Medication-induced nausea assessment questionnaire and analysis of the factors that contribute to the manifestation of nausea

UVOD. Mučnina, neprijatan osećaj u predelu grla i/ili želuca, koji može i ne mora dovesti do povraćanja, je svesno prepoznavanje podsvesne ekscitacije u oblasti medule, blisko udružene sa delovima centra za povraćanje. Mučnina može biti uzrokovana: iritativnim impulsima iz gastrointestinalnog trakta, impulsima koji potiču iz donjih moždanih struktura, povezanim sa bolešću vožnje i impulsima iz cerebralnog kortkesa. Lekovi izazivaju mučninu u različitoj meri, što je od značaja kada treba izabrati terapiju kod pacijenta koji mučninu teško podnose i skloni su odustajanju od dalje terapije. Apstraktne koncepte (kakav je i mučnina) je teško kvantitativno izmeriti, i u tu svrhu koristimo upitnike. CILjEVI RADA. Studija je imala tri cilja: (1) prevođenje i transkulturološka validacija dela upitnika o gastrointestinalim simptomima iz ugla pacijenta (PROMISGSS deo koji se odnosi na mučninu i povraćanje); (2) razvoj i ispitivanje sopstvenog upitnika za procenu mučnine posle primene lekova, kroz utvrđivanje pouzdanosti, validaciju i faktorsku analizu; (3) utvrđivanje faktora koji doprinose prekidu terapije zbog ekstremne mučnine kod pacijenata na terapiji gvožđem. METODOLOGIJA. Skala koja meri gastrointestinalne simptomime iz ugla pacijenta (PROMIS-GSS deo koji se odnosi na mučninu i povraćanje), prevedena je na srpski jezik i izvršena je transkulturološka validacija iste. Prevod i kulturološka adaptacija skale urađena je u skladu sa preoprukama datim u ISPOR (International Society for Pharmacoeconomics and Outcomes Research) vodiču. Razvijen je i sopstveni upitnik za procenu mučnine posle primene lekova (DINS-Drug Induced Nausea Scale), utvrđeni su njegova pouzdanost, validnost i sprovedena faktorska analiza. Ispitivanje pouzdanosti upitnika obavljeno je kroz određivanje koeficijentaIV Kronbahova alfa za ceo upitnik, Spirman-Braunovog koeficijenta i srednje vrednosti i varijanse za svako pitanje iz upitnika. Punovažnost sadržaja upitnika evaluirala je grupa stručnjaka nezavisna od istraživača. Punovažnost povezana sa kriterijumom je testirana pomoću tri metode: poređenjem novog upitnika kada su ovaj popunili istraživači i pacijenti samostalno; konvergentna validnost je testirana poređenjem skora novog upitnika sa skorom PROMIS-GSS nausea; divergentna validnost testitrana je poređenjem skora novog upitnika sa skorom upitnika Netolerancije neizvesnosti (Intolerance Uncertanity). Analiza glavnih komponenti upitnika rađena je da bi se otkrili glavni faktori koje upitnik meri. Pogodnost upitnika i uzorka za faktorsku analizu testirana je pomoću Bartletovog testa sferičnosi i Kajzer-Mejer-Olkinovog testa adekvatnosti uzorkovanja. Faktori su ekstrahovani prvo bez rotacije, uz uslov da brojka koja označava količinu informacija koju nosi jedan faktor (eigenvalue) mora biti veći od 1 i korišćenjem Scree plot (ekstrahovani faktori bili su iznad ,,lakta“ dijagrama). Potom su referentne ose rotirane ortogonalno Varimaks metodom i urađena je još jedna ekstrakcija faktora, koristeći iste kriterijume kao za nerotirajuće rešenje. Vremenska stabilnost novog upitnika i PROMIS-GSS nauseaupitnika testirani su drugim popunjavanjem upitnika , koje su istraživači obavili dve nedelje posle prve posete apoteci. Prisustvo i stepen mučnine izazvane