Background
Prader–Willi syndrome (PWS), a genetically determined disorder, the most frequent cause of early onset obesity, is associated with physical and cognitive dysfunctions and behavioural ...disturbances; these disturbances are frequently treated with psychotropic medication. The aim of this cross‐sectional study was to describe the characteristics of the first large national sample of persons with PWS in Spain and analyse the relationships of those characteristics with key demographic and clinical factors, particularly with obesity and the regular use of psychotropic medication.
Methods
Participants were recruited among all members of the Spanish Prader–Willi Association who agreed to take part in the study and fulfilled its inclusion criteria. Family and patient demographic features, family size and birth order, intelligence quotient (IQ), anthropometric measures, lifestyle habits, behavioural disturbances (with the Aberrant Behavior Checklist) and clinical data, as well as use of psychotropic drugs and their side effects (with the UKU scale), were collected in genetically confirmed cases of PWS. Bivariate and logistic regression analyses were used for determining the associations of demographic and clinical factors with both obesity and the regular use of psychotropic medication.
Results
The cohort included 177 participants (aged 6–48 years), that is, 90 (50.8%) males and 87 (49.2%) females. Behavioural disturbances were present in a range of 75% to 93% of participants; psychotropic medication was prescribed to 81 (45.8%) of them. Number of siblings showed a direct correlation with IQ, especially among males, and inappropriate speech was more intense in only‐child females. Obesity was, in parallel, strongly associated with ascending age and with not being currently under growth hormone (GH) treatment. Participants taking any psychotropic medication were characterised by more frequent age ≥30 years, high level of hyperactivity and a psychiatric diagnosis.
Conclusions
Characterisation of persons with PWS in Spain confirms their physical and behavioural phenotype and supports the long‐term application of GH therapy and the rational use of psychotropic medication.
Summary
Introduction
Medication errors are frequent at care transition points and can have serious repercussions. Study objectives were to examine the frequency/type of reconciliation errors at ...hospital admission and discharge and to report on the drugs involved, associated risk factors and potential to cause harm in a healthcare setting with comprehensive digital health records.
Material and methods
A prospective observational 2‐year study was conducted in the Internal Medicine Department of a regional hospital. The best possible medication history was obtained from different sources by clinical pharmacists and compared with prescriptions at admission and discharge. The frequency and type of reconciliation errors were studied at admission and discharge, evaluating risk factors for their occurrence and their potential to cause harm.
Results
The study included 814 patients (mean age: 80.2 years). At least one reconciliation error was detected in 525 (64.5%) patients at admission, with a mean of 2.2 ± 1.3 errors per patient and in 235 (32.4%) patients at discharge. Drug omission was the most frequent reconciliation error (73.6% at admission and 71.4% at discharge); 39% of errors at admission and 51% at discharge had potential to cause moderate or severe harm. The risk of error at admission was higher with more pre‐admission drugs (p < 0.001) and, among patients with reconciliation errors, the number of errors was significantly higher in those receiving more drugs pre‐admission or with more comorbidities. The risk at discharge was higher in patients with more drugs prescribed at discharge (p = 0.04) and in those with a longer hospital stay (p = 0.03).
Conclusions
Medication reconciliation procedures are required to minimise medication discrepancies and enhance patient safety. Integration of patient health records across care levels is necessary but not sufficient to prevent errors.
Alzheimer's disease (AD) is the most common cause of dementia in the elderly. AD brains are characterized by the presence of neurofibrillary tangles (NFTs) and neuritic plaques. NFTs are constituted ...of paired helical filaments, which are structurally composed by assembled hyperphosphorylated and truncated tau polypeptides. To date, the integral constituents of NFTs remain unknown mainly due to the high insolubility of NFTs. The aim of this study was to identify by tandem mass spectrometry, the polypeptides contained in both isolated NFTs by laser capture microdissection and total homogenates, using tissue sections from paraformaldehyde-fixed AD brains. In the first case, we isolated 2,000 NFTs from tissue samples of hippocampus from each of the three Mexican AD brains used in our study. These were previously stained with anti-hyperphosphorylated tau AT-100 antibodies. After the removal of paraformaldehyde and delipidation with organic solvents, we tested three solubilization methods. We identified 102 polypeptides from total homogenates and 41 from isolated NFTs. We selected UCH-L1, transferrin, and GAPDH polypeptides to be studied by immunofluorescence and confocal microscopy. Only UCH-L1 and GAPDH colocalized with hyperphosphorylated tau in NFTs.
