The experiences of the community pharmacy team in supporting people with dementia and family carers with medication management during the COVID-19 pandemic

BackgroundThe novel coronavirus COVID-19 pandemic has changed the lives of people across the globe in significant and long-lasting ways. People with dementia were significantly and disproportionally affected at the height of the pandemic in England. Community pharmacies in England continued to operate during the pandemic but had to adjust the way they provided key healthcare services. The impact of these changes on the provision of medication services to people with dementia is underexplored.ObjectiveTo explore the experiences of the community pharmacy team in supporting people with dementia and their family carers with the management of medications during the COVID-19 pandemic.MethodsAn interpretivist/constructivist research paradigm was used; semi-structured one-to-one telephone interviews were conducted with any member of the community pharmacy team who had been involved in providing medication services to people with dementia in England before and during the COVID-19 pandemic. Recruitment took place between July and August 2020. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis.ResultsFourteen participants were interviewed with equal numbers of qualified pharmacists and non-pharmacist staff. Participants were in their role for an average of 4.5 years. The analysis of interviews generated three themes: 1) key interactions curtailed due to COVID-19 restrictions, 2) utilising resources within and outside of the pharmacy to provide tailored services for people with dementia, and 3) the interplay between professional duty and personal values underpinned decisions to provide medication services.ConclusionsThe study provided a unique and important first insights to our understanding of how the community pharmacy team in England supported people with dementia and their family carers during the COVID-19 pandemic. These insights provide opportunities for reflection by individuals, healthcare teams, healthcare organisations, policy makers and the public, in an international context, to enable long-term planning, investment and implementation of strategies beyond the current pandemic.     

Effect of multimorbidity on quality of life in adult with cardiovascular disease: a cross-sectional study

Background

The aim of present study was to describe the effect of multimorbidity on Health-Related Quality of Life (HRQoL) in patients with coronary artery disease (CAD).

Methods

A cross-sectional study with a simple sampling method of 296 patients undergoing coronary artery bypass surgery in a referral hospital of the northern part of Iran was conducted between April, 2015 and September, 2016. Multimorbidity was defined as the presence of at least two chronic diseases based on self-reporting and medical records. HRQoL was measured using the 36-item short form (SF-36) health status survey. We used analysis of variance (ANOVA) to assess the effect of multimorbidity on mental and physical component of HRQoL.

Results

Approximately, 69% of CAD patients had at least one other disease like diabetes or hypertension. Patients without multimorbidity compared with patients with multimorbidity were significantly older (p?=?0.012) and more educated (p?=?0.002). Both physical and mental component score of HRQoL was better in patients without any morbidity (48.82 vs. 43.93 with 95%CI of mean difference: 3.37–6.42 and 54.85 vs. 50.44 with 95% CI of mean difference: 1.68–7.15, respectively). Both physical and mental component score was significantly lower in female and lower educated patients (physical mean score 43.07 vs. 46.54 with P?=?.001 and 42.53 vs. 46.82 with P?<?.001 and mental mean score 49.98 vs. 52.65 with P?=?.055 and 49.80 vs. 52.75 with P?=?.022 for sex and education, respectively). Also, two-way ANOVA showed that regards to morbidity, physical component score was greater in patients with lower education level than higher education level (P?<?.001).

Conclusion

The findings of this study suggest that women, lower education level and overweight patients reported lower quality of life. HRQoL is affected by multimorbidity among CAD patients specially in less educated.

     

Predictive value of salivary microRNA-320a,vascular endothelial growth factor receptor 2, CRP and IL-6 in Oral lichen planus progression

Introduction

MicroRNA (miRNA) 320a and vascular endothelial growth factor receptor 2 (VEGFR-2) expression as the angiogenic biomarkers might be therapeutic targets in Oral lichen planus (OLP). IL-6 and C-reactive protein (CRP) could be prognostic in OLP, dysplastic OLP and Oral squamous cell carcinoma (OSCC). Therefore, their salivary detections as the noninvasive tools were aimed in this study.

Materials and methods

Histopathologic examinations were carried out to distinguish the patients with dysplastic OLP and OSCC. Salivary microRNA expression analysis was performed using RT-qPCR. IL-6 and CRP levels were also measured in saliva via ELISA method. VEGFR-2 expression in various sections was evaluated using immunohistochemistry.

Results

A significant decrease in salivary microRNA-320a in dysplastic OLP and OSCC but not in OLP without dysplasia was found. VEGFR-2 visualization confirmed the increasing angiogenic process in these cases. A significant increase in IL-6 level was detected in cases with OLP, dysplastic OLP and OSCC. CRP levels also showed a significant increase in dysplastic OLP and OSCC. A positive correlation between IL-6 and CRP levels was found.

Conclusion

Identification of the salivary microRNA-320a and hs-CRP might provide a convenient noninvasive predictive tool for dysplastic OLP, whereas IL-6 could be a diagnostic and therapeutic target in both OLP without dysplasia and dysplastic OLP cases.

