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Introduction: There is a dearth of information on older users (65+ years) of medical cannabis, who may face unique challenges due to altered metabolism with aging, concurrent medication use, and risk of adverse effects. This observational study aimed to describe a large cohort of older medical cannabis users in Canada. Method(s): From Oct 2014 to Oct 2020, a commercial medical cannabis provider based in Canada collected anonymized data for research purposes from patient volunteers. Data included demographic, social, and health details (at intake) and cannabis products, self-perceived changes in symptoms and change in medications (at follow-up, variable duration). Cannabis products were categorized as cannabidiol (CBD) only, tetrahydocannabinol (THC) only or mixed CBD/THC. Of the mixed, formulations could be in 1:1 ratios (CBD+/THC+), predominantly CBD (CBD+/THC-) or predominantly THC (CBD-/THC+). Result(s): In total, 9766 subjects in the older cohort (65+ years old) completed the entire questionnaire (mean age (SD) = 73.6 (6.8) y, 60% female). They represented 23.1% of the total dataset (N = 42,267, mean (SD) =51.5 (16.8) y). The proportion of adults in the older cohort tended to increase over time (pre-2018: 17.6%;2018: 26.7%;2019: 31.2%;2020: 22.7%, when the overall intake decreased from 8869 to 5644). Among the older cohort, 15.5% were previous cannabis users and 67.7% were referred for chronic pain (mainly arthritis, chronic pain, lower back pain). Concomitant analgesic use was common (over-the-counter analgesics: 44.5%;opioids: 28.3%;NSAIDs: 24.5%). 7.9% of the sample (compared to 19.9% in the whole sample) were referred for psychiatric disorders, though 21.4% indicated antidepressant use and 12.3% indicated benzodiazepine use. Another 7% were referred for neurological disorders. Follow-up data were captured in visits (11,992) from 4698 older patients, averaging 2.5 visits per patient. The type of medical cannabis used changed over time, with increasing use of cannabis oil compared to herbal cannabis. In 2020, of 2478 visits, 78.9% use was cannabis oil and 6.7% was herbal forms (pre-2018: 57.6% vs 36.2%). The composition of cannabis oil demonstrated a preference for cannabinoid oil (CBD+) over tetrahydrocannabinol (THC+) in 6043 visits: 45.2% were using CBD+ preparations, only 3.2% were using THC+ preparations, and for CBD/THC combinations, CBD predominated (CBD+/THC-: 30.5%;CBD+/THC+: 16.8%;CBD-/THC+: 4.3%). Adverse-effects (7062 visits) included dry mouth (15.8%), drowsiness (8.6%), dizziness (4%) and hallucinations (0.6%). Patients reported improved pain, sleep and mood over time, though 15-20% reported no improvement or worsening. Medication use was mostly unchanged, though 40% of opioid users reported requiring reduced dosages. Conclusion(s): These data were drawn from a large convenience sample. The data suggest an increasing proportion of older users of medical cannabis, though COVID-19 may have affected recent use. Female users comprised a higher proportion, and cannabis oil containing CBD was preferred. Systematic studies of effectiveness and safety in older users of cannabinoids are needed given its increasing use. Funding(s): No funding was received for this work.Copyright © 2021
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Drug resistance or multidrug resistance is multidimensional and complex. Over the past decade and especially during the covid-19 pandemic, the incidence of drug resistant infections increased despite the implementation of infection control precautions. This was most commonly seen in low- and middle-income countries, due to the higher burden of infectious diseases, lack of proper infrastructure, unregulated antimicrobial prescriptions over the counter, limited surveillance of antimicrobial use and resistance patterns. This was further compounded by the dearth of healthcare personnel trained in appropriate infectious disease management. Strategies in high income countries to prevent and manage drug resistant infections are unfortunately, not implementable in LMICs due to differences in antimicrobial resistance (AMR) burden, access to newer antibiotics, limited infrastructure and human resources with requisite expertise with lack of economic investment by regulatory authorities to tackle AMR. During the covid-19 pandemic, the lack of therapeutic options and the similar clinical picture initially led to rampant antimicrobial use which in turn contributed to rise in multi-drug resistant infections (MDR). Along with inappropriate antimicrobial use, redistribution of staff assigned to enforce infection control practices, shortage of personnel protective equipment, overcrowded healthcare settings, use of