A study to evaluate the potential contribution of medication use to falls in elderly patients presenting to an acute hospital

Introduction: Falls in elderly patients is a growing burden on healthcare resources globally. 10-15% of presentations in those ≥65 years at acute hospital services is due to falls. Medicines and polypharmacy are modifiable risk factors for falls. Different classes of medicines increase the risk of falling to differing extents. Aims: The aim was to review the role of medicines in falls in elderly at Our Lady of Lourdes Hospital Drogheda (OLOL). The objectives were: 1: Examine polypharmacy. 2: Examine the implication of the top five classes of falls risk increasing drugs (FRIDs) as potential causative factors in falls. 3: Determine is there a difference in medicine profile between those residing at home and in Long Term Care Facilities (LTCFs). 4: Has the Clinical Pharmacist a role in reducing patients’ risk of future falls. Methods: Admission records in OLOL were checked daily for elderly patients admitted due to a fall. When consent was granted data was collected from their records. Results: 94 patients met the inclusion criteria. 53 were recruited, 41 were excluded. Only 1 LTCF resident was recruited for the study, therefore objective 3 could not be examined. The Falls Risk Odds Ratio (FROR) was reduced for benzodiazepines, ACEi’s, ARB’s and diuretics but it was not a statistically significant reduction in FROR (p=0.22). Polypharmacy: Patients on ≥ 5 medicines on admission (41) 77%; Patients on ≥ 5 medicines on review (44) 83%; Polypharmacy by Medicine Class : Antipsychotics 100%; Benzodiazepines 100% ; Sedatives 100% Antidepressants 94%; Antihypertensives 76%. No of patients on ≥1 FRID: 94.3%. FRID prescribing by class: Antihypertensives 79.2%; Antidepressants 30.2%; Benzodiazepines 13.2%; Sedatives 11.3% ; Antipsychotics 1.9%. Clinical Pharmacist Recommendations Actioned Overall 41.7%. Actioned per FRID class: Antihypertensives 57.9%; Benzodiazepines 28.7%. Conclusions: Pharmacists have a role to play in highlighting polypharmacy and the prescribing of FRIDs

Predicting amputation and multiple debridements in tooth knuckle injuries

Background: Tooth knuckle injuries can be expensive to treat and may necessitate amputation in some cases. Several limitations exist in the literature regarding our knowledge around the factors predicting amputation and the need for multiple debridements in treating this injury. Methods: A historic cohort study of 321 patients treated for tooth knuckle injuries was undertaken. Twenty-one demographic, clinical and laboratory variables were collected. Two outcome measurements were collected - the need for amputation and the need for more than one surgical debridement. A multivariate logistic regression was performed to determine the relationship between the predictor variables and the outcome measurements. Results: Of the 321 patients examined, 1.6% required amputations and 25% required multiple debridements. Osteomyelitis was found to be a major predictor for amputation in these patients (OR = 35). Delayed presentation (OR = 1.1) and diabetes (OR = 2.6) were found to significantly increase the risk of requiring multiple debridements. Conclusions: Our models were able to predict what patients were at the greatest risk for amputation and multiple debridement. Reducing rates of osteomyelitis and delays in presentation may help reduce the incidence of amputation and reoperation in this injury

Ultrafast studies of the photophysics of cis and trans states of the green fluorescent protein chromophore

Cis–trans photoisomerization is proposed as a key process in the photoswitching of some photoactivatable fluorescent proteins. Here we present ultrafast fluorescence measurements of the model GFP chromophore (HBDI) in the cis state and in a mixture of the cis and trans states. Our results demonstrate that the mean lifetimes of the cis and trans states are remarkably similar. Therefore, the specific isomer of the chromophore cannot be solely responsible for the different photophysics of the bright and dark states of photoactive proteins, which must therefore be due to differential interactions between the different isomers of the chromophore and the protein

Ultrafast Studies of the Photophysics of Cis and Trans States of the Green Fluorescent Protein Chromophore

Cis–trans photoisomerization is proposed as a key process in the photoswitching of some photoactivatable fluorescent proteins. Here we present ultrafast fluorescence measurements of the model GFP chromophore (HBDI) in the cis state and in a mixture of the cis and trans states. Our results demonstrate that the mean lifetimes of the cis and trans states are remarkably similar. Therefore, the specific isomer of the chromophore cannot be solely responsible for the different photophysics of the bright and dark states of photoactive proteins, which must therefore be due to differential interactions between the different isomers of the chromophore and the protein

Ultrafast Studies of the Photophysics of Cis and Trans States of the Green Fluorescent Protein Chromophore

Cis–trans photoisomerization is proposed as a key process in the photoswitching of some photoactivatable fluorescent proteins. Here we present ultrafast fluorescence measurements of the model GFP chromophore (HBDI) in the cis state and in a mixture of the cis and trans states. Our results demonstrate that the mean lifetimes of the cis and trans states are remarkably similar. Therefore, the specific isomer of the chromophore cannot be solely responsible for the different photophysics of the bright and dark states of photoactive proteins, which must therefore be due to differential interactions between the different isomers of the chromophore and the protein

PD1 blockade potentiates the therapeutic efficacy of photothermally-activated and MRI-guided low temperature-sensitive magnetoliposomes

This study investigates the effect of PD1 blockade on the therapeutic efficacy of novel doxorubicin-loaded temperature-sensitive liposomes. Herein, we report photothermally-activated, low temperature-sensitive magnetoliposomes (mLTSL) for efficient drug delivery and magnetic resonance imaging (MRI). The mLTSL were prepared by embedding small nitrodopamine palmitate (NDPM)-coated iron oxide nanoparticles (IO NPs) in the lipid bilayer of low temperature-sensitive liposomes (LTSL), using lipid film hydration and extrusion. Doxorubicin (DOX)-loaded mLTSL were characterized using dynamic light scattering, differential scanning calorimetry, electron microscopy, spectrofluorimetry, and atomic absorption spectroscopy. Photothermal experiments using 808 nm laser irradiation were conducted. In vitro photothermal DOX release studies and cytotoxicity was assessed using flow cytometry and resazurin viability assay, respectively. In vivo DOX release and tumor accumulation of mLTSL(DOX) were assessed using fluorescence and MR imaging, respectively. Finally, the therapeutic efficacy of PD1 blockade in combination with photothermally-activated mLTSL(DOX) in CT26-tumor model was evaluated by monitoring tumor growth, cytokine release and immune cell infiltration in the tumor tissue. Interestingly, efficient photothermal heating was obtained by varying the IO NPs content and the laser power, where on-demand burst DOX release was achievable in vitro and in vivo. Moreover, our mLTSL exhibited promising MR imaging properties with high transverse r 2 relaxivity (333 mM −1 s −1), resulting in superior MR imaging in vivo. Furthermore, mLTSL(DOX) therapeutic efficacy was potentiated in combination with anti-PD1 mAb, resulting in a significant reduction in CT26 tumor growth via immune cell activation. Our study highlights the potential of combining PD1 blockade with mLTSL(DOX), where the latter could facilitate chemo/photothermal therapy and MRI-guided drug delivery