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Diabetes along with related comorbidities associated with high disability rates severely threatens human health. The etiology of diabetes is complex. Genetics, environmental factors, eating habits, drug usage, aging, and lack of movement play important roles in the development of diabetes. Intestinal flora is reportedly closely related to the occurrence and development of type 2 diabetes. Herein, we review changes in abundance and proportion of intestinal flora in patients with type 2 diabetes and regulation of intestinal flora through diet, drugs, and surgery to prevent and treat type 2 diabetes. A more appropriate clinical diagnosis and treatment plan could be made considering changes in intestinal flora in the future.

Coccidiosis is one of the most important parasitic diseases of poultry worldwide. Chemotherapy remains the principal means to control this disease albeit the increasing problems of drug resistance. The aim of this study was to examine the drug usage of anticoccidials in the six communities of Umuahia, Abia state. Data such as type, class and composition of drugs used, level and frequency of usage, route ofadministration and anticoccidial program adopted by different farms were collected from 85 poultry farms within the study region. Results showed that the ionophores anticoccidials were not in use whereas the sulphonamides constituted the bulk of the drugs used (79.3%). Others were; thiamine analogue (21.1%), aminopyrimidine (33.7%), guanidine (14.4%), pyrimidine derivative (15.1%) and nitroimidazol (8.6%). Most of the drugs (>60) contained vitamin A and K. The most popular drug combinations were sulphaquinoxaline and diveradine with vitamin A and K (Embazine Forte) among thirteen trade-marked drugs under use. Close to 25.0% of farms practiced shuttle program and the rest continuous program of administration. Anticoccidials were administered through in-water medication for prophylactic and therapeutic use, and for both in the different farm applications in 43.5, 27.7 and 31.8 (%) respectively. The lack of usage of the ionophores and the massive use of sulphonamides coupled with low application of the right anticoccidial programs in this region presents a serious danger of anticoccidial resistance with consequent high prevalence of the disease. Keywords: Anticoccidials, Coccidiosis, Drug resistance, Ionophores, Poultry, Sulphonamides

Objective Adherence to asthma controller medications is suboptimal among adolescents. We evaluated predictors of adherence and longitudinal patterns of medication use between 8th and 10th grade among a sample of youth of diverse race/ethnicity. Methods Eighth graders with asthma on controller medications (N = 62; 40.0% non-Latino white; 23.7% Black; 37.3% Latino; 37.3% female) completed measures of medication beliefs, responsibility for asthma management, and family cohesion. Objective methods tracked medication use longitudinally. Results Adherence declined during the high school transition, from 48.0% in eighth grade to 34.1% in tenth grade (F = 5.35, p < .01). Males had lower adherence (b = −10.11, SE = 5.37, p = .02, f2 = 0.11), as did Latino youth (b = −12.21, SE = 8.23, p = .03, f2 = 0.12). Family cohesion was associated with higher adherence (b = 4.38, SE = 1.98, p = .04, f2 = 0.06). Latent class models (LCMs) suggested a three-class model of longitudinal adherence patterns. This included low, declining adherence (Class 1 = 29%; higher proportion male, p = .02), high, sustained adherence (Class 2 = 26%, high family cohesion, p = .05, higher proportion female, p = .02), and low, sustained adherence (Class 3 = 45%; higher proportion Latino, p = .05, higher proportion male, p = .02). Conclusions Asthma medication adherence declined between 8th and 10th grade. LCMs indicated some youth have stable patterns of adherence (high or low), whereas others demonstrate declines. Gender differences were observed, and family cohesion was associated with higher, sustained adherence. Interventions building on family resources and targeting the barriers adolescents face are necessary to improve asthma management during this vulnerable period.

Glucose-6-phosphate dehydrogenase G6PD is a cytoplasmic enzymes that are found in all cells of the human body, it plays an essential and vital role in preventing cellular damage from reactive oxygen radicles ROS. Pharmacist can play a major role in providing G6PD deficient patients with the useful information about medications that needs to be avoided in such conditions. Therefore, this study was conducted to assess the pharmacist knowledge about medications use in G6PD deficient patients. Study’s results showed that most of the pharmacists were able to define G6PD deficiency correctly. However, majority were not able to identify risk factors for hemolysis correctly. With regards to the pharmacists’ knowledge about drug usage pattern in G6PD deficient patients, they showed an overall good knowledge as they were able to correctly identify the contraindicated and used with caution medications. Pharmacists should use continuous pharmaceutical education to keep up with updated evidence based information regarding medication use in specific population such as G6PD deficient individuals especially in G6PD prevalent regions.

Background and Objectives: Injection drug usage is a major public health issue. The study is aimed to find the clinical profile and trends of injection drug usage in young people who attended de-addiction services at a tertiary care center in North India. Methods: This retrospective record review analyzed data from consecutive young-aged people attending de-addiction services at a tertiary care hospital in North India between 2015 and 2019. The sociodemographic data and clinical and injection-related characteristics were discerned from the data. Results: Out of 135 patients included in the analysis, 132 (97.8%) were male. There was a 13-fold rise in treatment seeking over the past 5 years (2015: 7 vs. 2019: 98). One hundred and thirty-two (97.8%) were male. High Risk behavior was present such as sharing of needles in 31 (22.9%), paraphernalia sharing in 24 (17.8%), 6 (4.4%) reported ever-having symptoms of sexually transmitted infection, 13 (9.6%) had sex with sex worker, 9 (6.7%) reported ever-having HIV screening, 6 (4.4%) reported having HIV positive status. Thirty-two (23.7%) reported having previous treatment for drug abuse and 13 (9.6%) reported previously being hospitalized for drug abuse. Heroin usage has been present in 96 (71.1%) followed by pentazocine usage in 19 (14.1%). Conclusion: Our findings revealed that treatment-seeking young age population (the WHO defined age group 15–24 years) from the defined geographical location has been showing an increasing trend in injecting drug user usage along with greater injection and sexual risk behaviors associated with it. This can be used to design the public health strategy to educate regarding avoiding injection drug-related practices.

OBJECTIVE: Drug utilization habits of the pregnant are a critical aspect of rational use of the medicine (RUM). This study aimed to analyze the RUM related attitudes and the behaviors of women during their pregnancies. METHODS: The data were collected between May 2016–October 2016 by conducting surveys to 71 pregnant women admitted to the private and governmental hospitals in five districts of Northern Cyprus. The sociodemographic characteristics of the pregnant as well as their attitudes and behaviors concerning drug use were evaluated. RESULTS: The mean age and the gestational week of the patients was 29.7±4.3 years and 25.7±11.2 weeks, respectively. Planned pregnancies constituted 71.8% of all. The percentage of patients with an unplanned pregnancies who were using drugs at the time of the survey (25.0%) was lower than that in those with planned pregnancies (49.0%, p

The latent reservoir for human immunodeficiency virus type 1 (HIV-1) in CD4+ T cells is a major barrier to cure. HIV-1–infected persons who inject drugs (PWID) often struggle to maintain suppression of viremia and experience nonstructured treatment interruptions (NTIs). The effects of injecting drugs or NTIs on the reservoir are unclear. Using the intact proviral DNA assay, we found no apparent effect of heroin or cocaine use on reservoir size. However, we found significantly larger reservoirs in those with frequent NTIs or a shorter interval from last detectable HIV RNA measurement. These results have important implications for inclusion of PWID in HIV-1 cure studies.

Background: In India, asthma imposes a substantial burden; though the disease still remains under-recognized, underestimated and under-treated in masses.With a global need of promoting rational drug use in healthcare, drug utilization pattern studies could provide feedback to prescribers and help in fostering rational drug usage. The present study was planned to study the drug utilization pattern in patients of asthma in a tertiary care set-up in eastern India and to evaluate it with respect to GINA guidelines. Materials and Methods: The study was carried out over a period of one year where cases with confirmed diagnosis of asthma, who gave informed consent to participate were included.Drug usage pattern was determined in the light of drugs prescribed, mean drugs per prescription, percentage of drugs prescribed in generic name and having conformation to national essential drug list. Percentage of inhalational, injectable, fixed dose combination and antibiotics per prescription were noted. Data were checked for completeness and statistically analysed. Results: The present study included 370 participants. A total of 1514 drugs were prescribed, with 4.09 drugs per prescription. 12.55% of drugs prescribed were from national essential drug list. A total of 1031 anti-asthma drugs were prescribed with 2.8 anti-asthma drugs per prescription. Among the various classes of anti-asthma drugs, maximum prescribed were inhalational corticosteroids, followed by long acting inhalational beta 2 agonist and anti-leukotriene drugs. 96.5% of total patients were on inhalational drugs, with budesonide and formeterol being majorly prescribed. Conclusion: The usage pattern as assessed in our study was in conformation to GINA guidelines. Guidelines like GINA have enlightened physicians about the rational prescribing in asthmatic patients.