prolonged broad-spectrum antimicrobials in patients requiring during intensive care and mechanical ventilation contributed to the rise in hospital transmission of multidrug resistant infections during the pandemic. To mitigate the effects of drug resistance, healthcare systems must ensure effective implementation of surveillance of antimicrobials, AMR patterns especially in MDR HAIs and antimicrobial stewardship interventions to promote optimal antimicrobial use. National level investment to improve diagnostics must be given priority as it can limit drug resistance and promote the role of biomarkers in streamlining antimicrobial use. These need to be planned to facilitate future integration with any future pandemic surveillance.Copyright © 2023
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The corona virus disease 2019 (COVID-19) pandemic has increased the interest in self-care strategies, including self-medication. Medical students, as future health practitioners, learn more about medications than other students. This study aimed to describe self-medication practices for preventing COVID-19 among medical students at Universitas Islam Indonesia. This observational study used a cross-sectional design and was undertaken in November- December 2020. The study sample included 336 undergraduate medical students determined using a consecutive sampling technique based on inclusion and exclusion criteria. Data were collected using an online questionnaire about self-medication practices in the preceding 3 months. Among a total of 336 students, 137 (41%) reported using self-medication intending to prevent COVID-19, and 126 (92%) of these 137 took preventive supplements, mainly vitamins C, D, and E, and omega-3. Seven students reported the use of zinc, mainly in combination with other vitamins. Students who practiced self-medication lived closer to people confirmed with COVID-19, washed their hands more often, and desinfected their belongings more frequently than their counterparts (p<0.05). The mean duration for consuming vitamins was 11-16 days. Forty students (29%) used herbal medicine to prevent COVID-19;ginger, turmeric, honey, black seed, cutcherry, and Curcuma were the most often consumed herbal remedies. Fourteen students (10%) reported taking over-the-counter medications to relieve symptoms related to COVID-19, including antipyretic, analgesic, antiseptic, antihistamine, decongestant, antitussive, and expectorant medications. Most respondents (82%) purchased their medications at pharmacies, and 11 (9%) obtained them from online shops. These findings show the high rate of self-medication using vitamins and herbal remedies for COVID-19 prevention among university medical students. Further studies are needed to explore students' knowledge about the risks of self-medication including the use of herbal medicines.Copyright © 2022 Marmara University Press.
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December 2019 has become one of the most surprising days in the whole world in light of the flare-up of a most infectious sickness brought about by novel Covid or Severe Acute Respiratory Syndrome Corona virus 2 (SARS-CoV-2). This study is conducted to assess the benefits of the use of home remedies to prevent the cause of Covid-19 and evaluate the assessment of dietary changes and physical activity in the prevention of Covid-19. A questionnaire-based online survey is conducted using Google forms consisting of multiple-choice questions about home remedies, lifestyle and dietary changes made by the people during this pandemic. These home remedies included using different types of herbal preparations, steam inhalation, physical exercise and OTC medications for prophylaxis. Questions likewise included about being infected by Coronavirus-19(during first wave or second) and their recovery period, additionally collected their viewpoint for changes made, for example how much they are useful in the prevention of the attack and whenever encountered any undesirable impacts. Total responses were 210, among which 121(57.6%) responses were from females and 89(42.4%) from males. 65 people tested Covid positive (42 during the first wave and 23 during the second wave). 118(56.2%) of people think these changes are very beneficial. (Rated 4 and 5 out of 5 points). From our survey, we concluded that different herbal preparations of their composition, which they thought are helpful, and steam inhalations have been used. Rating regarding the use and effectiveness was also found to be average. Further studies are needed to prove and provide clear evidence about adverse and side effects associated with the use of herbal products.Copyright © 2022 Society of Pharmaceutical Sciences and Research. All rights reserved.
