Exploring the limited use of transdermal medications in psychiatry:Challenges and potential solutions

Transdermal medications are an useful yet underutilized tool in the field of psychiatry.Despite numerous advantages of using this route of medication delivery,transdermal medications remain less popular compared to other routes of medication administration such as oral and intramuscular routes in the management of various psychiatric conditions.In this editorial,we examine the advantages of transdermal medications with a brief overview of transdermal being used in psychiatry and other medical specialties.We discuss the factors that play a role in their limited usage in psychiatry.We highlight certain patient categories who can specifically benefit from them and discuss potential solutions that can broaden the perspective of treating clinicians making this an intriguing avenue in the field of psychiatry.

Metabolic complications of psychotropic medications in psychiatric disorders:Emerging role of de novo lipogenesis and therapeutic consideration

Although significant advances have been made in understanding the pathophysiology of psychiatric disorders(PDs),therapeutic advances have not been very convincing.While psychotropic medications can reduce classical symptoms in patients with PDs,their long-term use has been reported to induce or exaggerate various pre-existing metabolic abnormalities including diabetes,obesity and non-alcoholic fatty liver disease(NAFLD).The mechanism(s)underlying these metabolic abnormalities is not clear;however,lipid/fatty acid accumulation due to enhanced de novo lipogenesis(DNL)has been shown to reduce membrane fluidity,increase oxidative stress and inflammation leading to the development of the aforementioned metabolic abnormalities.Intriguingly,emerging evidence suggest that DNL dysregulation and fatty acid accumulation could be the major mechanisms associated with the development of obesity,diabetes and NAFLD after long-term treatment with psychotropic medications in patients with PDs.In support of this,several adjunctive drugs comprising of anti-oxidants and antiinflammatory agents,that are used in treating PDs in combination with psychotropic medications,have been shown to reduce insulin resistance and development of NAFLD.In conclusion,the above evidence suggests that DNL could be a potential pathological factor associated with various metabolic abnormalities,and a new avenue for translational research and therapeutic drug designing in PDs.

Drug utilization evaluation of medications used in the management of neurological disorders

Background and object:The burden of neurological disorders in India is expected to increase due to the rapid demographic and epidemiological transition,with irrational drug use,which is also a global concern.Thus,drug utilization evaluation is designed to ensure appropriate medicine use within the healthcare settings.The aim of the study was to assess the rate and pattern of drug utilization in the management of neurological disorders.Materials and methods:A hospital-based cross-sectional drug utilization evaluation study on neurological drugs was carried out at the Department of Neurology over a span of six months.All legible prescriptions consisting neurological medications irrespective of patient's gender,aged≥18 years were included for the study.The World Health Organization(WHO)core drug use indicators were used to assess the drug prescribing and utilization patterns.Results:A total of 310 prescriptions were reviewed,where male predominance was found to be 56.45%.Out of 310 prescriptions,drugs belonging to 26 neurological classes were prescribed for the management of various neurological disorders.The majority of patients were diagnosed with epilepsy and the most prescribed drugs per patient were phenytoin(14.8%)and valproic acid(6.45%).By following the WHO core drug prescribing indicators,65.47%of drugs prescribed from the India National List of Essential Medicines,2022,followed by 29.83%of drugs prescribed in generic name and 10.86%of prescriptions including injections.Conclusion:The study findings showed that the prescribing pattern in the Department of Neurology was in accordance with the WHO core prescribing indicators.But,the extent of polypharmacy prescriptions was very high.Therefore,interventions are very necessary to promote rational drug prescribing patterns and thus clinical pharmacists can contribute to assess and review the drug utilization pattern to optimize the drug therapy and improvement in patient safety.

