Validation of the Spanish version of the low vision quality of life questionnaire

PURPOSE: To validate Spanish Low Vision Qualify of Life (SLVQOL) questionnaire, a quality of life instrument specifically designed for patients with visual impairment, and evaluate its psychometric properties. METHODS: The study included 170 visually impaired patients and 195 healthy subjects. Participants were administered the SLVQOL, the NEI VFQ-25, and the EQ 5D-5L questionnaires. Reliability, test–retest reproducibility, feasibility, and construct validity of the SLVQOL were assessed. The Generalized Partial Credit Model was used to fit the data and the performance of each item was characterized using category response curves and item information. RESULTS: The reliability of the SLVQOL was 0.981 (95% CI: 0.978—0.985). Test–retest reproducibility was good (¿=0.864, P < .001). A cut-off point of 105 or 106 was optimal to detect visual impairment, with a sensitivity of 95.4% and a specificity of 91.8%. Construct validity was shown by the corresponding convergence or divergence correlations between the score of the SLVQOL and its dimensions and the overall and partial scores of the NEI VFQ-25 and the EQ 5D-5L. Item response theory analysis showed discrimination and information parameters ranging from 0.539 to 3.063 and from -1.894 to 1.074, respectively. CONCLUSION: The SLVQOL was able to quantitatively assess and identify differences in the quality of life among patients with visual impairment and normal subjects. The psychometric properties evaluated suggest that this tool has excellent validity, internal consistency, and reproducibility, but may benefit from a reduction of the number of items.Peer ReviewedPostprint (author's final draft

Drug Interactions With New Synthetic Opioids

Fentanyl, fentanyl analogs, and other new synthetic opioids (NSO) have burst onto the illegal drug market as new psychoactive substances (NPS). They are often sold as heroin to unsuspecting users and produce euphoria through their agonist action on μ- opioid receptors. Their high consumption, often combined with other substances, has led to multiple intoxications during recent years. In some countries, such as the United States, the consumption of opioids, whether for medical or recreational purposes, has become epidemic and is considered a public health problem. Fentanyl analogs are more potent than fentanyl which in turn is 50 times more potent than morphine. Furthermore, some fentanyl analogs have longer duration of action and therefore interactions with other substances and medicines can be more serious. This review is focused on the potentially most frequent interactions of opioid NPS taking into account the drugs present in the reported cases of poly-intoxication, including other illegal drugs of abuse and medication. Substances involved are mainly antidepressants, antihistamines, antipsychotics, benzodiazepines, analgesics, anesthetics, psychostimulants, other opioids, alcohol, and illegal drugs of abuse. The interactions can be produced due to pharmacokinetic and pharmacodynamic mechanisms. Naloxone can be used as an antidote, although required doses might be higher than for traditional opioid intoxications. It is crucial that doctors who habitually prescribe opioids, which are often misused by patients and NPS users, be aware of designer opioids' potentially life-threatening drug-drug interactions in order to prevent new cases of intoxication

Commercial cinema as a resource for learning Pharmacology

Commercial movies are increasingly used as a teaching method in many college disciplines. In medicine they are an important resource to teach some aspects of medicine that will gain a considerable benefit of being illustrated using the cinematographic language. Doctor-patient relationship, ethics dilemmas, or professionalism are the most considered in commercial movies. In the present paper we deal with the interest in the field of pharmacology, whose knowledge is in the frontier of basic and clinical fields. We review the use of movies for improving the teaching of pharmacology and clinical pharmacology. Some movies are especially useful to this purpose such as Awakenings (1990), Lorenzo's oil (1992), The constant gardener (2005) and more recently Dallas Buyers Club (2013). Some recommendations for its optimal use in the teaching of pharmacology and clinical pharmacology are included.Las películas comerciales se utilizan cada vez más como método de enseñanza en muchas disciplinas universitarias. En medicina son un recurso importante para enseñar algunos aspectos médicos al ser ilustrados usando el lenguaje cinematográfico. La relación médico-paciente, los dilemas éticos o el profesionalismo son alguno de los temas más presentes en las películas comerciales. En el presente manuscrito tratamos del interés del cine comercial en el campo de la farmacología, cuyo conocimiento está en la frontera de los campos básicos y clínicos. Revisamos el uso de películas para mejorar la enseñanza y aprendizaje de la farmacología y la farmacología clínica. Por ello describimos algunas películas que son especialmente útiles para este propósito, como Awakenings / Despertares de 1990, Lorenzo's oil / El aceite de Lorenzo de 1992, The constant gardener / El jardinero fiel de 2005 y más recientemente Dallas Buyers Club (2013). Se incluyen algunas recomendaciones para su uso óptimo en la enseñanza de farmacología y farmacología clínica