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Cidofovir is well described as an effective antiviral agent. It is reported to treat viral warts successfully in immunocompetent and immunocompromised individuals. Unfortunately, its use may be limited by the high cost and pain of treatment. We here report the successful treatment of multiple palmoplantar warts in an 8-year old male undergoing chemotherapy for relapsed acute lymphoblastic leukaemia. His most significant lesion was a 3 x 3 x 1.5 cm tumorous lesion on the central plantar forefoot that interfered with weight bearing. It had been resistant to over-the-counter treatments, cryotherapy, silver nitrate cautery, curettage and cautery, cantharadin and topical 5-fluorouracil. He was developing multiple satellite lesions and they had spread to the toes, the other foot and both hands, totalling more than 30 lesions. The first treatment session was during sedation for intrathecal chemotherapy. One millilitre of cidofovir (diluted to 15 mg mL-1) was instilled to the largest lesion (although solution was seen visibly escaping from the surface). The remainder of the vial was compounded to topical cidofovir 1% in Eucerin, which he applied once daily to remaining lesions. His postprocedure recovery was unremarkable, with no analgesia requirements or other complications. By the time of review 4 weeks later, the verruca that had received one session of intralesional treatment had completely resolved. Some of the smaller warts had shrunk in size. Despite reports of pain associated with intralesional cidofovir injections, our patient was keen for a repeated treatment to more lesions without sedation/anaesthetic. He tolerated the treatment of a number of remaining lesions without the need for topical or local anaesthesia. Treatments continued at 4-weekly intervals (to coincide with his chemotherapy regimen) with good response and no side-effects. After three treatment sessions most lesions had resolved with only some smaller lesions remaining. Unfortunately, his next treatments were suspended as he contracted COVID-19. In summary, we report the successful eradication of significant and widespread viral warts in an immunocompromised paediatric patient. Reports in patients under 10 years of age are scarce. We also confirm excellent tolerance of the procedure. Although the high cost of cidofovir may seem prohibitive, given that one vial could generate around 25 mL solution and 0.2-1 mL is needed per lesion, we would argue that it may be more costeffective than multiple sessions of other less/ineffective modalities. Furthermore, its antiviral mechanism of action is particularly beneficial in immunocompromised patients in comparison with other modalities, which require an efficient immune response in order to be successful.
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Gathering and analysing the signals from the field is a key practice in counteracting pharmaceutical crime: the connection between the units dealing with pharmacrime and enforcement/customs offices is quite obvious, but also the networks set up for pharmacovigilance, quality defects, distribution, e-market, GXP should be properly considered, since suspicious signals may be found in reports that are usually not considered in terms of possible criminal behaviours, as it happened in 2014 with the Volcano Operation led by AIFA, that was triggered by a quality report, allowing to discovered an impressive scheme for falsification, theft and laundering of medicines at European level. The usual reports that the AIFA competent office submit to in-depth analysis relate to: * medicines without Marketing/Import Authorization in Italy, found at customs following passengers or in courier shipments;* medicines in transit at Italian customs offices, coming/going from/to third countries;* medicines from third countries, lacking any authorization in Italy, intended for local communities in Italy;* medicines without AIC in Italy, found in points of sale not authorized for the marketing of medicines or illegally held, in large quantities, by unauthorized private parties;* pharmacologically active medicines/active substances, the subject of suspicious commercial transactions between third countries;* falsified medicines, found in Europe and in non-EU countries;* medicines bearing falsified machine-readable stickers;* stolen medicines;and * illegal websites. In this framework, the increase in the use of e-commerce (due to lockdown and pandemic), increasing demand for 'miracle medicines' against COVID-19 and other diseases: illegal framework (and strategies) are changing, as it is reflected in the most recent recurring cases that were investigated, that is, * Traditional Chinese Medicines without authorization in Italy (customs and local shops);* Non authorized medicines marketed as cosmetics (local shops);* Medicines against relevant diseases, e.g. psoriasis, sold as cosmetics (online market);* Counterfeit OTC products from unauthorized channels (online market);and * 'Miracle medicines' for the prevention of COVID-19 (online market and local distribution). The increase in the use of e-commerce (due to lockdown and pandemic) is changing the channels for offering: social network had a major role in creating the demand for 'miracle medicines' against COVID-19, mirroring the one we already know for other diseases. This change in the offer also triggered a change in the communication strategy: the need for a reaction to the so-called 'infodemic', that is, the outbreak of fake news, mainly circulating through social network, forced AIFA to find proper models for showing the whole framework behind many apparently nonrelated issues, underlining the danger related to the new channels/products, more than their illegality.
