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Background: In the absence of acute phase reaction, ferritin concentration has been used as a standard measurement of iron stores. Low birth weight babies are at risk of developing iron lack because ferritin concentration at birth is influenced by duration of gestation, maternal iron status and conditions altering maternal–foetal iron exchange. Aim: The aim of this study was to determine the ferritin concentrations of low birth weight babies in comparison with that of normal birth weight babies. Materials and methods: Fortyfour normal birth weight (NBW) babies and 40 low birth weight (LBW) babies were recruited for the study. About 1.0ml of venous blood was drawn aseptically from each subject into a micro EDTA tube, centrifuged at 5000rpm for 5 minutes, the plasma separated into cryotubes and stored at-20oC until ready for quantitative determination of ferritin concentrations using direct immunoenzymatic colorimetric method. Data obtained was analysed statistically using the Statistical Package for Social Sciences (SPSS, version 23, Chicago, IL, USA). Results: Gestational age correlated positively with ferritin concentrations in LBW neonates (p

Fins are commonly utilized to enhance (dissipate) heat in various engineering systems that include heat exchangers. In the present investigation, the impact of multi-boiling and thermo-geometric factors on a convective–radiative rectangular porous fin subjected to the temperature-dependent thermal conductivity of linear and non-linear variations is discussed extensively. The governing equations describing the problem were formulated with the aid of Darcy law. Similarity variables were employed to reduce the models to non-dimensional form. The solution of the governing dimensionless equation is approximated using the RK4 and spectral local linearization methods. Before parametric analysis, the agreement between the two numerical methods was established. Findings reveal that the non-linear variation of thermal conductivity shows better thermal efficiency than the linear variation. An improvement in the multi-boiling heat transfer parameter retards the temperature distribution of the fin. Furthermore, increasing the thermo-geometric parameter will result in a progressive decrease in the temperature of the fin. The results obtained in this work will aid in the design of heat exchangers and other heat transfer equipments.

The purpose of this study was to develop prototype farm plans according to the multi-objective production goals of small-scale arable crop producers in Kogi State, Nigeria. A multi-stage sampling technique was used to select a total of 137 farm households in different local government areas (LGAs). A structured questionnaire complemented with interview schedule was used to collect primary data from the respondents. Descriptive statistics and linear goal programming were used for data analysis. The results obtained indicate that the optimal plan of generating an income of ₦242,076.20 requires 0.368 ha of melons, 0.044 ha of yam/maize mixture and 0.259 ha of sorghum/groundnuts. The optimal net profit was 44.05% higher than that achieved by implementing the existing plan. To meet family food requirements, the solution plan prescribed devoting 0.048 ha to cassava, 0.211 ha to sorghum, 0.368 ha to melons, 0.074ha to Bambara nuts, and 1.065 ha to sorghum/groundnuts to generate an income of ₦158,475.00. To minimize paid labour and generate an income of ₦168,325.50, the plan prescribed devoting 0.195 ha to rice, 0.502 ha to melons and 0.246 ha to Bambara nuts. Out of the three basic farm household objectives considered, meeting family food requirements and limiting labour expenditure were overachieved, whereas the objective of maximizing farm income was underachieved. A great deal of the existing staple food plan was found consistent with the prescribed optimal plan, except in the case of existing cassava and Bambara nut production which was falling short of the optimal production prescribed. The maize/groundnut production had the lowest shadow prices. However, land, labour, capital, agrochemicals, fertilizers and seeds constituted the limiting resources in the plan. It was found that these resources were not optimally allocated in the existing plan for arable crop activities. Therefore, the respondents were advised to utilize their resources as prescribed in the optimum plan, supported by farm advisory services in selecting good crop mixtures.

Abstract Background To assess the effects of policy of selective versus routine episiotomy on mother and baby for women delivering vaginally in Shanghai and whether the hospital type has any effect on the outcomes. Method This was a multi-center retrospective cohort study in Shanghai between March 2015 and May 2017. The study population were vaginal births with selective or routine episiotomy (n = 5478) in 20 secondary or tertiary hospitals. Main Outcome Measure was the incidence of severe perineal lacerations. The adjusted odds ratios (aOR) and 95% confidence intervals (CI) were estimated by logistic regression and presented as the effect sizes. All models were stratified by the utilization of level (secondary and tertiary) and type (general and Obstetric) of hospital. Results The primary outcome was not significantly different between vaginal births with routine and selective episiotomy. Patients with selective episiotomy had a lower risk of postpartum hemorrhage, and newborns in the selective episiotomy group had a lower risk of shoulder dystocia and Neonatal Ward compared to those with routine episiotomy. Newborns in selective episiotomy group had a lower risk of birth injury in tertiary hospital. However, newborns in selective episiotomy group had a higher risk of birth injury in general hospitals. Conclusion Selective episiotomy is safe and can be recommended over routine episiotomy in obstetric and tertiary hospital settings in China.

