major barrier (intrapersonal) and varied in their views about self-testing with a partner (interpersonal). Participants offered programmatic/policy recommendations, suggesting that they preferred accessing self-test kits in settings where training could be provided. Participants believed they should be able to pick up multiple test kits at the same time and that the test kits should be free or low cost. These study findings will help guide the design of self-testing programs for truckers and other mobile populations.


Assuntos
Condução de Veículo , Infecções por HIV/diagnóstico , Programas de Rastreamento/métodos , Adulto , Condução de Veículo/psicologia , Condução de Veículo/estatística & dados numéricos , Infecções por HIV/epidemiologia , Acesso aos Serviços de Saúde , Humanos , Quênia/epidemiologia , Masculino , Pesquisa Qualitativa , Autoadministração , Parceiros Sexuais
5.
Cochrane Database Syst Rev ; 7: CD012990, 2020 07 23.
Artigo em Inglês | MEDLINE | ID: mdl-32700772

RESUMO

BACKGROUND: Parkinson's disease (PD) is a progressive disorder characterised by both motor and non-motor problems. Glucagon-like peptide-1 (GLP-1) receptor agonists, licensed for treatment of type 2 diabetes, work by stimulating GLP-1 receptors in the pancreas, which triggers the release of insulin. GLP-1 receptors have been found in the brain. Insulin signalling in the brain plays a key role in neuronal metabolism and repair and in synaptic efficacy, but insulin signalling is desensitised in the brain of people with PD. Researchers are exploring the neuroprotective effects of GLP-1 receptor agonists in neurodegenerative disorders such as PD. OBJECTIVES: To evaluate the effectiveness and safety of GLP-1 receptor agonists for Parkinson's disease. SEARCH METHODS: We searched the Cochrane Movement Disorders Group trials register; the Cochrane Central Register of Controlled Trials (CENTRAL), in the Cochrane Library; and Ovid MEDLINE and Embase. We also searched clinical trials registries, and we handsearched conference abstracts. The most recent search was run on 25 June 2020. SELECTION CRITERIA: We included randomised controlled trials (RCTs) of adults with PD that compared GLP-1 receptor agonists with conventional PD treatment, placebo, or no treatment. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed studies for inclusion, extracted data, and assessed risk of bias. We rated the quality of evidence using GRADE. We resolved discrepancies between the two data extractors by consultation with a third review author. MAIN RESULTS: Through our searches, we retrieved 99 unique records, of which two met our inclusion criteria. One double-blind study of exenatide versus placebo randomised 62 participants, who self-administered exenatide or placebo for 48 weeks and were followed up at 60 weeks after a 12-week washout. One single-blind study of exenatide versus no additional treatment randomised 45 participants; participants in the intervention group self-administered exenatide for 12 months, and all participants were followed up at 14 months and 24 months following absence of exenatide for 2 months and 12 months, respectively. These trials had low risk of bias, except risk of performance bias was high for Aviles-Olmos 2013. Exenatide versus placebo Primary outcomes We found low-certainty evidence suggesting that exenatide improves motor impairment as assessed by the Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) Part III in the off-medication state (mean difference (MD) -3.10, 95% confidence interval (CI) -6.11 to -0.09). The difference in scores was slightly greater when scores were adjusted for baseline severity of the condition (as reported by study authors) (MD -3.5, 95% CI -6.7 to -0.3), exceeding the minimum clinically important difference (MCID). We found low-certainty evidence suggesting that exenatide has little or no effect on health-related quality of life (HRQoL) as assessed by the Parkinson's Disease Questionnaire (PDQ)-39 Summary Index (SI) (MD -1.80, 95% CI -6.95 to 3.35), the EuroQol scale measuring health status in five dimensions (EQ5D) (MD 0.07, 95% CI -0.03 to 0.16), or the EQ5D visual analogue scale (VAS) (MD 5.00, 95% CI -3.42 to 13.42). Eight serious adverse events (SAEs) were recorded, but all were considered unrelated to the intervention. Low-certainty evidence suggests that exenatide has little or no effect on weight loss (risk ratio (RR) 1.25, 95% CI 0.89 to 1.76). Exenatide versus no treatment Primary outcomes at 14 months We found very low-certainty evidence suggesting that exenatide improves motor impairment as assessed by MDS-UPDRS Part III off medication (MD -4.50, 95% CI -8.64 to -0.36), exceeding the MCID. We are uncertain whether exenatide improves HRQoL as assessed by the PDQ-39 SI (MD 3.50, 95% CI -2.75 to 9.75; very low-quality evidence). We found very low-certainty evidence suggesting that exenatide has little or no effect on the number of SAEs (RR 1.60, 95% 0.40 to 6.32). We found very low-certainty evidence suggesting that exenatide may lead to weight loss (MD -2.40 kg, 95% CI -4.56 to -0.24). Primary outcomes at 24 months We found evidence as reported by study authors to suggest that exenatide improves motor impairment as measured by MDS-UPDRS Part III off medication (MD 5.6 points, 95% CI 2.2 to 9.0). Exenatide may not improve HRQoL as assessed by the PDQ-39 SI (P = 0.682) and may not result in weight loss (MD 0.1 kg, 95% CI 3.0 to 2.8). AUTHORS' CONCLUSIONS: Low- or very low-certainty evidence suggests that exenatide may improve motor impairment for people with PD. The difference in motor impairment observed between groups may persist for some time following cessation of exenatide. This raises the possibility that exenatide may have a disease-modifying effect. SAEs were unlikely to be related to treatment. The effectiveness of exenatide for improving HRQoL, non-motor outcomes, ADLs, and psychological outcomes is unclear. Ongoing studies are assessing other GLP-1 receptor agonists.