Effective case management is central for malaria control, but not all of those affected by malaria have access to prompt, effective treatment. In Kenya, free malaria treatment has been implemented since 2006. However, questions remain regarding effective treatment. We conducted cross-sectional epidemiological and questionnaire surveys in four counties in western Kenya in 2004, 2010, and 2016, and antimalarial availability surveys in 2016. We found a significant decline in self-reported malaria cases and an improvement in knowledge of malaria prevention and treatment since 2004. Parasite prevalence declined significantly from 2004 to 2010; however, it has remained unchanged since then. Artemisinin-based combination therapies (ACTs) and sulfadoxine-pyrimethamine (SP) drugs were widely available everywhere. The proportion of ACT usage increased from none in 2004 to 48% and 69%, respectively, in 2010 and 2016, whereas SP drug usage declined from 88% in 2004 to 39% in 2010 and 27% in 2016. During the 2016 survey, non-intermittent preventive treatment in pregnancy use of SP was common (20.9% of all surveyed individual treatments). In 2004, 27.2% (168/617) of households sought hospital treatment alone, and this number increased to 50.6% in 2016. The key factors affecting treatment-seeking behavior were education level, wealth index, household size, and distance to hospitals. Our results indicated that gaps in malaria case management remain and out-of-policy treatment is still a concern.

Summary Background The present study has the objective to assess the zinc (Zn), copper (Cu), and oxysterols plasma levels in type 1 (DM1) (n = 26) and type 2 (DM2) (n = 80) diabetes patients, as compared to healthy controls (n = 71), in order to testify whether metal levels may have a significant impact on the association between oxysterols and diabetes. Methods Plasma trace elements and plasma oxysterols were assessed using atomic absorption spectrometry and LC-MS/MS, respectively. Lifestyle, smoking status, alcohol intake, and drug usage, as well as microvascular complications, were also monitored and reported. Results The obtained data demonstrated that both DM1 and DM2 patients were characterized by significantly elevated HbA1c, FBG, TC, LDL-C, VLDL-C, and TG levels as compared to controls. Plasma Zn levels and Zn/Cu ratio in DM1 and DM2 patients were about 3- and 2-fold lower than controls. No significant differences in plasma Cu levels were reported. The 7-ketocholesterol (7-kchol) levels in DM1 and DM2 patients exceeded these values in healthy individuals by 2.5 and 5-fold, respectively. Similarly, cholestan-3β, 5α, 6β-triol (chol-triol) levels were more than 3- and 6-fold higher when compared to the respective values in non-diabetic controls. In regression models decreased plasma Zn and elevated oxysterol levels were significantly associated with HbA1c and fasting plasma glucose levels, after adjustment for anthropometric and clinical variables, as well as routine biochemical markers. Conclusions Plasma Zn concentration is inversely associated with both 7-kchol and chol-triol levels. Assessment of Zn and oxysterol levels may be used both for risk assessment and as targets for the treatment of diabetes mellitus.

Highlights • LRB was correlated to irradiation technique and several % rectal wall cut points. • The predictive role of dosimetric variables relates to the irradiation technique. • Dose volume objectives for patients treated with IMRT/VMAT are reported., Background and purpose Dose-volume objectives for the rectum have been proposed to limit long term toxicity after moderately hypofractionated radiotherapy (MHRT) for localized prostate cancer. The purpose of the present study is to validate and possibly refine dose volume objective for the rectal wall after 20-fraction MHRT. Materials and methods All patients treated by 20-fraction MHRT at a single Institution were identified and relative rectal wall (%RW) DVH retrieved. The endpoint of the study is the development of grade 2+ late rectal bleeding (LRB) according to a modified RTOG scale. Clinical and dosimetric predictors of LRB were investigated at both uni- and multi-variable analysis. Results 293 patients were identified and analyzed. Of them, 35 (12%) developed the endpoint. At univariable analysis, antithrombotic drug usage (yes vs no), technique (3DCRT vs IMRT/VMAT) and several %RW DVH cut-points were significantly correlated with LRB. However, within patients treated by 3DCRT (N = 106), a bi-variable model including anti-thrombotic drug usage and selected %RW dose/volume metrics failed to identify independent dosimetric predictors of LRB. Conversely, within patients treated with intensity modulation (N = 187), the same model showed a progressively higher impact of the percent of RW receiving doses above 40 Gy. Based on this model, we were able to confirm (V32), refine (V60) and identify a novel (V50) cut-point for the %RW. Conclusion We recommend the following dose volume objectives for the %RW in order to minimize the risk of LRB after 20-fraction MHRT: V32 ≤ 50%; V50 ≤ 25.8% and V60 ≤ 10%.

The development of tumor necrosis factor alpha (TNF-) inhibitors is probably one of the most significant advancement in the management of a number of inflammatory rheumatic disorders to date. High efficacy of the treatment is associated with relatively rare and very heterogeneous adverse reactions. The reactions are gradually recognized with an increase in number of the patients receiving medication and prolonged period of the drug usage. Neurological adverse events in patients receiving TNF- inhibitors are not common. This finding emergence a question of coincidental occurrence of the nervous system involvements as opposite to suggestion of induction of the nervous system disease or unmasking of latent disease due to the drug administration. Potential association of anti-TNF- therapy with demyelination is one of neurological adverse reaction, and is an important concern for every day clinical practice of rheumatologist as well as is an interesting problem from pathophysiological point of view.

The consumption of alcohol and illicit substances has shown alarming levels among young university students, and its use may be associated with the coping strategy of academic burnout. This review aimed to synthesize the scientific evidence related to the consumption of alcohol and illicit substances associated with burnout syndrome in university students. Searches were carried out in: Biblioteca Virtual em Saúde, PubMed, Web of Science, PsycNet and Scopus databases, with no year limitation and based on the PRISMA guideline. Among the 2.269 articles identified, 16 met the inclusion criteria. All studies evaluated students in the health area, 12 studies found an association between the variables, with alcohol and illicit substances consumption strongly related to burnout syndrome. It was concluded that there is an association between the studied variables, indicating that the presence of burnout syndrome in university students can result in the use of negative strategies as a coping measure. Resumo O consumo de álcool e substâncias ilícita tem apresentado níveis alarmantes entre jovens universitários, e seu uso pode estar associado à estratégia de enfrentamento do burnout acadêmico. Esta revisão teve por objetivo sintetizar as evidências científicas relacionadas ao consumo de álcool e substâncias ilícitas associadas a síndrome de burnout em estudantes universitários. Foram realizadas buscas nas bases: Biblioteca Virtual em Saúde, PubMed, Web of Science, PsycNet e Scopus, sem limitação de ano e baseado na guia PRISMA. Entre os 2.269 artigos identificados, 16 atenderam aos critérios de inclusão. Todos os estudos avaliaram estudantes da área da saúde, 12 estudos encontraram associação entre as variáveis, sendo o consumo de álcool e substâncias ilícitas fortemente relacionado à sindrome de burnout. Concluiu-se que há associação entre as variáveis estudadas, indicando que a presença da síndrome de burnout em universitários pode resultar no uso de estratégias negativas como medida de enfrentamento. Resumen El consumo de alcohol y de sustancias ilícitas ha mostrado niveles alarmantes entre los jóvenes universitarios, y su uso puede estar asociado con estrategias de enfrentamiento del burnout académico. Esta revisión tuvo como objetivo sintetizar la evidencia científica relacionada con el consumo de alcohol y de sustancias ilícitas asociadas al síndrome de burnout en estudiantes universitarios. Las búsquedas se realizaron en las bases Biblioteca Virtual en Salud, PubMed, Web of Science, PsycNet y Scopus, sin limitación de año y basándose en la guía PRISMA. De los 2.269 artículos encontrados, 16 cumplieron los criterios de inclusión. Todos los estudios evaluaron estudiantes del área de salud y 12 estudios encontraron asociación entre las variables, entre los que el consumo de alcohol y de sustancias ilícitas estuvo fuertemente relacionado con el síndrome de burnout. Se concluyó que existe asociación entre las variables estudiadas, indicando que la presencia de síndrome de burnout en estudiantes universitarios puede resultar en el uso de estrategias negativas como medida de enfrentamiento.

