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Use and Safety of Respiratory Medicines in Children

The lack of appropriately authorised and formulated medicines for use in the pediatric population is a longstanding problem and cause for concern. As a result, most medicines are prescribed to children on an off -label or an unlicensed basis. Dosing regimens approved for adults are extrapolated to pediatric age groups, for example on the basis of proportionality of weight, without pediatric pharmacokinetic or pharmacodynamic data. Safety and effi cacy are presumed to be the same as in adults, but this may not be the case. Evidence-based information in children is often not readily available, and prescribing decisions may have to be based on accepted practice presented in formularies. On January 26, 2007, the new regulation of the European Union (EU) on medicinal products for pediatric use came into force. The overall aim of the regulation is to improve the health of children in the EU. More specifi cally the objectives include: increasing the development of medicines for use in children; ensuring that medicines used to treat chi

TELEMEDICINE AND HEALTH POLICY CHANGES IN RESPONSE TO RESTRICTIONS RELATED TO COVID-19 PANDEMICS IN LATVIA

Publisher Copyright: Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.Objective: Remote consultations are quickly emerging to give more access to real-time, high-quality, efficient, and cost-effective healthcare in the current COVID-19 pandemic.Objective is to investigate the changing experiences of remote consulting for patients in Latvia and plan effective health policies, to provide a full analysis of the policy for telemedicine applications and solutions based on the current conditions.; Design and Method: Materials and approaches include an examination of normative documents as well as a variety of informational sources. The information offered is mostly based on national strategy papers, official reports, and scientefic publications on Tele-medicine implementation.; Results: Telemedicine's range will continue to expand, connecting patients and providers internationally as providers look to expand globally. This will not only help improve the long-term policies about health but may also provide patients with rare diseases alternative avenues to seek highly specialized care. Telemedicine strategy must react faster than ever during the COVID-19 epidemic. Latvia has reacted to Covid pandemics and have noticable implemented new possibilities to provide new approaches provided by telemedicine: providing remote consutlations to patients in different sectors, using E-referrals that were implemented but not sufficiently used before, providing more possibilites to provide remote services also for consiliums, physician-physiscan online consultations. New ICT tools were used for patient remote monitoring. The normative regulation, stategical decisions and changes in long-term policy documents haven't been changed, so there are limitations to provide the telemedice expansion or stable use after the emengency situation ends. Health policies about telemedicine have another key role with to pursuing that.; Conclusions: Telemedicine is fast expanding, demand for this service is rising. Although not a replacement for face-to-face consultations, this study illustrates that remote consulting can be an acceptable adjunct to traditional face-to-face consultations. More research is required to identify overall safety and applicability. Digital Health Strategy in Latvia is still on developing stage. Changes or legislation to clarify Telemedicine are still in the process. It is important to provide a good environment for Telemedicine to expand, setting strategies and visions on how those new approaches will be regulating normatively and administratively. (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)publishersversionPeer reviewe

LATVIA’S DOCTORS EXPERIENCE ON PROVIDING REMOTE CONSULTATIONS DURING COVID-19 PANDEMICS

Publisher Copyright: Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.Objective: Major challenge for health care service became a situation of a pandemic caused by COVID-19 infection, when doctors continued to provide care switching to remote consultations when possible. This provided better accessibility to receive consultation form doctor, and those consultations where sometimes the only way to be consulted for the patient.Aims of the study: To explore and analyze Latvia's doctors experience on providing remote consultations during COVID-19 pandemics.; Objective: 1) To detect the volume and type of work physicians are able to manage remotely. 2) To find out what technical, GDPR-associated and other difficulties face doctors during the process. 3) To define the general attractiveness of remote consulting.; Design and Method: Two groups of doctors filled in the questionnaires in year 2021.; Results: In one group, which consisted of 200 general practitioners, most respondents consider they could provide remote medical consultation about healthy lifestyle - 89,0% (n = 178); regarding check-ups, screening results - 86,5% (n = 173); to manage recommendations of other healthcare specialists - 66% (n = 132). Difficulties faced: 54,0% (n = 108) were not satisfied with payment, 22,5% (n = 45) admitted lack of specific skills, 45,5% (n = 91) found it problematic to make e-referrals. 61,0% (n = 122) like the idea of implementing services in practice on a regular basis. Another group, which consisted of 62 doctors of different specialties working in Clinical University Hospital. All doctors (62) were consulting by phone, 18 doctors only by phone, however 44 were consulting via e-mails, social network on video-conference platforms as well.Research revealed that the process of patient identification, search of patient's data and sensitive data transfer is complicated, time consuming and requires different approaches to manage.; Conclusions: Latvian doctors have experience in remote consulting. When consulting remotely Latvian doctors were facing technical, legal, social and other difficulties. Some Latvian doctors are interested in introducing remote consulting services in their practice, if the restrictive moments for their provision would be eliminated. As well as there is need for amendments in normative regulation for providing remote consultations, and challenges relates to payment system implementations especially for state paid services. (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)publishersversionPeer reviewe

Prevalence of odontogenic sinus tracts in patients referred for endodontic therapy