Assuntos
Exenatida/uso terapêutico , Receptor do Peptídeo Semelhante ao Glucagon 1/agonistas , Doença de Parkinson/tratamento farmacológico , Viés , Método Duplo-Cego , Exenatida/administração & dosagem , Exenatida/efeitos adversos , Humanos , Hipoglicemiantes/administração & dosagem , Hipoglicemiantes/uso terapêutico , Placebos/administração & dosagem , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Autoadministração , Método Simples-Cego
6.
Pharm. pract. (Granada, Internet) ; 18(2): 0-0, abr.-jun. 2020. tab, graf
Artigo em Inglês | IBECS | ID: ibc-194051

RESUMO

BACKGROUND: Self-administered medication (SAM) is encouraged in many hospitals worldwide as it increases patients' knowledge and understanding of their medication, but the effects on other outcomes, e.g. compliance or medication errors, were unclear. OBJECTIVES: To compare medication knowledge, adherence, medication errors, and hospital readmission among inpatients receiving SAM education under the supervision of a multidisciplinary team (study group) with those receiving routine nurse-administered medication (control group). METHODS: This study was a PROBE design. Inpatients with chronic diseases were randomly allocated (1:1) to either the study group or the control group using stratified-block randomization. Knowledge of medications was measured at hospital discharge and at the first two follow-up visits; adherence was measured at the first two follow-up visits, medication errors while in hospital, and hospital readmission within 60 days after discharge. For normally distributed continuous outcomes, mean difference and 95%CI were estimated; otherwise the median and the Mann-Whitney test p-value were reported. The percentage difference and 95%CI were reported for binary outcomes. RESULTS: 70 patients were randomized (35 in each group); all received complete follow-up. Both groups were similar at baseline. Mean (SD) age (years) were 59.2 (11.0) for the study group and 58.3 (12.0) for the control group. Percentages of females in the respective groups were 54.3 and 60.0. Mean time from discharge to the first follow-up visit was two weeks in both groups and time to the second follow-up visit were 68.8 days (study group) and 55.0 days (control group). The study group had significantly higher medication knowledge than the control group at hospital discharge (of the 10-point scale, medians, 8.56 and 6.18, respectively, p < 0.001). The corresponding figures were similar in both groups at the first follow-up visit (medians, 8.25 and 6.26, respectively, p < 0.001). Adherence to medication at the first visit in the study group (percentage mean 92.50% (SD=5.33%)) was significantly higher than that in the control group (79.60% (SD=5.96%)), percentage mean difference 12.90%, [95%CI 10.20%:15.60%], p < 0.001. Medication knowledge and adherence were sustained at the second follow-up visit. During hospitalization, no medication errors were found in the study group, and minimal errors occurred in the control group (1.48%, [95%CI 0.68%:2.28%] of doses administered, p = 0.001). Hospital readmission within 60 days after discharge was significantly lower in the study group (11.4%) than that in the control group (31.4%), percentage difference 20.0% (95%CI 1.4%:38.6%), 1-side Fisher exact p = 0.039. CONCLUSIONS: Among in-patients with chronic diseases, SAM program significantly increased knowledge of and adherence to prescribed medications. Medication errors regarding administration errors were infrequent but significantly higher in the control group. SAM reduced hospital readmission within 60 after discharge