Prescription patterns of antidiabetic and cardiovascular preventive medications in community-dwelling older adults with type 2 diabetes mellitus:a cross-sectional study

OBJECTIVE To describe trends in antidiabetics drug prescription patterns in community-dwelling older adults with type 2 dia-betes mellitus(T2DM)and to evaluate the use of cardiovascular preventive medications among those diagnosed with atheroscler-otic cardiovascular disease(ASCVD).METHODS This cross-sectional,face-to-face interview study that comprised community-dwelling older adults(≥65 years)dia-gnosed with T2DM.The study questionnaire included the patients’demographics,clinical data,and current medication use.Pati-ents with established ASCVD were further classified into low(i.e.,not receiving evidence-based therapy or only one)and high(i.e.,receiving at least two evidence-based therapies)composite score groups.Bivariate analysis followed by multivariable logistic re-gression analysis were performed to evaluate the demographic/clinical characteristics associated with the use of antidiabetic mo-notherapy/polytherapy and evidence-based pharmacotherapy.RESULTS A total of 500 older adults were enrolled.The mean age of included participants was 73±7 years,310 participants(62%)were males,and 385 participants(77.0%)had established ASCVD.Antidiabetic monotherapy was reported in 251 partici-pants(50.2%),with metformin followed by sulfonylureas being the most commonly prescribed drugs as monotherapy.The results of the multivariable analysis showed that age[odds ratio(OR)=0.89,95%CI:0.85-0.94,P<0.001],obesity(OR=4.18,95%CI:1.63-10.36,P=0.003),hypertension(OR=4.2,95%CI:1.22-7.66,P=0.04),and dyslipidemia(OR=4.1,95%CI:1.28-8.30,P=0.01),were significantly associated with the prescription of cardiovascular preventive medications.CONCLUSIONS Only one in twenty-one participant with T2DM and ASCVD collectively received three guideline-recommen-ded therapies,indicating a deficiency of utilization of cardiovascular preventive drugs.

Medications in type-2 diabetics and their association with liver fibrosis

BACKGROUND The prevalence of nonalcoholic fatty liver disease(NAFLD) is significantly rising worldwide. Type-2 diabetes(T2D) is a major risk factor for NAFLD progression.AIM To assess the association of commonly used medications to advanced fibrosis(AF) in patients with biopsy-proven NAFLD and T2D.METHODS We used the International Classification of Disease 9 th Revision Clinical Modification coding system to identify patients with T2D and included patients who underwent liver biopsy for suspected NAFLD between January 1, 2000 to December 31, 2015. We compared demographics, clinical characteristics, and differences in pattern of medication use in patients who had biopsy-proven AF to those without it. A univariate and multivariate analysis was performed to assess the association of different classes of medication with the presence of AF.RESULTS A total of 1183 patients were included in the final analysis, out of which 32%(n =381) had AF on liver biopsy. Mean age of entire cohort was 52 years and majority were females(65%) and Caucasians(85%). Among patients with AF, 51% were on oral hypoglycemics, 30% were on insulin, 66% were on antihypertensives and 27% were on lipid lowering agents for the median duration of 19 mo, 10 mo, 26 mo, and 24 mo respectively. Medications associated with decreased risk of AF included metformin, liraglutide, lisinopril, hydrochlorothiazide, atorvastatin and simvastatin while the use of furosemide and spironolactone were associated with higher prevalence of AF.CONCLUSION In our cohort of T2D with biopsy proven NAFLD, the patients who were receiving metformin, liraglutide, lisinopril, hydrochlorothiazide, atorvastatin and simvastatin were less likely to have AF on biopsy, while patients who were receiving furosemide and spironolactone had a higher likelihood of having AF when they underwent liver biopsy. Future studies are needed to confirm these findings and to establish measures for prevention of NAFLD progression in patients with T2D.

