Prevalence, incidence and indications of hypno-sedative treatments in hospitalized patients aged 75 and older

Introduction Sleep impairment is a common problem in older persons and is associated with adverse health and economic consequences. The most prescribed hypnosedatives in Switzerland are benzodiazepines, benzodiazepine-like hypnosedatives and clomethiazole. In the elderly persons, these medications have been associated with decreased cognitive performance, an increased risk of addiction and an increased risk of falls. The main aim of this study was to determine the prevalence, incidence and indications of hypnosedative prescriptions in older in-patients admitted to a Swiss university hospital. Furthermore, we planned to investigate the possible relationship between hypnosedatives' prescription and patients' falls during the hospital stay and we compared the prevalence of hypnosedative drugs' prescribing between geriatric and non-geriatric clinical wards.Materials & Methods This observational study included all patients aged 75 years or older admitted to a Swiss university hospital for 24 h or more. Prescription-related data were recorded every day for 26 consecutive days in the two geriatric wards, and twice, a week apart, in three non-geriatric wards.Results A total of 204 patients (mean age 84.7 ± 0.7 years, 66% women) were included. The prevalence of hypnosedative drugs prescription was 73% and the incidence was 28% on the two geriatric wards. The most common indications for a prescription on geriatric wards was insomnia (51%), followed by continuation of usual treatment (12%). The most frequently prescribed hypnosedative drug was clomethiazole (64% of the patients), followed by lorazepam (11%). We were not able to demonstrate any significant correlation between the number of hypnosedative drugs prescribed and the number of falls during hospital stay. The prevalence of hypnosedative drugs prescriptions was similar between geriatric and non-geriatric wards. The proportion of patients treated by at least one hypnosedative increased between hospital admission (32%) and discharge (45%).Discussions, Conclusion This study reveals a high prevalence of hypnosedative prescription in medical in-patients aged 75 years or older. Main indication was insomnia and the most frequently prescribed hypnosedative molecule was clomethiazole. Prescription incidence was also very high and the proportion of patients being prescribed a hypnosedative increased during hospital stay. Systematic interventions need to be integrated in order to reduce elderly inpatient exposure to treatments that are associated with adverse health outcomes.Conference information: ESCP 40th International Symposium on Clinical Pharmacy. Clinical Pharmacy: Connecting Care and Outcomes Dublin Ireland, 19-21 October 2011

Fruit and seed morphology of Euphorbia aggr. flavicoma. Taxonomic implications

Capsula and seed morphology of W. European species of Euphorbia aggr. flavicoma has been studied. A total of 1500 seeds coming from 13 taxa have been investigated under light microscope, scanning electron microscope and binocular stereoscope. Data were processed by multivariate analysis and the corresponding dendrogram is presented. At de end of the paper, a key is presented allowing to the separation of taxa down to the species level.

Seed morphology of the genus Delphinium L. (Ranunculaceae) in Turkey

La morfologia de les granes de 28 espècies de Delphinium recollides a Turquia ha estat estudiada per mitjà de la Microscòpia Electrònica de Rastreig (MER). Quatre tipus principals de granes són reportats: subgloboses amb anells continus de lamelles, subpiramidals amb esquames amples o primes, subpiramidals allargades amb esquames i sector-esferoïdals reticulades, que es corresponen amb les seccions reconegudes en els sistemes taxonòmics habituals del gènere, cosa que indica llur bona resolució taxonòmica. Es discuteixen les implicacions biogeogràfiques i sistemàtiques.

Dégénérescence maculaire liée à l'âge exsudative: efficacité et limites des différents traitements [Exudative age-related macular degeneration: efficacy and limits of the different treatments].

Ocular neovascularizations are responsible for irreversible loss of vision in various diseases, including age-related macular degeneration. Treatments have changed greatly, and photodynamic therapy with verteporfin has come into common use. However, the visual prognosis remains poor. The recent approval of new antiangiogenic molecules such as ranibizumab and pegaptanib should allow for new therapeutical possibilities. The unapproved ophthalmological use of bevacizumab requires further studies. This paper updates what is known about old and new neovascularization treatments: their mechanism of action, their efficacy, and their toxicity. It reviews the principal clinical studies, and concludes with the recognized recommendations. For the first time, ophthalmologists can hope not only to stabilize loss of vision, but also to improve visual acuity. Complementary treatments can now be tested in associations, concomitantly or not, with the hope of improving visual results.