No disponible


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Autoadministração , Comunicação Interdisciplinar , Sistemas de Medicação/organização & administração , Conduta do Tratamento Medicamentoso , Estimativa de Kaplan-Meier , Erros de Medicação/prevenção & controle
7.
Pharm. pract. (Granada, Internet) ; 18(2): 0-0, abr.-jun. 2020. tab, graf
Artigo em Inglês | IBECS | ID: ibc-194054

RESUMO

OBJECTIVE: To determine the accuracy, variability, and weight uniformity of tablet subdivision techniques utilized to divide the tablets of five drug products that are commonly prescribed for use as half tablets in Jordan. METHODS: Ten random tablets of five commonly subdivided drug products were weighed and subdivided using three subdivision techniques: hand breaking, kitchen knife, and tablet cutter. The five commonly subdivided drug products (warfarin 5 mg, levothyroxine 50 μg, levothyroxine 100 μg, candesartan 16 mg, and carvedilol 25 mg) were weighed. The weights were analyzed for acceptance, accuracy, and variability. Weight variation acceptance criteria were adopted in this work as a tool to indicate the properness of the subdivision techniques used to produce acceptable half tablets. Other relevant physical characteristics of the five products such as tablet shape, dimensions, face curvature, score depth, and crushing strength were measured. RESULTS: All tablets were round in shape, had weights that ranged between 100.63 mg (standard deviation=0.99) and 379.04 mg (standard deviation=3.00), and had crushing strengths that ranged between 23.29 N (standard deviation=3.58)and 103.35 N (standard deviation=14.98). Both candesartan and carvedilol were bi-convex in shape with an extent of face curvature equal to about 33%. In addition, percentage score depth of the tablets had a range between 0% and 24%. The accuracy and variability of subdivision varied according to the subdivision technique used and tablet characteristics. Accuracy range was between 81% and 109.8%. Moreover, the relative standard deviation was between 1.5% and 17.4%. Warfarin 5 mg subdivided tablets failed the weight variation test regardless of the subdivision technique used. Subdivision by hand produced half tablets that were acceptable for levothyroxine 50 μg and levothyroxine 100 μg. Subdivision by knife produced half tablets that were acceptable only for candesartan tablets. However, the tablet cutter produced half tablets that passed the weight variation test for four out of the five drug products tested in this study. CONCLUSIONS: The tablet cutter performed better than the other subdivision techniques used. It produced half tablets that passed the weight uniformity test for four drug products out of the five


No disponible


Assuntos
Humanos , Comprimidos/uso terapêutico , Autoadministração , Prescrições de Medicamentos , Reprodutibilidade dos Testes , Comprimidos/química , Tecnologia Farmacêutica/métodos , Erros de Medicação/prevenção & controle , Jordânia , Comprimidos/farmacocinética , Preparações de Ação Retardada/química , Preparações de Ação Retardada/farmacocinética
8.
Eur J Endocrinol ; 183(2): 119-127, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32580144