Assessment of Knowledge, Attitude and Practices towards the Disposal of Unused and Expired Medications among Students of Private Medical Universities in Lusaka, Zambia

Background: The disposal of unused and expired medications has been a concern in many countries in that, the pharmaceutical waste enters the ecosystem and eventually causes a negative impact on human health and environment. Aim: To assess the knowledge, attitude and disposal practices of unused and expired medicines by students in the private medical universities in Lusaka of Zambia. Method: A cross-sectional survey was conducted over a period of 8 weeks among 391 respondents from three private universities in Lusaka. Respondents were polled using semi structured questions that focused on their knowledge, attitudes, and disposal practices for unused and expired drugs. In order to analyze data, the statistical package for social sciences (SPSS) version 20 was utilized. Results: The mean age of the participants was 23 years (SD: ±3). Out of the 391 participants, 320 (81.8%) knew about medicine waste and 391 (100.0%) responded that unsafe disposal of unused and expired medicine poses a threat to human health and can harm the environment. The drug-take-back system was unknown to a vast percentage of the respondent 371 (94.9%). The majority 274 (70.1%) of respondents had unused medicine stored at home, with antibiotics 215 (56.0%) and analgesia 111 (28.4%) being the most prevalent types of drugs kept in the households. The most commonly used disposal practice for unused 126 (32.2%) and expired medicines 274 (70.1%) was throwing them in household garbage. Only 27 (6.9%) and 30 (7.7%) reported returning unused and expired medicines to the nearest pharmacy respectively. The majority of respondents believed the risk stemmed from the presence of an undesired drug in the home, the potential for harm to children, a lack of proper information on safe disposal practices, and the necessity for a take-back program. Conclusions: The majority of the study participants used unsafe methods to dispose of unused and expired medicine. However, most of the participants acknowledged that unsafe disposal of unused and expired medicines is a public health problem and proposed the need to introduce drug take-back programs in the communities.

Poor awareness of preventing aspirin-induced gastrointestinal injury with combined protective medications

AIM:To investigate prescribing pattern in low-dose aspirin users and physician awareness of preventing aspirin-induced gastrointestinal(GI) injury with combined protective medications.METHODS:A retrospective drug utilization study was conducted in the 2nd Affiliated Hospital,School of Medicine,Zhejiang University.The hospital has 2300 beds and 2.5 million outpatient visits annually.Data mining was performed on all aspirin prescriptions for outpatients and emergency patients admitted in 2011.Concomitant use of proton-pump inhibitors(PPIs),histamine 2-receptor antagonists(H2RA) and mucoprotective drugs(MPs) were analyzed.A defined daily dose(DDD) methodology was applied to each MP.A further investigation was performed in aspirin users on combination use of GI injurious medicines [non-steoid anti-inflammatory drugs(NSAIDs),corticosteroids and clopidogrel and warfarin] or intestinal protective drugs(misoprostol,rebamipide,teprenone and gefarnate).Data of major bleeding episodes were derived from medical records and adverse drug reaction monitoring records.The annual incidence of major GI bleeding due to low-dose aspirin was estimated for outpatients.RESULTS:Prescriptions for aspirin users receiving PPIs,H2RA and MPs(n = 1039) accounted for only 3.46% of total aspirin prescriptions(n = 30 015).The ratios of coadministration of aspirin/PPI,aspirin/H2RA,aspirin/MP and aspirin/PPI/MP to the total aspirin prescriptions were 2.82%,0.12%,0.40% and 0.12%,respectively.No statistically significant difference was observed in age between patients not receiving any GI protective medications and patients receiving PPIs,H2RA or MPs.The combined medication of aspirin and PPI was used more frequently than that of aspirin and MPs(2.82% vs 0.40%,P < 0.05) and aspirin/H2RA(2.82% vs 0.12%,P < 0.05).The values of DDDs of MPs in descending order were as follows:gefarnate,hydrotalcite > teprenone > sucralfate oral suspension > L-glutamine and sodium gualenate granules > rebamipide > sucralfate chewable tablets.The ratio of MP plus aspirin prescriptions to the total MP prescriptions was as follows:rebamipide(0.47%),teprenone(0.91%),L-glutamine and sodium gualenate granules(0.92%),gefarnate(0.31%),hydrotalcite(1.00%) and sucralfate oral suspension(0.13%).Percentages of prescriptions containing aspirin and intestinal protective drugs among the total aspirin prescriptions were:rebamipide(0.010%),PPI/rebamipide(0.027%),teprenone(0.11%),PPI/teprenone(0.037%),gefarnate(0.017%),and PPI/gefarnate(0.013%).No prescriptions were found containing coadministration of aspirin and other NSAIDs.Among the 3196 prescriptions containing aspirin/clopidogrel,3088(96.6%) prescriptions did not contain any GI protective medicines.Of the 389 prescriptions containing aspirin/corticosteroids,236(60.7%) contained no GI protective medicines.None of the prescriptions using aspirin/warfarin(n = 22) contained GI protective medicines.Thirty-five patients were admitted to this hospital in 2011 because of acute hemorrhage of upper digestive tract induced by low-dose aspirin.The annual incidence rates of major GI bleeding were estimated at 0.25% for outpatients taking aspirin and 0.5% for outpatients taking aspirin/warfarin,respectively.CONCLUSION:The prescribing pattern of low-dose aspirin revealed a poor awareness of preventing GI injury with combined protective medications.Actions should be taken to address this issue.

