Treatment of Positive Urine Cultures at End-of-Life and the Effect on Terminal Delirium Management

Background: The decision to initiate antibiotics in hospice patients that are very near end-of-life is a complex ethical and stewardship decision. Antibiotics may be ordered to improve urinary tract infection–related symptoms, such as delirium. However, infection symptoms may be managed using antipsychotics, antipyretics, antispasmodics, and analgesics instead. Currently, there are no studies that compare symptom management between those who receive antibiotics and those who do not. Methods: A retrospective chart review was conducted for patients admitted to a hospice inpatient unit. Charts were included if the patient was admitted for delirium and had a Palliative Performance Scale score ≤40%, the urine culture was positive for organism growth, and the patient died while in the HIU. Clinical and demographic data was collected. Medication use was tallied for the 5 days prior to the date of death. Results: Sixty-one charts met the inclusion criteria. Thirty-five patients received antibiotics (ABX+) and 26 did not (ABX−). There was no difference in any medication consumption between groups during the 5 days prior to death. The ABX+ group died 8.2 days after obtaining the urine sample vs 6 days ( P =0.046). The ABX+ group had more documented urinary tract–specific infection symptoms (66% vs 38%, P =0.042). More than half of antibiotic courses were discontinued prematurely. Conclusion: The results of this study do not show a difference in overall medication consumption between groups, which suggests that antibiotics may not help improve terminal delirium symptoms in those with a suspected urinary tract infection at end-of-life.

Changes in the Sensitization Pattern to Alternaria alternata Allergens in Patients Treated with Alt a 1 Immunotherapy

Alternaria alternata is the most important allergenic fungus, with up to 20% of allergic patients affected. The sensitization profile of patients sensitized to A. alternata and how it changes when treated with immunotherapy is not known. Our objective is to determine the allergen recognition pattern of allergic patients to A. alternata and to study its association to the parameters studied in a clinical trial recently published. Sera of 64 patients from the clinical trial of immunotherapy with native major allergen Alt a 1 were analyzed by immunoblotting; 98. 4% of the patients recognized Alt a 1. The percentage of recognition for Alt a 3, Alt a 4, and/or Alt a 6, Alt a 7, Alt a 8, Alt a 10 and/or Alt a 15 was 1.6%, 21.9%, 12.5%, 12.5%, and 12.5% respectively. Of the 64 patients, 45 (70.3%) only recognized Alt a 1 among the allergens present in the A. alternata extract. Immunotherapy with Alt a 1 desensitizes treated patients, reducing their symptoms and medication consumption through the elimination of Alt a 1 sensitization, which is no longer present in the immunoblotting of some patients. There may be gender differences in the pattern of sensitization to A. alternata allergens, among others.

Electroanalgesia in chronic low back pain

Low back pain or low back pain is a set of painful manifestations, affecting 90% of the population, including the elderly and young people. It has numerous causes, such as joint degeneration, biomechanical and functional changes, incorrect posture, among others. Thus, there is limitation in ROM, pain, burning sensation and functional incapacity. Electrotherapy is the use of electrical currents for different therapeutic purposes. It is used to control pain, reduce edema and muscle spasm. To identify the effects of electroanalgesia on pain in patients with low back pain chronic. Anon-systematic review of the literature was performed, where randomized clinical trials published between 2006 and 2020 were selected, according to the highest score in the scorePEDro. The search involved the databases PEDro e PubMed, through the following terms: electroanalgesia, chronic, back pain, backache, TENS, electrotherap, placebo, massage. Six studies with a PEDro score between 7 and 10 were selected. In all studies, electroanalgesia was compared with massage or placebo. In five studies, when TENS was compared with massage, there was an immediate reduction in pain, improvement in disability and a reduction in medication consumption. In one study, after ten sessions there was no difference between TENS and interferential current. Another study showed that laser was more effective than TENS in reducing pain. There is no difference between TENS and interferential current. Electroanalgesia appears, in the short term, to reduce pain, medication consumption, as well as improve disability. Laser is more effective than TENS in reducing pain.

