Potential drug interactions analysis of COVID-19 patients at a hospital in West Java

Background: Treatment guidelines of COVID-19 are changing continuously by involving many off-label and various symptomatic or supportive drugs. The use of these various drugs might increase the patient’s risk of developing drug interactions. Objective: The study aimed to analyze potential drug-drug interactions in COVID-19 inpatients and the correlated factors. Method: A cross-sectional study was conducted in a hospital by using inpatients admitted from August-December 2020. Potential drug-drug interaction was analyzed by using Lex-Interact® software. Results: From 107 patients, the majority of them are in moderate severity-degree (98.1%), having comorbidities (93.5%), and polypharmacy (98.1%). The average of potential drug interactions was 8.47±8,04, with most of the interaction in risk rating C-monitor therapy. Major potential drug interactions found were prolongation of QT interval and disturbance of drug absorption in the gastrointestinal tract. A positive correlation occurred between drug interactions found and comorbidity (r=0.436), number of drugs per prescription (r=0.674), and length of stay (r=0.222) Conclusions: COVID-19 patient is at risk for developing potential drug interactions that can affect the patient's physiological condition and reduce drug effect. It is necessary to manage the medication schedule, therapy modification, administration route changing, dosage adjustment, and monitoring of effects that might occur because of the drug interactions. Keywords: drug interaction, COVID-19, inpatient, correlated factor

Feedback and Feedforward Auditory-Motor Processes for Voice and Articulation in Parkinson's Disease

Purpose Unexpected and sustained manipulations of auditory feedback during speech production result in “reflexive” and “adaptive” responses, which can shed light on feedback and feedforward auditory-motor control processes, respectively. Persons with Parkinson's disease (PwPD) have shown aberrant reflexive and adaptive responses, but responses appear to differ for control of vocal and articulatory features. However, these responses have not been examined for both voice and articulation in the same speakers and with respect to auditory acuity and functional speech outcomes (speech intelligibility and naturalness). Method Here, 28 PwPD on their typical dopaminergic medication schedule and 28 age-, sex-, and hearing-matched controls completed tasks yielding reflexive and adaptive responses as well as auditory acuity for both vocal and articulatory features. Results No group differences were found for any measures of auditory-motor control, conflicting with prior findings in PwPD while off medication. Auditory-motor measures were also compared with listener ratings of speech function: first formant frequency acuity was related to speech intelligibility, whereas adaptive responses to vocal fundamental frequency manipulations were related to speech naturalness. Conclusions These results support that auditory-motor processes for both voice and articulatory features are intact for PwPD receiving medication. This work is also the first to suggest associations between measures of auditory-motor control and speech intelligibility and naturalness.

Microencapsulated Isoniazid-Loaded Metal–Organic Frameworks for Pulmonary Administration of Antituberculosis Drugs

Tuberculosis (TB) is an infectious disease that causes a great number of deaths in the world (1.5 million people per year). This disease is currently treated by administering high doses of various oral anti-TB drugs for prolonged periods (up to 2 years). While this regimen is normally effective when taken as prescribed, many people with TB experience difficulties in complying with their medication schedule. Furthermore, the oral administration of standard anti-TB drugs causes severe side effects and widespread resistances. Recently, we proposed an original platform for pulmonary TB treatment consisting of mannitol microspheres (Ma MS) containing iron (III) trimesate metal–organic framework (MOF) MIL-100 nanoparticles (NPs). In the present work, we loaded this system with the first-line anti-TB drug isoniazid (INH) and evaluated both the viability and safety of the drug vehicle components, as well as the cell internalization of the formulation in alveolar A549 cells. Results show that INH-loaded MOF (INH@MIL-100) NPs were efficiently microencapsulated in Ma MS, which displayed suitable aerodynamic characteristics for pulmonary administration and non-toxicity. MIL-100 and INH@MIL-100 NPs were efficiently internalized by A549 cells, mainly localized in the cytoplasm. In conclusion, the proposed micro-nanosystem is a good candidate for the pulmonary administration of anti-TB drugs.

The PostStroke-Manager – combining mobile, digital and sensor-based technology with personal assistance: protocol of the feasibility study

