scholarly journals Drug utilization research in coinfected patients with tuberculosis and HIV/AIDS

2020 ◽  
Vol 11 (1) ◽  
pp. 0420
Author(s):  
Isabella S. LOBO ◽  
Wânia S. CARVALHO ◽  
Natália H. RESENDE
Keyword(s):  
Opportunistic Infections ◽  
Anatomical Therapeutic Chemical ◽  
High Viral Load ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Appropriate Treatment ◽  
Advanced Immunodeficiency ◽  
Reference Hospital ◽  
Specialized Care ◽  
Drug Utilization Research

Objectives: This study aims to describe and classify the drugs prescribed for coinfected patients treated at a reference hospital. Methods: A retrospective cross-sectional study with analysis of information contained in a database prepared in an earlier study The Anatomical Therapeutic Chemical (ATC) classification system was used to classify the prescribed drugs. Results: Eighty-one coinfected individuals participated in the study, with a mean age of 40 years old and numerous comorbidities. A total of 147 drugs were found and, when the frequency of prescription was evaluated, the most used therapeutic groups were anti-infectious, considering the large number of opportunistic infections (OIs) presented by coinfected patients, followed by feeding tract drugs used to treat adverse drug reactions. We could observe that 73% of the evaluated population had a CD4+ T lymphocyte count <200 cells/mm3 and a high viral load, indicating advanced immunodeficiency. Conclusion: It is necessary to develop strategies aimed at coinfected patients, such as specialized care, early diagnosis and appropriate treatment of coinfection. It is also important to carry out more studies on the use of drugs among coinfected patients to create actions directed to this population that may contribute to the rational use of drugs.

scholarly journals Intrabases divergences in the mHealth era: a drug interaction investigation in an infectious-diseases hospital setting

2021 ◽  
Vol 10 (14) ◽  
pp. e559101417156
Author(s):  
Roberta Souza ◽  
Pedro Ivo da Silva ◽  
Paulo César Cascao ◽  
Clarissa Alencar Sousa ◽  
Angela Ferreira Lopes
Keyword(s):  
Drug Interaction ◽  
Average Length ◽  
Anatomical Therapeutic Chemical ◽  
Hospital Setting ◽  
Cross Sectional Study ◽  
Healthcare Applications ◽  
Cross Sectional ◽  
Average Length Of Stay ◽  
Reference Hospital ◽  
Aid Decision

Introduction: Information on potential drug interactions (PDI) are obtained from databases available on the web or through mobile healthcare applications (mHealth), and can prevent unfavorable clinical outcomes for patients. This study compared PDI information available in Micromedex® drug interaction checker, its web version and its mHealth app. Method: A cross-sectional study realized based on a retrospective review of drug prescriptions in a reference hospital in infectology in the Midwest Region of Brazil, 2018. We selected all prescriptions containing two or more drugs. Drugs were classified according to the first level of the Anatomical Therapeutic Chemical (ATC) classification, according to the route of administration and the number of drugs prescribed. PDIs were classified according to the severity system and four-level evidence classification system. Results: This study selected 72 patients, predominantly male, median age of 38 years, average length of stay of 15.8 days, and most diagnosed with HIV/AIDS. The most frequently prescribed anatomical groups according to ATC were digestive system and metabolism (22.1%) and general anti-infectives for systemic use (21.6%). The average number of drugs per prescription was 10.8 (SD±6.7). The Micromedex® mHealth app found 381 PDIs while its web version detected 502 PDIs, with an average of 5.3 and 7.0 and frequency of 61.1% and 72.2%, respectively. According to the severity classification in mHealth and web versions, the following stood out, respectively: 221 and 321 severe; 139 and 149 moderate. The majority (>65%) of identified PDIs had their documentation classified as reasonable. Conclusion: Digital tools although they aid decision-making, are not unanimous and consistent in detecting such interactions.