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Purpose: Osteoarthritis of the knee (knee OA) is the most prevalent form of OA, frequently leading to significant pain and an overall reduction in quality of life. The available options for managing pain, associated with knee OA, are well documented. They include various oral analgesic medications (for example, NASIDs and opioids), intraarticular agents, notably, hyaluronic acid and corticosteroids, and where pharmacological and lifestyle options have been exhausted, orthopedic surgery, including total knee replacement (TKR). The treatment option(s) a patient may receive, in which order and at what time point, post-diagnosis may vary significantly between healthcare centers. The current study focuses specifically on knee OA in Germany, aiming to determine the epidemiology, patient characteristics and treatment schemes for the management of pain associated with knee OA. Method(s): A non-interventional, retrospective health claims data analysis was performed with an anonymized, age- and sex-representative sample of the Institute for Applied Health Research Berlin GmbH (InGef) database. The database that was used for this study includes approximately 4.8 million persons from approx. 60 statutory health insurances (SHI). Patients >=18 years of age were analyzed cross-sectionally for each year 2015-2020. Using ICD-10 and ATC codes, newly diagnosed patients in 2015 were also analyzed longitudinally until end of 2020. Result(s): The average period prevalence of knee OA was 7.34%, with a slight increase during the years 2015-2020. Incidence ranged from 1.71% of patients in 2015 to 1.46% of patients in 2020. Females and patients aged >=66 years had both a higher prevalence and incidence proportion compared to males and younger persons. Approximately 62% of newly diagnosed patients in 2015 received medical treatment during follow-up, most of whom were prescribed non-opioid analgesics;WHO I category (96.84%), followed by WHO II (2.45%) and WHO III (0.71%), as first line treatment. This analysis could not account for the use of any over the counter medications, or medicines prescribed in hospital, prior to, or after diagnosis. As many as 16.58% of newly diagnosed patients had surgery within 5 years. Knee replacement was the most common type of surgery with rising prevalence. The number of patients in whom surgery was performed decreased slightly from 5,38% to 4,03% during the study years considered (Figure 1);the decrease in 2020 may, in-part, be a reflection of the COVID-19 pandemic and the knock-on impact on healthcare systems. Of the 8,318 surgical patients, 2,101 patients (25.26%) had no record of having received any prescription pharmacological treatment prior to first surgery. The median time from first diagnosis until surgery in newly diagnosed patients was 346 days for any surgery, and 564 days for knee replacement. [Formula presented] Conclusion(s): With a stable incidence and a growing population, the number of patients with knee OA in Germany is slowly rising. In parallel, there is an slight decrease in total knee surgeries occurring each year with an increasing proportion of TKRs. Time until first surgery, in general, and TKR in newly diagnosed patients is relatively short, compared to other countries, with some patients having no record of having received any prescription medication prior to first surgery. Other treatment options such as opioids and intraarticular agents, appear to play a relatively minor role, in newly diagnosed patients, in current practice in Germany.Copyright © 2023
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In the age of 'influencers', social media is exerting an ever-increasing impact in dermatology. More than half the world's population use social media and its popularity continues to grow. However, studies have confirmed that content is not always evidence based. Owing to its accessibility, social media is frequently used as an information resource for patients on managing their own skin condition. The influence that it has on parents and guardians in paediatric dermatology is less well described. A 10-point questionnaire was designed to assess social media use in parents and guardians with regard to their child's skin condition. Data were collected on parent or guardian age, sex, online platforms used and changes in management as a direct result of social media-sourced information. Children's demographics, diagnosis and disease duration were also noted. Questionnaires were anonymously distributed in a general paediatric dermatology outpatient clinic waiting room over 3 months. A chi2-test of independence was used to examine the relationship between social media use and parent or guardian age, sex and child's disease duration. In total, 116 parents and guardians participated in the survey. Average child age was 9.9 years (range 0-18), male-to-female ratio 1 : 1. Diagnoses included eczema (n = 35;30%), naevi or other skin lesions (n = 27;23%), acne (n = 18;15%) and psoriasis (n = 4;3%). Ninety-three (80%) of the dermatoses had a duration of > 1 year. Over 40% (n = 48) of parents and guardians used social media on at least one occasion as an educational resource for their child's skin condition across eight online platforms, most commonly Facebook (n = 21;44%), Google (n = 15;31%) and YouTube (n = 8;16%). There was no significant relationship between social media use and parent or guardian age (P = 0.89), sex (P = 0.10) or disease duration (P = 0.77). Of the 48 social media users, 26 (54%) parents and guardians changed their use of over-the-counter products, and a further 14 (29%) altered use of physician-prescribed treatments as a result of social media-derived information. Our findings suggest that a significant number of parents and guardians use social media to understand their child's dermatosis and some change the management based on it. Following the COVID-19 pandemic, a shift to virtual platforms for human interactions has fuelled the use of social media. With its growing popularity, it is likely that dermatologicalrelated content will also increase and therefore this should be addressed in both adult and paediatric clinics.