RESUMO

Objective: Patients with adrenal insufficiency (AI) suffer from impaired quality of life and are at risk of adrenal crisis (AC) despite established replacement therapy. Patient education is regarded an important measure for prevention of AC and improvement of AI management. A standardized education programme was elaborated for patients with chronic AI in Germany. Design: Longitudinal, prospective, questionnaire-based, multi-centre study. Methods: During 2-h sessions, patients (n = 526) were provided with basic knowledge on AI, equipped with emergency cards and sets and trained in self-injection of hydrocortisone. To evaluate the education programme, patients from eight certified centres completed questionnaires before, immediately after and 6-9 months after training. Results: 399 completed data sets were available for analysis. Questionnaire score-values were significantly higher after patient education, indicating successful knowledge transfer (baseline: 17 ± 7.1 of a maximum score of 29; after training: 23 ± 4.2; P < 0.001), and remained stable over 6-9 months. Female sex, younger age and primary cause of AI were associated with higher baseline scores; after education, age, cause of AI and previous adrenal crisis had a significant main effect on scores. 91% of patients would dare performing self-injection after training, compared to 68% at baseline. An improvement of subjective well-being through participation in the education programme was indicated by 95% of the patients 6-9 months after participation. Conclusion: Patient group education in chronic AI represents a helpful tool for the guidance of patients, their self-assurance and their knowledge on prevention of adrenal crises. Repeated training and adaptation to specific needs, for example, of older patients is needed.


Assuntos
Insuficiência Adrenal/tratamento farmacológico , Educação de Pacientes como Assunto/métodos , Educação de Pacientes como Assunto/normas , Doença Aguda/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Etiquetas de Emergência Médica , Tratamento de Emergência , Feminino , Alemanha , Terapia de Reposição Hormonal , Humanos , Hidrocortisona/administração & dosagem , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Qualidade de Vida , Autoadministração , Inquéritos e Questionários , Adulto Jovem
9.
Gut ; 69(9): 1592-1597, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32499303

RESUMO

OBJECTIVE: Treatment options for non-hospitalised patients with coronavirus disease 2019 (COVID-19) to reduce morbidity, mortality and spread of the disease are an urgent global need. The over-the-counter histamine-2 receptor antagonist famotidine is a putative therapy for COVID-19. We quantitively assessed longitudinal changes in patient reported outcome measures in non-hospitalised patients with COVID-19 who self-administered high-dose famotidine orally. DESIGN: Patients were enrolled consecutively after signing written informed consent. Data on demographics, COVID-19 diagnosis, famotidine use, drug-related side effects, temperature measurements, oxygen saturations and symptom scores were obtained using questionnaires and telephone interviews. Based on a National Institute of Health (NIH)-endorsed Protocol to research Patient Experience of COVID-19, we collected longitudinal severity scores of five symptoms (cough, shortness of breath, fatigue, headaches and anosmia) and general unwellness on a four-point ordinal scale modelled on performance status scoring. All data are reported at the patient level. Longitudinal combined normalised symptom scores were statistically compared. RESULTS: Ten consecutive patients with COVID-19 who self-administered high-dose oral famotidine were identified. The most frequently used famotidine regimen was 80 mg three times daily (n=6) for a median of 11 days (range: 5-21 days). Famotidine was well tolerated. All patients reported marked improvements of disease related symptoms after starting famotidine. The combined symptom score improved significantly within 24 hours of starting famotidine and peripheral oxygen saturation (n=2) and device recorded activity (n=1) increased. CONCLUSIONS: The results of this case series suggest that high-dose oral famotidine is well tolerated and associated with improved patient-reported outcomes in non-hospitalised patients with COVID-19.