The COVID-19 vaccination is a crucial public health intervention for controlling the spread and severity of the SARS-CoV2 virus. COVID-19 vaccines have been developed in record time, but their deployment has varied across countries, owing to differences in health system capacity, demand for the vaccine, and purchasing power of countries. The aim of this rapid review is to summarize and synthesize experiences on COVID-19 vaccine service delivery and integration to inform future COVID-19 vaccination programming and contribute to the knowledge base for future pandemic management. A systematic search was conducted in PubMed, Scopus, and Global Index Medicus databases. Twenty-five studies were included in the analysis. Included studies spanned nine countries where COVID-19 vaccines were delivered through mass, mobile, and fixed-post vaccination service delivery models. There was limited evidence of integrating COVID-19 vaccines into routine services for pregnant women, people who inject drugs, and leveraging existing health programs to deliver COVID-19 vaccines to the general population. Common challenges reported were vaccine skepticism, lack of adequate health workers, and linguistic barriers to access. Partnerships with a variety of stakeholders and the involvement of volunteers were vital in overcoming barriers and contributed to the efficient functioning of COVID-19 vaccination programs.

Background: The presence of human leukocyte antigen (HLA) B*57:01 allele predicts hypersensitivity reaction (HSR) to abacavir (ABC), a nucleoside reverse-transcriptase inhibitor used for human immunodeficiency virus (HIV) treatment. However, the prevalence of this allele amongst Nigerians with HIV is yet to be established. We aimed to determine the prevalence of HLA-B*57:01 allele amongst Nigerians with HIV infection. Methods: We conducted a multicentre cross-sectional epidemiologic survey. Between April 2016 and April 2017, patients were enrolled across five HIV treatment facilities in Nigeria. Participants' demographic information and their history of ABC exposure were obtained, and venous blood was obtained for HLA typing. Results: One thousand five hundred and four (1504) adults were enrolled, with a mean age of 44.6 ± 10.7 years, 1078 (71.7%) were female. 1463 (97.3%) were on antiretroviral therapy. ABC use was reported by 12 (0.8%) participants and none reported HSR. Of 1500 blood samples that were processed, 1458 (97.2%) were successfully typed. Of these, 132 (9.1%) were HLA-B*57 positive using non-specific low-resolution HLA-B*5701 primer mix. On further analysis, none of the 132 samples (0%) had the HLA-B*5701 allele. Conclusion: HLA-B*5701allele is rare amongst Nigerians.

Abstract Background There is an increasing prevalence of women who tend to delay childbirth until a very advanced age. However, there is sparse data regarding very advanced maternal age (vAMA) and the interplay between vAMA and assisted reproductive technology (ART) on adverse perinatal outcomes. The study aimed to assess the risk of adverse maternal and neonatal outcomes of vAMA women (≥43 years), and to investigate the effect of maternal age on adverse maternal and neonatal outcomes in ART pregnancies. Methods Data was obtained from a population-based retrospective cohort of women who delivered in Ontario, Canada, between April 1st, 2012 and March 31st, 2015. The adjusted relative risks (ARR) and 95% confidence intervals (CI) for adverse maternal and neonatal outcomes were estimated by using multivariate log-binomial regression models among age groups. All models were stratified by the utilization of ART (ART and spontaneous conceptions). Results Women at vAMA had a higher risk of composite outcome comprised of preeclampsia, intrauterine growth retardation, stillbirth, and placental abruption than the younger counterparts (ARR = 1.38, 95% CI: 1.23–1.55 compared to mothers aged 20–34; ARR = 1.26, 95% CI: 1.12–1.42 compared to mothers aged 35–42). Increased risk of the primary outcome in ART compared to spontaneous conception was only observed in women aged 20–34 years (ARR = 1.24, 95% CI: 1.14–1.35). For women conceived with ART, the risk for the primary outcome significantly increased in women at vAMA (ARR = 1.29, 95% CI: 1.01–1.65 compared to mothers aged 20–34; ARR = 1.36, 95% CI: 1.06–1.74 compared to mothers aged 35–42). Conclusion Women at vAMA have higher risks of adverse maternal and neonatal outcomes. Although the utilization of ART may carry an independent role for adverse perinatal outcomes, it does not further enhance the adverse effect of vAMA.