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The abuse and misuse of OTC medicines is a common problem in community pharmacies and is expected to escalate during the COVID-19 pandemic. However, there is limited research on the patterns, causes, and consequences of these incidents during the pandemic. This article aims to provide evidence-based insights into the potential impact of COVID-19 on the abuse and misuse of OTC medicines, and suggest strategies for reducing these occurrences for pharmacy practitioners and healthcare managers.Copyright © The Author(s) 2023.
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Objectives: Early investments in new diagnostic technologies that allow for rapid and decentralized testing were critical in reducing SARS-CoV-2's detrimental health and economic effects. This study evaluates public knowledge about, acceptance of and willingness to use COVID-19 self-testing kits. Methods: An online descriptive cross-sectional questionnaire was used in this study. The final study population included all contacted national and resident adults, age 18 and over, who were willing to engage in the study. The survey was divided according to participants' demographic information and 11 questions assessed the respondents' understanding of and willingness to use COVID-19 self-testing kits. The statistical analysis was carried out using SPSS version 24. Multivariate linear regression models were used to identify the factors influencing respondents' knowledge of and attitudes toward the acceptability of self-testing kits for COVID-19 and their willingness to use these kits. Key findings: A total of 876 respondents participated in the study and completed the whole questionnaire. The average knowledge score on the acceptability of and willingness to use self-testing kits for COVID-19 was 70.2%, with a 95% confidence interval (CI) [69.1%, 71.4%]. Participants who were postgraduate, female and vaccinated against COVID-19, as well as employees and older participants, were jointly highly associated with higher levels of knowledge about, acceptance of and willingness to use self-testing kits for COVID-19. Moreover, participants who had been infected with COVID-19, were vaccinated against COVID-19 or were female, employees, older, Western or Arabic were jointly highly associated with positive attitudes about the acceptability of and willingness to use self-testing kits for COVID-19. Conclusions: The majority of the respondents have acceptable levels of knowledge about, acceptance of and willingness to use self-testing kits for COVID-19. Nonetheless, future studies should consider the issues of pre- and post-test counselling, false negative results and the sale of unregulated testing kits. Additional information should be communicated so that people can make informed decisions and be protected from possible abuse of COVID-19 self-testing kits when they become available in pharmacies.
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Background: In large-scale community transmission, such as severe acute respiratory syndrome of the COVID-19, monitoring geographic trends and estimating the transmission intensity is critical to support decisions on actions to be taken. Though major efforts are concentrated on testing the populations, the availability and timing of this data pose a clear limitation to realtime monitoring. Purpose(s): This study proposes a retrospective analysis to develop a novel methodology to detect and monitor the COVID-19 epidemiological activity using a selected subset of over-the-counter (OTC) products sold in community pharmacies in Portugal. Previous studies have successfully demonstrated this approach to different epidemiological outbreaks as individuals tend to self-manage the symptoms. Method(s): The subset of OTC products was selected considering therapeutic indication for symptoms of infection by SARS-CoV-2 and the trends observed for diagnosed cases in Portugal. The similarities between the trends of the subset of products and the daily new-suspected and new-confirmed cases of COVID-19, respectively, were assessed using lagged spearman correlation analysis. The trend of the subset of products selected presented high and statistically significant correlations to new-suspected and new-confirmed cases lagging 14-16 days (correl.>0.82;p<0.001). Highest correlation to both new-suspected and new-confirmed cases was found lagging 15 days (0.879 and 0.888, respectively;p<0.001). Conclusion(s): The study supports the use of the methodology presented to anticipate the trends of COVID-19 outbreaks in Portugal, both locally and nationwide, considering representativity of the presence of community pharmacies to the distribution of populations.
