Objective: To assess factors associated with low adherence to pharmacotherapy in elderly patients. Methods: A prospective cross sectional observational study was conducted in Bharati Hospital and Research Centre, Pune over a period of 6 months. A total of 240 Elderly patients (≥60 years), taking 4 or more medications daily for any medical illness or illnesses were enrolled in the study. The details like age, gender, educational and employment status, physical activity, social history, past medical and medication history, current medications were noted in self pre designed patient pro forma. The medication adherence was assessed by using Brief Medication Questionnaire (BMQ). Results: The assessment of the patient's responses to the four scale BMQ showed that out of 240 patients, only 5.8% patients were adherent in regimen scale, 60% were adherent in belief scale, 15% were adherent in recall scale and 37.5% were adherent in access scale. Complexity of medication regimen (74.1%) was the main barrier to medication adherence. More than half of patients were unable to name their medications (68.3%). The main reason for non adherence would be related to patient related factors such as lack of knowledge about the disease (63.3%), inadequate knowledge regarding therapy (60%), taking so many pills at the same time (51.7%), forgetfulness (50.84%), difficulty in remembering to take all the pills (48.3%) and difficulty on refilling in time (20.0%). Conclusion: Various factors associated with medication nonadherence were complexity of medication regimen, lack of knowledge about the disease and therapy, difficulty in remembering to take medications and taking so many pills at the same time.
The COVID 19 pandemic continues its havoc over the last six months in India. The present study of the initial phase of illnesses in mild to moderate cases of SARS-COVID is the rampant community transmission. This observational and cross-sectional study aimed to analyse and correlate the socioeconomic and demographic parameters with clinical and psychosocial presentations of the COVID disease through a questionnaire-based interaction Mild and moderate COVID positive patients with stable hemodynamic were enrolled for the study. The findings revealed that of the 179 patients, the majority of patients were adults below 60 years of age group, followed by the older age group above 60. Males had a slightly higher preponderance than females. The majority of people in their families were medium to big and overcrowded, lacked social distance and poor hygiene practises were partially attributable to bad social economic conditions. Most of the patients originated from the red area, i.e. high-risk zone, as well as the high level of transmission of COVID illnesses to human beings. The majority of patients were in the poor and lower middle classes (Kuppuswamy modified scale).Most of the occupations of COVID patients involved the lower strata labour jobs. Fifty percent of patients had no symptoms at onset and remained asymptomatic throughout the illness. There were many issues and insecurities in most patients relating to the current illness, future well-being of families, job and financial concerns that warrant strategies to be implemented during and in post COVID era.
The COVID-19 disease continues its rampage on the human population all over the world. The pathogenesis mechanisms involve various inflammatory and altered immune responses and oxidative processes, leading to complications like cytokines storm and death in vulnerable cases. Therefore, in this review, we summarize current evidence on melatonin therapy for viral infections with focus on possible underlying mechanisms of melatonin actions. Since this pandemic crisis elapses time, researchers worldwide are busy trying new solutions to overcome the heavy toll of the COVID-19 illness morbidity and mortality. One such drug with growing recognition is melatonin. Melatonin is a well-known anti-inflammatory and antioxidant molecule which helps in promoting adaptive immunity. Melatonin improves sleep and anxiety and also can prevent fibrosis. It is a readily available over-the-counter medication that can be manufactured easily in bulk, hence inexpensive to a patient from a developing nation like India. It can be orally administered and has a wide margin of safety. This article reviews the various facets, merits, demerits, and rationale of the re-use use of molecule melatonin, which is yet to be recognized.
A 38-year-old male was diagnosed with acute myocardial infarction (AMI) without a history of any significant clinical conditions. His subjective complaints and objective findings were clearly suggesting an acute ischemic attack along with vitamin B12 deficiency. While managing him for AMI, serology tests for vitamin B12 revealed low levels along with the mild elevation of serum homocysteine level. He was managed with thrombolytic agent, β-adrenergic blocker, aspirin, antiplatelet agents, anticoagulants, statin, vitamin B complex, and folic acid supplements. The clinical pharmacist intervened by suggesting discontinuation of clopidogrel as two antiplatelet agents (clopidogrel and ticagrelor) were administered along with an anticoagulant, thereby increasing the risk of bleeding in the patient. Clopidogrel was stopped as ticagrelor is a better antiplatelet agent when given in combination with low dose aspirin. Furthermore, aspirin dose was reduced to enhance the efficacy of ticagrelor and provide better secondary prevention for vascular diseases.
Ever since the human race has been exposed to the novel COVID 19 illness, newer and newer intriguing features of the COVID viral plethora are seen with each passing day. Many manifestations of the COVID 19 illness have been baffling and unexplainable to researchers currently. One such unusual presentation seen is ‘happy hypoxia’ or silent hypoxemia in a third of patients' total number. This review article is intending to put some light on the puzzling condition of happy hypoxia. We authors refer you through various theories postulated for happy hypoxia. It has definite clinical implications in the sense that it can be lifesaving if detected early and promptly in a COVID patient. We conclude that happy hypoxia or silent hypoxemia is a new entity and should be diagnosed with a high index of suspicion in COVID suspect patients in both young patients with no co morbidities and the elderly and diabetics. Diagnostic modalities like pulse oximeter should be widely used at hospitals and clinics and for self-monitoring by the patients at homes. Also, chest X-rays or HRCT imaging of the lungs is essential in the early stages to identify the early infective changes with compromised lung function and rule out this happy hypoxia. Also, further research is essential to find the exact ethologic of this subclinical though ominous prognostic entity.
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