Assuntos
Infecções por Coronavirus , Monitoramento de Medicamentos/métodos , Famotidina/administração & dosagem , Pandemias , Pneumonia Viral , Avaliação de Sintomas/métodos , Adulto , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/fisiopatologia , Relação Dose-Resposta a Droga , Feminino , Antagonistas dos Receptores Histamínicos H2/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Oximetria/métodos , Medidas de Resultados Relatados pelo Paciente , Pneumonia Viral/diagnóstico , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/fisiopatologia , Estudos Retrospectivos , Autoadministração , Resultado do Tratamento
10.
PLoS One ; 15(6): e0233806, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32479539

RESUMO

BACKGROUND: Intentional self-harm is a common cause of hospital presentations in New Zealand and across the world, and self-poisoning is the most common method of self-harm. Paracetamol (acetaminophen) is frequently used in impulsive intentional overdoses, where ease of access may determine the choice of substance. OBJECTIVE: This cross-sectional study aimed to determine how much paracetamol is present and therefore accessible in urban New Zealand households, and sources from where it has been obtained. This information is not currently available through any other means, but could inform New Zealand drug policy on access to paracetamol. METHODS: Random cluster-sampling of households was performed in major urban areas of two cities in New Zealand, and the paracetamol-containing products, quantities, and sources were recorded. Population estimates of proportions of various types of paracetamol products were calculated. RESULTS: A total of 174 of the 201 study households (86.6%) had at least one paracetamol product. Study households had mostly prescription products (78.2% of total mass), and a median of 24.0 g paracetamol present per household (inter-quartile range 6.0-54.0 g). Prescribed paracetamol was the main source of large stock. Based on the study findings, 53% of New Zealand households had 30 g or more paracetamol present, and 36% had 30 g or more of prescribed paracetamol, specifically. CONCLUSIONS: This study highlights the importance of assessing whether and how much paracetamol is truly needed when prescribing and dispensing it. Convenience of appropriate access to therapeutic paracetamol needs to be balanced with preventing unnecessary accumulation of paracetamol stocks in households and inappropriate access to it. Prescribers and pharmacists need to be aware of the risks of such accumulation and assess the therapeutic needs of their patients. Public initiatives should be rolled out at regular intervals to encourage people to return unused or expired medicines to pharmacies for safe disposal.


Assuntos
Acetaminofen/administração & dosagem , Uso de Medicamentos/estatística & dados numéricos , Características da Família , Uso Indevido de Medicamentos sob Prescrição/estatística & dados numéricos , Acetaminofen/provisão & distribução , Adulto , Cidades/estatística & dados numéricos , Armazenamento de Medicamentos , Feminino , Humanos , Masculino , Nova Zelândia , Autoadministração
11.
Middle East Afr J Ophthalmol ; 27(1): 59-61, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32549727

RESUMO

We report a case of severe ocular injury and impaired vision after self-administration of alum. A 56-year-old female administered an alum substance in the left eye and experienced severe corneal thinning, a scar, and decreased vision. The active compounds in the alum substance were analyzed using scanning electron microscopy. When topically administered, alum may cause severe ocular injury. Public awareness, early recognition of the injuries, and timely intervention may prevent permanent ocular damage.


Assuntos
Adjuvantes Imunológicos/toxicidade , Compostos de Alúmen/toxicidade , Doenças da Córnea/induzido quimicamente , Transtornos da Visão/induzido quimicamente , Adjuvantes Imunológicos/química , Compostos de Alúmen/química , Doenças da Córnea/diagnóstico , Feminino , Medicina Herbária , Humanos , Microscopia Eletrônica de Varredura , Pessoa de Meia-Idade , Autoadministração , Microscopia com Lâmpada de Fenda , Espectrometria por Raios X , Transtornos da Visão/diagnóstico
12.
Psychopharmacology (Berl) ; 237(7): 2007-2018, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32382781