Background/Introduction The novel coronavirus disease (COVID-19) inpatient mortality rate is approximately 20% in the United States. Reports have described a wide pattern of abnormalities in echocardiograms performed in patients admitted with COVID-19. The role of premorbid transthoracic echocardiogram (TTE) in the prediction of COVID-19 severity and mortality is yet to be fully assessed. Purpose To assess whether a pre-COVID TTE can identify patients at high risk of adverse outcomes who are admitted with COVID-19. Methods All patients who underwent a TTE from one year to one month prior to an index inpatient admission for COVID-19 were retrospectively enrolled across five clinical sites. Demographic information, medical history, and laboratory data were included for analysis. Echocardiograms were analyzed by an observer blinded to clinical data. Linear and logistic regressions were performed to detect the association of variables with death, invasive mechanical ventilation, initiation of dialysis, and a composite of these endpoints during the COVID-19 admission. Outcomes were then adjusted for a risk score using inverse propensity weighting incorporating age, sex, diabetes, hypertension, obstructive sleep apnea, history of atherosclerotic cardiovascular disease, atrial fibrillation, diuretic use, and angiotensin-converting enzyme inhibitor or angiotensin receptor blocker use. Results There were 104 patients (68±15 years old, 49% male, BMI 31.4±9.1kg/m2) who met inclusion criteria (baseline characteristics in Table 1). Mean time from TTE to positive SARS-CoV-2 PCR test was 139±91 days. Twenty-nine (28%) participants died during the index COVID-19 admission. There was no association of pre-COVID echocardiographic measures of systolic ventricular function with any endpoint. Diastolic function, as assessed by LV e', was associated with mortality (Table 2). There were 25 patients (24%) with a normal lateral e' (≥10cm/s); none died. There were 35 (34%) patients with LV e' lateral velocity Conclusion In patients with an echocardiogram prior to COVID-19, impaired diastolic function as represented by an abnormal LV e' lateral velocity was associated with both inpatient COVID-19 mortality and a composite outcome of death, mechanical ventilation, and initiation of dialysis, even after adjustment for multiple co-morbidities and medication use. Knowledge of the pre-COVID TTE results may help clinicians identify patients at higher risk of adverse outcomes during an admission for COVID-19. Funding Acknowledgement Type of funding sources: None.

Substance abuse is a growing public mental health issue. Recent data from Global Burden of Disease study demonstrate that age standardized DALYs rate attributed to drug use disorders has increased by 25% in age group of 25-49 years during 1990-2019 (Lancet 2020; 396 1204-22). Standardized DALY rate due to alcohol use disorders reduced by 1/5 in this age group during the last 30 years, however it remains among the top 20 causes leading to greatest losses of DALYs in this age group. European countries persist to have high burden of diseases due to substance abuse. Social ecological model enables to structure individual, family, community and broader societal risk factors for substance abuse in specific groups within society. Some European countries (e.g. Germany) face increased migration especially from the war affected countries like Syria. Respective refugees and migrants may demonstrate higher substance abuse (alcohol and drug abuse) prevalence as an outcome of traumatic exposures and reflect the attempts to escape past and present experiences. In other countries (e.g. Lithuania), who still reflect transitional societies, substance abuse rates remain high due to psychosocial stress and structural barriers to implement effective prevention. Identification of risk factors may alleviate targeted and tailored prevention. The aim of the workshop is to systematize substance abuse risk factors in specific population groups based on socio-ecological framework applying different methodological approaches. There is a knowledge gap in culturally sensitive and translated into different languages instruments which assess substance use in refugee populations, especially from the Arabic countries. Therefore, a systematic review results on culturally sensitive substance abuse screening and assessment instruments among refugee populations will be presented. The qualitative study conducted in Germany will provide findings and insights on substance abuse perceptions among Syrian migrants and refugees. Understanding the explanatory model of Syrian refugees could inform future interventions to prevent substance abuse and design tailored interventions. Assessment of the behavioral risk factors related to injecting dug use in Lithuanian population using respondent driven sampling technique will be presented. Identifying individual and social risk factors may lead to targeted and effective prevention. Key messages Context specific knowledge of substance use is necessary for prevention including past and present factors. As refugee populations continue to grow, adequate screening instruments for substance abuse/dependence are needed.

Background Addiction to illicit drugs is considered as medical condition requiring effective measures to prevent the disease and minimize harms of this addiction. Injecting drug use increases the risk for acquiring blood-borne infections among people who inject drugs (PWID). The aim of the study was to assess the risk behavior related to the use of intravenous narcotic and psychotropic substances among PWID in Lithuania. Methods A cross sectional survey using respondent driven sampling (RDS) of active intravenous drug users (n = 369) in Lithuania has been conducted in 2018-2019. RDS is a peer-referral sampling methodology applied to estimate characteristics of underserved populations that cannot be sampled randomly. 8 seeds were selected in 5 different sites across the country to recruit the study subjects. Descriptive statistics and logistic regression were conducted. Results Data collection was completed using 4 waves. Each seed yielded 3 to 24 eligible recruits. 80% of the sample were males, 20% - females. Age mean is 36.8 years, SD-7.69. The age of debut injecting drugs was 13 years, average age 20 years, SD 4.8. Average injecting duration was 12 years. 76% were incarcerated during their lifetime. 59% of PWID reported injecting heroin, 39% phentanyl, 13% amphetamines. 79% reported using sterile needles and syringes while injecting the last time and 21% were not. 17% were sharing non sterile injecting equipment during the last 30 days. Conclusions Younger age when started injecting drugs, duration of injecting drugs and imprisonment increased the risk of using unsterile needles and syringes and sharing injecting equipment. Main messages Behavioural risk factors are related to higher risks of drug use related infectious diseases. Targeted psychosocial interventions are needed to prevent the behavioural risks of injecting drug use.

Background Erectile Dysfunction (ED), is a common complication in type 2 diabetic men. Present study was undertaken to investigate the association between demographic factors, metabolic parameters and medication use with ED among type 2 diabetics. Methods This was a cross-sectional study. Married men aged 20-60 years with a diagnosis of type 2 diabetes attending the outpatient unit of Department of Endocrinology at PSG Hospitals during the months of May and June 2019 were enrolled. The severity of erectile function was assessed using the validated International Index of Erectile Function (IIEF-5) questionnaire. All subjects were evaluated based on demographic factors, clinical parameters and medications used. Results Out of the 204 patients enrolled, 65 (31.86%) were found to have ED. ED was significantly associated with patients who were having less physical activity, hypertension, obesity and diabetic retinopathy. A significant increase in the prevalence of ED with duration of diabetes was observed. In patients with diabetes, for 1-5, 6-10 and 11-30 years, the prevalence was 24.1%, 27.7% and 53.1% respectively. Conclusions For type 2 diabetes, increasing duration of diabetes poses a greater risk for ED. Hypertension, less physical activity and some medications increase the prevalence of ED. Key messages Our results suggest that health care providers who address sexual dysfunction issues with their diabetic patients early may be able to reduce the severity or delay the onset of ED by implementing intensive lifestyle changes as the first step management for type 2 diabetes.