Seed morphology of Iberian Species of the genus Aconitum L.

Es presenta un estudi morfològic-biomètric de les granes deis taxons del genere Aconitum L. presents a la Península Ibérica. Es tracten aspectes que fan referencia a: 1) disposició de les granes al fol-licle, 2) definido de paramètres (forma general i ornamentado de l'episperma), 3) biometria i 4) descripció de les granes deis représentants ibérics. Els microcaràcters relacionats fonamentalment amb el relleu epispérmic, forma i ornamentado de la base d'inserció (hílum i cél-lules umbil-licals), son els que es mostren mes utils per discriminar els taxons i els que proporcionen mes informado filogenética. Els résultats que s'exposen coincideixen, en línies generals, amb els d'altres autors (SEITZ, 1969; CAPPELETTI & POLDINI, 1984). Es presenten, tanmateix, discrepancies importants pel que fa a la morfología seminal, en especial de l'ornamentació de l'episperma, en les especies A. anthora, A. napellus s.l., A. burnatii i A. vulparia subsp. ranunculifoiium. Es presenta, sovint, polimorfisme seminal en les diferentes poblacions, aïllades geogràficament, d'una mateixa especie o subspècie, tant en el context ibèric com d'Europa central i meridional. Es conclou que aquest polimorfisme és una manifestado mes de la plasticitat fenotípica del genere, particularment intensa en les especies colonitzadores d'àmplia valencia ecológica (A. napellus, s.l.; A. vulparia, s.l.), possiblement conseqiiència de la deriva genética de les poblacions.

Diagnostic et prise en charge des douleurs de la région scapulaire [Diagnosis and treatments of scapular pain].

Shoulder pain is one of the most common reasons for bone and joint consultations in general practice. In most situations, it is due to a lesion of the rotator cuff. A detailed history can often exclude a cervical or visceral origin of the pain. A full clinical examination especially active and passive mobility provides a good diagnostic approach. It can be refined by specific clinical tests that must nevertheless be interpreted with caution. The management of pathologies of the rotator cuff does not require imaging immediately. Ultrasound is increasingly recognized as the imaging procedure of choice in most situations. For abarticular shoulder pathologies, therapy is primarily conservative. The exact role of infiltration of steroids remains unclear. Only an acute traumatic rupture of the rotator cuff warrants prompt surgical intervention.

Dewaterability of sewage sludge by ultrasonic, thermal and chemical treatments

Sludges resulting from wastewater treatment processes have a characteristically high water content, which complicates handling operations such as pumping, transport and disposal. To enhance the dewatering of secondary sludge, the effect of ultrasound waves, thermal treatment and chemical conditioning with NaOH have been studied. Two features of treated sludges were examined: their rheological behavior and their dewaterability. The rheological tests consisted of recording shear stress when the shear rate increases and decreases continuously and linearly with time, and when it increases and decreases in steps. Steady-state viscosity and thixotropy were obtained from the rheological tests, and both decreased significantly in all cases with increased treatment intensity. Centrifugation of ultrasonicated and thermally treated sludges allowed the total solid content to be increased by approximately 16.2% and 17.6%, respectively. These dewatered sludges had a lower viscosity and thixotropy than the untreated sludge. In contrast, alkali conditioning barely allowed the sludge to be dewatered by centrifugation, despite decreasing its viscosity and thixotropy.

Matriconditioning integrated with gibberellic acid to hasten seed germination and improve stand establishment of pepper and tomato

Emergence and stand establishment of tomato (Lycopersicon lycopersicum (L.) (Karsten ex Farw) and pepper (Capsicum annus L.) seeds are often slow and erratic, particularly under stress conditions. Field emergence trials sometimes have not responded to priming in pepper. This study examined the combined effects of matriconditioning and gibberellin application on the germination and stand establishment of pepper and tomato seeds. Pepper and tomato seeds were conditioned with a solid carrier, Micro Cel E, in the presence of gibberellic acid (GA) for 1, 2 , 3 and 4 days at 15 and 25ºC. The results showed that, in all cases, even under stress conditions, the combination of matriconditioning with GA was effective in improving germination and emergence of pepper and tomato. The germination time was, in average, reduced by 2 to 3 days by primed seeds. Thus, matriconditioning, during which germination is suspended, provides an unique means to rapidly and efficiently digest the endosperm by GA-induced enzymes and reduce the mechanical restraints of endosperm thus providing energy to start and sustain embryo growth.