preparatima gvožđa meren je DINS-om. Studija je dizajnirana kao opservaciona, a metodologija rada je podrazumevala studiju preseka. Uzorak pacijenata je bio uzastopan tj. u studiju su uključeni svi pacijenti koji su posetili apoteku tokom trajanja studije (njih 128), a koristili su oralne preparate gvožđa. Anketiranje je izvršeno anonimno i na dobrovoljnoj osnovi. REZULTATI I ZAKLjUČCI. DINS skala meri jedan fenomen, intenzitet mučnine izazvane oralnim preparatima gvožđa. Ima odličnu pouzdanost (Kronbahova alfa 0.892, kada je ocenjen od strane istraživača,Spirmanov koeficijent 0.965; (p<0.001)) i vremensku stabilnost (Kronbahova alfa posle ponovljenog ocenjivanja bila je 0.901). DINS instrument pokriva suštinske aspekte mučnine, koji takođe mogu biti uključeni u fenomene gađenja i povraćanja: pojava (pitanje 2), učestalost (pitanje 3), trajanje (pitanje 1) i ozbiljnost (pitanja 4 i 5) Ovo istraživanje otkrilo je samo dva faktora za statistički značajnim uticajem na učestalost i stepen mučnine posle oralne primene preparata gvožđa: unos kafe i istorija gastroinestinalnih bolesti. U ovom istraživanju nije nađena veza između tipa soli gvožđa, dnevne doze ili doznog režima sa težinom mučnine. Prevođenjem i validacijom upitnika za merenje mučnine, kao i stvaranjem novog upitnika za merenje mučnine izazvane lekovima stvoreni su uslovi da se u kliničkoj praksi proceni u kojoj meri lek koji se uvodi u terapiju stvara gastrointestinalne tegobe kod pacijenta, te da li je neophodno odustajanje od terapije tim lekom i uvođenje drugog leka. KLjUČNE REČI. Upitnik; mučnina; preparati gvožđa; DINS; PROMISINTRODUCTION. Nausea, an unpleasant feeling in the throat and/or the stomach, which may or may not lead to vomiting, represents conscious awareness of the subconscious excitation in the medulla area, close to the brain’s vomiting center. Nausea can be caused by: irritative impulses in the gastrointestinal tract, impulses originating from the lower brain structures responsible for motion sickness, and impulses originating from the cerebral cortex. Medication can cause varying degrees of nausea. Abstract concepts such as nausea are difficult to measure quantitatively, so in order to do so, we use questionnaires. AIMS. The translation and transcultural validation of the part of the questionnaire dealing with gastrointestinal symptoms from the patient’s perspective (PROMIS-GSS), the part dealing with nausea and vomiting; The development and testing of the medication-induced nausea assessment questionnaire, determining its reliability, validation, and factorial analysis; Determining the factors which contribute to a cessation of treatment due to extreme nausea in patients taking iron supplements. A separate medication-induced nausea assessment questionnaire was developed (DINS-Drug Induced Nausea Scale). This instrument was factorially analyzed and has been determined to be reliable and valid. An interesting phenomenon was observed – medication-induced nausea, which is the most common reasonfor the cessation of otherwise effective treatments. A new nausea assessment questionnaire was developed according to the guidelines established by Robert F. The questionnaire’s reliability was assessed through calculation of: Cronbach’s alpha for the questionnaire as a whole, the Spearman-Brown coefficient and the average values and variance for each individual question found