Background Guidelines recommend multidisciplinary models for the management of infective endocarditis but have failed to incorporate the unique challenges of treating drug-use associated infective endocarditis (DUA-IE). Given the drug use and overdose epidemic with rising cases of DUA-IE, we created a multidisciplinary Drug Use Endocarditis Team (DUET), which convened monthly case conferences among the specialties involved, including Infectious Diseases, Cardiothoracic Surgery, Cardiology and Addiction Medicine. Objective: To conduct a retrospective cohort study of the patients presented at the DUET conferences from August 2018 to February 2020 to (1) assess clinical and demographic characteristics and (2) describe clinical outcomes. Methods A retrospective chart review was conducted to analyze 57 patient cases, including descriptive statistical analyses of demographics, clinical characteristics, and outcomes. Results Among our DUET cohort, 43.8% represented isolated right-sided endocarditis, and 84% involved native valve. Methicillin-susceptible Staphylococcus aureus was the most common microorganism isolated. ID was consulted in 94.7% of cases and overall 43.9% completed the planned antimicrobial course. The 7 patients who developed relapse/recurrent IE were initially managed medically, and 5 did not complete the initial antimicrobial course. Formal cardiothoracic surgery consultation was obtained in 57.9% and 24.6% were managed operatively. Of the patients managed operatively, 64.3% completed the antimicrobial course. The rate of antibiotic completion was higher among patients managed operatively but did not reach statistical significance (p=0.08). Formal addiction medicine consultation was obtained in 85.9% of cases, with 63.1% discharged on medications for opioid use disorder (MOUD). The rate of MOUD on discharge was not significantly different between patients managed operatively and non-operatively. Figure 1: Patient Characteristics Figure 2: Infection Characteristics Figure 3: Outcome Analyses Conclusion ID is nearly universally involved in the care of patients with DUA-IE, but this patient population requires input from numerous sub-specialties. Multidisciplinary care teams provide a promising framework for DUA-IE to enhance and integrate nuanced decision-making. Disclosures Sarah E. Wakeman, MD, Celero Systems (Advisor or Review Panel member)Optum Labs (Grant/Research Support)UpToDate (Other Financial or Material Support, Author)

Despite its long history of untoward side effects of a systemic autoimmune disease, drug-induced lupus can be difficult to recognize because of the disconnect between chronic drug usage and onset of symptoms. In this case, the patient was treated with hydralazine for two years when symptoms were initially reported, but a diagnosis of hydralazine-induced lupus was not considered for another half year. Despite treatment with steroidal and nonsteroidal anti-inflammatory medications during this period, rheumatologic symptoms and signs continued to deteriorate, consistent with the diagnosis of systemic lupus erythematosus. Not until the patient voluntarily discontinued hydralazine did symptoms begin to improve, fully resolving over the subsequent 6–12 months largely in the absence of anti-inflammatory medication. This patient demonstrates that failure to recognize a drug-induced disease etiology can result in substantial worsening of rheumatologic symptoms over the subsequent six months, ultimately satisfying criteria for systemic lupus erythematosus. While symptoms and signs largely normalized, some laboratory abnormalities and occasional arthralgia remained two years after discontinuing hydralazine, suggesting smoldering inflammatory disease.

Adverse drug reactions are crucial events related to drug usage that ought to be reported and the effects of which can be minimized by careful and vigilant use of drugs. Pharmacovigilance refers to the systematic practice of reporting, assessing and preventing such events. Although such practice is vital in any healthcare system, its actual implementation has been found to be very limited in a country like Nepal. With the aim of disseminating information about such events and the role of healthcare professionals in pharmacovigilance, a one-day workshop was organized with international and national speakers on this subject at Nepal Cancer Hospital and Research Center, Lalitpur, Nepal, which also has a regional pharmacovigilance center . The workshop included lectures and hands-on training and had an audience from diverse fields of healthcare such as pharmacy, medical, surgical and radiation oncology, pathology and nursing staff. The feedback from the participants revealed that practical demonstration and hands-on training with extensive topic coverage were the best feature of the workshop, while less interaction during the lectures was a source of dissatisfaction with a recommendation to conduct more events focused on similar topics in the future.

Given the lean and muscular male body ideal, men’s body concerns and negative body talk (i.e., fat talk and muscle talk) tend to focus on muscularity and fat. It remains to be seen how men’s negative body talk and appearance concerns relate to unhealthy eating and exercise symptoms and attitudes abo

Introduction. The ways of usage of pharmacological drugs during the festering setptic diseases are different. Today the most effective is endolymphatic, which influencies causative agent and toxins directly in the lymphatic system before they enter the blood circle. Endolymphatic method of drug usage allows to reate and support therapeutic concentrated doses of antibiotics in the lymphatic system. Thus this method can be used in a complex treatment of peritonitis.Aim of research. Our aim is to improve the results of a complex treatment with endolymphatic combined therapy (ECT) for patients with acute peritonitis.Materials and methods. 37 patients, aged 19-72 with acute peritonitis have been examined. These patients were treated at the surgical department of Uzhhorod regional hospital in the period of 2015-2019. There were two groups of patients: main group with 22 patients and control group with 15 patients. Only main group of patients used endolymfatic combined therapy (ECT). To asses the level of endogenic intoxication we determined the level of middle molecular mass blood serum and made calculation of leucocyte index of intoxication. To assess the activity of non-specific defense of the body we determined body resistance index.Results and discussion. The analyses of the received data show that the usage of endolymfatic combined therapy (ECT) within the complex treatment of peritonitis leads to fast elimination of endogenous intoxications phenomena. Namely, leucocytes are 25% less, rod-core neutrophils are 35% less, leucocyte intoxication index is 25% less, level of peptides with middle molecular mass is 20% less, index of a body resistance is 25% higher, are this leads to a quick recovery of the body defence forces in comparison to a control group patients.Conclusion. Clinicaly enabled us to establish that in case of the complex treatment of peritonitis the endolymphatic combine therapy diminishes endogenic intoxication contributes rapid normalisation of the immunologic findings and rapid restored protective function of organism.

Background: This is the first detailed Indian electronic medical record (EMR)-based real-world observational study to understand the clinical characteristics, associated comorbidities/risk factors and treatment(s) of CAD patients across India.Methods: EMR data of adult Indians (aged ≥ 18 years) diagnosed with CAD was retrospectively analyzed.Results: The majority of the participants had stable IHD (93%), were men (68.5% in ACS, 59.8% in stable IHD), most common age group was 40-64 years in ACS (56.6%) and stable IHD (51.4%). Both are common in metros (ACS 52%, 62% stable IHD). There is a high frequency of hypertension (38.2% in ACS, 59% in stable IHD) and diabetes mellitus (32.3% in ACS, 57.6% in stable IHD). Most common treatments are antiplatelet drugs and lipid-lowering drugs (96%).Conclusions: In India, stable IHD is the most prevalent form in vast majority of patients. The patients with CAD are mostly males, are mainly located in metros and majority fall between the age group of 40-64. The major comorbidities are hypertension and diabetes mellitus. Sociodemographic and clinical characteristics for CAD in India may not be similar to what is reported from the west. There is a significant difference in drug usage and adherence to guidelines in India for CAD.

