Prognostic implications of thyroid disease in patients with atrial fibrillation

Atrial fibrillation (AF) is often accompanied by thyroid disease (THD). This study aimed to explore the relationship between THD and the occurrence of significant clinical outcomes in patients with AF. This post hoc analysis utilized data from the MISOAC-AF trial (NCT02941978), which enrolled hospitalized patients with AF. Patients were categorized based on their THD history into hyperthyroidism, hypothyroidism, or euthyroidism. Cox regression models were employed to calculate unadjusted and adjusted hazard ratios (aHRs). The primary outcomes of interest included all-cause mortality, cardiovascular death, and hospitalizations during the follow-up period. The study included 496 AF patients (mean age 73.09 ± 11.10 years) with available THD data, who were followed-up for a median duration of 31 months. Among them, 16 patients (3.2%) had hyperthyroidism, 141 (28.4%) had hypothyroidism, and 339 (68.4%) had no thyroid disease. Patients with hypothyroidism exhibited higher rates of hospitalization during follow-up (aHR: 1.57, 95% CI 1.12 to 2.20, p = 0.025) compared to the euthyroid group. Elevated levels of thyroid-stimulating hormone (TSH) were correlated with an increased risk of cardiovascular mortality (aHR: 1.03, 95% CI 1.01 to 1.05, p = 0.007) and hospitalizations (aHR: 1.06, 95% CI 1.01 to 1.12, p = 0.03). Conversely, lower levels of triiodothyronine (T3) were associated with higher risks of all-cause mortality (aHR: 0.51, 95% CI 0.31 to 0.82, p = 0.006) and cardiovascular mortality (aHR: 0.42, 95% CI 0.23 to 0.77, p = 0.005). Among patients with AF, hypothyroidism was associated with increased hospitalizations. Furthermore, elevated TSH levels and decreased T3 levels were linked to higher cardiovascular and all-cause mortality risks, respectively.

Pharmacists’ perceptions and views regarding gender inequality in the pharmacy workforce

Introduction

Gender equality, one of the main human rights, is a factor that catalyses the quality of healthcare. In the pharmacy workforce, there is evidence of gender inequality (GI). Females make up to 70% of the pharmacy personnel worldwide but they hold only 25% of leadership roles.1 This male-dominated leadership is a predictor of high rates of harassment.2 Sexual harassment (SH) is a sensitive topic, which concerns many professions. In the pharmacy profession, SH can happen at any point in the career. Nowadays, the dynamics of the lesbian, gay, bisexual, transgender, queer, or questioning (LGBTQ+) community (LGBTQ+c) have been growing, with its members claiming equal treatment with the rest of the society. LGBTQ+c may feel embarrassed and so avoid healthcare, which implies a poor health prognosis and exacerbates health inequalities.3

Aim

This study aimed to identify pharmacists’ perceptions regarding GI, their experiences in SH and to explore their behaviours and practice in LGBTQ+c in Greece.

Methods

This quantitative research used a survey-based questionnaire (consisting of 6 sections and 55 multiple-choice and Likert scale questions, including on demographics, designed after an extensive literature search. The study was conducted in Corfu (the 4th largest island in Greece) based on the local knowledge and convenience of the researcher. A pilot study was also conducted for the validity and reliability of the questions with no further changes. The questionnaires were distributed electronically (March/April 2022) in all 117 pharmacies in Corfu. The data underwent descriptive statistical analysis. Prior to data collection, all documentation was ethically approved by the Pharmaceutical Association of Corfu in Greece.

Results

In total, 90 pharmacists responded positively and completed the questionnaire (response rate of 77%). A total of 63,3% (n=57) of the sample were female and 36,7% (n=33) were male pharmacists. It was also identified through responses that although women are satisfactorily represented in the pharmacy profession (80%, n=72), the leading positions are occupied by men. (88.9%, n=80). Furthermore, it was observed that female pharmacists receive verbal violence and SH more often, both in the community pharmacy (96.6%, n=86) and in the university (66.3%, n=59). The effects of such behavior appeared to exert psychological pressure on the pharmacist, resulting in reduced performance (83.3%, n=75). Pharmacists (81.2%, n=73) expressed the need of a more specialised education on how to deal with patients from LGBTQ+c.

Discussion/Conclusion

This appears to be the first study exploring GI in the pharmacy profession in Greece, the forms in which it manifests, the ways of dealing with it, and the parameters regarding the management of LGBTQ+c in the pharmacy premises. The study’s limitations included the small sample size, the minimum data collection period (two months) and the location (Corfu); thus, the results might not be generalisable. In conclusion, further training may eliminate GI in the pharmacy workforce and contribute to the formation of a more multifaceted cognitive spectrum that will strengthen the pharmacists’ role in the provision of a fully integrated care to all patients and to provide a safe care environment for people belonging to the LGBTQ+c.

References

1. Health inequities and their causes. (n.d.). Retrieved January 31, 2022, from https://www.who.int/news-room/facts-in-pictures/detail/health-inequities-and-their causes

2. Martin, A., Naunton, M., & Peterson, G. M. Gender balance in pharmacy leadership: Are we making progress? Research in Social and Administrative Pharmacy, 2021, 17(4), 694– 700. https://doi.org/10.1016/J.SAPHARM.2020.05.031

3. Maxwell, E., Salch, S., Boliko, M., & Anakwe-Charles, G. Discrepancies in Lesbian, Gay, Bisexual, and Transgender Patient Care and How Pharmacists Can Support an Evolved Practice. American Journal of Pharmaceutical Education, 2017, 81(7). https://doi.org/10.5688/AJPE8176181

Management of external ear keloids using form-pressure therapy

Keloids are a frequent finding after physical trauma. Keloids of the pinna (helix and antihelix) as a complication of ear-piercing are the most difficult cases. Clinicians have tended to avoid the surgical approach, preferring local conservative treatment with corticosteroids or other treatments. We report use of intrakeloid resection and a form-pressure device to treat pinna keloids and avoid recurrence. The purpose is to maintain the form of the folds of the pinna. The recommendation for this therapy is to maintain the pressure at 24-30 mmHg, and the duration of the form-pressure therapy in our patients was about 25 weeks.

The effectiveness of mandibular infiltration compared to mandibular block anesthesia in treating primary molars in children

Mandibular infiltration has been routinely avoided in treating mandibular molars because of its questionable adequacy. The purpose of our investigation was to determine the effectiveness of mandibular infiltration compared with mandibular block in treating primary molars in children, and to relate the effectiveness to age and type of treatment performed. The study population consisted of 89 cooperative children, 3 to 9 years old, requiring the same type of treatment on contralateral mandibular molars. The half-mouth study design was used. Dental procedures included class I and II amalgam restorations, stainless steel crowns, formocresol pulpotomies, and extractions. Evaluations of pain and behavior for each anesthesia technique and type of treatment were made using sounds, motor, and ocular changes indicating pain and the Frankl Behavior Rating Scale. Evaluations were made upon probing, rubber dam placement, and during tooth preparation and extraction. No statistically significant differences was found between the two anesthetic techniques for either behavior or pain when performing amalgam or stainless steel crown restorations (P = 0.05). Mandibular infiltration was less effective than mandibular block for pulpotomy and extraction (P = 0.05). No significant relationship to age as determined by primary or mixed dentition, for effectiveness was noticed.