THE SITUATION OF RECOGNITION OF SOME NON-COMMUNICABLE DISEASES AND TREATMENT AND PREVENTIVE BEHAVIORS OF PEOPLE IN THUA THIEN HUE PROVINCE

2019 ◽  
pp. 80-86
Author(s):  
Phuoc Thuoc Doan ◽  
Thi Huong Nguyen ◽  
Thi Thanh Nhan Tran ◽  
Thi Phuong Thao Nguyen ◽  
Thi Thuy Hang Nguyen ◽  
...  
Keyword(s):  
Dietary Habits ◽  
Cross Sectional Study ◽  
Communicable Diseases ◽  
Sectional Study ◽  
Preventive Behaviors ◽  
Cross Sectional ◽  
Non Communicable Diseases ◽  
Treatment And Prevention ◽  
Knowing That ◽  
Appropriate Treatment

Background: Non-communicable diseases seriously affect public health and socio-economic development of the country due to the high number of people suffering from diseases, being disabled and mortal. However, the proportion of people who recognized themselves a suffering from non-communicable diseases such as hypertension, diabetes and dyslipidemia is not high. For cases that their disease situations have been identified, there are not appropriate treatment and preventive behaviors. Objectives: 1) To determine the proportion of 25 - 84 years old peoplewho identified themselves as suffering from hypertension, diabetes and dyslipidemia. 2) To learn treatment and preventive behaviors in the group of people who identified themselves as suffering from diseases. Methods: A cross-sectional study was conducted with a randomly selected sample of 1600 residents in Thua Thien Hue province. Results: The proportion of people knowing that they are suffering from hypertension, diabetes and dyslipidemia was 29.4%; 3.2% and 7.8% respectively. Among them, the proportion of people who did not treat and treated irregularly accounted for 42.7%; 13.7% and 75.2% respectively; the proportion of people who did not change their lifestyles and dietary habits accounted for 50.1%; 5.9% and 56.8% respectively. Conclusions: The proportion of people who identified themselves as suffering from some non-communicable diseases without appropriate treatment and preventive behaviors is alarming. Interventions are needed to help people realize the importance of treatment and prevention effectively. Key words: Non-communicable diseases, hypertension, diabetes, dyslipidemia

scholarly journals Evaluation of Nutritional Risk and Prevalence of Obesity in Patients with Covid-19 in A Reference Hospital in Salvador, Bahia, Brazil: A Cross-Sectional Study

2021 ◽  
Vol 14 (01) ◽  
pp. 011-015
Author(s):  
Rodrigo Fernandes Weyll Pimentel ◽  
Gilson Cruz de Moraes ◽  
Shalla Gomes Cavalcanti Barcelos ◽  
Pedro Carlos Muniz de Figueiredo ◽  
Magno Conceição Das Merces
Keyword(s):  
Cross Sectional Study ◽  
Nutritional Risk ◽  
Sectional Study ◽  
Cross Sectional ◽  
High Prevalence ◽  
Reference Hospital ◽  
Prevalence Of Obesity ◽  
Nrs 2002 ◽  
Study Type ◽  
Nutritional Risk Screening

Abstract Introduction The Coronavirus has spread to almost every country in the world, causing the coronavirus disease (COVID-19). The coronavirus stands out among the other infections especially by it's high contagious power and important effects on the respiratory system. The COVID-19 has differents ways of presentation and these are influenced by the patient's previous nutricional status, correlated with the patient's lifestyle and comorbities. Objective this survey seeks to analyze the nutritional status and the prevalence of obesity in patients hospitalized with SARS-CoV-2. Methods: this is a descriptive, prospective and cross-sectional study type, which 41 patients affected by COVID-19 were interviewed. Patient's weight and height were used to assess the BMI, and nutritional risk assessment was performed using the Nutritional Risk Screening tool (NRS 2002). For the analysis, Absolute (AF) and Relative Frequency (RF), the mean and the standard deviation were calculated. Results It was observerd that 78% of the participants had a high nutritional risk, while only 22% had a low nutritional risk. Besides that, 34% showed overweight and 41.4% showed obesity. Conclusion the existence of a high prevalence of increased nutritional risk was evidenced, in addition to the high frequency of overweight in patients affected by SARS-CoV-2.