Objectives: The primary aim of this study was to assess the prevalence, location and distribution of odontogenic sinus tracts in a population of Turkish adult patients referred for endodontic therapy. The second aim was to investigate the influence of the factors such as sex, age, systemic disease, existence and diameter of periapical radioluceny on the prevalence of the clinically detected sinus tracts among Turkish population. Materials and Methods: A total of 499 patients’ records according to the demographic data and the presence of periapical radiolucency and of sinus tract were included to the present study. The location of the sinus tracts was recorded as well. Data were analyzed using Pearson chi-square and Fisher’s Exact Tests (p=0.05). Results: The number of the teeth who had sinus tracts was 37 (7.4%). Sixteen of 37 teeth with sinus tracts were associated with posterior teeth (43%). No significant differences were found in the prevalence of sinus tracts between two genders (p>0.05). 40-50 year age group showed the highest prevalence of sinus tracts. Conclusions: Approximately one in thirteen teeth referred for root canal treatment had a sinus tract. Fourty-three percent of sinus tracts were associated with posterior teeth with high prevalence of openings in buccal aspects of the gingiva. Therefore, practitioners should be careful while examining posterior teeth referred for endodontic treatment

Improving sensitivity of machine learning methods for automated case identification from free-text electronic medical records

Background: Distinguishing cases from non-cases in free-text electronic medical records is an important initial step in observational epidemiological studies, but manual record validation is time-consuming and cumbersome. We compared different approaches to develop an automatic case identification system with high sensitivity to assist manual annotators. Methods. We used four different machine-learning algorithms to build case identification systems for two data sets, one comprising hepatobiliary disease patients, the other acute renal failure patients. To improve the sensitivity of the systems, we varied the imbalance ratio between positive cases and negative cases using under- and over-sampling techniques, and applied cost-sensitive learning with various misclassification costs. Results: For the hepatobiliary data set, we obtained a high sensitivity of 0.95 (on a par with manual annotators, as compared to 0.91 for a baseline classifier) with specificity 0.56. For the acute renal failure data set, sensitivity increased from 0.69 to 0.89, with specificity 0.59. Performance differences between the various machine-learning algorithms were not large. Classifiers performed best when trained on data sets with imbalance ratio below 10. Conclusions: We were able to achieve high sensitivity with moderate specificity for automatic case identification on two data sets of electronic medical records. Such a high-sensitive case identification system can be used as a pre-filter to significantly reduce the burden of manual record validation

Effect of octreotide on oxidative stress in the erythrocyte and kidney tissue in adriamycin-induced experimental nephrotic syndrome model

Abstract Introduction: Nephrotic syndrome (NS) is one of the reasons of end-stage kidney disease, and elucidating the pathogenesis and offer new treatment options is important. Oxidative stress might trigger pathogenesis systemically or isolated in the kidneys. Octreotide (OCT) has beneficial antioxidant effects. We aimed to investigate the source of oxidative stress and the effect of OCT on experimental NS model. Methods: Twenty-four non-uremic Wistar albino rats were divided into 3 groups. Control group, 2 mL saline intramuscular (im); NS group, adriamycin 5 mg/kg intravenous (iv); NS treatment group, adriamycin 5 mg/kg (iv) and OCT 200 mcg/kg (im) were administered at baseline (Day 0). At the end of 21 days, creatinine and protein levels were measured in 24-hour urine samples. Erythrocyte and renal catalase (CAT) and thiobarbituric acid reactive substance (TBARS) were measured. Renal histology was also evaluated. Results: There was no significant difference among the 3 groups in terms of CAT and TBARS in erythrocytes. Renal CAT level was lowest in NS group, and significantly lower than the control group. In treatment group, CAT level significantly increased compared with NS group. In terms of renal histology, tubular and interstitial evaluations were similar in all groups. Glomerular score was significantly higher in NS group compared with control group and it was significantly decreased in treatment group compared to NS group. Conclusions: Oxidative stress in NS might be due to the decrease in antioxidant protection mechanism in kidney. Octreotide improves antioxidant levels and histology in renal tissue and might be a treatment option

Renal complications of lipodystrophy: A closer look at the natural history of kidney disease

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/144612/1/cen13732_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/144612/2/cen13732.pd

Assessment of pediatric asthma drug use in three European countries; a TEDDY study.

Asthma drugs are amongst the most frequently used drugs in childhood, but international comparisons on type and indication of use are lacking. The aim of this study was to describe asthma drug use in children with and without asthma in the Netherlands (NL), Italy (IT), and the United Kingdom (UK). We conducted a retrospective analysis of outpatient medical records of children 0-18 years from 1 January 2000 until 31 December 2005. For all children, prescription rates of asthma drugs were studied by country, age, asthma diagnosis, and off-label status. One-year prevalence rates were calculated per 100 children per patient-year (PY). The cohort consisted of 671,831 children of whom 49,442 had been diagnosed with asthma at any time during follow-up. ß2-mimetics and inhaled steroids were the most frequently prescribed asthma drug classes in NL (4.9 and 4.1/100 PY), the UK (8.7 and 5.3/100 PY) and IT (7.2 and 16.2/100 PY), respectively. Xanthines, anticholinergics, leukotriene receptor antagonists, and anti-allergics were prescribed in less than one child per 100 per year. In patients without asthma, ß2-mimetics were used most frequently. Country differences were highest for steroids, (Italy highest), and for ß2-mimetics (the UK highest). Off-label use was low, and most pronounced for ß2-mimetics in children <18 months (IT) and combined ß2-mimetics + anticholinergics in children <6 years (NL). CONCLUSION: This study shows that among all asthma drugs, ß2-mimetics and inhaled steroids are most often used, also in children without asthma, and with large variability between countries. Linking multi-country databases allows us to study country specific pediatric drug use in a systematic manner without being hampered by methodological differences. This study underlines the potency of healthcare databases in rapidly providing data on pediatric drug use and possibly safety