Medication adherence in Elderly during COVID-19 pandemic: what role can the emergency department play?

INTRODUCTION: elderly frequently present a poly-pathology recurring polypharmacy. Therefore, strict medication adherence is essential to avoid poor health outcomes especially during health crises like the current COVID-19 pandemic. The aims of our study were to identify the predictors of medication non-adherence in elderly and to expose the role of the emergency department (ED) to improve the therapeutic adherence during COVID-19 pandemic. METHODS: it was a two steps study. Primary, an observational, prospective survey over one month, including 100 elderly patients consulting to the emergency department. Medication adherence was assessed by Morisky's 4-questions scale; predictors of non-adherence have been identified. Secondary, a report of elderly medication management by the emergency physicians during the COVID-19 pandemic confinement. RESULTS: first step: 100 patients, mean age of 73±8 years. The average number of drugs was 4±2. Medication non-adherence was reported in 39%, predictors of therapeutic non-adherence were: polypharmacy (OR=2.41; CI95% [1.60;3.61]), rural origin (OR=6.72; CI95% [1.47;30.63]) and metabolic diseases history (OR=5.24; CI95% [1.48;18.53]). In the second step, 816 elder lies were enrolled, mean age: 73±7 years. The therapeutic attitude in the emergency department was to prescribe the same treatment (60%) to adjust the doses of the drugs prescribed (14%) to stop one or more drugs (13%) or to indicate new treatments (13%). Thirty-five percent of patients were admitted for short-term hospitalization. CONCLUSION: medication non-adherence is common in elderly, due to several factors. During the COVID-19 pandemic, the emergency services in Tunisia played an important role in the follow-up and therapeutic continuity of these elderly patients.

Relapse of rare diseases during COVID-19 pandemic: bicytopenia in an adult patient with thiamine-responsive megaloblastic anaemia.

Thiamine-responsive megaloblastic anaemia (TRMA) is a syndrome associated with megaloblastic anaemia, diabetes mellitus and sensorineural deafness, due to mutations in the SLC19A2gene, which codes for a thiamine carrier protein. Oral thiamine supplementation is the main treatment. We report the case of a 19-year-old man known for TRMA, who presented in the emergency department with bicytopenia (haemoglobin 5,4 g/dL, thrombocytes 38×109/L) revealed by dyspnea and chest pain. Investigations excluded bleeding, hemolysis, coagulopathy and iron deficiencies. A recent infection and an acute coronary syndrome have also been eliminated. We later found out that thiamine treatment had been discontinued three months before, due to general confinement in Tunisia during the COVID-19 pandemic. Parenteral administration of 100 mg of thiamine daily resulted in the recovery of haematopoiesis within three weeks.

Respiratory distress in a patient with Klinefelter syndrome: a suspicion of COVID-19 hiding severe pulmonary embolism.

Klinefelter syndrome is the most common congenital abnormality causing primary hypogonadism and predisposing to a state of hypercoagulability. We report the case of a 37-year-old man, of Algerian nationality, diagnosed with Klinefelter syndrome admitted to the hospital via the emergency room for acute chest pain and dyspnea. The patient arrived in Tunisia 36 hours ago. On admission, body temperature was 38.2°C, blood pressure, pulse and respiratory rate were 130/70 mmHg, 120/minute and 26/minute, respectively. He had an oxygen saturation of 87% in room air. His electrocardiography revealed a complete right bundle-branch block, chest X-Ray was normal. In front of the clinical presentation and the origin of the patient coming from an endemic country, COVID-19 infection was suspected but ruled out by pharyngeal swabs testing negative by real-time reverse-transcription polymerase chain reaction test and massive pulmonary embolism was diagnosed from his chest computed tomography images. The symptoms improved with anticoagulation treatment.