scholarly journals SAT0078 SAFETY OF LOW DOSE METHOTREXATE (MTX) IN HUMAN IMMUNODEFICIENCY VIRUS (HIV) INFECTION

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 974.2-974
Author(s):  
A. Gunay ◽  
A. Davidson ◽  
I. Colmegna ◽  
D. Lacaille ◽  
H. Loewen ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Adverse Events ◽  
Low Dose ◽  
Opportunistic Infections ◽  
Case Reports ◽  
Cross Sectional Study ◽  
Study Quality ◽  
Sectional Study ◽  
Cross Sectional ◽  
Immunodeficiency Virus

Background:Increased awareness of the efficacy of MTX in rheumatic disease is leading to more MTX use in patients from HIV endemic areas. While HIV related immunosuppression may contribute to improvement of some rheumatic diseases, immune reconstitution from highly active antiretroviral therapy (HAART) may lead to exacerbation or presentation of autoimmune disorders for which MTX therapy may be warranted. Most management guidelines for rheumatic disease do not address MTX use in the context of HIV.Objectives:To systematically review the published literature on the safety of using MTX ≤30 mg per week in HIV.Methods:We searched CINAHL, Embase, Global, MEDLINE and World of Science databases (Jan 1990 to May 2018) for terms including ‘methotrexate’ and ‘human immunodeficiency virus’. We also searched citations from review articles. Titles, abstracts or full manuscripts were screened independently by 2 reviewers to identify studies reporting HIV in patients taking MTX. Study quality was assessed using the McGill Mixed Methods Appraisal Tool (MMAT). Data was extracted on MTX and HIV adverse events (MTX toxicity, HIV viral load, CD4 count). Descriptive summaries are presented for studies providing outcomes in patients taking MTX ≤30 mg per week.Results:After removing duplicates and studies not meeting criteria or not providing sufficient information, 42 of the 2714 identified reports were included (1 clinical trial, 2 cohort, 1 cross-sectional study, 38 case reports/case series). Most reports (81%) originated from USA or Europe. Study quality was generally good with most studies fulfilling 50-100% of MMAT criteria. The randomized controlled trial (USA) assessing MTX on atherosclerotic disease in HIV showed that adverse events were more common in MTX versus placebo (12.8% vs 5.6%, p non-inferiority <0.05) and included infection, transient CD4 and CD8 drop, pulmonary toxicity, and death (1 attributed to MTX/HIV, 1 unrelated). One cohort study (South Africa) reported 43 RA patients on MTX who acquired HIV. In this cohort, RA generally improved despite only 5 individuals continuing MTX. No data on MTX adverse event rates was reported. One cohort study (USA) reported 13 HIV patients with myositis. One received MTX (with other immunosuppression) without MTX adverse effects but died due to AIDS. A cross-sectional study (France) of 43 HIV pts with autoimmune disease reported one patient on MTX (and other immunosuppression) developed an adverse event (cytopenia) compared to 5/33 patients not on MTX (cytopenia). The 38 case reports/series described 54 individuals with HIV receiving MTX. Of these studies, 27 (describing 42 subjects) reported on MTX adverse events and 35 (describing 46 subjects) reported on HIV adverse events. MTX adverse events developed in 29 subjects (hematologic 13, renal/hepatic 1, opportunistic infections 10, other events 2). HIV adverse events were noted in 23 subjects (Kaposi’s sarcoma 4, CD4 decrease 16, HIV viral titer increase 4). Five deaths were reported (2 infection, 1 infection and wasting, 2 HIV related deaths). Most subjects also received corticosteroids or other immunosuppressants including biologics.Conclusion:There remains limited data on the safety of low dose MTX in HIV. Surveillance for HIV is warranted for individuals on MTX who are at risk for acquiring HIV. Caution and careful monitoring for MTX toxicity, opportunistic infections and HIV state is suggested if MTX is used in the setting of HIV particularly if combined with other immunosuppression.References:[1] Clin Infectious Disease 2019:68[2] J Rheumatology 2014:41[3] Arthritis and Rheumatism 2003:49[4] Medicine 2017:96Acknowledgments :Funding from International League Against RheumatismMcGill University Global Health Scholar AwardsDisclosure of Interests:Alize Gunay: None declared, Anna Davidson: None declared, Ines Colmegna: None declared, Diane Lacaille: None declared, Hal Loewen: None declared, Michele Meltzer: None declared, Yewondwossen Mengistu: None declared, Rosie Scuccimarri: None declared, Zenebe Yirsaw: None declared, Sasha Bernatsky: None declared, Carol Hitchon Grant/research support from: UCB Canada; Pfizer Canada