RESUMO

RATIONALE: The beta-lactam antibiotic ceftriaxone reliably attenuates the reinstatement of cocaine seeking. While the restoration of nucleus accumbens core (NA core) GLT-1 expression is necessary for ceftriaxone to attenuate reinstatement, AAV-mediated GLT-1 overexpression is not sufficient to attenuate reinstatement and does not prevent glutamate efflux during reinstatement. AIMS: Here, we test the hypothesis that ceftriaxone attenuates reinstatement through interactions with glutamate autoreceptors mGlu2 and mGlu3 in the NA core. METHODS: Male and female rats self-administered cocaine for 12 days followed by 2-3 weeks of extinction training. During the last 6-10 days of extinction, rats received ceftriaxone (200 mg/kg IP) or vehicle. In experiment 1, rats were killed, and NA core tissue was biotinylated for assessment of total and surface expression of mGlu2 and mGlu3 via western blotting. In experiment 2, we tested the hypothesis that mGlu2/3 signaling is necessary for ceftriaxone to attenuate cue- and cocaine-primed reinstatement by administering bilateral intra-NA core infusion of mGlu2/3 antagonist LY341495 or vehicle immediately prior to reinstatement testing. RESULTS: mGlu2 expression was reduced by cocaine and restored by ceftriaxone. There were no effects of cocaine or ceftriaxone on mGlu3 expression. We observed no effects of estrus on expression of either protein. The antagonism of mGlu2/3 in the NA core during both cue- and cocaine-primed reinstatement tests prevented ceftriaxone from attenuating reinstatement. CONCLUSIONS: These results indicate that ceftriaxone's effects depend on mGlu2/3 function and possibly mGlu2 receptor expression. Future work will test this hypothesis by manipulating mGlu2 expression in pathways that project to the NA core.


Assuntos
Comportamento Aditivo/metabolismo , Ceftriaxona/administração & dosagem , Cocaína/administração & dosagem , Núcleo Accumbens/metabolismo , Receptores de Glutamato Metabotrópico/metabolismo , Animais , Comportamento Aditivo/tratamento farmacológico , Transtornos Relacionados ao Uso de Cocaína/tratamento farmacológico , Transtornos Relacionados ao Uso de Cocaína/metabolismo , Inibidores da Captação de Dopamina/administração & dosagem , Extinção Psicológica/efeitos dos fármacos , Extinção Psicológica/fisiologia , Feminino , Masculino , Núcleo Accumbens/efeitos dos fármacos , Ratos , Ratos Sprague-Dawley , Receptores de Glutamato Metabotrópico/antagonistas & inibidores , Autoadministração
13.
Psychopharmacology (Berl) ; 237(7): 1989-2005, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32388619

RESUMO

RATIONALE: Abuse of the psychostimulant methamphetamine (METH) can cause long-lasting damage to brain monoaminergic systems and is associated with profound mental health problems for users, including lasting cognitive impairments. Animal models of METH exposure have been useful in dissecting the molecular effects of the drug on cognition, but many studies use acute, non-contingent "binge" administrations of METH which do not adequately approximate human METH use. Long-term METH exposure via long-access (LgA) self-administration paradigms has been proposed to more closely reflect human use and induce cognitive impairments. OBJECTIVE: To better understand the role of contingency and patterns of exposure in METH-induced cognitive impairments, we analyzed behavioral and neurochemical outcomes in adult male rats, comparing non-contingent "binge" METH administration with contingent (LgA) METH self-administration and non-contingent yoked partners. RESULTS: Binge METH (40 mg/kg, i.p., over 1 day) dramatically altered striatal and hippocampal dopamine, DOPAC, 5-HT, 5-HIAA, BDNF, and TrkB 75 days after drug exposure. In contrast, 6-h LgA METH self-administration (cumulative 24.8-48.9 mg METH, i.v., over 16 days) altered hippocampal BDNF in both contingent and yoked animals but reduced striatal 5-HIAA in only contingent animals. Neurochemical alterations following binge METH administration were not accompanied by cognitive deficits in Morris water maze, novel object recognition, or Y-maze tests. However, contingent LgA METH self-administration resulted in impaired spatial memory in the water maze. CONCLUSIONS: Overall, substantial differences in neurochemical markers between METH exposure and self-administration paradigms did not consistently translate to deficits in cognitive tasks, highlighting the complexity of correlating METH-induced neurochemical changes with cognitive outcomes.