in the questionnaire. The validity of the questionnaire was evaluated by an independent panel consisting of three medical specialists from the Clinical Centre of Kragujevac. Criteria validity was tested according tothree methods: a) the new questionnaire was filled out by researchers and patients independently and the results compared; b) convergent validity was tested by comparing the scores of the new questionnaire with the scores of PROMIS-GSS nausea; and c) divergent validity was tested by comparing the scores of the new questionnaire with the scores of Intolerance of Uncertainty. Main component analysis was performed in order to ascertain the main factors assessed by the questionnaire. The suitability of the questionnaire and the samples for factorial analysis were tested using Bartlett’s sphericity test and the Kaiser-Meyer-Olkin Measure of Sampling Adequacy. The factors were extracted first without rotation, under the condition that the number denoting the amount of information carried by a single factor (the eigenvalue) must be greater than 1 and by using the Scree plot (the extracted factors were above the “elbow” of the diagram). Then the referential axes were rotated orthogonally using the varimax rotation method and a second factor extraction was performed using the same criteria as for the non-rotating solution. The test-retest reliability of this questionnaire and the PROMIS-GSS nausea questionnaire were tested by having the researchers fill out a second questionnaire two weeks after the initial visit to the pharmacy. The patients were tested over thetelephone in thesecond instance. The presence and degree of nausea caused by the iron supplements was tested by the DINS test. The study was designed to be observable. This was a cross-sectional study. The patient sample was consecutive, meaning that all patients who visited the pharmacy during the course of the study (128 of them) were included, provided they used oral iron supplements. The questionnaire was filled out anonymously by volunteers. RESULTS AND CONCLUSIONS. The DINS scale measures a single phenomenon - the intensity of nausea caused by oral iron supplements. It is highly reliable (Cronbach’s alpha 0.892, when graded by researchers) and has great test-retest reliability (Spearman’s rank correlation coefficient 0.965; (p<0.001) and Cronbach’s alpha was 0.901 after being graded a second time). The DINS instrument covers the essential aspects of nausea, which can also be a part of the phenomena of queasiness and vomiting: presence (question 2), frequency (question 3), length (question 1) and seriousness (questions 4 and 5).VIII This research reveals that only two factors have a statistically significant impact on the frequency and degree of nausea after oral ingestion of iron supplements: ingestion of coffee and a history of gastrointestinal disease. No connection was found between the type of ferrous salts, daily dosage or the dosage regiment and the degree of nausea. By translating and validating a questionnaire for measuring nausea, and by creating a new questionnaire for measuring drug-induced nausea, conditions have been created to assess in clinical practice the extent to which the drug introduced into the therapy produces gastrointestinal complaints in the patient, and whether it is necessary to discontinue therapy the drug and the introduction of another drug