Predictors of Psychiatric Morbidity in Cancer Patients

1994 ◽  
Vol 165 (5) ◽  
pp. 593-598 ◽  
Author(s):  
Judy Harrison ◽  
Peter Maguire
Keyword(s):  
Risk Factors ◽  
Cancer Patients ◽  
Psychiatric Morbidity ◽  
Significant Proportion ◽  
Cross Sectional Study ◽  
Future Research ◽  
Cross Sectional ◽  
Appropriate Treatment ◽  
Study Designs ◽  
Patients Experience

BackgroundA significant proportion of cancer patients experience psychiatric morbidity in association with diagnosis and treatment. If this morbidity is to be reduced, a better understanding is needed of the factors which influence adjustment to cancer.MethodA review of the literature was carried out to explore those factors associated with poor psychological adjustment to cancer. These are described under four headings: characteristics of the patient; disease and treatment variables; the interaction between patient and illness; and environmental factors.ResultsA number of risk factors for psychiatric morbidity can be identified from each of the four areas. Methodological limitations are highlighted, in particular the preponderance of cross-sectional study designs.ConclusionsIncreased awareness of the risk factors for psychiatric morbidity should lead to earlier detection and more appropriate treatment. Future research should focus on those risk factors which are potentially modifiable.

scholarly journals Clinical Assessment and Management of Spondyloarthritides in the Middle East: A Multinational Investigation

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Mohammed Hammoudeh ◽  
Hanan Al Rayes ◽  
Adel Alawadhi ◽  
Kamel Gado ◽  
Khalid Shirazy ◽  
...  
Keyword(s):  
Middle East ◽  
Disease Burden ◽  
Clinical Laboratory ◽  
Management Strategies ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
East Region ◽  
Appropriate Treatment ◽  
Treatment Data ◽  
Middle East Region

Data on spondyloarthritis (SpA) from the Middle East are sparse and the management of these diseases in this area of the world faces a number of challenges, including the relevant resources to enable early diagnosis and referral and sufficient funds to aid the most appropriate treatment strategy. The objective was to report on the characteristics, disease burden, and treatment of SpA in the Middle East region and to highlight where management strategies could be improved, with the overall aim of achieving better patient outcomes. This multicenter, observational, cross-sectional study collected demographic, clinical, laboratory, and treatment data on 169 consecutive SpA patients at four centers (Egypt, Kuwait, Qatar, and Saudi Arabia). The data collected presents the average time from symptom onset to diagnosis along with the presence of comorbidities in the region and comparisons between treatment with NSAIDs and biologics. In the absence of regional registries of SpA patients, the data presented here provide a rare snapshot of the characteristics, disease burden, and treatment of these patients, highlighting the management challenges in the region.

scholarly journals A Profile Of Patients Registered At Art Centre At Surat Municipal Institute Of Medical Education & Research In Surat City, Gujarat, India

1970 ◽  
Vol 8 (2) ◽  
pp. 11-16
Author(s):  
B Modi ◽  
P Patel ◽  
S Patel
Keyword(s):  
Medical Education ◽  
Opportunistic Infections ◽  
Cross Sectional Study ◽  
Cd4 Count ◽  
People Living With Hiv ◽  
Time Duration ◽  
Cross Sectional ◽  
Study Results ◽  
Entry Points ◽  
Living With Hiv