Association of hyperuricemia and gamma glutamyl transferase as a marker of metabolic risk in alcohol use disorder

Excessive alcohol consumption leads to overproduction of urates and renal function plays a critical role in serum uric acid levels. We aimed to assess associations of hyperuricemia in patients with alcohol use disorder (AUD) and comparable Glomerular Filtration Rate (GFR). A total of 686 patients undergoing treatment for AUD between 2013 and 2017 were eligible (77% men); age at admission was 47 years [interquartile range (IQR), 40-53 years], age of onset of alcohol consumption was 16 years [IQR, 16-18 years] and the amount of alcohol consumed was 160 g/day [IQR, 120-240 g/day]. Body Mass Index was 24.7 kg/m(2) [IQR, 21.9-28.4 kg/m(2)], eGFR was 105 mL/min/1.73 m(2) [IQR, 95.7-113.0 mL], 9.7% had metabolic syndrome and 23% had advanced liver fibrosis (FIB-4>3.25). Prevalence of hyperuricemia was 12.5%. The eGFR-adjusted multivariate analysis showed that relative to patients with GGT 300 U/L were 4.31 (95% CI 1.62-11.46) and 10.3 (95% CI 3.50-29.90) times more likely to have hyperuricemia, respectively. Our data shows that hyperuricemia in the context of AUD is strongly associated with serum GGT levels and suggest an increased cardio-metabolic risk in this population

Validation of the Spanish version of the Low Vision Quality of Life Questionnaire

Purpose: To validate the Spanish Low Vision Qualify of Life (SLVQOL) questionnaire, a quality of life instrument specifically designed for patients with visual impairment, and evaluate its psychometric properties. Methods: The study included 170 visually impaired patients and 195 healthy subjects. Participants were administered the SLVQOL, the NEI VFQ-25, and the EQ 5D-5L questionnaires. Reliability, test–retest reproducibility, feasibility, and construct validity of the SLVQOL were assessed. The Generalized Partial Credit Model was used to fit the data and the performance of each item was characterized using category response curves and item information. Results: The reliability of the SLVQOL was 0.981 (95% CI: 0.978–0.985). Test–retest reproducibility was good (ρ = 0.864, P < .001). A cut-off point of 105 or 106 was optimal to detect visual impairment, with a sensitivity of 95.4% and a specificity of 91.8%. Construct validity was shown by the corresponding convergence or divergence correlations between the score of the SLVQOL and its dimensions and the overall and partial scores of the NEI VFQ-25 and the EQ 5D-5L. Item response theory analysis showed discrimination and information parameters ranging from 0.539 to 3.063 and from −1.894 to 1.074, respectively. Conclusion: The SLVQOL was able to quantitatively assess and identify differences in the quality of life among patients with visual impairment and normal subjects. The evaluated psychometric properties suggest that this tool has excellent validity, internal consistency, and reproducibility, but may benefit from a reduction of the number of items

Disposition of Phytocannabinoids, Their Acidic Precursors and Their Metabolites in Biological Matrices of Healthy Individuals Treated with Vaporized Medical Cannabis

Inhalation by vaporization is a useful application mode for medical cannabis. In this study, we present the disposition of Δ9-tetrahydrocannabinol (THC), cannabidiol (CBD), their acidic precursors, and their metabolites in serum, oral fluid, and urine together with the acute pharmacological effects in 14 healthy individuals treated with vaporized medical cannabis. THC and CBD peaked firstly in serum and then in oral fluid, with higher concentrations in the first biological matrices and consequent higher area under the curve AUCs. Acidic precursors Δ-9-tetrahydrocannabinolic acid A (THCA) and cannabidiolic acid (CBDA) showed a similar time course profile but lower concentrations due to the fact that vaporization partly decarboxylated these compounds. All THC and CBD metabolites showed a later onset with respect to the parent compounds in the absorption phase and a slower decrease to baseline. In agreement with serum kinetics, THC-COOH-GLUC and 7-COOH-CBD were the significantly most excreted THC and CBD metabolites. The administration of vaporized medical cannabis induced prototypical effects associated with the administration of cannabis or THC in humans, with a kinetic trend overlapping that of parent compounds and metabolites in serum. The pharmacokinetics of cannabinoids, their precursors, and their metabolites in biological fluids of individuals treated with vaporized medical cannabis preparations showed a high interindividual variability as in the case of oral medical cannabis decoction and oil. Inhaled medical cannabis was absorbed into the organism earlier than decoction and oil. Cannabinoids reached higher systemic concentrations, also due to the fact that the acid precursors decarboxylated to parent cannabinoids at high temperatures, and consequently, the physiological and subjective effects occurred earlier and resulted with higher intensity. No serious adverse effects were observed