The aim of this paper is to review the literature and identify orofacial manifestations of hematological diseases with special reference to hemato-oncologic, immuno-deficiency disorders, and human immunodeficiency virus infection. A computerized literature search using MEDLINE was conducted for published articles on orofacial manifestations of hematological diseases with emphasis on hemato-oncologic and human immunodeficiency virus (HIV) infection. Mesh phrases used in the search were: Oral diseases AND hematological disorders; orofacial diseases AND leukemias; orofacial lesions AND lymphomas; orofacial diseases AND multiple myeloma, orofacial manifestations AND HIV. The Boolean operator "AND" was used to combine and narrow the searches. The full texts of these articles were thoroughly examined. References in these articles also were manually searched non-Medline articles. Only relevant articles were selected for the review. Orofacial manifestation of malignant hematological diseases may present as primary clinical features due to infiltration of orofacial tissues, or as secondary due to the subsequent infiltration of normal bone marrow elements, or tertiary due to the side effects of the treatment. HIV-associated orofacial lesion may be a clinical indicator of HIV infection in otherwise healthy, undiagnosed individuals; an early clinical feature of HIV infection; clinical markers for the classification and staging of HIV disease or may be a predictor of HIV disease progression. Orofacial manifestations of malignant hematological diseases and HIV infection are not uncommon findings in clinical practice. These manifestations may be clinical indicators of hematologic disorders in otherwise healthy, undiagnosed individuals.

The aim of this paper is to review the literature and identify orofacial manifestations of hematological diseases, with particular reference to anemias and disorders of hemostasis. A computerized literature search using MEDLINE was conducted for published articles on orofacial manifestations of hematological diseases, with emphasis on anemia. Mesh phrases used in the search were: oral diseases AND anaemia; orofacial diseases AND anaemia; orofacial lesions AND anaemia; orofacial manifestations AND disorders of haemostasis. The Boolean operator "AND" was used to combine and narrow the searches. Anemic disorders associated with orofacial signs and symptoms include iron deficiency anemia, Plummer-Vinson syndrome, megaloblastic anemia, sickle cell anemia, thalassaemia and aplastic anemia. The manifestations include conjunctiva and facial pallor, atrophic glossitis, angular stomatitis, dysphagia, magenta tongue, midfacial overgrowth, osteoclerosis, osteomyelitis and paraesthesia/anesthesia of the mental nerve. Orofacial petechiae, conjunctivae hemorrhage, nose-bleeding, spontaneous and post-traumatic gingival hemorrhage and prolonged post-extraction bleeding are common orofacial manifestations of inherited hemostatic disorders such as von Willebrand′s disease and hemophilia. A wide array of anemic and hemostatic disorders encountered in internal medicine has manifestations in the oral cavity and the facial region. Most of these manifestations are non-specific, but should alert the hematologist and the dental surgeon to the possibilities of a concurrent disease of hemopoiesis or hemostasis or a latent one that may subsequently manifest itself.

Background. Anaemia is a common complication of human immunodeficiency virus (HIV) infection. The aim of this study was to investigate the impact of HIV infection and zidovudine on red blood cells (RBC) parameters and urine methylmalonic acid (UMMA) levels in patients with HIV infection. Material and Methods. A cross-sectional study involving 114 subjects, 94 of which are HIV-infected nonanaemic and 20 HIV negative subjects (Cg) as control. Full blood count parameters and urine methylmalonic acid (UMMA) level of each subject were determined. Associations were determined by Chi-square test and logistic regression statistics where appropriate. Results. Subjects on zidovudine-based ART had mean MCV (93 fL) higher than that of control group (82.9 fL) and ART-naïve (85.9 fL) subjects and the highest mean RDW. Mean UMMA level, which reflects vitamin B12 level status, was high in all HIV-infected groups but was significantly higher in ART-naïve subjects than in ART-experienced subjects. Conclusion. Although non-zidovudine therapy may be associated with macrocytosis (MCV > 95 fL), zidovudine therapy and ART naivety may not. Suboptimal level of vitamin B12 as measured by high UMMA though highest in ART-naïve subjects was common in all HIV-infected subjects.