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The great use of telecommunication technology propels new healthcare system of telemedicine through which diagnosis as well as treatment can be done in the remote areas. The ancient Greek language explain the terminology of telemedicine in the phrase of distance healing. As per WHO, Telemedicine is the delivery of health-care services, where distance is a critical factor, by all health-care professionals using information and communications technologies for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries, research and evaluation, and the continuing education of health-care workers, with the aim of advancing the health of individuals and communities. Historically the concept of teleconsultation was evolved in the first half of twentieth century when the data of ECG was communicated through telephone lines, this can be traced as first evidence of this unique healthcare system. Further the introduction of electrical system of telegraph as well as evolution of telephone revolutionized this system of healthcare. when the Technology of telemedicine help both patients as well as service providers in multiple ways involving physicians, surgeons, pharmacists, paramedical staff, IT and electronics engineers, government, hospitals and end user public Location is now a days no problem and therefore there is no limitation of the availability of healthcare facilities to such location or remote location. The biggest role in such development is played by the communication technology which may provide healthcare services to every nook and corner of the location. It can decrease the health staff pressure because in India WHO guidelines ask to maintain the ratio 1:1000 of doctor and Indian public compared to present 0.62:1000 ratio of doctor and public. The great advantage of this system is that in case of epidemic or pandemic like COVID 19 Telemedicine can keep the health staff are well general public free from contagious infection (COVID-19). There are a number of networking communication modes that can be applied, which may improve the patient compliance,dosage regimen can be managed in better fashion thus increase the longevity of person life. Disasters management during pandemics present unique challenges which can be addressed effectively as happened during the lockdown. This technology-based practice can break the infectivity chain of the transmission of communicable diseases This chapter incorporates basic concept of telemedicine, its origin and types, communication technologies, services by telemedicine, types of telemedicine, tools of telemedicine, telemedicine software's and guidelines related to practicingtelemedicine in reference to Indian context. Copyright © RJPT All right reserved.
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Medicines use plays an important role in women's decisions to start or continue breastfeeding. Some may stop breastfeeding or the medicine to avoid combining the two, as they feel very strongly about tainting their milk when breastfeeding[10]. Women deserve to be involved in discussions on compatibility, using evidence-based resources presented in a manner in which they can understand. There is a presumption by some healthcare professionals, mothers, families and wider society that formula has benefits over breast milk with a trace of medication in, or that adverse events are likely and serious if this breast milk is consumed. In addition, there is a reticence from healthcare professionals to use professional judgement and go outside the licence application for medicines. This leaves the mother with a dilemma: to interrupt or stop breastfeeding to take the medication, or to delay medication - with chronic diseases, the latter is rarely an acceptable option. In January 2021, the MHRA launched the Safer Medicines Consortium, owing to the "need for reliable and consistent information about medicines used before or during pregnancy and breastfeeding for women and the healthcare professionals who advise them". The vision of the consortium is that "all women will have access to accurate and accessible information to make informed decisions with their healthcare professional about taking medicines before or during pregnancy or breastfeeding"[44]. As experts in medicines, pharmacists should share evidence-based information with the mother and support her in making a decision that is right for her and her baby, as outlined above. Copyright © 2021 Pharmaceutical Press. All rights reserved.
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There have been increasing reports of misuse of a range of prescription and over-the-counter (OTC) drugs for recreational purposes. The use of psychoactive pharmaceuticals and 'pharming' are new, widespread phenomena involving the non-medical use of prescription and OTC drugs, which are recreationally used to achieve psychoactive effects either on their own or in combination with other substances. This article provides an overview of the topic, focusing on a range of medicines (e.g. prescription medicines such as quetiapine, gabapentinoids, Z-drugs, bupropion, venlafaxine and over-the-counter medicines such as loperamide, dextromethorphan, benzydamine, promethazine, chlorphenamine, diphenhydramine and hyoscine butylbromide) that have emerged as misused and diverted, or are already described through the literature, as well as recorded by drug users' online websites reporting new trends and experimentations of drug abuse. This rapidly changing drug scenario represents a challenge for pharmacy, psychiatry, public health and drug control policies. Moreover, possibly resulting from the COVID-19 pandemic, drug use habits and availability have changed, causing a shift in behaviours relating to both prescription and OTC medicines. Healthcare professionals should be aware of potential prescription drugs diversion, recognise misuse cases, consider the possibility of polydrug misuse, and prevent it where possible. Pharmacists can prevent and reduce drug abuse, and should be involved in evidence-based actions to detect, understand and prevent drug diversion activities and the adverse effects of drug misuse. Copyright © 2020 Pharmaceutical Press. All rights reserved.