Xanthomonas arboricola pv. corylina - identification of the pathogen and population biodiversity

Bakteriozna plamenjača leske, čiji je prouzrokovač fitopatogena bakterija Xanthomonas arboricola pv. corylina (Xac), najznačajnije je bakteriozno oboljenje ove jezgraste voćke u svetu. U našoj zemlji bolest je prvi put uočena 50-ih godina prošlog veka, nakon čega nije bilo daljih proučavanja ovog patogena. U periodu 2008 - 2011. godine, u nekoliko rejona gajenja leske u Srbiji uočena je pojava simptoma pegavosti lišća, nekroze i uvelosti pupoljaka i letorasta, koji su ukazivali na moguću bakterioznu prirodu oboljenja. Simptomatični uzorci obolelih biljaka prikupljeni su sa različitih lokaliteta u našoj zemlji sa ciljem utvrđivanja etiologije oboljenja. Iz zaraženog biljnog tkiva izolovani su Gram i oksidaza negativni, katalazapozitivni aerobni sojevi bakterija žute boje kolnija na HA podlozi. Za dalji rad odabrano je ukupno 47 reprezentativnih sojeva, koji su proučeni primenom standardnih i savremenih metoda. U istraživanja su uključeni i sojevi poreklom iz Poljske, kao i referentni sojevi Xac poreklom iz međunarodnih kolekcija. Detaljno su proučene morfološke, patogene, biohemijsko-fiziološke, serološke i genetičke odlike sojeva, na osnovu kojih su svi proučavani sojevi identifikovani kao Xanthomonas arboricola pv. corylina. Na podlozi od hranljivog agara (HA) formirane su sitne i sjajne kolonije, dok su one na podlozi obogaćenoj glukozom (GYCA) bile krupne, sluzaste i ispupčene. Svi proučavani sojevi hidrolizuju skrob, želatin i eskulin, koriste glukozu, maltozu, saharozu kao izvor ugljenika, ali ne i sorbitol, metabolišu kvinate, razvijaju se pri 35°C i u prisustvu 2% NaCl. Sojevi su prouzrokovali hipersenzitivnu reakciju na listovima duvana i paradajza i mahunama boranije. Patogenost sojeva potvrđena je testom patogenosti na domaćinu i reprodukcijom simptoma prirodne infekcije. Na osnovu Biolog testa utvrđena je raznovrsnost proučavanih sojeva čiji su metabolički profili bili specifični za rod Xanthomonas...Bacterial blight of hazelnut, caused by Xanthomonas arboricola pv. corylina (Xac), is the most important bacterial disease of this nut crop worldwide. In our country, after the disease was initially described in the 1950s, there were no further data about the research of this pathogen. During the growing season of 2008-2011, symptoms of leaf spots, bud and twig necrosis and dieback, suggesting bacterial infection, were observed on hazelnut plants in several localities in Serbia. In order to study etiology of disease, symptomatic samples of diseased hazelnut plants were collected from different hazelnut-growing regions in the country. Isolations from the diseased tissue resulted in Gram and oxidase negative, catalase-positive, aerobic yellow bacterial colonies. Total of 47 representative strains were selected for further study. Strains isolated from hazelnut in Poland and various reference strains of Xac originating from international collections were also included in research. Based on their morphological, pathogenic, biochemical, physiological, serological and genetic characteristics tested strains were identified as Xanthomonas arboricola pv. corylina. Bacterial colonies formed on NA medium were small and glistening and on glucose amended GYCA medium large, mucous and domed. All strains hydrolyzed starch, gelatin and esculin, used glucose, maltose, sucrose as a carbon source, but not sorbitol, metabolized quinates, developed at 35 °C in the presence of 2% NaCl. The strains induced hypersensitive reaction of tobacco, tomato leaves and bean pods. Pathogenic nature of the strains was confirmed in pathogenicity test on host plants by reproduction of symptoms similar to natural infection. Based on carbon source utilization, metabolic diversity of investigated strains was confirmed. Strain's metabolic profiles were specific for Xanthomonas genus. Serological methods (ELISA i IF test) indicated similarity in serological characteristics among the studied strains, as well as the control Xac strain..

The effect of input energy on toughness of weld metal made by gas metal arc welding of microalloyed steel

Instrumentiranim Šarpijevim klatno je ispitana udarna žilavost metala šava dva valjana mikrolegirana čelika, zavarena elektrolučno u zaštiti mešavine gasova. Prethodno određena optimalna mešavina gasova (Ar+5%CO2+0.9%O2) je korišćena sa različitim vrednostima unete energije da bi se odredio njen uticaj na žilavost metala šava na različitim temperaturama. Optimalne vrednosti unete energije su određene za oba čelika, koje su davale najveću energiju rasta prsline u prisustvu acikularnog ferita, kao dominantne mikrostrukture.Impact toughness of weld metals of two hot rolled microalloyed steels, welded by gas shielded metal arc process, has been evaluated by using the instrumented Charpy pendulum. Previously determined optimum gas mixture (Ar+5%CO2+0.9%O2) was used with different energy inputs to determine its effect on weld metal toughness at different testing temperatures. For both steels the optimum energy input has been determined, providing maximum crack propagation energy due to presence of acicular ferrite, as a dominant microstructure

The effect of input energy on toughness of weld metal made by gas metal arc welding of microalloyed steel