Funding Acknowledgements Type of funding sources: Other. Main funding source(s): Daiichi Sankyo Europe GmbH Background Direct oral anticoagulants (DOACs) have been shown to be non-inferior to vitamin K antagonists (VKA) regarding both efficacy and safety outcomes in patients with atrial fibrillation (AF). However, elderly are underrepresented in the underlying clinical trials. Purpose The aim of this study was to compare risks of major bleeding events and compare healthcare resource utilization (HRU) between AF patients treated with edoxaban or VKA in elderly. Methods A cohort study was conducted using claims databases of Caserta and Palermo Local Heath Units in Italy. AF patients starting use of edoxaban or VKA between August 1st, 2016 and December 31st, 2018 were included. Date of the first dispensing was defined as the index date. The study population was matched based on a propensity score based on factors associated with the outcome. We restricted to patients aged ≥65, ≥1 year database history, and no use of the index drug in the year before index date. Incidence rates of bleeding outcomes and rates of HRU were assessed per 1,000 and 100 person-years follow-up (PY), respectively. Cox regression analyses to adjust for baseline covariates were used for comparisons of incidence rates of bleeding outcomes among all edoxaban and VKA users. Poisson regression analyses were used for comparisons of rates of HRU among all edoxaban and VKA users. Both analyses were adjusted for age. Sex, region and year of index date were considered for the adjusted models as well, using a backward stepwise approach to select eligible variables. Results 1,317 edoxaban users and 2,924 VKA users were included in the matched population. Mean age was 79 in both treatments groups, and 43% of the edoxaban users and 45% of the VKA users was male. Bleeding risks were significantly lower among edoxaban users compared to VKA users aged ≥65 (adjusted HR 0.39 (95% CI 0.19-0.83)) and among patients aged ≥75 (adjusted HR 0.37 (95% CI 0.16-0.86)). Among patients aged ≥65, edoxaban users were significantly less often hospitalised (RR 0.56 (95% CI 0.46-0.68)) and the total number of hospitalised days were also significant lower (RR 0.58 (95% CI 0.42-0.80)) compared to VKA users. Among patients aged ≥75, similar results were observed for the number of hospitalisations. Edoxaban users had significant less out-patient visits compared to VKA users (among patients aged ≥65 the RR was 0.44 (95% CI 0.39-0.50) and among patients ≥75 this was 0.40 (95% CI 0.35-0.47). Use of out-patient medication use was significantly lower among edoxaban users compared to VKA users among patients aged ≥65 (adjusted RR 0.91 (95% CI 0.88-0.95)) as well as among patients aged ≥75 (adjusted RR 0.91 (95% CI 0.87-0.95)). Conclusion Study results show a decreased bleeding risk of edoxaban compared to VKA in both age groups of patients with AF. Hospital based HRU has shown to be lower among edoxaban users compared to VKA users in both age groups. Out-patient HRU was also lower among edoxaban users.

Background and Aims Posttransplantation diabetes Mellitus (PTDM) is one of the major medical problems in renal transplant recipients (RTRs). Diuretic-induced hyperglycemia and diabetes have been described in the general population. We aimed to investigate whether diuretics also increase PTDM risk in RTRs. Method We included 486 stable outpatient RTRs (with a functioning graft ≥1 year) without diabetes from a prospective longitudinal study (the Transplantlines Food and Nutrition Study [NCT02811835]). Participants were classified as diuretic users and non-diuretic users based on their medication use recording at baseline. PTDM was defined according the American Diabetes Association’s diagnostic criteria for diabetes. Multivariable Cox proportional-hazards regression analyses were performed to assess the prospective association between diuretic use and the risk of PTDM development. Results Median time since transplantation was 5.4 (2.0-12.2) years and 168 (35%) RTRs were taking diuretics. After 5.2 (IQR, 4.0 5.9) years of follow up, 54 (11%) RTRs developed PTDM. In Kaplan-Meier (log-rank test, p Conclusion This study demonstrates that diuretics overall, associated with the risk of developing PTDM in RTRs, independent of established risk factors for PTDM development. The association was consistent for thiazide and loop diuretics.

Background/Aims Polymyalgia rheumatica (PMR) is one of the commonest indications for long term glucocorticoid (GC) use, leading to an increased risk of osteoporosis and fragility fractures. Clinical guidelines recommend prescribing medication including vitamin D, calcium and anti-resorptives, such as bisphosphonates. The aim of this study was to examine the association of reported falls and prescriptions of medications for osteoporosis with future fragility fractures in a cohort of people with PMR. Methods 652 people with an incident diagnosis of PMR responded to a baseline survey between June 2012 and June 2014. This included data on general health, sociodemographics, history of falls and medication. Data on fractures and prescriptions were collected at 12 and 24 months. Fragility fractures were defined as fractures of the hip, wrist or spine. Logistic regression models were used to assess the association between baseline characteristics and fractures at 12 and 24 months. Analysis was conducted unadjusted and adjusted for age, gender, reported medication use and falls history. Results 112 (17.2%) baseline respondents reported a previous fragility fracture. 60 (83.3%) of the 72 respondents who reported a fragility fracture between baseline and month 12 also reported a fragility fracture at baseline. 49 (79.1%) of the 60 respondents who reported a fragility fracture at between the month 12 and 24 also reported a fragility fracture at baseline. Falls before baseline was the most significant predictor of fragility fracture at 12 (OR 2.35 95% CI 1.35-4.12) and 24 (OR 1.91 95% CI 1.05-3.49) months. Fewer than 50% of respondents were ever prescribed treatment for osteoporosis. Being prescribed treatment for osteoporosis was associated with a reduced incidence of fragility fractures at 24 months (adjusted OR 0.28 95% CI 0.10-0.80), but an increased incidence at 12 months (adjusted OR 2.10 95% CI (1.3-3.48). Calcium and vitamin D prescription, gender and age were not significantly associated with fracture outcome. Conclusion Despite guidelines, fewer than 50% of patients were prescribed medications for osteoporosis. This data highlights the risks of fractures in PMR patients who have experienced previous falls. Over a period of two years, medication for osteoporosis was significantly protective, hence more needs to be done to encourage adherence to guidelines. Further studies need to address reasons for non-adherence to guidelines and the effects of long-term treatment. Disclosure B. Sokhal: None. S.L. Hider: None. Z. Paskins: None. C.D. Mallen: None. S. Muller: None.

Many of the gut-microbiome-derived signatures for liver cirrhosis, especially the important ones, were likely under the influence of proton pump inhibitors (PPIs). Wu et al. suggest that drug usage is a confounding factor in metagenomics analysis that should be controlled for.

Objectives:Elderly-onset rheumatoid arthritis (EORA) is reported to differ from young-onset rheumatoid arthritis (YORA) with regard to patient background and drug treatment. We examined the amount of drug administered to patients who achieved low disease activity (LDA) for rheumatoid arthritis at our hospital., Methods:Demographics, clinical history, and treatments were compared between patients with EORA (n = 70) and YORA (n = 190)., Results:There was a significant difference in the average age (73.8 vs. 57.8 years), disease duration (6.66 vs. 14.7 years), and sex (62.9% males vs. 83.7% females), but no difference in rheumatoid factor positivity (85.3% vs. 80.7%), anti-citrullinated peptide antibody positivity (86.5% vs. 87.7%), simplified disease activity index (4.28 vs. 4.59), or disease activity score 28-CRP (1.99 vs. 2.04) in the EORA and YORA groups, respectively. There were also no significant differences in prednisolone use (37.1% vs. 36.3%), amount of methotrexate administered (MTX) (1.45 vs. 1.41 mg), and MTX use (55.7% vs. 65.3%). However, the MTX dose (2.89 vs. 4.09 mg/week, p = .011) and overall biologics use (32.9% vs. 56.3%, p = .0012) were significantly lower in patients with EORA than in those with YORA., Conclusion:Patients with EORA may be able to achieve LDA with lower drug dosage than those with YORA.

Background and Aim The number of elderly patients with ulcerative colitis (UC) is increasing worldwide. The clinical practice of associated treatment is still unclear. Therefore, we aimed to analyze clinical treatment realities and mortality in elderly and non‐elderly patients with UC. Methods We collected UC patients' data using the diagnosis procedure combination (DPC) database system and divided eligible patients into elderly (≥65 years) and non‐elderly (≤64 years) groups. We investigated and compared their therapeutic histories (medical treatments vs. surgery). Logistic regression analysis was conducted to identify clinical factors affecting surgery and in‐hospital death in each group. Results The rates of systemic steroid injection, molecular targeting drug usage, and surgery were not different between the two age groups. Meanwhile, the rate of in‐hospital death in elderly patients was higher than that in non‐elderly patients (2.7% vs. 0.19%, P, The clinical practice of treating elderly patients with ulcerative colitis (UC) is overall not different from treating non‐elderly patients with UC. Although the form of medical treatment and surgery rate for elderly patients with UC may not be significantly different from non‐elderly patients, the rate of in‐hospital death for elderly patients is higher.