Prevention of macrovascular complications in patients with type 2 diabetes mellitus: Review of cardiovascular safety and efficacy of newer diabetes medications

Lack of conclusive beneficial effects of strict glycemic control on macrovascular complications has been very frustrating for clinicians involved in care of patients with diabetes mellitus (DM). Highly publicized controversy surrounding cardiovascular (CV) safety of rosiglitazone resulted in major changes in United States Food and Drug Administration policy in 2008 regarding approval process of new antidiabetic medications, which has resulted in revolutionary data from several large CV outcome trials over the last few years. All drugs in glucagon-like peptide-1 receptor agonist (GLP-1 RA) and sodium-glucose cotransporter-2 (SGLT-2) inhibitor classes have shown to be CV safe with heterogeneous results on CV efficacy. Given twofold higher CV disease mortality in patients with DM than without DM, GLP-1 RAs and SGLT-2-inhibitors are important additions to clinician’s armamentarium and should be second line-therapy particularly in patients with T2DM and established atherosclerotic CV disease or high risks for CV disease. Abundance of data and heterogeneity in CV outcome trials results can make it difficult for clinicians, particularly primary care physicians, to stay updated with all the recent evidence. The scope of this comprehensive review will focus on all major CV outcome studies evaluating CV safety and efficacy of GLP-1 RAs and SGLT-2 inhibitors.

Presence of phthalates in gastrointestinal medications: Is there a hidden danger?

Pharmaceutical companies that produce gastrointestinal(GI)medications often utilize phthalates for their ability to localize medication release.Commonly prescribed GI medications that may utilize phthalates are 5-Aminosalicylates,proton pump inhibitors,and pancreatic enzymes.Our understanding of the cumulative health effects of phthalates from medications remains unclear,and there is increasing evidence that phthalates are not harmless.Experimental studies in animals have shown that phthalates,specifically dibutyl phthalate and Di-(2-ethyl-hexyl)phthalate,have the potential to alter and/or inhibit reproductive biology and in utero development.Despite the lack of definitive human data,many cohort and cross-sectional studies demonstrate concerning associations between phthalates and poor health status,specifically developmental problems.Longitudinal studies and studies with larger sample sizes are required to determine whether phthalates actually cause negative health consequences.It is also important that physicians regularly review and discuss with patients the medicinal ingredients in their medications and supplements,specifically in pregnant woman with inflammatory bowel disease.

Ischemic colitis after mesotherapy combined with anti-obesity medications

Mesotherapy and anti-obesity medications are gradually gaining worldwide popularity for purposes of body contouring and weight loss.Their adverse effects are various,but there is a tendency to disregard them.Ischemic colitis is one of the most common diseases associated with non-obstructive blood vessel disorders.However,there have been no case reports about the adverse effects resulting from mesotherapy only or in combination with anti-obesity medications.We report on an interesting case of ischemic colitis after mesotherapy combined with anti-obesity medications in a 39-year-old female who had no risk factors.