Background. This study sought to identify the pattern of electrocardiographic changes in steady state adult sickle cell anaemia. Methods. A case-control, cross-sectional study was conducted amongst sickle cell patients attending the sickle cell clinic of Lagos State University Teaching Hospital, Ikeja, and HbAA controls. All consenting participants had haemoglobin electrophoresis done and were subjected to electrocardiography (ECG). The descriptive data were given as means ± standard deviation (SD). The differences were considered to be statistically significant when the p value obtained was

Background: Sickle cell disease is a genetic abnormality involving the haemoglobin. The consequent haemoglobin S causes polymerization of haemoglobin resulting in haemolysis and anaemia. Although, it is primarily a red cell disorders, the white blood cells and platelets are also affected by the mutation. The study aimed to provide baseline haematological values in sickle cell disease patients in steady state and compare the deviation from haemoglobin phenotype AA control values. Methods: A case-control study was conducted amongst homozygous sickle cell patients attending the sickle cell clinics of Lagos State University Teaching Hospital Ikeja and haemoglobin phenotype AA controls. A blood sample of 4.5mls was collected from each participant for full blood count analysis. All blood samples were screened for HIV and haemoglobin phenotypes confirmed using cellulose acetate haemoglobin electrophoresis at pH 8.6. Results: A total of 103 subjects and 98 controls were enrolled. Cases consisted of 57 (55.33%) females and 46 (44.66%) males, while controls were made up of 68 (69.38%) females and 30 (30.61%) males. The overall mean haemoglobin concentration, packed cell volume, mean cell volume, mean cell haemoglobin and mean cell haemoglobin concentration of the cases were 7.93±1.47, 24.44±4.68, 81.52±7.89, 26.50±3.20, 32.50±1.07 respectively, for the controls were 13.83±1.32, 43.07±3.95, 86.90±4.69, 28.50±1.34,32.06±0.90 respectively. The overall mean of white blood cell and platelet counts for the cases were 10.27±3.94 and 412.71±145.09 respectively and for the controls 5.67±1.59 and 222.82±57.62. Conclusion: Homozygous sickle cell disease patients have lower values of red cell parameters, but higher values of white cell and platelets counts compared to haemoglobin phenotype AA controls.

INTRODUCTION: Transmission of human T-lymphotropic viruses (HTLV) occurs from mother to child, by sexual contact and blood transfusion. Presently, in most centres in Nigeria, there is no routine pre-transfusion screening for HTLV. The study aims to determine the prevalence of HTLV-1 and HTLV-2 among healthy blood donors at a tertiary centre in Lagos. METHODS: A cross-sectional study was carried out at the blood donor clinic of the Lagos State University Teaching Hospital (LASUTH), Ikeja. About 5mls of venous blood was collected from each subject into a sterile plain bottle after obtaining subject's consent. The serum separated and stored at -200C. Sera were assayed for HTLV by an enzyme-linked immunoassay (ELISA) for the determination of antibodies to HTLV 1 and HTLV -2. Western blot confirmatory testing was done on reactive samples. All donors were also screened for HIV, HBsAg and HCV by rapid kits. RESULTS: The seroprevalence of HTLV -1 by ELISA was 1.0% and 0.5% by Western Blot among blood donors. A total of 210 healthy blood donors were enrolled. Only 2 (1.0%) blood donors were repeatedly reactive with ELISA test. On confirmatory testing with Western Blot, 1 (0.5%) blood donor was positive for HTLV. All the healthy blood donors were negative for HIV, HbsAg and HCV. None of the 210 blood donors had been previously transfused; as such no association could be established between transfusion history and HTLV positivity among the blood donors. CONCLUSION: The seroprevalence of HTLV in this environment is low among healthy blood donors.

The Kikuchi-Fujimoto is a rare, self-limiting disease, which is characterized by regional lymphadenopathy. It occurs worldwide with a higher prevalence among Asians and women below the age of forty years. We present 41-year-old Nigerian woman who was investigated extensively for unilateral left cervical lymphadenopathy. She was eventually diagnosed as having the Kikuchi-Fujimoto disease and was managed conservatively thereafter. We describe a case report and review of literature for better awareness of the disease amongst medical practitioners and pathologists in Africa.

Background. Priapism is a pathological condition of penile erection that persists beyond, or is unrelated to, sexual stimulation. Impotence and infertility are major problems in male sickle cell disease patients, and priapism has been implicated as a cause of impotence and infertility. The aim of this study is to determine priapism prevalence and assess the knowledge of male homozygous male patients about it in Lagos, Nigeria. Methods. A cross-sectional study was conducted amongst male homozygous sickle cell disease patients of Lagos State University Teaching Hospital. Pretested questionnaires were distributed to determine the prevalence and assess their knowledge on priapism. Data were analyzed using SPSS version 16.0. Results. A total of 114 consenting subjects filled the questionnaires, 85 of 114 (74.6%) had not heard about priapism before this study. A total of 77 of 114 (67.5%) did not know that they are at risk of priapism. Whilst 84 of 114 (73.7%) were not aware that priapism is a complication of SCD. The majority, 94 of 114 (82.5%), were not aware that priapism could cause impotence. Conclusion. There is a need to create more awareness about this complication amongst sickle cell disease patients in order to stem the incidence of impotence and infertility amongst them.

