Polypharmacy and Potential Drug Interactions Causing Neurological Symptoms in Geriatric Patients with Epilepsy

Objective:Polypharmacy brings with it the risk of potential drug interaction. This study aimed to investigate polypharmacy, potential drug interactions, the drug interactions causing neurological symptoms in geriatric patients with epilepsy, and diffenrences between drug interaction databases.Methods:The study included patients with epilepsy aged 65 and over (the demographic information, antiepileptic drug use, other chronic diseases, and medications of the patients were retrospectively recorded from their files). The use of 5 or more drugs was accepted as polypharmacy. Potential drug interactions were checked from 2 open access databases (database-1; database-2), and interacting drugs, interaction types, clinical results, and differences between databases were determined.Results:This study included 126 patients (56 females/70 males), the mean age was 73.13 ± 7.42 (65-92), and the mean duration of antiepileptic drug (69.8% monotherapy) use was 9.08 ± 13.68 (0.5-58) years. The most commonly used antiepileptic drug was levetiracetam (69.8%). Totally 88 patients had at least 1 central nervous system disease (except epilepsy), and 116 had a chronic diseases other than central nervous system disease. Polypharmacy frequency was 75.4%. The most commonly used drug groups with the highest potential drug interaction risk were antihypertensives (69%), antia ggreg ant-a ntico agula nts (67%), statins (44%), proton pump inhibitors (41%), and antidepressants (39%). The major, intermediate, and minor potential drug interactions for database-1 and database-2 were 44 versus 53; 586 versus 428, and 127 versus 70, respectively. The most important potential drug interactions were the increased risk of hemorrhage and thrombotic events, arrhythmia, and blood pressure changes.Conclusion:It is important to know about potential drug interactions (especially involving cardiac drugs, antidepressants, statins, and proton pump inhibitors) in the evaluation of the entire neurological picture of geriatric epilepsy patients

How effective are energy efficiency and renewable energy in curbing CO2 emissions in the long run? A heterogeneous panel data analysis

Energy efficiency and renewable energy are considered to be two indispensable solutions to control GHG (greenhouse gas) emissions. Moreover, industrialization is at the center of discussions on the roles of countries to reduce CO2 emissions. However, the literature is underprovided to understand the long run contribution of energy efficiency, renewable energy and industrial composition in reducing GHG emissions at the macro level. In this study, we differentiate the effects of economic activity, energy efficiency, economic structure and use of renewable energy resources on CO2 emissions. We develop energy efficiency indices for thirty six countries for the period of 1971-2009 and use a CCE (common correlated effects) estimator model that is consistent under heterogeneity and cross-sectional dependence. We find a positive significant effect of energy efficiency on CO2 emissions in the long-run. Similarly, substituting renewable energy for non-renewable energy reduces CO2 emissions in the long-run. Our results ensure widely discussed roles of energy efficiency and renewable energy in curbing CO2 emissions. Furthermore, the scale of economic activity measured by real income and industrialization have significant positive effect on CO2 emissions. (C) 2015 Elsevier Ltd. All rights reserved

Quality of Life in Multiple Sclerosis: Are Depressive Findings as Effective as Physical Disability?