Introduction: An estimated 2.4 million Indians are currently living with HIV. In India, the antiretroviral treatment program started with a free ART treatment in 2003. This study was conducted in order to understand the clinico-epidemiological profi le of patients attending ART centre and the effectiveness of the therapy. Methodology: A cross sectional study was conducted at an ART center of Surat Municipal Institute of Medical Education and Research (SMIMER), in Surat city of Gujarat State. The data of 2357 PLHAs (People Living with HIV/ AIDS) registered at ART centre in one year time duration starting from 21st January 2010 was included in the study. Results: Among the total 2357 subjects, 1483 (63%) were males. In our study 42.3% of patients were between 31 to 40 years of age. Among the employed subjects, 32.9% of patients were laborer. Voluntary Counseling and Testing Centre (VCTC) was most common entry point of patient with 50% followed by private practitioner with 23% and NGOs with 6.2%. Other entry points are self referred, RNTCP etc. Tuberculosis and diarrhoea were the most common opportunistic infections. There was signifi cant improvement in CD4 count, bodyweight and functional status of the subjects after receiving the ART for an average duration of 6 months. Conclusion: The economically productive & sexually active people and those with lesser education are at higher risk of becoming sero-positive. The subjects showed signifi cant improvement after receiving ART with respect to the CD4 count and average body weight. DOI: http://dx.doi.org/10.3126/saarctb.v8i2.5895 SAARCTB 2011; 8(2): 11-16

scholarly journals Opportunistic Infections and Associated Factors among HIV/AIDS Patients taking Ante-Retroviral Therapy at Selected Hospitals in Sidama Zone, Southern Ethiopia: A facility-based cross-sectional study

2019 ◽  
Author(s):  
Demelash Wachamo ◽  
Fisseha Bonja
Keyword(s):  
Associated Factors ◽  
Opportunistic Infections ◽  
Public Health Problem ◽  
Cross Sectional Study ◽  
High Morbidity ◽  
Major Public Health Problem ◽  
Sectional Study ◽  
Aids Patients ◽  
Cross Sectional ◽  
Hiv Aids

Abstract Background Opportunistic infections are late complications of HIV infection is the depletion of the immune system. It is a major public health problem and high morbidity AIDS patients die of AIDS-related infections in developing countries like Ethiopia. Identification of opportunistic infections (OIs) is important to develop a specific intervention. Therefore, this study aimed to assess the burden and associated factors of opportunistic infections.Method A facility-based cross-sectional study was conducted on 420 randomly selected HIV/AIDS patients taking anti-retroviral therapy. Data was collected from selected hospitals in Sidama Zone based on population proportion to size. Data was collected by a pre-tested questionnaire and a pre-tested checklist from the medical records of patients. Data entry and analyzed for descriptive and logistic regression models by SPSS v.23. The result declared as statistically significant at p < 0.05.Result The magnitude of opportunistic infections was 39.6%. Major identified OIs was oral candidacies 23.2%, recurrent bacterial pneumonia 21.5%, Herpes zoster 6.3%, and Pulmonary Tuberculosis 6.0%.The magnitude of opportunistic associated with; older age [AOR=2.69, 95% CI: 1.33-5.43], No formal education [AOR=3.12, 95% CI: 1.06-9.25], Low monthly income [AOR=2.27, 95%CI:1.35-3.83], initial CD4 count less than 200 cells/mm3 [AOR=1.91, 95% CI:1.05-3.46), WHO clinical stage II [AOR=2.43, 95% CI:1.34-4.42] and stage III and IV [AOR=4.27, 95% CI: 2.12-8.59], had no extra medicine additional to ART (prophylaxis) had [AOR= 5.91, 95% CI: 3.31-10.56], who interrupt ART medicines [AOR=2.03, 95% CI: 1.09- 3.80] and Khat chewing [AOR=5.48, 95% CI: 2.32-12.96] when compared to their counterparts.Conclusions The overall magnitude of opportunistic infections was high when compared with other studies. Health officials and clinicians need to give attention on the strengthening of the provision if ART with prophylaxis on early-stage and adhrerence, implementation of the TB/HIV collaboration activity, and early initiation of ART to reduce opportunistic infections.

scholarly journals Health Canada’s use of expedited review pathways and therapeutic innovation, 1995–2016: cross-sectional analysis

BMJ Open ◽  
2018 ◽  
Vol 8 (8) ◽  
pp. e023605 ◽  
Author(s):  
Joel Lexchin
Keyword(s):  
Anatomical Therapeutic Chemical ◽  
Cross Sectional Study ◽  
New Drugs ◽  
Cross Sectional ◽  
Time Period ◽  
Therapeutic Value ◽  
Kappa Value ◽  
Innovative Drugs ◽  
Sectional Analysis ◽  
Health Canada