Angiotensin-converting enzyme 2 receptors,chronic liver diseases,common medications,and clinical outcomes in coronavirus disease 2019 patients

The severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),the virus responsible for coronavirus disease 2019(COVID-19),enters affected cells through the angiotensin-converting enzyme 2(ACE2)receptor,which is highly expressed in type II alveolar cells,enterocytes,and cholangiocytes.SARS-CoV-2 infection causes fever,dry cough,and breathing difficulty,which can progress to respiratory distress due to interstitial pneumonia,and hepatobiliary injury due to COVID-19 is increasingly recognized.The hepatobiliary injury may be evident at presentation of the disease or develop during the disease progression.The development of more severe clinical outcomes in patients with chronic liver diseases(CLD)with or without cirrhosis infected with SARS-CoV-2 has not been elucidated.Moreover,there is limited data related to common medications that affect the disease severity of COVID-19 patients.Additionally,ACE2 receptor expression of hepatobiliary tissue related to the disease severity also have not been clarified.This review summarized the current situation regarding the clinical outcomes of COVID-19 patients with chronic liver diseases who were treated with common medications.Furthermore,the association between ACE2 receptor expression and disease severity in these patients is discussed.

Medical influences,surgical outcomes: Role of common medications on the risk of perforation from untreated diverticular disease

Numerous drugs,largely used in the wards or at home,have a significant influence on patients with untreated diverticular disease.The consequences can be disastrous,may require an emergency operation,postoperative intensive care,and overall influence the patient’s length of stay and the final outcomes.Bearing these considerations in mind the routine or chronic administration of pain-killers,steroids and non-steroidal anti-inflammatory should be balanced in patients with known diverticular disease as it normally happens with other conditions potentially affected by these drugs(i.e.,peptic ulcer disease or chronic obstructive pulmonary disease).This is even more important in the old and frail patient where an eventual surgical treatment may not always be possible.

Effects of antiseizure medications on alternative psychosis and strategies for their application

Forced normalization(FN)is a unique phenomenon that is often seen in the treatment of epilepsy.FN is characterized by abnormal mental behavior and disordered emotions in epilepsy patients despite a significantly improved electroencephalogram and successful seizure control;the occurrence of FN seriously affects patients’quality of life.The causes of FN include antiseizure medications(ASMs),epilepsy surgery and vagus nerve stimulation,with ASMs being the most common cause.However,with the timely reduction or discontinuation of ASMs and the use of antipsychotic drugs,the overall prognosis is good.Here,we perform an extensive review of the literature pertaining to FN,including its epidemiology,possible mechanisms,clinical features,treatment and prognosis.

Improving Adherence to Prescribed Antidiabetics and Cardiovascular Medications in Primary Health Care Centers in Nyala City, South Darfur State-Sudan

Aims: Prospective pharmacist’s interventions aimed to improve patient’s knowledge and behaviors to adhere to medications in patients with type 2 diabetes with or without cardiovascular medical conditions in primary health care (PHCs) centers in Nyala city, South Darfur State, Sudan. Methodology and Materials: 300 patients were enrolled for assessing adherence with the Brief Medication Questionnaire (BMQ) in ten PHCs in Nyala city. We assessed patients’ responses to BMQ pre-and post-interventions plan by: complex interventions, humanitarianism and disease outcomes determined by health-related outcomes (SF-36), glycosylated hemoglobin (HbA1c) and blood pressure. Results: BMQ scores have improved significantly in four screens (pre-and post-interventions): regimen [4.6 ± 0.2 to 1.8 ± 0.1;P = 0.001], belief [1.6 ± 0.3 to 0.3 ± 0.3;P = 0.007], recall [1.7 ± 0.2 to 0.6 ± 0.2;P = 0.043] and access screens [1.8 ± 0.1 to 0.4 ± 0.1;P = 0.005];which have indicated an improved patients’ adherence to medications. Percentage of subjects reaching target of post prandial blood glucose (PPBG) have increased from 28.0% to 49.3%;[P = 0.02] post interventions. PPBG mean values have decreased significantly from [11.1 ± 0.6 mmol/L to 8.1 ± 0.8 mmol/L;<span