Amaç: Multipl Sklerozda (MS) yaşam kalitesinin bozulması tedavi uyumunu ve klinik takibi güçleştirir. Çalışmamızda hastaların yaşam kalitesine etki eden faktörlerden fiziksel nedenler ile psikolojik olarak en fazla gözlenen depresif bulgular arasında karşılaştırma yaparak, bu konunun önemini vurgulamayı amaçladık. Yöntemler: Mc Donalds kriterlerine göre relapsing-remitting tanısı almış 100 hasta çalışmaya dahil edildi. Sosyodemografik özellikleri, hastalık başlangıç yaşları, hastalık süreleri, özürlülük düzeyleri, Beck Depresyon Ölçeği, Yorgunluk Şiddet Ölçeği ve Kısa Form Yaşam Kalitesi Ölçeği skorları kaydedildi. Bulgular: 65’i kadın, 35’i erkek 100 hastanın yaş ortalaması 35,21 ± 8,86 (min-max:18-63) yıldı. Ortalama Krutzke Genişletilmiş Dizabilite Durum Skalası (EDSS) skorları 1,65 ± 1,47 (min-max:0-6,5) olarak kaydedildi. Beck Depresyon Ölçeği skorları kadınlarda erkeklere göre daha yüksek gözlendi (13,8 ± 11,02 vs 10,17 ± 6,15; p:0,036). Depresyonu olan hastaların depresyonu olmayanlara göre; yorgunluk şiddet ve yorgunluk etki ölçeği skor ortalamaları daha yüksekken, yaşam kalitesi ölçeği skorları daha düşük izlendi (p<0,001). Depresyon varlığının ve EDSS skorlarının yaşam kalitesi skorlarına etkisi incelendiğinde, yaşam kalitesi ölçeği ile EDSS skorları arasında istatistiksel açıdan anlamlı negatif yönlü orta şiddette bir ilişki gözlendi (r=-0,508; p<0,001). Yaşam kalitesi ile depresyon skorları arasında istatistiksel açıdan anlamlı negatif yönlü orta şiddette bir ilişki saptandı (r=-0,507; p<0,001). Sonuç: MS hastalarının fiziksel özürlülüğü nedeniyle ortaya çıkan yaşam kalitesi bozukluğu benzer şekilde depresif bulgular için de geçerlidir. Sonuçlarımız fiziksel özürlülük oluşmaması için gereken özenin (tedavi seçimi, yeni tedavi arayışları gibi) depresif bulgular için de gösterilmesi ve multipl skleroz hastasına multidisipliner yaklaşımın gerekliliğini bir kez daha ortaya koymuştur.Objective: Impairment of multiple sclerosis (MS) life make it difficult to comply with treatment and the clinical follow-up. In our study we emphasized the importance of this problem, compared with the most common depressive results the physical factors that affect the quality of life for patients. Methods: 100 patients were included in the study who were diagnosed with re-transmission in accordance with Mc Donalds criteria. Social demographic properties, age, duration of the disease, levels of disability, Beck Depression Scale, Fatigue Severity Scale and Life Scale Short Form Quality were recorded. Results: The mean age was 35,21 ± 8,86 (min-max:18-63) years for 100 patients, 65 females and 35 males. Approximately 1.65 ± 1.47 Expanded Disability Status Scale (EDSS) scores (min-max. 00-6.5) were recorded. In women the rate of Beck Depression was higher than in men (13.8 ± 11.02 vs 10.17 ± 6.15; p: 0.036). The mean measures of fatigue severity and tiredness were higher, but the scale of the quality of life was lower (p<0.001) according to patients with no depression. On the basis of a statistically significant negativemoderate relationship between the quality of life scale and EDSS scores (r = -0.508; p < 0.001) when depression and EDSS scores were evaluated. The negative correlation between quality of life and depression values was statistically significant (r=-0.507; p < 0.001). Conclusion: For depressive findings, the quality of life disorder caused by MS patients are equally valid. Once again, our results have shown the need to ensure that depressive observations are avoided (such as medication availability, the need for a new procedure) and that a multidisciplinary approach is needed for patients with multiple sclerosis

Compound muscle action potential scan and MScanFit motor unit number estimation during Wallerian degeneration after nerve transections

Background Compound muscle action potential (CMAP) scan and MScanFit have been used to understand the consequences of denervation and reinnervation. This study aimed to monitor these parameters during Wallerian degeneration (WD) after acute nerve transections (ANT).Methods Beginning after urgent surgery, CMAP scans were recorded at 1-2 day intervals in 12 patients with ANT of the ulnar or median nerves, by stimulating the distal stump (DS). Stimulus intensities (SI), steps, returners, and MScanFit were calculated. Studies were grouped according to the examination time after ANT. Results were compared with those of 27 controls.Results CMAP amplitudes and MScanFit progressively declined, revealing a positive correlation with one another. SIs were higher in WD groups than controls. Steps appeared or disappeared in follow-up scans. The late WD group had higher returner% than the early WD and control groups.Conclusions MScanFit can monitor neuromuscular dysfunction during WD. SIs revealed excitability changes in DS