INTRODUCTION: Patients with human immunodeficiency virus (HIV) infection frequently present with a wide spectrum of pulmonary and cardiac complications from the virus, opportunistic infections and neoplasms that may be associated with a high mortality rate. Diseases of the respiratory tract account for about half of deaths from AIDS, while cardiac diseases account for more than a quarter of deaths from AIDS. This study aimed at determining the prevalence of pulmonary and cardiac diseases using a chest radiograph in HAART-naïve HIV-infected patients. METHODS: This study was conducted at Lagos State University Teaching Hospital (LASUTH) HIV clinic between September 2010 and August 2011 amongst all registered HAART-naïve HIV/AIDS patients. Patients had posterior-anterior chest radiographs done in full inspiration. Participants were asked and aided to fill the structured questionnaires to obtain demographic data. RESULTS: Out of a total of one hundred and two recruited for the study, 54 ( 52.94%) had a normal chest radiograph, while 48 (47.06%) had abnormal chest radiograph .The abnormal findings included, 27.45% who had bronchopneumonia, 6.86% cardiomegaly, 5.88% pulmonary tuberculosis, 5.88% radiological features of congestive cardiac failure, and 0.98% bronchitis. CONCLUSION: It appears that more than half of HAART,naïve HIV-infected patients have normal chest radiographs. Bronchopneumonia (27.5%) is the commonest pulmonary abnormality associated with HIV infection, while the prevalence of pulmonary tuberculosis is 5.88%.

Background. CD4 count measures the degree of immunosuppression in HIV-positive patients. It is also used in deciding when to commence therapy, in staging the disease, and in determining treatment failure. Using the CD4 count, this study aimed at determining the percentage of HIV-positives who require antiretroviral therapy at enrollment in an HIV treatment and care centre. Methods. The Baseline CD4 count, age and gender of 4,042 HAART-naïve patients, who registered between December 2006 and June 2010, at Lagos State University Teaching Hospital, Ikeja, were retrospectively studied. Data were analyzed using SPSS version 16.0 (Statistical Package for Social Sciences, Inc., Chicago, Ill). Results. Patients consisted of 2507 (62%) female and 1535 (38%) males. The mean age of males was years and that of females years. Overall, the mean CD4 count was of cells/mm3. The mean CD4 count of males was cells/mm3 and that of females cells/mm3. A total of 72.3% males, 64.3% females and 67.4% overall registered patients had CD4 count 500 cells/mm3 at registration. Conclusion. Females account for more than half of registered patients in HIV clinic and have a relatively higher CD4 count than males. About three-quarter of HIV positives require antiretroviral therapy at registration.

Promoting the intake of foods rich in vitamin A is key to combating the increase in vitamin A deficiency. This research focused on the utilization of orange-fleshed sweet potatoes (a tuber-based food), cowpea (a pulse), and ripe bananas (a fruit) for the production of flour mix as a means to reduce Vitamin A deficiency in children. Different ratios of sweet potato-cowpea-banana (PCB) mix, resulting in 8 different blended samples, were optimized. The flour mix was evaluated for its overall acceptability, vitamin A content, beta-carotene, and other nutritional and functional properties. The panelists rated the sweet potato-cowpea banana blends labeled PCB 8 (60% OFSP, 30% cowpea, 5% ripe banana flour, and 5% sugar) as most preferred and acceptable with average scores of 8.96 points for color, 8.75 points for flavor, 8.88 points for appearance, 8.33 points for taste, 8.07 points for texture, and 8.39 points for overall acceptability on a 9-point hedonic scale. The vitamin A and beta-carotene contents ranged 7.62 to 8.35 mg/100 g and 0.15-0.17 mg/100 g for all blends. A significant difference in the functional properties of the flour mix were observed with an increase in the ratio of sweet potato flour addition. Findings from this study show that the flour mix PCB 4 (65% sweet potato, 30% cowpea, and 5% ripe banana flour) was acceptable (8.15) and is recommended based on its vitamin A content (8.35 mg/100 g), nutritional properties, and functional properties. The study showed that locally available food commodities have good nutritional value that will help reduce vitamin A deficiency in children., (© 2024. The Author(s).)