Alzheimer's disease is one of the leading causes of dementia in the elderly. It is considered the result of complex events involving both genetic and environmental factors. To gain further insights ...into this complexity, we quantitatively analyzed the proteome of cortex region of brains from patients diagnosed with Alzheimer's disease, using a bottom-up proteomics approach. We identified 721 isobaric-tagged polypeptides. From this universe, 61 were found overexpressed and 69 subexpressed in three brains with Alzheimer's disease in comparison to a normal brain. We determined that the most affected processes involving the overexpressed polypeptides corresponded to ROS and stress responses. For the subexpressed polypeptides, the main processes affected were oxidative phosphorylation, organellar acidification and cytoskeleton. We used Drosophila to validate some of the hits, particularly those non-previously described as connected with the disease, such as Sideroflexin and Phosphoglucomutase-1. We manipulated their homolog genes in Drosophila models of Aβ- and Tau-induced pathology. We found proteins that can either modify Aβ toxicity, Tau toxicity or both, suggesting specific interactions with different pathways. This approach illustrates the potential of Drosophila to validate hits after MS studies and suggest that model organisms should be included in the pipeline to identify relevant targets for Alzheimer's disease.
We report a set of differentially expressed proteins in three Alzheimer's disease brains in comparison to a normal brain. Our analyses allowed us to identify that the main affected pathways were ROS and stress responses, oxidative phosphorylation, organellar acidification and cytoskeleton. We validated some identified proteins using genetic models of Amyloid-β and Tau-induced pathology in Drosophila melanogaster. With this approach, Sideroflexin and Phosphoglucomutase-1 were identified as novel proteins connected with Alzheimer's disease.
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•AD affected pathways: ROS, stress responses, oxidative phosphorylation.•Some proteins were validated using a Drosophila genetic approach.•Sideroflexin and Phosphoglucomutase-1, two novel proteins connected with AD.
Author Affiliation: (1) Department of Internal Medicine, Hospital Universitario San Cecilio, Avda. de La Innovacion, s/n, 18016, Granada, Spain (2) Department of Internal Medicine, Hospital ...Universitario Virgen de Las Nieves, Granada, Spain (3) Hospital Pharmacy Unit, Hospital Universitario San Cecilio, Granada, Spain (a) alfredoj.pardo.sspa@juntadeandalucia.es Article History: Registration Date: 01/14/2021 Received Date: 01/04/2021 Accepted Date: 01/13/2021 Online Date: 01/31/2021 Byline:
Rationale, aims and objectives
We aim to determine the prevalence of reconciliation errors (REs) at admission to surgery departments, report their potential clinical impact and analyse possible risk ...factors.
Methods
Prospective observational study was conducted for 8 months in a regional public hospital in Spain. The study included patients consecutively hospitalized in the Department of Orthopedic Surgery and Traumatology or Department of Angiology and Vascular Surgery from May through December 2010. At 24–48 hours after hospital admission, the pre‐admission pharmacological treatment of patients was compared with the medication received in hospital to identify REs, which were classified by type and potential severity. Multivariate logistic regression analysis was conducted with the presence of RE as dependent variable.
Results
The study included 176 patients, 60.8% of whom were aged >65 years and consumed a mean of 5.55 (±4.33) drugs. 55.1% had ≥1 RE, with a mean of 3.21 REs per patient 95% confidence interval (CI; 2.72–3.70). The most frequent RE was drug omission (84.1%). No clinical risk was posed by 50.5% of the REs. Multivariate analysis evidenced fourfold higher risk of an RE in patients admitted for elective versus emergency surgery and a 1.35‐fold higher risk in patients receiving a larger number of drugs.
Conclusions
There was a high prevalence of REs among patients admitted to the surgical departments, most frequently the omission of a drug. The risk of an RE was higher in patients admitted for elective versus emergency surgery, as well as with the receipt of a larger number of drugs before admission.
BackgroundTaking multiple drugs with anticholinergic risk (AR) can adversely impact cognition and function. There are scales that rank the anticholinergic activity by the mean of the anticholinergic ...burden (AB) of the treatment, which is the sum of the score for each anticholinergic drug.PurposeThis study investigated the influence of AB on cognition and function in patients with multimorbidity over 65 years.Material and methodsThis was an observational and retrospective pilot study of patients with multimorbidity over 65 years. Changes in cognitive and functional performances, assessed using the Pfeiffer and Barthel test, respectively, between 3–15 months, were collected. AB was assessed with the anticholinergic burden calculator (http://www.anticholinergicscales.es/), which contains 10 scales. Included patients had to be treated with at least one drug included in at least one scale for at least half of the period and patients with severe dementia and/or Alzheimer’s disease were excluded.ResultsOne-hundred and seventy-seven patients were included in preliminary analysis (84±7 years, 62% females). The average number of drugs taken per patient was 10±4. The average number of drugs with AB was 4±2. We identified 77 and 41 patients with a change in cognitive disorder (CD) (44%) and functional disorder (FD) (23%), respectively, and 23 patients (13%) suffered falls.The patients identified with high AB according to each scale were: 96 patients on the ABC scale (54%), 57 on DBI (32%), 45 on DURAN (25%), 35 on ACB (20%), 32 on ADS (18%), 28 on ALS (16%), 28 on CrAS (16%), 20 on CHEW (11%), 19 on AAS (11%) and 10 on ARS (6%).Fifty-nine patients (77%) with a change in CD and 31 (76%) patients with a change in FD, had high AB on at least one scale. Eighteen (78%) of patients with falls had high AB on at least one scale.ConclusionWe found a high percentage of patients with multimorbidity over 65 years with deterioration of cognitive and functional function when they have taken anticholinergic drugs. Moreover, there are wide differences among the scales’ scores. It is necessary for a more exhaustive analysis of the results to determine which scales correlate better with DC and DF in these patients.References and/or acknowledgementsVillalba-Moreno, et al. 2016.No conflict of interest.
