Patient-Centred Management Of Polypharmacy: A Process For Practice

Лекарствата са най-често срещаната интервенция за подобряване на здравето. Броят лекарства, приемани от по-възрастните хора във Великобритания стабилно расте през последните три десетилетия. „Свръхупотреба на лекарства` („полифармация` - ‘polypharmacy`) е термин, който означава предписване или приемане на много лекарства. Нараства загрижеността в средите на първичната и специализираната медицинска помощ относно рисковете на свръхупотребата на лекарства. Тези тревоги са основани на данни за зависимост между свръхупотребата на лекарства и повишената честота на нежелани лекарствени реакции, хоспитализации, увеличени разходи за здравеопазване и неспазване на назначеното лечение. За Великобритания през последните 20 години това в голяма степен може да се отдаде на по-големия спектър налични лечения, базирани върху доказателства, насърчавани чрез терапевтични указания. Тези лечения са предназначени за отделни заболявания, за сметка на комплексен подход към едновременното наличие на повече болести (мултиморбидността), което засяга много пациенти в напреднала възраст. Също така в момента няма достатъчно национални указания, базирани върху доказателства, за намаляване и спиране на лекарства и отчитане на позицията на пациента. В тази статия се прави обзор на наличната литература във Великобритания за свръхупотребата на лекарства, с описание на четири ключови ресурса, всички от които ползващи международна литература и визиращи лекарствените аспекти на свръхупотребата на лекарства от гледна точка на клинициста. Подходът, ориентиран към пациента, съчетава както позицията на клиничните здравни професионалисти, така и на пациента. Материалът е разработен с ползване на съществуващия инструментариум и източници и е предназначен да насърчава извършването на прегледи на приеманите лекарства (medication reviews), които са на принципа на взаимодействието между пациент и клиничен специалист. Идеята е да се предостави информативна база за решения за спиране на лекарства и предприемане на мерки за управление на свръхупотребата на лекарства като част от цялостните стратегии за оптимизиране на лекарствата за пациентите. Представен е нагледно модел от седем стъпки, който включва указания за аспектите, които следва да се отчетат, действията, които да се предприемат и въпросите, които да се задават, за намаляване на свръхупотребата на лекарства и за безопасно преустановяване употребата на предписани лекарствени продукти.Medicines are the most common intervention to improve health. The number of medicines taken by older people in the UK has been steadily increasing for the last three decades. Polypharmacy is a term that refers to either the prescribing or taking many medicines. Concerns about the risks of polypharmacy in primary and secondary care are growing, supported by evidence which associates polypharmacy with increased adverse drug events, hospital admissions, increased healthcare costs and nonadherence. In the UK, this can largely be attributed, over the last 20 years, to the greater availability of evidencebased treatments promoted through therapeutic guidelines which are designed for single conditions, rather than addressing the multimorbidity that affects many older people. There is also currently a paucity of evidence-based national guidance around reducing and stopping medication and incorporating the patient perspective. This paper reviews current UK literature around polypharmacy including a description of four key resources which all make use of international literature and all focus on the medication aspects of polypharmacy from a clinician`s perspective. The patient-centred approach combines both clinical health professionals and patient perspective. Developed using existing resources, it is designed to assist with collaborative (patient and clinician based) medication review to inform decisions around deprescribing and address polypharmacy as part of overall strategies to optimise medicines for the patient. Presented as a diagrammatic representation in seven steps, it also includes guidance on points to consider, actions to take and questions to ask in order to reduce polypharmacy and undertake deprescribing safely

Antioxidant Properties of Phenolic Extracts of African Mistletoes (Loranthus begwensis L.) from Kolanut and Breadfruit Trees

Mistletoe (Loranthus begwensis L.) has been used ethno-botanically for the management of several tropical diseases for centuries; and the medicinal properties have been associated with their host plant. Therefore, this study sought to investigate the antioxidant properties of mistletoe from two host plants (breadfruit and kolanut trees). The result of the study revealed that mistletoe from kolanut tree (0.69 mg/g) had higher total phenol content than that of breadfruit tree (0.49 mg/g). Furthermore, the extracts chelate Fe2+ and scavenge DPPH radicals in a dose-dependent (0 – 30 mg/ml) pattern. Nevertheless, the EC50 revealed mistletoes from kolanut as having higher DPPH scavenging (15.77mg/ml) than that of breadfruit (16.29mg/ml), while L.begwensis from Breadfruit tree had higher Fe2+ chelating ability (1.97mg/ml) than that of Kolanut tree (2.23mg/ml). Likewise, mistletoe from kolanut (27.5mg/AAE g) had higher ferric reducing ability (FRAP) than that of breadfruit (22.0mg/AAE g). Although both mistletoe extracts showed promise as good antioxidant sources, the total phenol content and the antioxidant capacity pattern of the extracts suggest host dependency. Keywords: antioxidant, breadfruit tree, kolanut tree, Loranthus begwensis L