This aim of this study was to evaluate the effects of pretreatments and temperature on the hot air drying characteristics of hog plum fruits. Hog plum fruits were pretreated with olive oil/K 2 CO 3 or sunflower oil/K 2 CO 3 at 28 °C and olive oil/NaOH cum blanching at 96 °C for 15s, hot water at 96 °C for 15s, and dried in a hot air drier at 50, 60, and 70 °C. Mathematical models were used to fit the data of drying and rehydration kinetics. Results showed that increase in temperature reduced drying time, increased effective diffusivity and shrinkage. Sunflower oil aided chemical pretreated sample had the shortest drying time (780 min) and highest effective diffusivity (6.3 × 10 -8 m 2 /s) at 60 °C, faster rehydration ability at 60 °C, highest retention rate for ascorbic acid (15 %), phenolic content (29 %), and antioxidant activity (12.3 %), while olive oil aided chemical (K 2 CO 3 ) pretreated sample had the shortest drying time at 50 °C (990 min) and 70 °C (600 min), lowest shrinkage (48.5 %), slower rehydration capacity at 40 °C, and lowest colour change (ΔE = 11.5). Modified Henderson and Pabis and Vega-Gálvez were superior to other fitting models in predicting the drying and rehydration kinetics. Sunflower oil/K 2 CO 3 pretreatment could help improve the drying and quality characteristics of hog plum., Competing Interests: The authors declare no conflict of interest., (© 2021 The Author(s).)

Cationic Malachite green has been identified as a candidate for the endocrine disruptive compound found in the environment. In this study, the mechanism and isotherm modeling of effective adsorption of cationic malachite green dye onto acid-functionalized maize cob (AFMC) was investigated by batch technique. The operational parameters such as initial concentration (100-600 mg/L); contact time (10-120 min) and pH (3-10) influenced the removal efficiency and quantity adsorbed. A maximum of 99.3% removal efficiency was obtained at optimum conditions. AFMC physicochemical properties (surface area 1329 m 2 /g and particle size 300 μm < Ф < 250 μm) enhanced its efficiency. Based on R 2  > 0.97 and consistently low values of adsorption statistical error functions (ASEF), equilibrium data were best fitted to Freundlich isotherm. Kinetic data were best described by a pseudo-second-order model with consistent R 2  > 0.98 and validated by ASEF. The mechanism of the process was better described by intraparticle diffusion. Evidence of the adsorption process was confirmed by the change in morphology via Scanning Electron Microscopy (SEM) and surface chemistry by Fourier Transform infrared (FTIR). The performance of AFMC enlisted it as a sustainable and promising low-cost adsorbent from agro-residue for treatment of endocrine disruptive dye polluted water., (© 2021. The Author(s).)

Background Prescription opioids are a central aspect of pain management and as the prevalence of pain is increasing so is the rate of use of prescription opioids. Increased opioid prescriptions increases the risk of deaths and morbidity. Objective To (a) describe the 22-year trend of prescription opioid dispensing in Queensland, (b) examine the effect of opioid dose, formulation and socioeconomic status on the number of prescriptions dispensed. Design/setting Retrospective analysis of data from the Monitoring of Drugs of Dependence system of the Monitored Medicines Unit of Queensland Health, Australia. Participants Queensland residents (3.3 million) from 18 years old dispensed 18.8 million opioid prescriptions from January 1997 to December 2018. Results Opioid prescriptions dispensed annually increased to over two million in 2018 from about 150,000 prescriptions in 1997. The number of prescriptions for modified-release formulations dispensed annually was three times higher compared to the immediate-release formulations. Oxycodone accounted for over 60% of prescriptions for pharmaceutical opioids since 2013. There was an increase in the number of prescriptions dispensed as socioeconomic status decreased and modified-release opioid formulations positively affects the pattern of dispensing. The highest increase in number of prescriptions dispensed (for all opioids) was observed among the high socioeconomic status (IRR = 1.25, 95% CI 1.25, 1.26). The disparities in the annual number of prescriptions across dose categories are wider in the modified-release than the immediate-release formulations. Conclusion The dispensing of opioids increased significantly in Queensland. There was a positive relationship between the increased dispensing of opioids and locations of lower socioeconomic status.