     

Agreement rate of skin prick test with tissue eosinophil count in patients with nasal polyps

The pathogenetic mechanism of nasal polyps remains unknown, although allergy has been cited as an important factor in the etiology of nasal polyposis. Currently there is no definite histological criterion for differentiation of allergic from inflammatory nasal polyp. However, in a few studies, tissue eosinophil count has been used for this. This study aimed to find out the agreement rate of skin prick test and tissue eosinophil count in patients with nasal polyposis. Twenty five patients (18 males, 7 females) with nasal polyp were enrolled in this study. For each patient tissue sample from polyp material was taken for histopathological investigation. Moreover, skin prick test was performed for each patient using eleven common aeroallergens. Skin prick test was positive in 48% of the patients. Tissue eosinophil count of more than 50% was found in 75% of skin prick positive and in 69.2% of skin prick negative patients. Also tissue eosinophil count of more than 50% was found in 69.2% of patients with typical allergic symptoms as well as 75% of patients without allergic symptoms. No agreement was found between skin prick tests and tissue eosinophil counts in patients with nasal polyp. Also no difference was found between the tissue eosinophil counts in allergic and non allergic patients. Considering these results, it can be concluded that having a high tissue eosinophil count in patients with nasal polyp does not indicate that the polyp is allergic.     

Reliability and failure modes of narrow implant systems

Objectives

Narrow implants are indicated in areas of limited bone width or when grafting is nonviable. However, the reduction of implant diameter may compromise their performance. This study evaluated the reliability of several narrow implant systems under fatigue, after restored with single-unit crowns.

Materials and methods

Narrow implant systems were divided (n = 18 each), as follows: Astra (ASC); BioHorizons (BSC); Straumann Roxolid (SNC), Intra-Lock (IMC), and Intra-Lock one-piece abutment (ILO). Maxillary central incisor crowns were cemented and subjected to step-stress accelerated life testing in water. Use level probability Weibull curves and reliability for a mission of 100,000 cycles at 130- and 180-N loads (90 % two-sided confidence intervals) were calculated. Scanning electron microscopy was used for fractography.

Results

Reliability for 100,000 cycles at 130 N was ～99 % in group ASC, ～99 % in BSC, ～96 % in SNC, ～99 % in IMC, and ～100 % in ILO. At 180 N, reliability of ～34 % resulted for the ASC group, ～91 % for BSC, ～53 % for SNC, ～70 % for IMC, and ～99 % for ILO. Abutment screw fracture was the main failure mode for all groups.

Conclusions

Reliability was not different between systems for 100,000 cycles at the 130-N load. A significant decrease was observed at the 180-N load for ASC, SNC, and IMC, whereas it was maintained for BSC and ILO.

Clinical relevance

The investigated narrow implants presented mechanical performance under fatigue that suggests their safe use as single crowns in the anterior region.

     

Pharmacological properties of a potent and selective nonpeptide substance P antagonist.

We describe here the pharmacological properties of RP 67580 [(3aR,7aR)-7,7-diphenyl-2-[1-imino-2-(2-methoxyphenyl)ethyl] perhydroisoindol-4-one], a nonpeptide antagonist of substance P (SP). In vitro, the compound was found to inhibit in a competitive manner (Ki = 4.16 +/- 0.59 nM) [3H]SP binding to neurokinin receptors type 1 (NK1 receptors) in rat brain membranes. Contractions induced by SP and septide (a selective NK1 agonist) in guinea pig ileum were competitively inhibited by RP 67580 (pA2 = 7.16 and 7.59, respectively). Moreover, RP 67580 displayed the profile of a specific antagonist of NK1 receptors: it was not active on NK2 and NK3 receptors as seen in binding assays and in isolated preparations of rabbit pulmonary artery and rat portal vein. In the rat, low intravenous doses of RP 67580 totally inhibited the plasma extravasation induced by SP in the urinary bladder (ED50 = 0.04 mg/kg i.v.) and by antidromic electrical stimulation of the saphenous nerve in the hind paw skin (ED50 = 0.15 mg/kg i.v.). This compound was also active in two classical analgesic tests in mice: phenylbenzoquinone-induced writhing (ED50 = 0.07 mg/kg s.c.) and the formalin test (ED50 = 3.7 mg/kg s.c.). Its potency was of the same order as that of morphine. Thus we conclude that RP 67580, a SP antagonist, belongs to a class of drugs that may be useful in the management of various clinical pathologies where pain and neurogenic inflammation are involved.     

Warning signals of elevated prediabetes prevalence in the modern Iranian urban population

BackgroundWe sought to estimate the prevalence of diabetes mellitus (DM) and pre-DM and their associated factors among a sample of the Iranian urban population between 2017 and 2019.MethodsThe present investigation is a sub-study on the HAMRAH cohort study, a longitudinal population-based cohort study to assess the 10-year risk of cardiovascular diseases and their related risk factors in the adult population of the Iranian capital, Tehran. Via a multistage cluster randomized sampling method, 2123 adults aged between 30 and 75 years who had no history of cardiovascular diseases were selected for the study. With the aid of the 2010 American Diabetes Association criteria for the definition of DM and pre-DM, age and sex-specific prevalence rates were estimated.ResultsThe estimated overall prevalence of DM was 14.3% (95% CI: 13.1%–15.8%): 10.4% known DM (95% CI: 9.1%–11.8%) and 4% newly diagnosed DM (95% CI: 3.1%–5.1%). Pre-DM was detected in about 29.2% of the study participants (95% CI: 22.9–36.3%). Our logistic regression analysis revealed that increasing age, higher systolic blood pressure, higher levels of triglycerides, and lower levels of high-density lipoprotein were significantly associated with DM.ConclusionsDM and pre-DM follow a notable incremental pattern among the Iranian urban population. This finding underscores the significance of the need to improve prevention and screening strategies in the Iranian urban population.