Assuntos
Estimulantes do Sistema Nervoso Central/administração & dosagem , Cognição/efeitos dos fármacos , Hipocampo/efeitos dos fármacos , Hipocampo/metabolismo , Aprendizagem em Labirinto/efeitos dos fármacos , Metanfetamina/administração & dosagem , Ácido 3,4-Di-Hidroxifenilacético/metabolismo , Animais , Cognição/fisiologia , Dopamina/metabolismo , Proteínas da Membrana Plasmática de Transporte de Dopamina/metabolismo , Ácido Hidroxi-Indolacético/metabolismo , Masculino , Aprendizagem em Labirinto/fisiologia , Transtornos da Memória/induzido quimicamente , Transtornos da Memória/metabolismo , Ratos , Ratos Wistar , Autoadministração/psicologia
15.
BMC Public Health ; 20(1): 730, 2020 May 19.
Artigo em Inglês | MEDLINE | ID: mdl-32429950

RESUMO

BACKGROUND: Along with sexual partners of other high-risk groups, men who purchase sex (MWPS) represented 18% of new HIV diagnoses worldwide in 2018. They are therefore an important population for HIV prevention globally. Despite very low HIV testing coverage among MWPS in many countries, the role of HIV self-testing to increase testing coverage has not been explored. We, therefore, conducted a pilot intervention study to evaluate the uptake and acceptability of assisted and unassisted HIV self-testing among MWPS in Indonesia. METHODS: MWPS attending seven brothels in Bali between December 2017 and January 2018 were recruited by lay health providers to participate in a brief health survey, and then invited to have a HIV self-test (assisted or unassisted) with an OraQuick® ADVANCE Rapid HIV-1/2 Antibody Test and complete a post-test acceptability survey. RESULTS: A total of 292 men completed the health survey (response rate: 70%) and 188 (64.6%) accepted HIV self-testing. Of these men, 13.3% had ever tested for HIV and 58.9% reported condom use at their last sexual encounter with a brothel-based female sex worker. Nearly all men (98.9%) who accepted a HIV self-test preferred assisted HIV self-testing - of whom 83.9% preferred to be fully assisted and 16.1% opted to be partially assisted and read their results privately. Of the men who accepted the test and showed the result to the lay health providers, 4 (2.1%) received reactive results. Linkage following HIV self-test is a concern, as none of the four men with a reactive result attended HIV testing at the recommended referral HIV testing clinic over a two-month follow-up period. CONCLUSIONS: This study is the first to investigate the acceptance of HIV self-testing when offered to MWPS in brothels by lay health providers. The high uptake of HIV self-testing suggests that this testing model is acceptable and could increase the very low HIV testing coverage among MWPS. The strong preference for fully assisted HIV self-testing highlights the importance of involving lay health providers in future testing programs. When scaling up HIV self-testing programmatically, strategies to improve linkage-to-care should be considered and evaluated.


Assuntos
Infecções por HIV/diagnóstico , Homens/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Autoadministração/psicologia , Testes Sorológicos/psicologia , Profissionais do Sexo/psicologia , Adulto , HIV , Infecções por HIV/epidemiologia , Infecções por HIV/psicologia , Humanos , Indonésia/epidemiologia , Masculino , Projetos Piloto , Autoadministração/métodos , Testes Sorológicos/métodos , Inquéritos e Questionários
16.
J Allergy Clin Immunol Pract ; 8(7): 2310-2321.e4, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32417446