Background There is an association between the duration of prescription opioids use and an increased risk of serious harm, often unintentional. Objective (1) Describe the trends in duration of prescription opioids dispensing and, (2) determine the risk of long-term use (≥4 months) based on patients' socioeconomic status, daily dose in oral daily morphine milligram equivalent, and opioid formulation. Setting Residents of Queensland (2,827,727), Australia from the age 18 years and who were dispensed pharmaceutical opioids from 1 January 1997 to 31 December 2018. Method Retrospective, longitudinal population-based analysis using data obtained from the Monitoring of Drugs of Dependence system of the Monitored Medicines Unit of Queensland Health. Main outcome measure Contribution of socioeconomic status, and daily dose and opioid formulation (modified-release or immediate-release) to the risk of long-term opioid use. Results There was little difference between the number of patients dispensed opioids for ≥4 months and ≤3 months between 1997 and 2011. Thereafter, the number for those using opioids long-term increased. The highest risk of having opioids dispensed for ≥4 months were for patients in the lowest level of socioeconomic status (adjusted odds ratio 1.36; 95% CI, 1.34, 1.38), compared to people in the highest socioeconomic status areas, followed by the low-socioeconomic status areas, mid-socioeconomic status areas, and high-socioeconomic status areas respectively. The risk of being dispensed prescription opioids for ≥4 months significantly increased as the dose increased: adjusted odds ratio 1.73; 95% CI, 1.71, 1.75, adjusted odds ratio 1.89; 95% CI, 1.87, 1.92, and adjusted odds ratio 3.63; 95% CI, 3.58, 3.69 for the ≥20 to <50 oral daily morphine milligram equivalent, ≥50 to <100 oral daily morphine milligram equivalent and ≥100 oral daily morphine milligram equivalent dose categories, respectively. Conclusion Higher doses and living in a low socioeconomic status areas were associated with increased risk of long-term dispensing of opioid prescriptions.

Background: Accessing multiple prescribers for opioid prescription, referred to as doctor-shopping, is associated with an increased risk of opioid overdose and fatalities., Aim: The primary aim of this study was to assess the probability of accessing multiple prescribers among patients dispensed prescription opioids., Method: A retrospective population-based study using the Monitoring of Drugs of Dependence system of the Medicines Monitoring Unit (MMU) of Queensland Health, Australia. We assessed the odds of accessing multiple prescribers across both -short-term (≤1 month, 2-3 months) and longer-term (4-6 months and ≥7 months). We examined the relationship between multiple doctor visits, the dispensed dose of opioid and patient's residential socioeconomic status (SES)., Result: Compared to those dispensed opioid prescriptions for ≥7-12 months, those dispensed opioids for ≤1 month were more likely to have visited ≥3 prescribers (adjusted odds ratio (aOR)) 4.06, 95% CI 4.01, 4.10, while for 2-3 months and 4-6 months the odds were aOR 2.36, 95% CI 2.33, 2.39 and aOR 1.79, 95% CI 1.74, 1.79 respectively. Patients dispensed opioid doses of ≥100 oral morphine milligram equivalent per day (MME/day) were more likely to obtain prescriptions from ≥3 prescribers compare to those receiving a dose of <20MME/day (aOR 1.90; 95% CI 1.87, 1.94). The probability of obtaining opioid prescriptions from multiple prescribers increased as the socioeconomic status decreased: aOR 1.41; 95% CI 1.38, 1.44 for lowest SES compared to the highest SES., Conclusion: Patients were more than four time likely to be dispensed opioid prescriptions from multiple prescribers within the first 30 days of initiating opioid treatment, possibly as part of multidisciplinary referral post-hospital discharge. High dose opioid and low SES was associated with higher probability of accessing multiple prescribers., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background Ageing is associated with changes in physiology, functional ability, declined in cognition and multiple co-morbidities. Alterations in pharmacodynamic and pharmacokinetic aspects also occur. Medications can improve the quality of life in people with multiple co-morbidities; polypharmacy and ageing could increase risks of medication misadventures and adverse events leading to hospital admissions. Medication management services (MedsCheck, Diabetes MedsCheck and Home Medication Review) were implemented in Australia to: increase patients' knowledge about their medicines, increase patients' confidence in using their medicines, and reduce avoidable hospital admissions. Objective This study aims to investigate patients' awareness, understanding and uptake of medication management services in relation to medication adherence. Setting Study was conducted at the Maryborough hospital, Queensland, Australia. Method This was a questionnaire based prospective study. A questionnaire was developed based on the questions used in the evaluation of the MedsCheck and Diabetes MedsCheck pilot program. Main outcome/Result We identified 243 participants of which 198 patients agreed to participate. Of the participants, 68.1% were taking more than five different medications a day and 34.3% of participants were taking more than 10 different medications a day. Those that consumed five or more doses of medication a day constitutes 72%. Only 3% had accessed medication management services prior to hospital admission. Many of participants (76.3%) noted that they had issues with different generics/brands of medication and only 23.2% of participants stated that they had a good understanding of drug-drug interactions. Conclusion Hospitalised patients are unaware of medication management services that could reduce frequency of re-hospitalisation. Community and hospital pharmacists can play a major role increasing patients' awareness of the availability of these services.