Outbreaks of Hepatitis A, caused by the Hepatitis A Virus (HAV), remain a worldwide health concern. We conducted a retrospective chart review to characterize patients with acute HAV during an outbreak at our urban tertiary care center to better characterize patients infected with HAV. We searched our electronic records for patients with positive HAV IgM antibodies during a period of outbreak in Philadelphia, May 2017-December 2019. Characteristics of patients were recorded. We searched an equal period of time prior to the outbreak, September 2014-April 2017, to compare the two patient populations. During the outbreak we diagnosed 205 cases of acute HAV compared to just 23 during an equal time period prior to the onset of the outbreak. When compared to the results reported by the public health department for 2019, this accounted for 39.9% of patients documented in the city. A history of drug use was found in 49.4% of our patients while 19.5% of patients were homeless. Our analysis of homelessness and drug usage among documented cases of HAV during the outbreak period mirrored data reported by the city. Further, our analysis found that 7 zip codes accounted for 60% of our patients. Biochemical measures of liver function were higher in patients examined during the outbreak.

Substance abuse is an established precursor to violent and non-violent crimes. Typical violent crimes are usually related to narcotics and alcohol sale, while non-violent crimes are related to the purchase. This study investigates correlations between substance abuse and crime rate in the United States. Data from the Federal Bureau of Investigation’s Uniform Crime Reports (UCR) Program was used in the study to compare drug usage, alcohol consumption, and crime rate. The researchers used Tableau (Visualization Application) to analyze the data and visual the comparison between the three entities. The main goal of the study was to seek a correlation that could provide insight to the increase in crime rate when people abuse substances.

Introduction: Atrial fibrillation increases the risk of stroke 5-fold. The efficacy of endocardial catheter ablation (CA) for drug - refractory persistent and longstanding persistent AF (PsAF) is limited and has led to the development of minimally invasive hybrid epicardial/endocardial ablation technique (hybrid Convergent) to achieve a comprehensive lesion set with durable transmural lesions. The CONVERGE IDE randomized controlled trial prospectively evaluated the effectiveness of Convergent ablation compared to CA for the treatment of PsAF. Methods: PsAF patients, >18 to Results: One hundred fifty-three patients (102 Convergent, 51 CA) with similar baseline characteristics were treated. Body mass index (mean 33.7, range 19.1- 50.1) and years since PsAF diagnosis (mean 4.4 years, range 0.5 - 26.0 years) were high; 42.5% (65/153) patients had longstanding persistent AF. In the Convergent arm, 4 major adverse events (3.9%, 4/102) were reported through the first 7 days and additional 4 events (3.9%) from days 8 - 30. The safety rates were lower than the performance goal of 12%. Rates of freedom from atrial arrythmia stratified by AAD use are included in Table1. Irrespective of the criteria, the hybrid Convergent procedure demonstrated significantly higher treatment success compared to CA (RR 1.28 - 1.67, p Conclusion: The hybrid Convergent procedure combining epicardial and endocardial ablation is safe and has superior effectiveness as compared to the endocardial catheter ablation for the treatment of PsAF, irrespective of AAD use.

Background Epilepsy, which is the most common symptom accompanying gliomas, was reported as an independent favorable prognosis factor for glioma patients. However, the correlation between glioma location and epilepsy prognosis, genesis and genetic phenotypes of the glioma associated seizure (GAS) patients is far from clear, the purpose of the current study was to provide probabilistic radiographic atlases reflecting seizure susceptible regions, relationship between tumor associated biomarkers and seizure initiation and poor epilepsy prognosis areas. Methods Preoperative MRIs were collected from 119 newly diagnosed patients with histologically confirmed gliomas. These samples were analyzed for seizure status and tumor genetic makers (TP53 mutations, MMP-9.PTEN, MGMT, EGFR and IDH1) using a statistical voxel-based lesion-symptom mapping (VLSM) method. Results We found bilaterally that the frontal lobe containing regions were associated with GAS for low grades gliomas, moreover lesions with the PTEN mutation and IDH1 mutation and seizure susceptible regions were located close together and partially overlapped, Patients with preoperative tumor involving the right frontal lobe may have good seizure control; however, for the glioma-infiltrated regions in front of the precentral regions in the left hemisphere, the epilepsy prognosis is poor. Conclusions The current results of seizure associated molecules and specific regions on structural MRI could be used in preoperative surgical planning, seizure prognosis predictions and anti-epilepsy drug usage.

Background High blood lipid levels are known risk factors for atherosclerotic cardiovascular events, but associations between lipid levels and atrial fibrillation (AF) are unclear. Some previous studies have suggested an inverse association between lipid levels and AF referred to as the “cholesterol paradox”. Purpose To examine the prevalence of AF by differing lipid levels in a large population-based study of almost 14,000 adults in Poland. Methods The LIPIDOGRAM 2015 study is a cross-sectional study of adults aged 18 years and older recruited in Poland in 2015/2016 by 438 family physicians. Poisson regression models with robust variance were used to estimate prevalence ratios (PRs) for AF with 95% confidence intervals (CIs) for participants with differing lipid profiles. Lipid measures including low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), total cholesterol (TC) and LDL/HDL ratios were grouped into quartiles with the lowest quartile as the reference group. Models were adjusted for potential confounding factors including age, sex, waist-to-hip ratio, smoking, alcohol intake, regular physical activity, hypertension, antihypertensive medication use and treatment of dyslipidaemia. Results 13,724 participants were recruited to the study, the median (interquartile range: IQR) age was 58.0 (47.7–65.8) years and 5.2% (n=708) had a diagnosis of AF, with a median (IQR) 3 (1–8) years since diagnosis. After adjusting for potential confounding factors, a statistically significant lower prevalence of AF was estimated for participants in the highest quartile for LDL-C (PR (95% CI): 0.60 (0.48, 0.75) p Conclusions The prevalence of AF was lower for people with higher levels of LDL-C, HDL-C, TC and higher LDL/HDL ratios; some of the difference in prevalence was explained by controlling for confounding factors, but in multivariable models the association remained statistically significant. This research adds to the body of evidence which suggests an inverse relationship between cholesterol levels and AF-the “cholesterol paradox” for AF. Funding Acknowledgement Type of funding source: None

Chinese hospital pharmacists must face the challenge of the Zero-Markup Drug Policy which has been implemented since 2017 in China. The policy mandates all drugs to be sold in hospitals with no markup on price. Besides pharmacist-managed clinics (PMCs),1 we found the surgery department may be a good place for pharmacists to play a role, because most surgeons are more interested in surgical procedures than medicinal treatment, and irrational drug usage is more common in the surgery department than in the internal medicine department. At the end of 2015, Guangdong Province Pharmaceutical Association (GDPA) put forward the concept of ‘surgical pharmacist’ first in China. The implementation of the Zero-Markup Drug Policy forced GDPA to create the position …

In the majority of cases, allergic rhinitis (AR) has its onset in children or adolescents, with the cardinal symptomatology of repeated sneezing, nasal pruritus, discharge, and a blocked nose. The customary way to classify AR is into seasonal and perennial variants, reflecting the allergenic underpinning of the disorder, but the World Health Organisation (WHO), in its Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines, employs a classification scheme dividing AR into intermittent or persistent types, based on the symptomatic duration. The current treatment modalities for AR are nasal steroids, nasal decongestants, anticholinergics, antihistamines, and panthenol. A novel pharmaceutical formulation that provides all the effects of the abovementioned drugs may be unique and has significant benefits such as single drug usage, cost-effectiveness, lesser side effects, etc. The proposed formulation enables to combine the anti-inflammatory, antihistaminic, decongestant, anticholinergic, and hydrating effects of these drugs into a single medicine.

Social norm theory suggests that students often overestimate the frequency and quantity of drug use among their peers (descriptive norms) as well as how acceptable their peers feel these risky behaviours to be (injunctive norms) and tend to match their own behaviour to this incorrect perception. This study aims to investigate whether a Danish social norms based intervention (The GOOD Life) using both descriptive and injunctive normative information may change students perception of peers' attitudes towards smoking, drinking and using cannabis. In total 38 schools were included in a cluster-randomised controlled trial and allocated to either intervention (n = 641) or control group (n = 714) during 2015/2016. Students (aged 13-17 years) from both groups completed an online survey before the intervention and 3 months after baseline. The GOOD Life intervention provided normative feedback tailored for each school-grade using three communication channels: classroom sessions, posters and web application. Outcome measures were perception of peers' attitude towards: smoking, drinking alcohol, getting drunk and using cannabis. All with five response options from 'never okay' (1) to 'okay' (5). Intervention effects at follow-up were examined using ordinal logistic regression models and marginal effect-estimates. Students in the intervention group were less likely to perceive peers to approve of smoking (Coef: -0.22, p = 0.04, 95%CI [-0.43; -0.01]). The marginal effect estimates showed that compared to the control group, students in the intervention group were 5% more likely to perceive that peers think it is never okay to smoke, 3% less likely to perceive that peers think it is okay to smoke occasionally and 1% less likely to perceive that peers think it is okay to smoke frequently. No significant effects were found for injunctive norms regarding alcohol consumption and cannabis use. Key messages The intervention The GOOD life has potential to produce change in perceived injunctive norms among Danish adolescents. Prevention programmes should thoroughly consider how to incorporate injunctive normative feedback.