Two alternative pathways for docosahexaenoic acid (DHA, 22:6n-3) biosynthesis are widespread among teleost fish

Docosahexaenoic acid (DHA) plays important physiological roles in vertebrates. Studies in rats and rainbow trout confirmed that DHA biosynthesis proceeds through the so-called “Sprecher pathway”, a biosynthetic process requiring a Δ6 desaturation of 24:5n-3 to 24:6n-3. Alternatively, some teleosts possess fatty acyl desaturases 2 (Fads2) that enable them to biosynthesis DHA through a more direct route termed the “Δ4 pathway”. In order to elucidate the prevalence of both pathways among teleosts, we investigated the Δ6 ability towards C24 substrates of Fads2 from fish with different evolutionary and ecological backgrounds. Subsequently, we retrieved public databases to identify Fads2 containing the YXXN domain responsible for the Δ4 desaturase function, and consequently enabling these species to operate the Δ4 pathway. We demonstrated that, with the exception of Δ4 desaturases, fish Fads2 have the ability to operate as Δ6 desaturases towards C24 PUFA enabling them to synthesise DHA through the Sprecher pathway. Nevertheless, the Δ4 pathway represents an alternative route in some teleosts and we identified the presence of putative Δ4 Fads2 in a further 11 species and confirmed the function as Δ4 desaturases of Fads2 from medaka and Nile tilapia. Our results demonstrated that two alternative pathways for DHA biosynthesis exist in teleosts

Phenolic Extract from Moringa oleifera

This study was designed to determine the antioxidant properties and inhibitory effects of extract from Moringa oleifera leaves on angiotensin-I-converting enzyme (ACE) and arginase activities in vitro. The extract was prepared and phenolic (total phenols and flavonoid) contents, radical (nitric oxide (NO), hydroxyl (OH)) scavenging abilities, and Fe2+-chelating ability were assessed. Characterization of the phenolic constituents was done via high performance liquid chromatography-diode array detection (HPLC-DAD) analysis. Furthermore, the effects of the extract on Fe2+-induced MDA production in rats’ penile tissue homogenate as well as its action on ACE and arginase activities were also determined. The extract scavenged NO∗, OH∗, chelated Fe2+, and inhibited MDA production in a dose-dependent pattern with IC50 values of 1.36, 0.52, and 0.38 mg/mL and 194.23 µg/mL, respectively. Gallic acid, chlorogenic acid, quercetin, and kaempferol were the most abundant phenolic compounds identified in the leaf extract. The extract also inhibited ACE and arginase activities in a dose-dependent pattern and their IC50 values were 303.03 and 159.59 µg/mL, respectively. The phenolic contents, inhibition of ACE, arginase, and Fe2+-induced MDA production, and radical (OH∗, NO∗) scavenging and Fe2+-chelating abilities could be some of the possible mechanisms by which M. oleifera leaves could be used in the treatment and/or management of erectile dysfunction

Sedimentology of Acid Saline Lakes in Southern Western Australia: Newly Described Processes and Products of an Extreme Environment

Naturally acid saline systems with pH values between 1.7 and 4 are common on the Yilgarn Craton of southern Western Australia. a combination of physical and chemical processes here yield a previously undescribed type of modern sedimentary environment. Flooding, evapoconcentration, desiccation, and eolian transport at the surface, as well as influx of acid saline groundwaters, strongly influence these lakes. Halite, gypsum, kaolinite, and iron oxides precipitate from acid hypersaline lake waters. Shallow acid saline groundwaters affect the sediments of the lakes and associated mudflats, sandflats, channels, and dunes by precipitating early diagenetic halite, gypsum, iron oxides, clays, jarosite, and alunite. These modern environments would likely yield a rock record composed mostly of bedded red siliciclastic and reworked gypsum sand, alternating with less common beds of bottom-growth gypsum and halite, with alteration by early diagenetic features diagnostic of acid saline waters. This documentation of sedimentary processes and products of modern acid saline environments is an addition to the comparative sedimentology knowledge base and an expansion of the traditional models for classifying brines. Implications include better interpretations of terrestrial redbeds and lithified martian strata, improved acid remediation methods, new models for the formation and occlusion of pores, and the new setting for finding previously undescribed extremophiles