Prescription opioid use has increased rapidly in developed countries, as have fatalities and other related adverse events. This review examines the intrinsic characteristics of opioids, including their mechanisms of action and pharmacokinetic and pharmacodynamic properties, to determine how the use of a regonised pharmacological remedy for a medically confirmed ailment could result in an accidental fatality. Opioids trigger biological processes that inhibit their own therapeutic effect. Prolonged use of opioids can result in activation of pronociceptive systems, leading to opioid-induced hyperalgesia and tolerance, while opioid metabolites can antagonise the antinociceptive action of the parent drug, also leading to opioid-induced hyperalgesia and tolerance. Pain stimulates respiration and counteracts the respiratory depression effect of opioids. Analgesia from opioids leads to loss of this protective mechanism, leading to increased risk of death due to respiratory failure. Increased patient counseling during opioid prescribing and dispensing, and limiting prescription to short-term use in non-malignant pain, may decrease the adverse effects of opioids. The vast majority of patients who unintentionally experience serious adverse events from pharmaceutical opioids do not start out as drug seekers. Even opioid use within prescribing guidelines can place some patients at risk of death and may prevent patients from seeking help for prescription opioid dependence.

Background: The rate of an unintentional drug overdose involving prescription opioids continues to rise. An understanding of the threshold dose and dose(s) associated with unintentional prescription opioid overdose will help to mitigate this epidemic., Objective: The objective of this systematic review is to systematically synthesise and meta-analyse studies on doses of prescription opioids and ascertain the doses of opioids that are associated with increased risk of severe opioid poisoning or mortality., Data Sources: A search of PubMed, EMBASE, CINAHL and Web of Science from inception to 16 January 2017 was conducted using search strategies and the MeSH (Medical Subject Headings) terms for studies of adult patients using prescription opioids who experienced an accidental overdose., Study Selection: Of the 1332 studies identified, 117 were selected for full article review. Ten met the inclusion criteria for qualitative analysis, but only seven studies were meta-analysed. The included studies were in English, and participants met predetermined International Classification of Diseases (ICD) codes. Studies were excluded if they included only paediatric participants or the participants met the ICD code for intentional self-harm., Data Extraction and Synthesis: Two researchers elaborated and validated a data extraction form. Data were then independently extracted by both reviewers as per this form. We assessed study quality using the Newcastle-Ottawa Scale (NOS) for non-randomised studies in meta-analyses. We performed a meta-regression using a random-effect model and summarised the results using relative risk (RR) and 95% confidence intervals (CIs). The threshold dose for an unintentional overdose is 20 morphine milligram equivalents (MME)/day. There were higher risks with larger doses: (1) ≤ 20 versus ≥ 21 MME/day: RR 2.81, 95% CI 1.09-7.22, p < 0.001; (2) ≤ 50 versus > 50 MME/day: RR 3.87, 95% CI 2.36-6.33, p < 0.001; (3) ≤ 100 versus > 100 MME/day: RR 4.28, 95% CI 2.61-7.1, p < 0.001; and (4) ≤ 50 versus > 50-100 MME/day: RR 3.09, 95% CI 1.84-5.18, p < 0.001). Heterogeneity was explained by the type of overdose event, inpatient or outpatient status, and length of observation. Type of pain (cancer or non-cancer pain) had no impact on heterogeneity., Limitations: The definition of exposure in studies included in the meta-analysis was heterogeneous. Some studies defined exposure as the filling of a prescription while others defined exposure as the prescription of an opioid to the patient, and all studies assumed that patients took the prescribed opioid. Medications that may contribute to overdose, such as benzodiazepines and other drugs, were not considered., Conclusions: A significantly increased risk of inadvertent prescription opioid overdose was found with 20-50 MME/day, with fatality more likely with opioid doses above 50 MME/day, although extensive heterogeneity was found with the dose comparisons. Clinicians should inform patients of this risk and monitor them closely., Protocol Registration: This protocol was registered with PROSPERO 2017: CRD42017058426.