Adherence to Drug Medications amongst Tuberculosis Patients in a Tertiary Health Institution in South East Nigeria

Tuberculosis remains one of the major health problems in many tropical countries. An estimated eight to ten million people develop overt tuberculosis annually worldwide as a result of primary infection, endogenous reactivation or exogenous re-infection. About half of all patients with TB do not complete treatment and this contributes to prolonged infectiousness, drug resistance, relapse and death. This study is aimed at assessing the adherence of TB patients to anti-TB medications as well as the factors influencing drug adherence in a tertiary health care institution in South-Eastern Nigeria. A descriptive cross-sectional study was conducted among 217 TB patients in Nnamdi Azi-kiwe University Teaching Hospital, Nnewi. Information was obtained using a self-administered and interviewer administered semi-structured questionnaire. The mean age of the respondents is 36.1 ± 13.3 years. More of the respondents were females (58.1%), while 41.9% were males. It was observed that 74.2% had never failed to take their anti-TB drugs while 24.2% agreed they had failed to take their drugs. The major reasons for failure to take drugs were no money for transport to collect new drugs and forgetfulness by 32.7% of the respondents respectively. The factors which influenced drug adherence were educational qualification, average monthly income, ill-health as a financial burden and receiving HIV drugs

Enhancing Hospital Management of High-risk Medications by Computer PDCA-Cycle

Objective： To imensify management on high-alert Medications, ensure clinical medication safety. Methods： Statistical analysis was applied between before and after the implementation of PDCA-cycle in the management of high-alert Medications. Results： After PDCA- cycle, the rate of management of high-alert Medications increased from 59.5% to 94.6% （P〈0.01）, Conclusion： Our study suggested that the PDCA-cycle play an important role in the management of high-alert Medications, and then can increase the level of safety on management and utilization of medicine.

Study of Antimicrobial Activity of Medications for Wound Treatment

This paper presents data on the study of antimicrobial activity of 16 medications used for wound treatment. Antimicrobial activity of medications has been studied by well diffusion method on standard microorganism test strains： S. aureus ATCC 25923, E. coli ATCC 25922, P. aeruginosa ATCC 27853, P. vulgaris ATCC 4636, B. subtilis ATCC 6633, and C. albicans ATCC 885/653. Integrated indexes of antimicrobial activity of medications using vector theory have been calculated, which allowed to place most active of them in the order of descending activity： Levomecolum A = 2.73, r2 = 0.82; Levosin A = 2.41, r2 = 0.83; Synthomycinum A = 2.33, r2 = 0.97; Methyluracilum cum myramistino A = 2.31, r2 = 0.83; Oflocainum-Darnitsa A = 2.25, 1-2 = 0.97; and Betadine A = 2.03, r2 = 0.97. The mean of integrated indexes of antimicrobial activity and the square of the correlation coefficient for the group of these medications are as follows： A = 2.02, and r2 = 0.91. Comparison of mean values of integrated indexes of antimicrobial activity of medicines for wound treatment with those of water-alcohol extracts from plant raw material containing alkaloids, tannins, hydroquinone, naphthoquinones, anthraquinones, and phenols has shown to be promising of further development of domestic agents having antimicrobial activity based on water-alcohol extracts from plant raw material.