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SESSION TITLE: Systemic Diseases with Deceptive Pulmonary Manifestations SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/18/2022 12:25 pm - 01:25 pm INTRODUCTION: Amyloidosis of the respiratory tract is rare. We present a case of tracheobronchial amyloid presenting as multifactorial cough with syncope. CASE PRESENTATION: The patient is a 65-year-old man with history of hypertension, hyperlipidemia, and allergic rhinitis who presented to the ED after a syncopal event. Two weeks prior, he had a new-onset myalgias and severe persistent cough, not resolving with over-the-counter medications. During a coughing paroxysm, he experienced a brief loss of consciousness. On arrival, his vital signs and physical exam were within normal limits except for Mallampati II, BM of 38.8 kg/m2. Basic laboratory testing was also unremarkable except for troponin T of 251 nl/dL and NT-ProBNP of 1181 pg/mL. NP swab for Sars-CoV-19 (PCR), Influenza A and B were not detected. CT of the chest revealed an area of circumferential mural soft tissue thickening in the left lower lobe bronchi. Cardiac MRI showed an area of subepicardial delayed enhancement, suggestive of myocardial inflammation or edema. Flexible bronchoscopy confirmed that the left lower lobe bronchus and proximal subsegmental bronchi had an infiltrative process with a friable, erythematous irregular mucosal surface. Forceps biopsy sampling and staining with Congo red, sulfate Alcian blue and Trichome stain were positive for amyloid deposits. Immunostain revealed predominantly CD3 positive T-Cells. Mass spectometry showed AL (lamda)-type amyloid deposition. GMS and AFB stains were negative. Telemetry showed 2-3 second pauses, correlated with episodes of cough. DISCUSSION: Amyloidosis is a disorder caused by misfolding of proteins and fibril accumulation in the extracellular space. It can present as a diffuse or localized process to one organ system. Several patterns of lung involvement have been described: nodular pulmonary, diffuse alveolar-septal, cystic, pleural, and tracheobronchial amyloidosis. Tracheobronchial amyloidosis is usually limited and not associated with systemic disease or hematologic malignancy. It can be asymptomatic, or can present with cough, dyspnea or signs of obstruction, including postobstructive pneumonia. Congo Red stained samples reveal green birefringence under polarized light microscopy. Further analysis of proteins usually reveals localized immunoglobulin light chains (AL). Cough syncope is due to increased intrathoracic pressure, decreased venous return and cardiac output, stimulation of baroreceptors, decreased chronotropic response, arterial hypotension and decreased cerebral perfusion. Our patient presented with multifactorial cough (possible viral infection, upper airway cough syndrome, amyloidosis) causing sinus pauses and syncope, on underlying myocarditis. CONCLUSIONS: Amyloid infiltration of the respiratory system is rare, but it should be considered in the differential diagnosis of airway disorders, nodular or cystic lung diseases, and pleural processes. Reference #1: Milani P, Basset M, Russo F, et al. The lung in amyloidosis. Eur Respir Rev 2017;26: 170046 [https://doi.org/10.1183/16000617.0046-2017]. Reference #2: Utz JP, Swensen SJ, Gertz MA. Pulmonary amyloidosis. The Mayo Clinic experience from 1980 to 1993. Ann Intern Med. 1996 Feb 15;124(4):407-13. doi: 10.7326/0003-4819-124-4-199602150-00004 Reference #3: Dicpinigaitis PV, Lim L, Farmakidis C. Cough syncope. Respir Med. 2014 Feb;108(2):244-51. doi: 10.1016/j.rmed.2013.10.020. Epub 2013 Nov 5. PMID: 24238768. DISCLOSURES: No relevant relationships by Amarilys Alarcon-Calderon No relevant relationships by Ashokakumar Patel
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SESSION TITLE: COVID-19 Case Report Posters 3 SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: Due to a wide range of clinical presentations, central venous thrombosis (CVT) is a rare neurologic condition that can be difficult to diagnose. Since the COVID-19 pandemic, more cases of venous thromboembolic events have emerged and been found associated with COVID-19. We detail a potential case of COVID-19 associated CVT. CASE PRESENTATION: A 28-year-old female with past medical history of obesity, polycystic ovary syndrome, recurrent sinusitis, and presumed history of COVID-19 infection with anosmia, ageusia, and sinusitis symptoms three- months prior presented to the hospital with 1-month history of worsening, right-sided pain behind her ear, eye, head, posterior neck and shoulder, nausea, and photophobia, which had worsened in the last 5 days. She initially tried over-the-counter medications with no improvement. Vital signs were unremarkable. Examination was notable for frontal sinus and right postauricular tenderness to palpation. C- reactive