RESUMO

BACKGROUND: Allergen immunotherapy (AIT) is safe and effective but is typically administered under strict clinic observation to mitigate the risk of a systemic reaction to immunotherapy (SRIT). However, in the setting of the global coronavirus disease 2019 pandemic, alternative care models should be explored. OBJECTIVE: To evaluate the cost-effectiveness of home immunotherapy self-administration (HITSA) in a highly idealized circumstance for provision of maintenance AIT in a shelter-in-place or other scenarios of unforeseen reduction in nonessential medical services. METHODS: Markov modeling was used to compare in-office clinic AIT in selected patients using cohort analysis and microsimulation from the societal and health care perspectives. RESULTS: Assuming similar SRIT rates, HITSA was found to be a cost-effective option with an incremental cost-effectiveness ratio of $44,554/quality-adjusted life-year when considering both incremental epinephrine autoinjector costs and coronavirus disease 2019 risks. Excluding epinephrine autoinjector costs, HISTA dominated other options. However, outside of pandemic considerations, HITSA was not cost-effective (incremental cost-effectiveness ratio, $198,877,286) at annual epinephrine autoinjector costs above $287. As the incremental HITSA SRIT rate increased above 15%, clinic AIT was the most cost-effective strategy. Excluding both pandemic risks and risk of motor vehicle accident fatality from round-trip clinic transit, clinic AIT dominated other strategies. Clinic AIT was the more cost-effective option at very high fatality relative risk for HITSA or at very low annual risk of contracting coronavirus disease 2019. CONCLUSIONS: Under idealized assumptions HITSA can be a safe and cost-effective option during a global pandemic in appropriately selected patients provided home rates of SRIT remain stable.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Dessensibilização Imunológica/economia , Letramento em Saúde , Pneumonia Viral/epidemiologia , Adolescente , Adulto , Criança , Pré-Escolar , Análise Custo-Benefício , Nível de Saúde , Humanos , Cadeias de Markov , Pessoa de Meia-Idade , Pandemias , Autoadministração , Adulto Jovem
20.
Neurology ; 94(22): 959-969, 2020 06 02.
Artigo em Inglês | MEDLINE | ID: covidwho-52532

RESUMO

The coronavirus 2019 (COVID-19) pandemic has potential to disproportionately and severely affect patients with neuromuscular disorders. In a short period of time, it has already caused reorganization of neuromuscular clinical care delivery and education, which will likely have lasting effects on the field. This article reviews (1) potential neuromuscular complications of COVID-19, (2) assessment and mitigation of COVID-19-related risk for patients with preexisting neuromuscular disease, (3) guidance for management of immunosuppressive and immunomodulatory therapies, (4) practical guidance regarding neuromuscular care delivery, telemedicine, and education, and (5) effect on neuromuscular research. We outline key unanswered clinical questions and highlight the need for team-based and interspecialty collaboration. Primary goals of clinical research during this time are to develop evidence-based best practices and to minimize morbidity and mortality related to COVID-19 for patients with neuromuscular disorders.


Assuntos
Infecções por Coronavirus/terapia , Imunossupressores/efeitos adversos , Doenças Neuromusculares/terapia , Pneumonia Viral/terapia , Antivirais/efeitos adversos , Cloroquina/efeitos adversos , Infecções por Coronavirus/complicações , Infecções por Coronavirus/prevenção & controle , Assistência à Saúde , Desprescrições , Progressão da Doença , Desenvolvimento de Medicamentos , Inibidores Enzimáticos/efeitos adversos , Síndrome de Guillain-Barré/etiologia , Visita Domiciliar , Humanos , Hidroxicloroquina/efeitos adversos , Fatores Imunológicos/efeitos adversos , Fatores Imunológicos/uso terapêutico , Imunossupressores/uso terapêutico , Infusões Subcutâneas , Macrolídeos/efeitos adversos , Doenças Musculares/etiologia , Miastenia Gravis/induzido quimicamente , Neurologia/educação , Doenças Neuromusculares/complicações , Pandemias/prevenção & controle , Pneumonia Viral/complicações , Pneumonia Viral/prevenção & controle , Guias de Prática Clínica como Assunto , Pesquisa , Comportamento de Redução do Risco , Autoadministração , Telemedicina , Vacinas Virais/uso terapêutico
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