ObjectivesThis study examines the use of expedited approval pathways by Health Canada over the period 1995 to 2016 inclusive and the relationship between the use of these pathways and the therapeutic gain offered by new products.DesignCross-sectional study.Data sourcesTherapeutic Products Directorate, Biologics and Genetic Therapies Directorate, Notice of Compliance database, Notice of Compliance with conditions web site, Patented Medicine Prices Review Board, La revue Prescrire, WHO Anatomical Therapeutic Chemical classification system.Primary and secondary outcomesPercent of new drugs evaluated by Health Canada that went through an expedited pathway between 1995 and 2016 inclusive. Kappa values comparing the review status with assessments of therapeutic value for individual drugs.ResultsOf 623 drugs approved by Health Canada between 1995 and 2016, 438 (70.3%) drugs went through the standard pathway and 185 (29.7%) an expedited pathway. Therapeutic evaluations were available for 509 drugs. Health Canada used an expedited approval pathway for 159 of the 509 drugs, whereas only 55 were judged to be therapeutically innovative. Forty-two of the 55 therapeutically innovative drugs received an expedited review and 13 received a standard review. The Kappa value for the entire period for all 509 drugs was 0.276 (95% CI 0.194 to 0.359) indicating ‘fair’ agreement between Health Canada’s use of expedited pathways and independent evaluations of therapeutic innovation.ConclusionHealth Canada’s use of expedited approvals was stable over the entire time period. It was unable to reliably predict which drugs will offer major therapeutic gains. The findings in this study should provoke a discussion about whether Health Canada should continue to use these pathways and if so how their use can be improved.

Medical and Economics Benefits of Tele-expertise in Dermatology: Case study in eight Health Centers in Mali.

2020 ◽  
Author(s):  
Cheick Oumar Bagayoko ◽  
Mahmoud Cissé ◽  
Joseph Aka ◽  
Adama Dicko ◽  
Abdrahamane Anne ◽  
...  
Keyword(s):  
Health Professionals ◽  
Medical Condition ◽  
Healthcare Providers ◽  
Cross Sectional Study ◽  
Economic Benefits ◽  
Expert Advice ◽  
Financial Benefit ◽  
African Countries ◽  
Cross Sectional ◽  
Specialized Care

Abstract Background: Mali, like many Sub-Saharan African countries, is experiencing an acute crisis with respect to the shortage of qualified health professionals. This crisis is even more acute when it comes to specialized medical fields such as dermatology. To address this shortage, a tele-dermatology project has been launched in Mali since 2015 in order to provide access to specialized care to the most remote populations.Objective: The aim of our study is to assess the medico-economic benefits of the pilot phase of this project.Methods: We conducted a retrospective cross-sectional study of all requests for expert advice sent to dermatology experts through the "Bogou" tele-expertise platform.The sample consisted of 52 patients at eight remote sites and ten health professionals, including 4 specialists.The economic study was done using a parameter of cost analysis and the professional evaluation of healthcare providers. It compared consultation and transportation fees (on-site and off-site), and used a questionnaire assessing items on a 5-level Lickert scale and open-ended questions to evaluate the satisfaction of health professionals. Data analysis was performed by SPSS v25.Results: During the period, 374 requests for tele-expertise were made for the benefit of 52 patients. 89.3% of requests were answered by specialists, with an average response time of 46 hours 59 minutes and extremes from 7 minutes to 415 hours 4 minutes. Eczema was the most common medical condition diagnosed. 98% of patients had never completed a dermatological consultation because of a lack of means to travel to the only specialized center in the country. Consequently, they were all very satisfied or satisfied with the tele-expertise service. The 52 participating patients in project have realized a great financial benefit. Together they saved an average of 5,824,500 XOF (9429 euros).All the health professionals surveyed also expressed satisfaction with the application. They confirmed that the project has enabled them to strengthen their skills in the management of dermatological pathologies.Conclusion: Based on the results of our study, we can say that tele-dermatology allows access to specialized care and a reduction in the costs of care for patients in remote areas.

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