Instrumentiranim Šarpijevim klatno je ispitana udarna žilavost metala šava dva valjana mikrolegirana čelika, zavarena elektrolučno u zaštiti mešavine gasova. Prethodno određena optimalna mešavina gasova (Ar+5%CO2+0.9%O2) je korišćena sa različitim vrednostima unete energije da bi se odredio njen uticaj na žilavost metala šava na različitim temperaturama. Optimalne vrednosti unete energije su određene za oba čelika, koje su davale najveću energiju rasta prsline u prisustvu acikularnog ferita, kao dominantne mikrostrukture.Impact toughness of weld metals of two hot rolled microalloyed steels, welded by gas shielded metal arc process, has been evaluated by using the instrumented Charpy pendulum. Previously determined optimum gas mixture (Ar+5%CO2+0.9%O2) was used with different energy inputs to determine its effect on weld metal toughness at different testing temperatures. For both steels the optimum energy input has been determined, providing maximum crack propagation energy due to presence of acicular ferrite, as a dominant microstructure

The effect of welding heat input on the weld metal toughness of microalloyed steels

Žilavost metala šava, jedan od kriterijuma prihvatljivosti zavarenog spoja, zavisi od količine unete toplote. Udarna žilavost metala šava dva toplo valjana mikrolegirana čelika, zavarena elektrolučnim postupkom u zaštiti mešavine gasova (Ar + 5% CO2+0,91% O2) je ispitana merenjem energije loma na instrumentiranom Šarpijevom klatnu. Utvrđeno je da je količina unete toplote od 7 kJ/cm optimalna za žilavost metala šava oba ispitivana čelika. Energija rasta prsline, kao bitna za žilavost metala šava, je za ovu količinu unete toplote veća od kritične, pa se ovako zavareni spoj može preporučiti za konstrukcije koje rade na niskim temperaturama.Weld metal toughness, one of weldment acceptability criteria, depends on heat input. Weld metal impact toughness of two hot rolled microalloyed steels, welded by electric arc with mixture gases shielding (Ar + 5% CO2+0,91% O2) is tested by measuring impact energy on instrumented Charpy pendulum. It has been found that heat input of 7 kJ/cm is optimal for weld metal toughness of both investigated steels. Crack growth energy, as substantial for weld metal toughness, is for this heat input higher than critical, and welded joint, produced in this way, can be recommended for manufacturing of welded structures for low temperature application

Identification of Agrobacterium vitis as a causal agent of grapevine crown gall in Serbia

In 2010, a serious outbreak of crown gall disease was observed on grapevines (Vitis vinifera L. cv. Cabernet Sauvignon) in several commercial vineyards located in the Vojvodina province, Serbia. Bacteria were isolated from the young tumor tissue on nonselective YMA medium and five representative strains were selected for further identification. Tumorigenic (Ti) plasmid was detected in all strains by PCR using primers designed to amplify the virC pathogenicity gene, producing a 414-bp PCR product. The strains were identified as Agrobacterium vitis using differential physiological and biochemical tests, and a multiplex PCR assay targeting 23S rRNA gene sequences. In the pathogenicity assay, all strains induced characteristic symptoms on inoculated tomato and grapevine plants. They were less virulent on tomato plants in comparison to the reference strains of A. tumefaciens and A. vitis. [Ministarstva nauke Republike Srbije, br. III46008: Development of integrated management of harmful organisms in plant production in order to overcome resistance and to improve food quality and safety

The effect of welding heat input on the weld metal toughness of microalloyed steels

