Inappropriate prescribing in hospitalized elderly patients

Inappropriate prescribing (IP) is a major healthcare problem in elderly patients. The risk of this problem increases during hospitalization. This is due to increase morbidity and thus increases the use of medications by the inpatients. This study will clarify the problem of IP for elderly people during hospitalization and will identify the different types of it. It also will highlight some tools that are used to assess the different types of IP and the prevalence of it in elderly patients during hospitalization. Finally, the study will address the consequences of IP in the elderly inpatients and the risks associated with the use of some potentially inappropriate medications (PIMs) in the elderly.

Evaluation of inappropriate prescribing to the hospitalized elderly patients in Al Shifa hospital, Gaza, Palestine

Background: The current study aimed to assess the prevalence of inappropriate prescribing (IP) for hospitalized elderly patients at Al Shifa Hospital, Gaza, Palestine.Methods: This study was a retrospective cross-sectional study. A total of 2385 prescribed drugs for 380 elderly inpatients in internal, cardiology, and respiratory departments were screened for IP. Four criteria were used to detect IP using chart review method; Drug-drug interactions (DDIs), drug contra-indications (CI), duplication of therapy and Beers' criteria 2012.Results: The results showed that 44.2% of patients had at least one IP. Around 33.2% of the patients had DDIs, 19.2% had IP according to Beers' criteria and 1.1% had drug CI. There was no duplication of therapy. A total of 323 IP instances were detected. Of them, 74% for DDIs and 24.8% for Beers' criteria. The prevalence of overall IP was significantly influenced by age (p-value=0.024), polypharmacy (p-value<0.001), degree of morbidity (p-value<0.001), and departments (p-value=0.018). The prevalence of DDIs was influenced by polypharmacy (p-value<0.001), degree of morbidity (p-value=0.001), and departments (p-value=0.005). Finally, the prevalence of IP according to Beers' criteria was significantly influenced by departments with the highest in the cardiology department (29.7%) (P-value=0.007).Conclusions: Although the overall IP was common, it was not far higher than that reported worldwide. The majority of IP was DDIs. Age, polypharmacy, degree of morbidity and departments influenced the occurrence of IP

Botulinum toxin injection versus internal anal sphincterotomy for the treatment of chronic anal fissure

Background: Anal fissure is a chronic condition characterized by painful defecation and rectal bleeding. The aim of this study was to compare injection of botulinum toxin versus surgical sphincterotomy for treatment of chronic anal fissure. Patients and methods: In a quasi-experimental trial in a university hospital in Kerman, 50 patients diagnosed with chronic anal fissure received 20 units botulinum toxin (n=25) or underwent lateral internal sphincterotomy (n=25). All patients were evaluated for pain, bleeding and healing of the fissure from one to six months later by another surgeon. The data was analyzed by SPSS software with the Mann-Whitney and Fisher's exact tests. Results: One month after treatment, the rate of healing and bleeding in the operation group was better than in the toxin group (P<0.05), while pain was equal. After two months, none of the patients in either group had complications. After six months follow-up, bleeding, pain and healing were better in the operation group. Conclusion: In the clinical evaluation, botulinum toxin is an effective alternative nonsurgical modality for the treatment of chronic anal fissure. We recommend botulinum toxin as the first step in treatment because of the 60 chance of cure with an easily performed treatment

Variability of the local ΦMS values over the gate area of MOS devices, Journal of Telecommunications and Information Technology, 2005, nr 1

The local value distributions of the effective contact potential difference (ECPD or the øMS factor) over thegate area of Al-SiO2-Si structures were investigated for thefirst time. A modification of the photoelectric øMS measurement method was developed, which allows determination of local values of this parameter in different parts of metaloxide-semiconductor (MOS) structures. It was found that the øMS distribution was such, that its values were highest far away from the gate edge regions (e.g., in the middle of a square gate), lower in the vicinity of gate edges and still lower in the vicinity of gate corners. These results were confirmed by several independent photoelectric and electrical measurement methods. A model is proposed of this distribution in which the experimentally determined øMS(x; y) distributions, found previously, are attributed to mechanical stress distributions in MOS structures. Model equations are derived and used to calculate øMS(x; y) distributions for various structures. Results of these calculations remain in agreement with experimentally obtained distributions. Comparison of various characteristics calculated using the model with the results of photoelectric and electrical measurements of a wide range of Al-SiO2-Si structures support the validity of the model

Role of water states on water uptake and proton transport in Nafion using molecular simulations and bimodal network

a b s t r a c t Using molecular simulations and a bimodal-domain network, the role of water state on Nafion water uptake and water and proton transport is investigated. Although the smaller domains provide moderate transport pathways, their effectiveness remains low due to strong, resistive water molecules/domain surface interactions. The water occupancy of the larger domains yields bulk-like water, and causes the observed transition in the water uptake and significant increases in transport properties

Role of Water States on Water Uptake and Proton Transport in Nafion using Molecular Simulations and Bimodal Network

Using molecular simulations and a bimodal domain network, the role of water state on Nafion water uptake and water and proton transport is investigated. Although the smaller domains provide moderate transport pathways, their effectiveness remains low due to strong, resistive water molecules/domain surface interactions. The water occupancy of the larger domains yields bulk-like water, and causes the observed transition in the water uptake and significant increases in transport properties

Multiplexed five-color molecular imaging of cancer cells and tumor tissues with carbon nanotube Raman tags in the near-infrared