Background Hospital-based strategies that link persons with infectious complications of opioid use disorder (OUD) to medications for OUD (MOUD) are of great interest. The objective of this study is to determine whether a hospital-based protocol would increase the use of MOUD and to identify barriers to MOUD during admission and at the time of discharge. Methods This study included participants with a documented or suspected history of injection drug usage receiving care for an infection at the University of Alabama at Birmingham Hospital from 2015 to 2018. The protocol, the intravenous antibiotic and addiction team (IVAT), included Addiction Medicine and Infectious Diseases consultation and a 9-item risk assessment. We quantified MOUD use before and after IVAT and used logistic regression to determine factors associated with MOUD. We explored barriers to MOUD uptake using chart review. Results A total of 37 and 98 patients met criteria in the pre- and post-IVAT periods, respectively. With IVAT, the percentage with OUD receiving MOUD significantly increased (29% pre-IVAT and 37% post-IVAT; P = .026) and MOUD use was higher in “high risk” participants (62%). Clinical and sociodemographic factors were not associated with MOUD receipt. Conclusions A hospital-based protocol may increase the use of MOUD; however, the uptake of MOUD remains suboptimal (

Background Previous evaluations of smokefree prison policies have suggested improvements in self-rated health and some smoking-related symptoms. No studies to date have investigated impacts on medication use as proxy measures of objective ill-health or as indicators of potential negative unintended consequences. These is limited evidence to date on these important outcomes. Methods We obtained from NHS National Services Scotland aggregate data on medication items dispensed in prisons, based on individual named patient medication records, and from the Scottish Prison Service data on the prison population, for the period Jan 2013-Nov 2019. Items of interest comprised those for smoking cessation (varenicline and buproprion); nicotine replacement; specific smoking-related health conditions (glyceryl trinitrate; inhaled bronchodilators and steroids; antibiotics; chloramphenicol eye drops; and proton pump inhibitors and H2 receptor antagonists), and potential unintended mental health consequences (anti-depressants). We also included a set of negative controls for which dispensing was not expected to be affected by the new smokefree policy (anticonvulsants, excluding pregabalin and gabapentin). Analyses were undertaken using AutoRegressive Integrated Moving Average (ARIMA) time series methods, with the dates of the policy's announcement and of implementation included as pre-specified breakpoints. Results The results of ARIMA modelling of medication dispensing are confidential until May 2020 due to their sensitivity and will be available to present at WCPH 2020. Conclusions The use of routinely available dispensing data as an indicator of objective health impacts and potential negative unintended consequences provides novel insights into the effectiveness of smokefree prison policies. Results will be of interest to international jurisdictions considering such policies and to those seeking to harness the potential of administrative data for natural experiments.

Objective To analyze the prevalence of diabetes mellitus (DM) according to different diagnostic criteria, in the Brazilian adult population, according to laboratory results from the Brazilian National Health Survey. Methods Analysis of laboratory data from the National Health Survey, collected between 2014 and 2015. The prevalence of diabetes was calculated according to different diagnostic criteria. The prevalence of diabetes was calculated according to the criterion of glycosylated hemoglobin ≥ 6.5% or using medication, using Poisson regression and calculating crude and adjusted PR and 95%CI. Results The prevalence of diabetes according to different criteria varies from 6.6 to 9.4%. Intermediate or pre-diabetes hyperglycemia ranged from 6.8 to 16.9%. Considering laboratory criteria or medication use, the prevalence of DM was 8.4 (95%CI 7.65-9.11). The adjusted PR for gender, age, educational level and region was lower for males (PR 0.75; 95%CI 0.63 - 0.89), increased with age: 30 to 34 years (PR 2.32; 95% CI 1.33 - 4.07), 40 to 59 years PR 8.1; 95%CI 4.86 - 13.46), 60 years old or older (PR 12.6; 95%CI 7.1 - 21.0), and higher educational levels was protective (PR 0.8; 95%CI 0.6 - 0.9). Therewas a higher PR in the Central West Region (PR 1.3; 95%CI 1.04 - 1.7), in overweight people (PR 1.8; 95%CI 1.4 - 2.1), and in obese people (PR 3.3; 95%CI 2.6 - 4.1). Conclusions The prevalence of diabetes was higher in females, people over 30 years of age, in populations with low educational levels, and people who were overweight and obese. The study advances in determining the diabetes situation in the country through laboratory criteria. These data demonstrate the importance of controlling hyperglycemia in order to avoid the vascular and systemic effects of DM. Key messages This is the first study to analyze the prevalence of DM using laboratory data from a representative sample of the Brazilian population. The study pointed to a strong association between overweight and obesity and diabetes, showing the importance of public health measures to encourage healthy eating and physical activity.

Background To estimate median survival time of AIDS patients, with and without tuberculosis (TB), in a cohort in Sao Paulo, Brazil, and to investigate survival predictors. Methods Retrospective cohort study of AIDS patients above 12 years old, registered at the Ministry of Health AIDS surveillance system between 2003-2007, and followed until 2014. Survival analysis used the Kaplan-Meier method and Cox proportional hazards model to estimate hazard ratios (HR), with respective 95% confidence intervals (CI = 95%). Results 35,515 patients were included, being 4,581 (12.9%) co-infected with TB. Among the latter, probability of survival 12 years after AIDS diagnosis was 95.2%, 82.9%, and 21.9%, respectively for patients receiving at least one third line ARV (HAART2), receiving triple therapy (HAART1) and the last one not on ARV. In the same period, the probability of survival for patients without TB, in the same order as for the therapeutic regimens, was 95.2%, 90.5%, and 40.9%, respectively. The main factors associated with survival, adjusted for the year of diagnosis, were: Living in the city of Sao Paulo (HR = 1,16;IC95% 1,01-1,32), living away from the capital city (HR = 1.43; 95%CI 1.25-1.62); or on the coast (HR = 1.49; 95%CI 1.21-1.82); having TB (HR = 1.70; 95%CI 1.49-1.87); above 49 years old (HR = 1.35; 95%CI 1.18-1.54); black (HR = 1.27; 95%CI 1.12-1.45); IV drug use (HR = 1.73; 95%CI 1.49-2.02); CD4+ below 200 cell/mm³ at AIDS diagnosis (HR = 2.31; 95%CI 1.97-2.72); viral load above 500 copies at AIDS diagnosis (HR = 1.99; 95%CI 1.72-2.30); HAART1 scheme (HR = 1.94; 95%CI 1.47-2.55); no ARV (HR = 8.22; 95%CI 2.95-22.87). Conclusions A large proportion of patients did not receive ARVs or were late diagnosed with AIDS, especially those with TB, whose survival was shorter. Survival is heterogeneous in the state, being lower in regions with higher TB rates. The results point to the need for specific strategies for patients with TB-HIV co-infection. Key messages Tuberculosis is the main cause of death among HIV-infected people, being responsible for one third of deaths in this group and causing a great impact on the survival of this population. The Brazilian policy of universal access to ARV and treatment for TB has increased the survival of AIDS-TB from 22% to 95% and in patients without TB from 50% to 95% up to 12 years after diagnosis.