protein was elevated at 26.2 mg/L. Non- contrasted brain computed tomography (CT) was concerning for right transverse sinus and superior sagittal sinus thrombosis. Brain magnetic resonance imaging (MRI) showed early signs of cortical edema and venous infarction and findings concerning for right mastoiditis. Intracranial venous MRI showed complete thrombosis of the right transverse and sigmoid sinus, superior sagittal sinus, and most of the superior draining cortical veins. Heparin drip was started. Initial empiric antibiotics for mastoiditis were stopped. Hyper-coagulopathy work-up with beta- 2 glycoprotein 1 antibodies and phospholipid antibodies were negative. As there were no other inciting factors for CVT found and no history of positive COVID-19 test, a COVID-19 antibody immunoassay was obtained and returned positive. The patient did not have a history of COVID vaccination. She was discharged on warfarin and enoxaparin. Anticoagulation was stopped after 6 months with repeat imaging showing resolution of clot burden. DISCUSSION: Usual risk factors associated with CVT are morbid obesity, hormone replacement therapy, oral contraceptive use, hereditary thrombophilia, and pregnancy. Literature on CVT related to COVID-19 is limited. In 41 documented cases, the average age of incidence is 50 years old and median onset of neurological symptoms from initial COVID-19 diagnosis is 7 days [0 to 21 days]. Our patient's neurological symptoms began about 3 months after her initial diagnosis, potentially making it the first known case of COVID-19 associated CVT with symptom onset past 21 days. Anticoagulation is the mainstay treatment for CVT, and duration depends on the presence of provoking factor. CONCLUSIONS: In patients with new neurologic symptoms and recent diagnosis of COVID-19, CVT should be considered in the differential diagnosis as it can initially present in a subtle manner. Early recognition could improve patient morbidity and mortality. Reference #1: Abdalkader, M., Shaikh, S. P., Siegler, J. E., Cervantes-Arslanian, A. M., Tiu, C., Radu, R. A., Tiu, V. E., Jillella, D. v., Mansour, O. Y., Vera, V., Chamorro, Á., Blasco, J., López, A., Farooqui, M., Thau, L., Smith, A., Gutierrez, S. O., Nguyen, T. N., Jovin, T. G. (2021). Cerebral Venous Sinus Thrombosis in COVID-19 Patients: A Multicenter Study and Review of Literature. Journal of Stroke and Cerebrovascular Diseases. https://doi.org/10.1016/j.jstrokecerebrovasdis.2021.105733 Reference #2: Idiculla, P. S., Gurala, D., Palanisamy, M., Vijayakumar, R., Dhandapani, S., Nagarajan, E. (2020). Cerebral Venous Thrombosis: A Comprehensive Review. European Neurology (Vol. 83, Issue 4). https://doi.org/10.1159/000509802 Reference #3: Ostovan VR, Foroughi R, Rostami M, et al. Cerebral venous sinus thrombosis associated with COVID-19: a case series and literature review. Journal of Neurology. 2021 Oct;268(10):3549-3560. DOI: 10.1007/s00415-021-10450-8. PMID: 33616740;PMCID: PMC7897893. DI CLOSURES: No relevant relationships by Shu Xian Lee No relevant relationships by Arif Sarwari No relevant relationships by Benita Wu
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December 2019 has become one of the most surprising days in the whole world in light of the flare-up of a most infectious sickness brought about by novel Covid or Severe Acute Respiratory Syndrome Corona virus 2 (SARS-CoV-2). This study is conducted to assess the benefits of the use of home remedies to prevent the cause of Covid-19 and evaluate the assessment of dietary changes and physical activity in the prevention of Covid-19. A questionnaire-based online survey is conducted using Google forms consisting of multiple-choice questions about home remedies, lifestyle and dietary changes made by the people during this pandemic. These home remedies included using different types of herbal preparations, steam inhalation, physical exercise and OTC medications for prophylaxis. Questions likewise included about being infected by Coronavirus-19(during first wave or second) and their recovery period, additionally collected their viewpoint for changes made, for example how much they are useful in the prevention of the attack and whenever encountered any undesirable impacts. Total responses were 210, among which 121(57.6%) responses were from females and 89(42.4%) from males. 65 people tested Covid positive (42 during the first wave and 23 during the second wave). 118(56.2%) of people think these changes are very beneficial. (Rated 4 and 5 out of 5 points). From our survey, we concluded that different herbal preparations of their composition, which they thought are helpful, and steam inhalations have been used. Rating regarding the use and effectiveness was also found to be average. Further studies are needed to prove and provide clear evidence about adverse and side effects associated with the use of herbal products.