Effect of an intensive cervical traction protocol on mid-term disability and pain in patients with cervical radiculopathy: An exploratory, prospective, observational pilot study

Background Cervical radiculopathy is a relatively common and disabling condition involving local pain in the neck region and pain that radiates into the upper limb. Recent data suggest that cervical traction may effectively reduce disability and pain, with a dose-response relationship. The main aim of this study was therefore to evaluate the mid-term effect of an intensive cervical traction protocol for patients with cervical radiculopathy on disability, and to compare the effects with those reported by non-intensive protocols in the literature. Methods We conducted a prospective open observational study of 36 patients referred by their general practitioner for symptoms suggestive of cervical radiculopathy. All patients underwent the same treatment: a 30-minute cervical traction protocol, twice a day, for five consecutive days. The main objective was the evaluation of disability at 3 months. We evaluated at baseline (D1), the end of the protocol (D5) and at mid-term (M3) disability, cervical pain, radiating pain, pain on motor imagery, presence of neuropathic pain and medication consumption. The primary outcome was the proportion of patients for whom the Neck Disability Index improved by more than the minimum clinically important difference of 7 points by M3. Results Thirty-six patients were included in this study. The Neck Disability Index improved by more than the minimum clinically important difference in 48.3% at M3. Mean Neck Disability Index (p < .001), mean cervical VAS (p < .001), mean radiating VAS (p < .001), and mean VAS for imagined lateral flexion and rotation (p < .002) improved significantly from D1 to D5 and from D1 to M3. Consumption of medication reduced at each time point. The proportion of patients with neuropathic pain reduced from 61.1% at D1 to 33.3% at D5 and 48.3% at M3. Conclusion Disability reduced by more than the minimum clinically important difference in almost half of the participants following the intensive traction protocol. These results are encouraging and suggest that this complex condition can be treated with relatively simple methods.

Isolated Dissection of the Ductus Arteriosus Associated with Sudden Unexpected Intrauterine Death

We report five cases of sudden intrauterine death due to premature closure of the ductus arteriosus. In four cases, this was caused by dissecting the hematoma of the ductus arteriosus with intimal flap and obliteration of the lumen. In one case, the ductus arteriosus was aneurysmatic, with lumen occlusion caused by thrombus stratification. No drug therapy or free medication consumption were reported during pregnancy. The time of stillbirth ranged between 26 and 33 gestational weeks. We performed TUNEL analysis for apoptosis quantification. The dissecting features were intimal tears with flap formation in four of the cases, just above the origin of the ductus arteriosus from the pulmonary artery. The dissecting hematoma of the ductus arteriosus extended downward to the descending aorta and backward to the aortic arch with involvement of the left carotid and left subclavian arteries. TUNEL analysis showed a high number of apoptotic smooth muscle cells in the media in two cases. Abnormal ductal remodeling with absence of subintimal cushions, lacunar spaces rich in glycosaminoglycans (cystic medial necrosis), and smooth muscle cell apoptosis were the pathological substrates accounting for failure of remodeling process and dissection.

Acceptance of Pharmaceutical Services by Home-Dwelling Older Patients: A Case Study in a Portuguese Community Pharmacy

Background: Aging-related comorbidities predispose older adults to polypharmacy and consequently an increased risk of adverse drug reactions and poor compliance. Pharmacists’ interventions can have a beneficial impact on the improvement of clinical outcomes. Thus, this work aimed to assess the acceptance of Portuguese home-dwelling older adults regarding a pharmaceutical service paid by patients for medication management and pharmacotherapy follow-up. We also intended to analyze medication, characterize the medication consumption profile, and identify the main difficulties of our sample during their daily medication management. Methods: A questionnaire on adherence and medication therapy management was applied to polymedicated patients ≥65 years old, in a community pharmacy. Results: Of the 88 participants, 92.2% would be willing to pay for a pharmacotherapy management service, and 75.6% answered that they would be willing to pay for an individual medication preparation service. In addition, 45.7% of the participants were categorized as lower adherents to a medication therapeutic regimen. Our sample reported that during their daily lives, they felt difficulty: to remember to take their pills (17%), to manage so many medicines (15.9%), and to swallow the pills (9.1%). Conclusions: Polymedicated older adults are willing to pay for a service to improve the management of their medicines, suggesting that they recognize the role of pharmacists in medication management. This study provides useful information for the conceptualization of a pharmacotherapy management service that includes medication review and a pharmacotherapy follow-up.