Background:Over the counter drug abuse is a growing problem and it needs more recognition. This current study is aimed to assess the pattern of over the counter drug usage among the patients attending Saveetha medical college hospital, Chennai, Tamil Nadu. Method: This cross-sectional questionnaire based study was conducted at Saveetha medical college and hospital, Chennai, Tamil Nadu. The patients who signed the informed consent form were the study participants, a total of 100 patients were involved. The study period lasted from 23rd January 2019 to 30th March 2019. After the data was obtained they wereanalyzed using Microsoft excel. Percentages and frequency were calculated. Result: A total of 100 filled questionnaires were collected from the study participants. Majority of the participants (63%) bought OTC drugs on occasion and the rest (37%) bought them always. Most of them (43%) consumed OTC drugs when the symptoms were minor/manageable, 33% of them whenever they felt sick and 24% when they couldn’t go to a doctor. Many (41%) believed they could relieve fever by using OTC drugs, 20% to relieve nausea and 39% to relieve headache. Antipyretics (47%) were the most commonly consumed OTC drug. Most (38%) common reason for choosing OTC drug was to save time. Conclusion: This study helped gauge the general public’s views on OTC drug usage and gives an idea about the amount of work that is yet to be done or has to be done to bring OTC drug abuse under control. It is almost obligatory to make the patients understand the detrimental effects of OTC misuse and abuse- and the most effective way to achieve this is by making the people aware of them in the first place. Even though OTC drug abuse is a largely recognized problem, we still have a long way to go in terms of actually solving it.

Background Women-specific factors exist that increases vulnerability to drug-related harms from injection drug use, including blood-borne viruses (BBVs), but gender-based differences in BBV prevalence have not been systematically examined. Methods We conducted meta-analyses to estimate country, regional, and global prevalence of serologically confirmed human immunodeficiency virus (HIV), hepatitis C virus (HCV; based on detection of anti-HCV antibody), and hepatitis B virus (HBV; based on detection of HBV surface antigen) in people who inject drugs (PWID), by gender. Gender-based differences in the BBV prevalence (calculated as the risk among women relative to the risk among men) were regressed on country-level prevalence and inequality measures (Gender inequality index, Human development index, Gini coefficient, and high, low or middle income of the country). Results Gender-based differences varied by countries and regions. HIV prevalence was higher among women than men in sub-Saharan Africa (relative risk [RR], 2.8; 95% confidence interval [CI], 1.8–4.4) and South Asia (RR, 1.7; 95% CI, 1.1–2.7); anti-HCV was lower among women in the Middle East and North Africa (RR, 0.6; 95% CI, .5–.7) and East and Southeast Asia (RR, 0.8; 95% CI, .7–.9). Gender-based differences varied with country-levels of the BBV prevalence in the general population, human development, and income distribution. Conclusion HIV was more prevalent in women who inject drugs as compared to their male counterparts in some countries, but there is variation between and within regions. In countries where women are at higher risks, there is a need to develop gender-sensitive harm-reduction services for the particularly marginalized population of women who inject drugs.

Objective The objective of this study was to determine the pattern of uterotonic drug usage in obstetric units of university-affiliated hospitals in Canada. Methods This was a prospective observational study conducted in the form of an electronic survey. The target group consisted of chiefs or directors of Obstetrics and Anaesthesia at university-affiliated hospitals across Canada. The survey was sent out between November 2016 and January 2017, using the program ‘SurveyMonkey’. Data on institutional obstetric practices and usage of uterotonic agents were collected. Results The survey was sent to 92 obstetricians and anesthesiologists from 46 institutions, of which 33 clinicians from 24 institutions responded. About 65% of clinicians were unaware of the rate of postpartum hemorrhage in their institution. The first-line agent for vaginal deliveries was reported as oxytocin by 94% and carbetocin by 6% of physicians. For women at low-risk for postpartum hemorrhage when undergoing cesarean deliveries (CD), 66% reported oxytocin as the first-line uterotonic, while 34% reported carbetocin. For CDs at high-risk of postpartum hemorrhage, 60% of physicians reported oxytocin and 40% reported using carbetocin initially. The use of second-line uterotonics was also variable. The choice of uterotonic was mainly based on perceived efficacy and Society of Obstetricians and Gynaecologists of Canada guidelines. Conclusion There is a lack of a unified approach to the use of uterotonic drugs for postpartum hemorrhage management in Canada. To improve the management of postpartum hemorrhage due to uterine atony, an evidence-based approach to usage and consensus between obstetricians and anesthesiologists is warranted.

OBJECTIVES: We aimed to assess the polypharmacy effect on appetite and malnutrition risk among Lebanese nursing home residents. We hypothesized that polypharmacy will be associated to lower appetite and increased of malnutrition. METHODS: A cross-sectional pilot study was carried out in two nursing homes in the North-Lebanon region. Fifty-three older adults (OA) aged 60 and above were recruited and were interviewed face-to-face. A general questionnaire was administered to gather information about their socio-demographics, dietary habits and physical activity routine. Appetite was evaluated by the Simplified Nutritional Appetite Questionnaire (SNAQ) validated for use with nursing homes residents. The participants' nutritional status was assessed using the Short Form of the Mini-Nutritional Assessment (MNA-SF). Polypharmacy was determined if OA were taking 5 or more medications. Information about attitudes towards the use, the number and the cost of medications was also collected. Differences in SNAQ and MNA scores based on polypharmacy were tested using Independent t-tests. Logistic regression was performed to assess the association between polypharmacy and nutritional status after adjusting for several factors. RESULTS: Our sample constituted of 49.1% females with an average age of 67.6 ± 3.8 and BMI of 22.3 ± 1.7 kg/m2. The majority were widowed (79.2%) and had a low level of education (85% elementary education). Regarding the MNA scores, 33% had a normal nutritional status while 59% were at risk of malnutrition and 8% were malnourished, with an average MNA score of 10.1 ± 2.2. The average SNAQ score was 11.0 ± 3.3, with 85% scoring ≤14, indicating an significant risk of at least 5% weight loss withing 6 months. Regarding medication use, 50.9% of OA take at least 5 drugs/d with an average of 4.3 ± 2 drugs. Independent t-tests showed that MNA scores were significantly lower in those taking 5 drugs/d vs those taking less (9.4 ± 2.5 vs 10.8 ± 1.6, P = .024) while no significant difference was observed for SNAQ scores (10.3 ± 2.9 vs 11.6 ± 3.6, P = .13). Logistic regressions did not show any significant association between polypharmacy and MNA or SNAQ categories. CONCLUSIONS: Lower MNA scores were observed in OA taking ≥5 drugs/d indicating a higher risk of malnutrition with polypharmacy. This is significant since malnutrition can further worsen the aging process. FUNDING SOURCES: N/A.

OBJECTIVES: In humans, perception for each taste (sweet, salt, sour, bitter and umami) has been independently related to food preferences and intake. Yet, the collective influence of perception of all 5 tastes on diet and cardiometabolic health remains unexplored. Therefore, our objective was to investigate the relations between a collective measure of taste perception – “taste perception profiles” – and adiposity. METHODS: We analyzed baseline data of 367 older adults (55–75 years; 55% female) with metabolic syndrome (MetS) participating in the PREDIMED-Plus Valencia trial. Taste perception was assessed for sweet, salt, sour, bitter and umami using sucrose, NaCl, citric acid, phenylthiocarbamide and monopotassium L-glutamate, respectively, and evaluated on a 0–5 scale. Taste perception profiles were derived from perception scores using predictive modeling and k-means clustering (KCA). Multivariable linear regression was used to evaluate the relations between taste perception profiles and BMI, body weight (BW) and waist circumference (WC), after adjustment for confounders. RESULTS: KCA identified 7 taste perception profiles: Low All (n = 79), High Umami (n = 61), High Bitter (n = 49), High Bitter & Umami (n = 44), High Sweet, Salt & Sour (n = 51), High All But Bitter (n = 49) and High All But Umami (n = 34). After adjusting for age, sex, physical activity, smoking, diabetes, medication use and energy intake, BMI, BW and WC were highest for the Low All profile (adjusted means: 33.4 kg/m(2), 87.5 kg and 108.4 cm; reference). Comparatively, mean BMI and BW were lower for High Bitter (–1.9 kg/m(2); –5.4 kg), High Bitter & Umami (–1.7; –4.7), High Sweet, Salt & Sour (–1.3; –4.6) and High All But Bitter (–1.7; –5.0) profiles; and WC was lower for High Bitter & Umami (–3.4 cm) and High All But Bitter (–4.9) profiles (all P