Author Correction : Association of hyperuricemia and gamma glutamyl transferase as a marker of metabolic risk in alcohol use disorder

Excessive alcohol consumption leads to overproduction of urates and renal function plays a critical role in serum uric acid levels. We aimed to assess associations of hyperuricemia in patients with alcohol use disorder (AUD) and comparable Glomerular Filtration Rate (GFR). A total of 686 patients undergoing treatment for AUD between 2013 and 2017 were eligible (77% men); age at admission was 47 years [interquartile range (IQR), 40-53 years], age of onset of alcohol consumption was 16 years [IQR, 16-18 years] and the amount of alcohol consumed was 160 g/day [IQR, 120-240 g/day]. Body Mass Index was 24.7 kg/m2 [IQR, 21.9-28.4 kg/m2], eGFR was 105 mL/min/1.73 m2 [IQR, 95.7-113.0 mL], 9.7% had metabolic syndrome and 23% had advanced liver fibrosis (FIB-4 > 3.25). Prevalence of hyperuricemia was 12.5%. The eGFR-adjusted multivariate analysis showed that relative to patients with GGT ≤ 50, those with GGT between 51 and 300 U/L and those with GGT > 300 U/L were 4.31 (95% CI 1.62-11.46) and 10.3 (95% CI 3.50-29.90) times more likely to have hyperuricemia, respectively. Our data shows that hyperuricemia in the context of AUD is strongly associated with serum GGT levels and suggest an increased cardio-metabolic risk in this population

Disposition of Cannabidiol Metabolites in Serum and Urine from Healthy Individuals Treated with Pharmaceutical Preparations of Medical Cannabis

The use of cannabis flowering tops with standardized amounts of active phytocannabinoids was recently authorized in several countries to treat several painful pathological conditions. The acute pharmacological effects and disposition of Δ-9-tetrahydrocannabinol (THC), cannabidiol (CBD), their acidic precursors and THC metabolites after oil and decoction administration have been already described. In this study, the disposition of CBD metabolites: 7-carboxy-cannabidiol (7-COOH-CBD), 7-hydroxycannabidiol (7-OH-CBD), 6-α-hydroxycannabidiol (6-α-OH-CBD), and 6-β-hydroxycannabidiol (6-β-OH-CBD) in the serum and urine of healthy volunteers was presented. Thirteen healthy volunteers were administered 100 mL of cannabis decoction in the first experimental session and, after 15 days of washout, 0.45 mL of oil. Serum and urine samples were collected at different time points, and the CBD metabolites were quantified by ultra-high-performance liquid chromatography-tandem mass spectrometry. The most abundant serum metabolite was 7-COOH-CBD, followed by 7-OH-CBD, 6-β-OH-CBD, and6-α-OH-CBD, after decoction and oil. Both 7-OH-CBD and the 6-α-OH-CBD showed similar pharmacokinetic properties following administration of both cannabis preparations, whereas 7-COOH and 6-α-OH-CBD displayed a significant higher bioavailability after decoction consumption. All CBD metabolites were similarly excreted after oil and decoction intake apart from 6-α-OH-CBD, which had a significantly lower excretion after oil administration. The pharmacokinetic characterization of CBD metabolites is crucial for clinical practice since the cannabis herbal preparations are increasingly used for several pathological conditions

Effects of mixing energy drinks with alcohol on driving-related skills

Energy drinks (EDs) reduce sleepiness and fatigue and improve driving performance whereas alcohol does just the opposite. Although it is a trendy combination among young people, the effects of alcohol mixed with EDs on driving performance have been poorly studied. The aim was to assess if there is an interaction between the effects of both drinks on driving-related skills as well as perceptions about driving ability.This work was supported by a grant from Ministerio del Interior, Dirección General de Tráfico-DGT (SPSIP2015-01798), Red de Trastornos Adictivos-RTA (SPIP2015-01798), Red de Trastornos Adictivos-RTA (RD16/0017/0010), Plan Nacional Sobre Drogas (PNSD 2018I037). Clara Pérez-Mañá and Esther Papaseit benefited from Juan Rodés fellowships (ISCIII, JR15/00005 and JR16/00020, respectively). The author’s work was independent from sources of funding.Peer ReviewedPostprint (published version