Introduction Post stroke management has moved into the focus as it represents the only way to secure acute treatment effects in the long term. Due to individual courses, post stroke management appears rather challenging and is hindered by existing barriers between treatment sectors. As a novel concept, the PostStroke-Manager combines digital and sensor-based technology with personal assistance to enable intersectoral cooperation, best possible reduction of stroke-related disability, optimal secondary prevention, and detection of physical and psychological comorbidities. Methods This prospective single-center observational study aims to investigate the feasibility of the PostStroke-Manager concept in an outpatient setting. Ninety patients who have suffered an ischemic or hemorrhagic stroke or transient ischemic attack will be equipped with a tablet and mobile devices recording physical activity, blood pressure, and electrocardiographic signals. Through a server-based platform, patients will be connected with the primary care physician, a stroke pilot and, if necessary, other specialists who will use web-based platforms. Via the tablet, patients will have access to an application with 10 newly designed components including, for instance, a communication tool, medication schedule, medical records platform, and psychometric screenings (e.g., depression, anxiety symptoms, quality of life, adherence, cognitive impairment). During the 1-year follow-up period, clinical visits are scheduled at three-month intervals. In the interim, communication will be secured by an appropriate tool that includes text messenger, audio, and video telephony. As the primary endpoint, feasibility will be measured by a 14-item questionnaire that addresses digital components, technical support, and personal assistance. The PostStroke-Manager will be judged feasible if at least 50% of these aspects are rated positively by at least 75% of patients. Secondary endpoints include feedback from professionals and longitudinal analyses on clinical and psychometric parameters. Perspective This study will answer the question of whether combined digital and personal support is a feasible approach to post stroke management. Furthermore, the patient perspective gained regarding digital support may help to specify future applications. This study will also provide information regarding the potential use of remote therapies and mobile devices in situations with limited face-to-face contacts. Trial registration German Register for Clinical Trials (DRKS00023213.), registered 27 April 2021.

ROLE OF AUSHADHA SEVAN KAAL IN AYURVEDA COMPARATIVE TO CHRONO THERAPEUTICS

According to Ayurveda Aushadha Sevan Kaal is the type of Avasthika Kaal. Kaal is an essential factor to consid- er when treating disease because it refers to the right timing of drug administration. Aushadha (medicine) is con- sidered under Trisutra. According to Acharya Charaka, Aushadha having reverse properties of Desha (Habitat), Matra (Dose) and Kaal (Time) can cure the diseases effortlessly. Our Acharya has enlightened the connection of Kaal and Dosha and suggested consideration while treating the patients. The precise timing at which patients take their medications is critical since it has a substantial impact on treatment outcomes. In Ayurveda, lots of Acharya has specified different Bhaishajya Kaal along with the Dosha, disease, general condition of the body, and in line with the type of preparations (Swaras, Kalka, Kwatha). Chrono Therapeutics is a term used in modern science to describe the concept of timed dose. It recommends synchronizing your medication schedule with your body's nat- ural clock. Though treating a disease success can be attained only when there is a proper arrangement of Desha(Region), Kaal (Time), Pramana (Dosage), Satmya (Wholesomeness), Asatmya (Unwholesomeness), Pathya (useful) & Apathya (harmful). In this study, an attempt was made to compare the Aushadha Kaal Prayoga with chronotherapeutics in modern science. The comparison was done on Aushadha Prayoga Kaal of certain diseases such as allergic rhinitis, asthma, rheumatoid arthritis, peptic ulcer, diabetes mellitus. Overall look, both are having similarities vs dissimilarities too. Keywords: Aushadha Sevan Kaal, Bhaishajya, Chrono Therapeutics, Circadian rhythm.

Level of non-adherence and its associated factors among adults on first-line antiretroviral therapy in Amhara Regional State, Ethiopia

Background In Ethiopia, nearly one-third of people living with human immunodeficiency viruses do not adhere to antiretroviral therapy. Moreover, information regarding non-adherence and its associated factors among adults on first-line antiretroviral therapy in Northeast Ethiopia is limited. Therefore, this study aimed to assess the level of non-adherence and its associated factors among adults on first-line antiretroviral therapy in North Shewa Zone, Amhara Regional State, Ethiopia. Methods A facility-based cross-sectional study was conducted on 326 participants selected by systematic random sampling technique from the five randomly selected public health facilities. Data were collected using the questionnaire adapted from the studies conducted previously and the collected data were entered into Epi data version 3.1 and exported to Stata version 14 for further analysis. Multivariable logistic regression analysis was done and an adjusted odds ratio with its corresponding 95% confidence interval was used to declare a statistical significance. Results The overall prevalence of non-adherence was 17.4% [95% CI: (12.8%, 21.2%)]. Patients with no formal education [AOR (95% CI) = 5.57 (1.97, 15.88)], those who did not use memory aids to take their medications [AOR (95% CI) = 3.01 (1.27, 7.11)], travel more than 10 kilometers to visit the nearby antiretroviral therapy clinics [AOR (95% CI) = 2.42 (1.22, 25.86)], those who used substance [AOR (95% CI) = 3.57 (1.86, 28.69)], and patients whose medication time interfered with their daily routine activities [AOR (95% CI) = 15.46 (4.41, 54.28) had higher odds of having non-adherence to first-line antiretroviral therapy compared to their counter groups. Conclusion The level of non-adherence to first-line antiretroviral therapy was 17.4%, higher compared to WHO’s recommendation. Hence, patients counseling focused on avoiding substance use, use memory aids, and adjusting working time with medication schedule are very crucial. Furthermore, the ministry of health and the regional health bureau with other stakeholders should expand antiretroviral therapy service delivery at health facilities that are close to the community to address distance barriers.