Drainage And Sedimentary Response Of The Northern Andes And The Pebas System To Miocene Strike-slip Tectonics: A Source To Sink Study Of The Magdalena Basin

Miocene strike-slip tectonics was responsible for creating and closing short-lived (ca. 6 Ma) passages and the emergence of isolated topography in the Northern Andes. These geological events likely influenced the migration and/or isolation of biological populations. To better understand the paleogeography of the Miocene hinterland and foreland regions in the Northern Andes, we conducted a source-to-sink approach in the Magdalena Basin. This basin is located between the Central and Eastern Cordilleras of Colombia and contains an ample Miocene record, which includes Lower Miocene fine-grained strata and Middle Miocene to Pliocene coarsening-up strata. Our study presents a new data set that includes detrital U–Pb zircon ages (15 samples), sandstone petrography (45 samples) and low-temperature thermochronology from the Southern Central Cordillera (19 dates); which together with previously published data were used to construct a paleogeographical model of the Miocene hinterland and foreland regions in the Northern Andes. The evolution of the Magdalena Basin during the Miocene was characterized by playa and permanent lake systems at ca. 17.5 Ma, which may be related to a marine incursion into NW South America and western Amazonia. The appearance of Eocene to Miocene volcanic sources in the Honda Group after ca. 16 Ma suggests the development of fluvial passages, which connected the Pacific with the western Amazonia and Caribbean regions. These passages were synchronous with a time of Miocene exhumation and topographic growth (ca. 16 to 10 Ma) in the Central Cordillera and the transition from lacustrine to fluvial deposition in the Magdalena Basin. Middle to Late Miocene strike-slip deformation promoted by oblique plate convergence and the oblique collision of the Panamá-Chocó Block likely explains the synchronous along-strike fragmentation and exhumation in the Central Cordillera

Carbonate crash and biogenic bloom in the late Miocene: Evidence from ODP Sites 1085, 1086, and 1087 in the Cape Basin, southeast Atlantic Ocean

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/95125/1/palo1086.pd

Garlic Accelerates Red Blood Cell Turnover and Splenic Erythropoietic Gene Expression in Mice: Evidence for Erythropoietin-Independent Erythropoiesis

Garlic (Allium sativum) has been valued in many cultures both for its health effects and as a culinary flavor enhancer. Garlic's chemical complexity is widely thought to be the source of its many health benefits, which include, but are not limited to, anti-platelet, procirculatory, anti-inflammatory, anti-apoptotic, neuro-protective, and anti-cancer effects. While a growing body of scientific evidence strongly upholds the herb's broad and potent capacity to influence health, the common mechanisms underlying these diverse effects remain disjointed and relatively poorly understood. We adopted a phenotype-driven approach to investigate the effects of garlic in a mouse model. We examined RBC indices and morphologies, spleen histochemistry, RBC half-lives and gene expression profiles, followed up by qPCR and immunoblot validation. The RBCs of garlic-fed mice register shorter half-lives than the control. But they have normal blood chemistry and RBC indices. Their spleens manifest increased heme oxygenase 1, higher levels of iron and bilirubin, and presumably higher CO, a pleiotropic gasotransmitter. Heat shock genes and those critical for erythropoiesis are elevated in spleens but not in bone marrow. The garlic-fed mice have lower plasma erythropoietin than the controls, however. Chronic exposure to CO of mice on garlic-free diet was sufficient to cause increased RBC indices but again with a lower plasma erythropoietin level than air-treated controls. Furthermore, dietary garlic supplementation and CO treatment showed additive effects on reducing plasma erythropoietin levels in mice. Thus, garlic consumption not only causes increased energy demand from the faster RBC turnover but also increases the production of CO, which in turn stimulates splenic erythropoiesis by an erythropoietin-independent mechanism, thus completing the sequence of feedback regulation for RBC metabolism. Being a pleiotropic gasotransmitter, CO may be a second messenger for garlic's other physiological effects

SJS/TEN 2019: From Science to Translation

Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) are potentially life-threatening, immune-mediated adverse reactions characterized by widespread erythema, epidermal necrosis, and detachment of skin and mucosa. Efforts to grow and develop functional international collaborations and a multidisciplinary interactive network focusing on SJS/TEN as an uncommon but high burden disease will be necessary to improve efforts in prevention, early diagnosis and improved acute and long-term management. SJS/TEN 2019: From Science to Translation was a 1.5-day scientific program held April 26-27, 2019, in Vancouver, Canada. The meeting successfully engaged clinicians, researchers, and patients and conducted many productive discussions on research and patient care needs