Prolonged Medical Cannabis Treatment is Associated With Quality of Life Improvement and Reduction of Analgesic Medication Consumption in Chronic Pain Patients

Introduction: Chronic non-cancer pain (CNCP) is one of the most prevalent indications for medical cannabis (MC) treatment globally. In this study, we investigated CNCP parameters in patients during prolonged MC treatment, and assessed the interrelation between CNCP parameters and the chemical composition of MC chemovar used.Methods: A cross-sectional questionnaire-based study was performed in one-month intervals for the duration of six months. Subjects were adult patients licensed for MC treatment who also reported a diagnosis of CNCP by a physician. Data included self-reported questionnaires. MC treatment features included administration route, cultivator, cultivar name and monthly dose. Comparison statistics were used to evaluate differences between the abovementioned parameters and the monthly MC chemovar doses at each time point.Results: 429, 150, 98, 71, 77 and 82 patients reported fully on their MC treatment regimens at six one-month intervals, respectively. Although pain intensities did not change during the study period, analgesic medication consumption rates decreased from 46 to 28% (p &lt; 0.005) and good Quality of Life (QoL) rates increased from 49 to 62% (p &lt; 0.05). These changes overlapped with increase in rates of (-)-Δ9-trans-tetrahydrocannabinol (THC) and α-pinene high dose consumption.Conclusion: Even though we observed that pain intensities did not improve during the study, QoL did improve and the rate of analgesic medication consumption decreased alongside with increasing rates of high dose THC and α-pinene consumption. Understanding MC treatment composition may shed light on its long-term effects.

Using of licensed and unlicensed anti-obesity medications among the university students

Background: Obesity is one of the most serious problems worldwide. Using anti-obesity medications have gained growing interest among adults as a shortcut for bodyweight management practice. This study aimed to determine the prevalence, knowledge, usage determinants, intake pattern and experienced effects of anti-obesity medications, licensed and unlicensed, among university students in Jordan. Materials and Methods: A cross-sectional study was conducted using a structured web-based questionnaire. Univariate and multivariate logistic regression analyses were used. Results: 418 students with a mean age of 21.5 responded to the questionnaire. The prevalence of anti-obesity medication intake was 11%. The majority (67.2%) had scored poor knowledge regarding these medications. The intake patterns indicated that 78.3% of the consumers were self-administrated without prescription and 76.1% of the consumers used licensed type. Despite being perceived as useful in weight reduction, vomiting, and nausea, were very common adverse events (65.2%). Besides being obese, students with excellent knowledge demonstrated higher odds (OR=24.38 (95%CI: 8.12-73.19) and 10.48 (95%CI: 4.03-27.26), respectively) for medication consumption compared with other, p < 0.0005. Conclusion: Using anti-obesity medications among university students is of concern, particularly due to using unlicensed types and the lack of clinical prescription. With the reported poor knowledge, it becomes crucial to launching awareness campaigns and tailored programs for this age group and the general population.

Giant Congenital Melanocytic Nevi (GCMN): Sebuah Laporan Kasus Langka

Giant Congenital Melanocytic Nevi (GCMN) is a nevus which present at birth or arise within the first few weeks of life. Incidence of GCMN is estimated at below 1:20.000 newborns. Lesion of GCMN usually appears with a black or brownish plaque and may have abnormal borders, flat or protruding surface and hypertrichosis. Giant Congenital Melanocytic Nevi (GCMN) is associated with malignant melanoma and neurocutaneous melanocytosis. A male newborn baby is reported to have a giant black hairy plaque, with irregular shape in his head since born. Patient was born naturally, full term, and normal birth weight. The mother has no medication consumption and disease history during pregnancy. In our three years follow up, there are multiple black patches with smaller size in front right and left leg, and the back of the body. The GCMN treatment consists of surgical and non-surgical procedures, psychological support, and lifelong monitoring. In this case, further examination and observation are needed.

Adolescents’ Explanatory Models for Headaches and Associations with Behavioral and Emotional Outcomes

More than one-third of adolescents experience recurrent headaches. Usually, these headaches are of primary origin and modulated by different biological and psychosocial factors. While parents are often consulted in scientific research and medical care about the nature of their child’s headache, it is unclear to what extent parents and their children agree upon the factors that cause them. Adolescents’ own attributions of headaches have rarely been investigated, and it is unclear how those attributions affect behavioral and emotional outcomes. In the present study, adolescents with chronic headaches (N = 248) and their parents (N = 120) rated the influence of various biological and psychosocial factors on the adolescents’ headaches. Associations between these factors and several behavioral and emotional outcomes were examined. The most frequently reported factor by both samples was stress; however, concordance between parents and adolescents was generally low. The factor “other disease” was significantly associated with medication consumption and school absence. This study is one of the first to provide insights into adolescents’ own attributions of headaches. Furthermore, the significant associations of the factor with behavioral outcomes reveal the importance of understanding personal explanatory models of headache. Future studies should examine associations between subjective headache causes and the individual’s experience of the disorder to improve headache interventions.