Determinants of HIV Treatment Adherence in Ethnically Diverse and Economically Disadvantaged Patients in a Tertiary Hospital, Nigeria

Antiretroviral Therapy (ART) Has Decreased The Mortality And Morbidity Of HIV/AIDS, And High Adherence To ART (>95%) Is Necessary For A Good Therapeutic Outcome. Non-Adherence Can Lead To Drug-Resistant HIV Caused By Failure To Achieve Maximal Viral Suppression. Little Is Known About Adherence To ART And Its Determinants Among Ethnically Diverse And Economically Disadvantaged Patients. The Purpose Of The Study Was To Identify The Level Of Adherence And Describe Factors That Influence ART Adherence Among Ethnically Diverse And Economically Disadvantaged Patients. This Is With A View To Providing Information That Could Help Health Care Providers Understand Patient Motivations For Discontinuing Their Antiretroviral Treatment And Helping Patients Collaboratively Develop Treatment Regimens That Facilitate Adherence And Optimize The Outcomes Of HIV/AIDS Therapy. A Cross-Sectional Descriptive Survey Was Used. Data Were Collected Among 400 HIV-Infected Patients On ARV Who Received Pretreatment And Ongoing Adherence Counseling And Education Since 2010 Using A Self-Administered Questionnaire. The Data Were Analyzed Using Statistical Package For Social Sciences (SPSS). Findings Showed That The Self-Reported Adherence To The Specific Timing For Taking The Medications (Medication Schedule) Was Significantly Low (8.3%). The Major Factors For Non-Adherence To Medication Reported In This Study Were Being Busy At Work Or School, Forgetfulness, Fasting And Travelling Away From Home. Also, Employment Status Was Associated With Poor Adherence, Which May Be Corroborated By The Major Reason For Non-Adherence (Busy At Work Or School). This Study Is One Of The First Steps In The Exploration Of The Relationship Of Factors Responsible And Medication Adherence Among HIV Patients. This Study Used Three Different Measures Of Medication Adherence. These Are Patients’ Knowledge Of The Benefits Of Taking The Drugs, Adherence To A Medication Schedule, And The Number Of Prescribed Doses Of Medications Missed. Health Care Providers Must Identify Possible Barriers To Adherence At The Earliest And Provide Appropriate Solutions. These Factors Should Be Considered When Designing And Implementing Adherence Interventions.

Smart about medications (SAM): a digital solution to enhance medication management following hospital discharge

Objective To outline the development of a software solution to improve medication management after hospital discharge, including its design, data sources, intrinsic features, and to evaluate the usability and the perception of use by end-users. Materials and Methods Patients were directly involved in the development using a User Center Design (UCD) approach. We conducted usability interviews prior to hospital discharge, before a user started using the application. A technology acceptance questionnaire was administered to evaluate user self-perception after 2 weeks of use. Results The following features were developed; pill identification, patient-friendly drug information leaflet, side effect checker, and interaction checker, adherence monitoring and alerts, weekly medication schedule, daily pill reminders, messaging service, and patient medication reviews. The usability interviews show a 98.3% total success rate for all features, severity (on a scale of 1–4) 1.4 (SD 0.79). Regarding the self-perception of use (1–7 agreement scale) the 3 highest-rated domains were: (1) perceived ease of use 5.65 (SD 2.02), (2) output quality 5.44 (SD 1.65), and (3) perceived usefulness 5.29 (SD 2.11). Discussion Many medication management apps solutions have been created and most of them have not been properly evaluated. SAM (Smart About Medications) includes the user perspective, integration between a province drug database and the pharmacist workflow in real time. Its features are not limited to maintaining a medication list through manual entry. Conclusion We can conclude after evaluation that the application is usable and has been self-perceived as easy to use by end-users. Future studies are required to assess the health benefits associated with its use.

Gender disparity among renal transplant recipients receiving immunosuppressive therapy

Immunosuppressant therapies are considered vital for the long-term survival of kidney grafts, however it can significantly modify patients’ HRQOL because of their adverse effects and the complex medication schedule they represent. Aims: (1) To explore symptom experiences and symptom distress with adverse effects of immunosuppressive therapies, (2) To assess the impact of symptoms experience and symptoms distress on health-related quality of life among renal transplant recipient, and (3) To correlate them with gender. One hundred Renal transplant recipients were interviewed using the End-Stage Renal Disease Symptom Checklist Transplantation Module (ESRDSCL-TM). Results: Most of the renal transplant participants reported best and good quality of life, however, there were a statistically significant differences by gender. Women reported low satisfaction in quality of life comparing with men. In relation to the most frequent distressing symptoms in men and women, the study revealed that women reported higher levels in majority of the given symptoms distress such as back pain, increased hair growth and mood swings. Moreover, women perceived higher means levels with respect to increased appetite while men reported more distress for the items as increased appetite, mood swings, decreased interest in sex, depression, and sleeplessness. Conclusion: Renal transplant recipients had good quality of life with immunosuppressive therapies, but intensive assessment of patients after transplantation should be done to identify their needs. Moreover, consideration should be taken with regards gender variations thus help planning to get better quality of life, as a relatively normal lifestyle is re-established.