Single-walled carbon nanotubes (SWNTs) with five different C13/C12 isotope compositions and well-separated Raman peaks have been synthesized and conjugated to five targeting ligands in order to impart molecular specificity. Multiplexed Raman imaging of live cells has been carried out by highly specific staining of cells with a five-color mixture of SWNTs. Ex vivo multiplexed Raman imaging of tumor samples uncovers a surprising up-regulation of epidermal growth factor receptor (EGFR) on LS174T colon cancer cells from cell culture to in vivo tumor growth. This is the first time five-color multiplexed molecular imaging has been performed in the near-infrared (NIR) region under a single laser excitation. Near zero interfering background of imaging is achieved due to the sharp Raman peaks unique to nanotubes over the low, smooth autofluorescence background of biological species.Comment: Published in Nano Researc

Ancient Migratory Events in the Middle East: New Clues from the Y-Chromosome Variation of Modern Iranians

Knowledge of high resolution Y-chromosome haplogroup diversification within Iran provides important geographic context regarding the spread and compartmentalization of male lineages in the Middle East and southwestern Asia. At present, the Iranian population is characterized by an extraordinary mix of different ethnic groups speaking a variety of Indo-Iranian, Semitic and Turkic languages. Despite these features, only few studies have investigated the multiethnic components of the Iranian gene pool. In this survey 938 Iranian male DNAs belonging to 15 ethnic groups from 14 Iranian provinces were analyzed for 84 Y-chromosome biallelic markers and 10 STRs. The results show an autochthonous but non-homogeneous ancient background mainly composed by J2a sub-clades with different external contributions. The phylogeography of the main haplogroups allowed identifying post-glacial and Neolithic expansions toward western Eurasia but also recent movements towards the Iranian region from western Eurasia (R1b-L23), Central Asia (Q-M25), Asia Minor (J2a-M92) and southern Mesopotamia (J1-Page08). In spite of the presence of important geographic barriers (Zagros and Alborz mountain ranges, and the Dasht-e Kavir and Dash-e Lut deserts) which may have limited gene flow, AMOVA analysis revealed that language, in addition to geography, has played an important role in shaping the nowadays Iranian gene pool. Overall, this study provides a portrait of the Y-chromosomal variation in Iran, useful for depicting a more comprehensive history of the peoples of this area as well as for reconstructing ancient migration routes. In addition, our results evidence the important role of the Iranian plateau as source and recipient of gene flow between culturally and genetically distinct population

Nectar, humidity, honey bees (Apis mellifera) and varroa in summer: a theoretical thermofluid analysis of the fate of water vapour from honey ripening and its implications on the control of Varroa destructor

This theoretical thermofluid analysis investigates the relationships between honey production rate, nectar concentration and the parameters of entrance size, nest thermal conductance, brood nest humidity and the temperatures needed for nectar to honey conversion. It quantifies and shows that nest humidity is positively related to the amount, and water content of the nectar being desiccated into honey and negatively with respect to nest thermal conductance and entrance size. It is highly likely that honeybees, in temperate climates and in their natural home, with much smaller thermal conductance and entrance, can achieve higher humidities more easily and more frequently than in man-made hives. As a consequence, it is possible that Varroa destructor, a parasite implicated in the spread of pathogenic viruses and colony collapse, which loses fecundity at absolute humidities of 4.3 kPa (approx. 30 gm−3) and above, is impacted by the more frequent occurrence of higher humidities in these low conductance, small entrance nests. This study provides the theoretical basis for new avenues of research into the control of varroa, via the modification of beekeeping practices to help maintain higher hive humidities

Multimodality Imaging of β-Cells in Mouse Models of Type 1 and 2 Diabetes

Objectiveβ-Cells that express an imaging reporter have provided powerful tools for studying β-cell development, islet transplantation, and β-cell autoimmunity. To further expedite diabetes research, we generated transgenic C57BL/6 "MIP-TF" mice that have a mouse insulin promoter (MIP) driving the expression of a trifusion (TF) protein of three imaging reporters (luciferase/enhanced green fluorescent protein/HSV1-sr39 thymidine kinase) in their β-cells. This should enable the noninvasive imaging of β-cells by charge-coupled device (CCD) and micro-positron emission tomography (PET), as well as the identification of β-cells at the cellular level by fluorescent microscopy.Research design and methodsMIP-TF mouse β-cells were multimodality imaged in models of type 1 and type 2 diabetes.ResultsMIP-TF mouse β-cells were readily identified in pancreatic tissue sections using fluorescent microscopy. We show that MIP-TF β-cells can be noninvasively imaged using microPET. There was a correlation between CCD and microPET signals from the pancreas region of individual mice. After low-dose streptozotocin administration to induce type 1 diabetes, we observed a progressive reduction in bioluminescence from the pancreas region before the appearance of hyperglycemia. Although there have been reports of hyperglycemia inducing proinsulin expression in extrapancreatic tissues, we did not observe bioluminescent signals from extrapancreatic tissues of diabetic MIP-TF mice. Because MIP-TF mouse β-cells express a viral thymidine kinase, ganciclovir treatment induced hyperglycemia, providing a new experimental model of type 1 diabetes. Mice fed a high-fat diet to model early type 2 diabetes displayed a progressive increase in their pancreatic bioluminescent signals, which were positively correlated with area under the curve-intraperitoneal glucose tolerance test (AUC-IPGTT).ConclusionsMIP-TF mice provide a new tool for monitoring β-cells from the single cell level to noninvasive assessments of β-cells in models of type 1 diabetes and type 2 diabetes