Analysis on Clinical Characteristics and Combination Medications of Elemene Injection in the Treatment of Esophageal Cancer in Real World Research

Objective:To explore the clinical characteristics of Elemene Injection in the treatment of patients with esophageal cancer.Methods:A total of 310 patients diagnosed with esophageal cancer from the Hoptital Information System(HIS)of 21 hospitals across the country were selected in the study,and these patients all had been treated with Elemene Injection.In this study,the clinical general medication record information,diagnosis scheme information,general treatment information and combined medications information were analyzed by frequency statistics and association rules.Results:Elemene Injection was used most in patients aged 46-65(177 cases,57.10%);male patients were more than female.Among the main diagnoses of the most seasons and solar terms in hospitalization,the top three diagnoses were esophageal malignant tumor,malignant tumor,and hypertension.In terms of combination medication,the combination of western medicine blood substitutes and perfusion fluids,general nutritional drugs,vitamins,antibacterial drugs,and immune-promoting drugs were the main ones;the combination of traditional Chinese medicine was mainly anti-tumor drugs(48.71%).In addition,among the combination medications,the highest frequency of Elemene Injection combined with western medicine and traditional Chinese medicine were Xiaoaiping Injection(消癌平注射液)and ascorbic acid.Conclusion:The main susceptible people of esophageal cancer was middle-aged around 46-65,and there were more male patients than female;through the first diagnosis of western medicine,it can be found that in addition to patients suffering from esophageal cancer or other cancers,patients with high blood pressure,heart disease,and diabetes could use Elemene Injection.Therefore,when receiving such patients,attention should be paid to checking whether the patient had such diseases.At the same time,when using Elemene Injection,it's necessary to pay attention to certain combined medications to avoid adverse reactions.

Adherence to cardiovascular medications in the South Asian population:A systematic review of current evidence and future directions

AIM: To review methods of assessing adherence and strategies to improve adherence to cardiovascular disease(CVD) medications,among South Asian CVD patients. METHODS: We conducted a systematic review of English language studies that examined CVD medication adherence in South Asian populations from 1966 to April 1,2015 in SCOPUS and Pub Med. Working in duplicate,we identified 61 studies. After exclusions,26 studies were selected for full text review. Of these,17 studies were included in the final review. We abstracted data on several factors including study design,study population,method of assessing adherence and adherence rate. RESULTS: These studies were conducted in India(n = 11),Pakistan(n = 3),Bangladesh(n = 1),Nepal(n = 1) and Sri Lanka(n = 1). Adherence rates ranged from 32%-95% across studies. Of the 17 total publications included,10 focused on assessing adherence to CVD medications and 7 focused on assessing the impact of interventions on medication adherence. The validated Morisky Medication Adherence Scale(MMAS) was used as the primary method of assessing adherence in five studies. Three studies used validated questionnaires similar to the MMAS,and one study utilized Medication Event Monitoring System caps,with the remainder of the studies utilizing pill count and self-report measures. As expected,studies using non-validated self-report measures described higher rates of adherence than studies using validated scale measurements and pill count. The included intervention studies examined the use of polypill therapy,provider education and patient counseling to improve medication adherence. CONCLUSION: The overall medication adherence rates were low in the region,which suggest a growing need for future interventions to improve adherence.

Effect of glaucoma on identification of bottle cap color in ophthalmic medications

A prospective, nonrandomized, observational trial of 60 glaucoma patients to correlate visual acuity and visual field with ability to distinguish bottle cap color of commonly used ophthalmic medications was conducted. A total of 103 eyes from 60 patients(30 women) were evaluated. The mean logMAR acuity was 0.34±0.54(approximately 20/45 Snellen acuity), average Humphrey Visual Field(HVF) mean deviation was-8.58±8.69 dB, mean Ishihara plates(out of 14) were 11.78±4.15, and bottle cap color score(out of 10) was 8.56±2.51. Multiple linear regression analysis revealed an independent correlation of visual acuity(P=0.0137) and Ishihara score(P<0.001) with cap color score, but no significant effect with visual field mean deviation(P>0.05). Glaucoma patients with poor visual acuity, but not necessarily advanced visual field loss, are likely to have difficultly identifying the color of their bottle caps. Physicians should be cognizant of this potential issue when reviewing medications with patients.