Durability and outcome of initial antiretroviral treatments received during 2000--2005 by patients in the Swiss HIV Cohort Study.

BACKGROUND: Little is known about time trends, predictors, and consequences of changes made to antiretroviral therapy (ART) regimens early after patients initially start treatment. METHODS: We compared the incidence of, reasons for, and predictors of treatment change within 1 year after starting combination ART (cART), as well as virological and immunological outcomes at 1 year, among 1866 patients from the Swiss HIV Cohort Study who initiated cART during 2000--2001, 2002--2003, or 2004--2005. RESULTS: The durability of initial regimens did not improve over time (P = .15): 48.8% of 625 patients during 2000--2001, 43.8% of 607 during 2002--2003, and 44.3% of 634 during 2004--2005 changed cART within 1 year; reasons for change included intolerance (51.1% of all patients), patient wish (15.4%), physician decision (14.8%), and virological failure (7.1%). An increased probability of treatment change was associated with larger CD4+ cell counts, larger human immunodeficiency virus type 1 (HIV-1) RNA loads, and receipt of regimens that contained stavudine or indinavir/ritonavir, but a decreased probability was associated with receipt of regimens that contained tenofovir. Treatment discontinuation was associated with larger CD4+ cell counts, current use of injection drugs, and receipt of regimens that contained nevirapine. One-year outcomes improved between 2000--2001 and 2004--2005: 84.5% and 92.7% of patients, respectively, reached HIV-1 RNA loads of <50 copies/mL and achieved median increases in CD4+ cell counts of 157.5 and 197.5 cells/microL, respectively (P < .001 for all comparisons). CONCLUSIONS: Virological and immunological outcomes of initial treatments improved between 2000--2001 and 2004--2005, irrespective of uniformly high rates of early changes in treatment across the 3 study intervals.

Dosage optimization of treatments using population pharmacokinetic modeling and simulation.

Pharmacokinetic variability in drug levels represent for some drugs a major determinant of treatment success, since sub-therapeutic concentrations might lead to toxic reactions, treatment discontinuation or inefficacy. This is true for most antiretroviral drugs, which exhibit high inter-patient variability in their pharmacokinetics that has been partially explained by some genetic and non-genetic factors. The population pharmacokinetic approach represents a very useful tool for the description of the dose-concentration relationship, the quantification of variability in the target population of patients and the identification of influencing factors. It can thus be used to make predictions and dosage adjustment optimization based on Bayesian therapeutic drug monitoring (TDM). This approach has been used to characterize the pharmacokinetics of nevirapine (NVP) in 137 HIV-positive patients followed within the frame of a TDM program. Among tested covariates, body weight, co-administration of a cytochrome (CYP) 3A4 inducer or boosted atazanavir as well as elevated aspartate transaminases showed an effect on NVP elimination. In addition, genetic polymorphism in the CYP2B6 was associated with reduced NVP clearance. Altogether, these factors could explain 26% in NVP variability. Model-based simulations were used to compare the adequacy of different dosage regimens in relation to the therapeutic target associated with treatment efficacy. In conclusion, the population approach is very useful to characterize the pharmacokinetic profile of drugs in a population of interest. The quantification and the identification of the sources of variability is a rational approach to making optimal dosage decision for certain drugs administered chronically.

Biochemical changes associated to soybean seeds osmoconditioning during storage

A work was carried out with the purpose of verifying the biochemical changes associated to soybean (Glycine max (L.) Merrill) seeds osmoconditioning. Seeds of the UFV 10, IAC 8 and Doko RC cultivars harvested at R8 development stage and submitted to different treatments were used. The biochemical evaluations were performed during seed storage, after the hydration-dehydration process. Initially, seeds were osmoconditioned in a polyethylene glycol (PEG 6000) solution, with the osmotic potential of -0.8 MPa and 20ºC, for a period of four days. After that, seeds were dried back until the initial moisture content (10-11%) and stored in natural conditions for three and six months. Two controls were used: untreated seeds (dry seeds) and water soaked seeds. Seed changes in protein and lipid, hexanal accumulation and fatty acids contents were evaluated. The results showed that seed storage under laboratory natural conditions caused reduction in protein, lipid and polyunsaturated fatty acids content and promoted hexanal production. Storage periods reduced protein levels for all treatments, however the PEG 6000 treatment showed lower protein reduction. The soybean seed storage increased hexanal production, but hexanal levels were smaller with osmoconditioning comparing to the other imbibition treatments.