CP-013 Review of oral therapies in prostate cancer Torne, G Rodriguez; Rustarazo, S Belda; Romero, S Caparros
European journal of hospital pharmacy. Science and practice,
03/2017, Letnik:
24, Številka:
Suppl 1
Journal Article
Recenzirano
BackgroundWorldwide, prostate cancer is the second most commonly diagnosed cancer in men. In Europe and Spain, for many years it was the number one cancer diagnosis (436 500 in Europe in 2012 and 32 ...641 in Spain in 2014).1 The use of oral therapies in metastatic patients instead of intravenous chemotherapy improves treatment comfort but the costs are much higher. According to the guidelines and protocols for chemotherapy, after failure with oral therapy, intravenous therapies must be started.PurposeTo evaluate control of the disease with oral therapies in prostate cancer patients and to determine if their treatments were switched to intravenous therapy in the event of failure of oral therapies.Material and methodsPatients treated with abiraterone or enzalutamide during the first half of 2016 in Complejo Hospitalario Universitario in Granada were included in the study. Those treatments that decreased prostate specific antigen (PSA) levels were classified as ‘effective’, while those that maintained PSA levels with variations of 5% were classified as ‘stable’. If there was an increase in PSA levels, these patients were classified as ‘non- effective’.Results22 patients were treated: 19 with abiraterone and 3 with enzalutamide. 63.63% (14 patients) had received 6 months or less of treatment at the time of the study. Regarding abiraterone, 9 were classified as ‘effective’ treatment, 4 were ‘stable’ and 5 had disease progression in spite of treatment with abiraterone. One patient was withdrawn due to medication toxicity. 2 patients treated with enzalutamide had disease progression and 1 had ‘effective’ treatment. 3 of 7 patients with progression (42.85%) continued treatment despite the poor results and did not switch to intravenous therapy. Abiraterone and enzalutamide accounted for 92.24% (€296 203.32 of €321 094.84) of the total expenditure of patients treated for prostate cancer.ConclusionThere was a high percentage of patients who failed oral therapies and continued with them without switching to intravenous therapy. This constitutes serious detriment to the patient and a marked increase in drug spending.References and/or acknowledgements1. Prostate cancer 2016. AECC (online). Available at https://www.aecc.es/SobreElCancer/CancerPorLocalizacion/cancerdeprostata/Paginas/incidencia.aspx (accessed 05/09/16).No conflict of interest
BackgroundSome of the most common adverse effects of protease inhibitors in treatment of HIV are dislypidaemia, diabetes and other metabolic disorders. These adverse effects should be recognised by ...health professionals so that they can perform an intervention to minimise the cardiovascular risk of the patient.PurposeTo analyse the impact of the metabolic adverse effects in HIV patients on darunavir/cobicistat monotherapy treatment.Material and methodsThis work is a descriptive observational study which took place in the outpatient consultation of a Hospital Pharmacy in a third-level hospital. We made a search of clinical variables as well as results of analytical tests. The variables included in this study were age, smoking habit, systolic blood pressure, presence of antihypertensive treatment, presence of diabetes mellitus, and HDL and total cholesterol serum concentrations at the beginning of treatment and at 6 and 12 months after. With these data, we calculated the Framingham Risk Score (FRS) at these months and we performed a statistical analysis.ResultsPatients (n=30) had a mean age of 50.2±11.6 years and 66.6% were males. They were all on treatment with a daily tablet of darunavir/cobicistat (800 mg/150 mg) as a single drug for HIV treatment. The median of FRS at the beginning of the treatment was 9.3 (3.9–22.7). At month 6 of treatment the median of FRS was 8.9 (4.2–20.8) and after 12 months was 8.9 (3.4–21.7). None of the patients had an increase of more than 4 points. A small group of patients (n=7) from this sample, who had an initial FRS over 25 were separately studied. Their mean FRS were 38.2 (28.4–39.4) at the beginning, 32.1 (28.9–36.4) at month 6 and 30.5 (25.2–37) at month 12. Five of these seven patients had a decrease in FRS of more than 4 points. Only one of them had an increase (2 points).ConclusionBased on these findings, we can affirm that there was no increase in the cardiovascular risk of the patients on treatment with darunavir/cobicistat, but there was also an improvement. Even patients at greater risk reduced their Framingham Risk Score. We want to show the importance of knowing the drugs deeply to prevent their adverse effects.No conflict of interest
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