Žilavost metala šava, jedan od kriterijuma prihvatljivosti zavarenog spoja, zavisi od količine unete toplote. Udarna žilavost metala šava dva toplo valjana mikrolegirana čelika, zavarena elektrolučnim postupkom u zaštiti mešavine gasova (Ar + 5% CO2+0,91% O2) je ispitana merenjem energije loma na instrumentiranom Šarpijevom klatnu. Utvrđeno je da je količina unete toplote od 7 kJ/cm optimalna za žilavost metala šava oba ispitivana čelika. Energija rasta prsline, kao bitna za žilavost metala šava, je za ovu količinu unete toplote veća od kritične, pa se ovako zavareni spoj može preporučiti za konstrukcije koje rade na niskim temperaturama.Weld metal toughness, one of weldment acceptability criteria, depends on heat input. Weld metal impact toughness of two hot rolled microalloyed steels, welded by electric arc with mixture gases shielding (Ar + 5% CO2+0,91% O2) is tested by measuring impact energy on instrumented Charpy pendulum. It has been found that heat input of 7 kJ/cm is optimal for weld metal toughness of both investigated steels. Crack growth energy, as substantial for weld metal toughness, is for this heat input higher than critical, and welded joint, produced in this way, can be recommended for manufacturing of welded structures for low temperature application

The effect of heat input on the ferrite modification in weld metal of low-carbon steels

U ovom radu je prikazano kako količina unete toplote pri zavarivanju utiče na mikrostrukturu metala šava dva toplo valjana mikrolegirana čelika, zavarena elektrolučnim postupkom u zaštiti mešavine gasova (Ar + 5% CO2 + 0,91% O2). Posebna pažnja je posvećena morfologiji acikularnog ferita, koja značajno utiče na mehaničke osobine metala šava.This paper describes the influence of welding heat input on the weld metal microstructure of two hot rolled micro alloyed steels, welded by electric arc in shielding gases mixture (Ar + 5% CO2 + 0,91% O2). Morphology of acicular ferrite, which has a great effect on the weld metal mechanical properties, is also discussed

The effect of heat input on the ferrite modification in weld metal of low-carbon steels

U ovom radu je prikazano kako količina unete toplote pri zavarivanju utiče na mikrostrukturu metala šava dva toplo valjana mikrolegirana čelika, zavarena elektrolučnim postupkom u zaštiti mešavine gasova (Ar + 5% CO2 + 0,91% O2). Posebna pažnja je posvećena morfologiji acikularnog ferita, koja značajno utiče na mehaničke osobine metala šava.This paper describes the influence of welding heat input on the weld metal microstructure of two hot rolled micro alloyed steels, welded by electric arc in shielding gases mixture (Ar + 5% CO2 + 0,91% O2). Morphology of acicular ferrite, which has a great effect on the weld metal mechanical properties, is also discussed

Application of holographic interferometry technique for investigation of the model designed of Al-Zn-Mg-Cu alloy

U ovom radu ispitivani model komore za rad u uslovima visokih pritisaka izrađen je od višekomponentne legure aluminijuma tipa Al-Zn-Mg-Cu, koja pripada legurama visoke čvrstoće, postignute mogućnošću rastvaranja legirajućih elemenata u osnovnoj površinski centriranoj rešetki aluminijuma. Primenom različitih termomehaničkih obrada ustanovljen je optimalan režim - Q + 20 % + 30 min./190°C, koji je praćen najboljim mehaničkim karakteristikama legure od koje je izrađena komora. Eksperimentalno dobijeni holografski zapisi - hologrami dešifrovani su analizom apsolutnog redosleda interferencijskih pruga, sa ciljem da analiza deformacija metodom holografske interferometrije bude doprinos u određivanju naponsko-deformacionog stanja konstrukcija pri različitim radnim režimima.In this paper an investigated high-pressure chamber model is designed of the multi-component alloy type Al-Zn-Mg-Cu, that belongs to high-strength alloys obtained by possibility of dissolution of alloying elements in the face centered cubic aluminum lattice. The optimal process - Q + 20% + 30 min/190°C is established by applying various thermo-mechanical treatments, and it is followed by the best mechanical characteristics of alloy used for the chamber designing. Holographic records - holograms, experimentally obtained, are decoded by analyzing the absolute order of interferometric fringes, with the aim that deformation analysis by holographic interferometry make a contribution to determination of stress-strain construction conditions for various working regimes