Propanolol and angiogenesis inhibition in hereditary haemorrhagic telangiectasia

Exploring symptoms perception and barriers to medication adherence among Thai Muslim patients with non-communicable diseases in a rural community in southern Thailand: a mixed-methods study

OBJECTIVES

This study aimed to explore the prevalence of medication non-adherence and influence of symptom perception and various barriers on medication adherence among Thai Muslim patients in a rural subdistrict of southern Thailand.

DESIGN

Explanatory sequential mixed-methods approach.

SETTING

A rural community in southern Thailand.

METHODS

Data collection spanned from March to December 2023. In the quantitative phase, 138 Muslim patients diagnosed with non-communicable diseases were enrolled, and their medication adherence and associated factors were assessed. In the qualitative phase, 22 participants were selected for in-depth interviews, and their symptom perceptions and the obstacles they faced in adhering to medication were explored. A focus group discussion involving 10 healthcare workers from a subdistrict health-promoting hospital was conducted to gain insights into healthcare providers' perspectives on patients' perceptions of symptoms and barriers to medication adherence.

OUTCOME MEASURES

Medication non-adherence was assessed, and the influence of symptom perception and various barriers on medication adherence was evaluated RESULTS: The prevalence of medication non-adherence in the study sample was 75.36%. The following factors were significantly associated with medication non-adherence: occupation (farmer) (adjusted OR=3.93; 95% CI 1.04 to 12.64), lack of recommendations on adjusting medication schedules/dosages during Ramadan (adjusted OR=2.65; 95% CI 1.06 to 6.61) and patients' perception of no symptoms (adjusted OR=3.72; 95% CI 1.23 to 11.25). The qualitative analysis highlighted patient-related issues, such as lack of symptom perception, limited health literacy regarding disease information and treatment and personal reasons for non-adherence (eg, forgetfulness, occupational constraints and transportation challenges for medical appointments). Additionally, healthcare system-related factors, patient-doctor relationships and communication gaps in medication management during Ramadan were identified as factors influencing medication non-adherence.

CONCLUSIONS

To improve adherence, healthcare providers should prioritise fostering positive patient-provider relationships and promoting patient care through enhanced health literacy initiatives.

Sclerotherapy and Topical Nasal Propranolol: An Effective and Safe Therapy for HHT-Epistaxis

OBJECTIVES

Epistaxis is the most frequent clinical manifestation of hereditary hemorrhagic telangiectasia (HHT). Several topical, systemic, and surgical treatments have been tried, but none have been completely effective. The aim of the present study is to evaluate whether a combined treatment sclerotherapy and topical therapy with propranolol 0.5% nasal formulation would reduce the epistaxis due to HHT and improve patient's quality of life.

METHODS

An observational cross-sectional study was carried out. The primary outcome measure was frequency and severity of epistaxis as measured by the epistaxis severity score (ESS) at baseline (4 weeks before therapy) and at least 4 weeks after the treatment was implemented. Quality of life was analyzed using EuroQol-5D (EQ-5D) scale and visual analogue (VAS) scale before and after treatment.

RESULTS

A total of 38 consecutive patients subjected to the combined treatment were evaluated (mean age: 57.2 years, standard deviation [SD] = 13.9; 60.5% women). The mean time of treatment was 37.1 weeks (SD = 14.9). Combined therapy significantly reduces frequency and severity of epistaxis, with an ESS improvement of 5 points from 6.9 ± 2.6 to 1.9 ± 1.3 (P < 0.05); however, the EQ-5D scale increased from 0.66 ± 0.27 to 0.93 ± 0.12 (P < 0.05). The difference in VAS means showed an increase from 44.6 ± 28.3 to 82.5 ± 12.5 (P < 0.05). The increases in quality of life are in line with the drop in ESS.

CONCLUSION

The study demonstrated that combined therapy (sclerotherapy and topical nasal propranolol) significantly reduced the epistaxis due to HHT and increased patients' quality of life.

LEVEL OF EVIDENCE

2c Laryngoscope, 129:2216-2223, 2019.

Syndrome in question

Rendu-Osler-Weber Syndrome also known as Hereditary Hemorrhagic Telangiectasia is a rare systemic fibrovascular dysplasia, with dominant autosomal inheritance. It is characterized by recurrent epistaxis, mucocutaneous telangiectasia, visceral arteriovenous malformation and positive family history. There may be hematologic, neurologic, dermatologic and gastrointestinal complications. Therapy is supportive and aimed at preventing complications. In this article we report a case of Rendu-Osler-Weber in a 64 year-old man, with history of mucocutaneous telangiectasia since the third decade of life, recurrent epistaxis, positive family history and vascular ectasia in the gastrointestinal tract.