FACTORS LEADING TO POOR ADHERENCE TO SECONDARY PROPHYLAXIS OF RHEUMATIC FEVER

Objectives: The objective of this study was to determine the level of adherence and possible barriers to secondary prophylaxis among patients with Rheumatic heart disease (RHD). Methodology: It is a cross-sectional study conducted at the largest tertiary care cardiac center of Karachi, Pakistan. We included patients with RHD, based on transthoracic echocardiography and adherence to the secondary prophylaxis and possible barriers were assessed using a structured questionnaire. Results: Among total of 195 patients 66.7% (130) were female, mean age was 32.25 ± 13.78 years. Rural residents were 51.3% (100) and 59.5% (116) of the patients were illiterate. Benzathine Penicillin injection was prescribed to 56.4% (110) patients, out of them 70.0% (77) of the patients were counseled regarding duration of secondary prophylaxis. The most common reason for non-adherence was reported to be a painful injection (19.1%). Conclusion: Majority of the RHD patients are not being prescribed and effectively counseled regarding secondary prophylaxis. Low adherence to the secondary prophylaxis was observed and the common reasons for non-adherence were painful injection, non-availability of nearby health facility, friends/family advising them otherwise, allergic reaction, and patients feeling sick and unable to take injection.

Ethyl Chloride Spray for Sensory Relief for Botulinum Toxin Injections of the Hands and Feet

Background: Botulinum toxin injections are effective in the treatment of palmar and plantar hyperhidrosis, but discomfort has limited its use. Objective: To study the use of ethyl chloride medium-stream spray in reducing injection discomfort. Methods: We used ethyl chloride medium-stream spray, in conjunction with precooling by frozen ice packs, in our No Sweat Clinic for our most recent 51 consecutive cases of botulinum toxin injection. Results: Ethyl chloride spray greatly facilitated the injection procedure, and all patients completed the injections without hesitation or delay. Conclusion: Ethyl chloride medium-stream spray, in conjunction with precooling by frozen ice packs, is highly effective in reducing painful injection sensations. Its use is safe, economical, and easy to learn and does not require special equipment.