Risk of Potential Drug-Drug Interactions among Brazilian Elderly A Population-Based, Cross-Sectional Study

Background: Drug-drug interactions (DDIs) are one of the main causes of adverse reactions related to medications, being responsible for up to 23% of hospital admissions. However, only a few studies have evaluated this problem in elderly Brazilians. Objectives: To determine the prevalence of potential DDIs (PDDIs) in community-dwelling elderly people in Brazil, analyse these interactions with regard to severity and clinical implications, and identify associated factors. Methods: A population-based cross-sectional study was carried out involving 2143 elderly (aged 60 years) residents of the metropolitan area of Sao Paulo, Brazil. Data were obtained from the SABE (Saude, Bem estar e Envelhecimento [Health, Well-Being, and Aging]) survey, which is a multicentre study carried out in seven countries of Latin America and the Caribbean, coordinated by the Pan-American Health Organization. PDDIs were analysed using a computerized program and categorized according to level of severity, onset, mechanism and documentation in the literature. The STATA software statistical package was used for data analysis, and logistic regression was conducted to determine whether variables were associated with PDDIs. Results: Analysis revealed that 568 (26.5%) of the elderly population included in the study were taking medications that could lead to a DDI. Almost two-thirds (64.4%) of the elderly population exposed to PDDIs were women, 50.7% were aged >= 75 years, 71.7% reported having fair or poor health and 65.8% took 2-5 medications. A total of 125 different PDDIs were identified; the treatment combination of an ACE inhibitor with a thiazide or loop diuretic (associated with hypotension) was the most frequent cause of PDDIs (n=322 patients; 56.7% of individuals with PDDIs). Analysis of the PDDIs revealed that 70.4% were of moderate severity, 64.8% were supported by good quality evidence and 56.8% were considered of delayed onset. The multivariate analysis showed that the risk of a PDDI was significantly increased among elderly individuals using six or more medications (odds ratio [OR] 3.37) and in patients with hypertension (OR 2.56), diabetes mellitus (OR 1.73) or heart problems (OR 3.36). Conclusions: Approximately one-quarter of the elderly population living in Sao Paulo could be taking two or more potentially interacting medicines. Polypharmacy predisposes elderly individuals to PDDIs. More than half of these drug combinations (57.6%, n = 72) were part of commonly employed treatment regimens and may be responsible for adverse reactions that compromise the safety of elderly individuals, especially at home. Educational initiatives are needed to avoid unnecessary risks.

Interactions among endocrinology, seasonal reproductive cycles and the nesting biology of the female green sea turtle

We collected data on plasma levels of testosterone+5a-dihydrotestosterone (T+DHT) and corticosterone (CORT) from adult female green sea turtles (Chelonia mydas) from southern Queensland during distinct stages of their reproductive cycle. Those females capable of breeding in a given year had elevated plasma steroid levels (T+DHT 0.91 +/- 0.08; CORT 1.05 +/- 0.29 ng/ml), associated with follicular development, until courtship began in October. At the beginning of the nesting season in November plasma levels of 2 CORT were related to when the female first nested (r(2) = 0.06; F = 10.45; P = 0.01). However, they were not correlated with the number of clutches a female laid in that season (F = 3.65; P = 0.08). We repeatedly sampled 23 turtles over the nesting season and profiled changes in steroids immediately following oviposition of each clutch. Levels of T+DHT (range 0.41-0.58 ng/ml) and CORT (range 2.13-2.81 ng/ml) were similar through the early stages of the nesting season and inter-nesting period, and declined to near basal levels (T+DHT 0.37 +/- 0.03 and CORT 1.85 +/- ng/ml) following the last clutch for the season. Steroid hormone levels were also low (T+DHT 0.38 +/- 0.16; CORT 0.46 +/- 0.21 ng/ml) in four independent post-breeding (atretic) females; samples for these females were taken at a time when body condition was presumably at the lowest for the season. Subtle changes in the nesting environment, such as variation in nesting habitat or the time of night that nesting occurred, were associated with a small and slow CORT increase. We suggest CORT is increased in nesting females to assist in lipid transfer to prepare the ovarian follicles and/or the reproductive organs for ovulation.

Herb-drug interactions among commonly used psychoactive substances by healthcare students

The concurrent use of herbs and/or nutritional supplements with psychoactive effect and prescription medications is common among college students. College students are a particularly vulnerable population, for they are under less social/familiar surveillance and seek greater independence, as well as under greater intellectual effort, stress, anxiety and depression, which predispose them to a higher consumption of psychoactive substances. Herbs, vitamins, and other dietary supplements may influence the effects of prescription and nonprescription drugs leading to adverse consequences, by increasing the potential for interactions. However, documented interactions between herbal medicinal products and prescribed drugs are rare. Objective: determine the prevalence of concomitant use of psychoactive substances among healthcare students in the Lisbon School of Health Technology, Portugal, in order to assess the risk of potential herb-drug interactions.

Interactions among systems of finite size en predictive relativistic mechanics III. Short-range interaction and second-order terms

We compute up to and including all the c-2 terms in the dynamical equations for extended bodies interacting through electromagnetic, gravitational, or short-range fields. We show that these equations can be reduced to those of point particles with intrinsic angular momentum assuming spherical symmetry.

Quasi-experimental estimates of fiscal spillovers and spatial interactions among Brazilian cities

Nós usamos a metodologia de Regressões em Descontinuidade (RDD) para estimar o efeito causal do Fundo de Participação dos Municípios (FPM) recebido por um município sobre características dos municípios vizinhos, considerando uma variedade de temas: finanças públicas, educação, saúde e resultados eleitorais. Nós exploramos a regra que gera uma variação exógena da transferência em munícipios próximos às descontinuidades no repasse do fundo de acordo com faixas de população. Nossa principal contribuição é estimar separadamente e em conjunto o efeito spillover e o efeito direto do FPM, considerando ambos municípios vizinhos ou apenas um deles próximos às mudanças de faixa. Dessa forma, conseguimos entender melhor a interação entre municípios vizinhos quando há uma correlação na probabilidade de receber uma transferência federal. Nós mostramos que a estimativa do efeito direto do FPM sobre os gastos locais diminui em cerca de 20% quando controlamos pelo spillover do vizinho, que em geral é positivo, com exceção dos gastos em saúde e saneamento. Nós estimamos um efeito positivo da transferência sobre notas na prova Brasil e taxas de aprovação escolares em municípios vizinhos e na rede estadual do ensino fundamental. Por outro lado, o recebimento de FPM por municípios vizinhos de pequena população reduz o provimento de bens e serviços de saúde em cidades próximas e maiores, o que pode ocorrer devido à redução da demanda por serviços de saúde. A piora de alguns indicadores globais de saúde é um indício, no entanto, de que podem existir problemas de coordenação para os prefeitos reterem seus gastos em saúde. De fato, quando controlamos pela margem de vitória nas eleições municipais e consideramos apenas cidades vizinhas com prefeitos de partido diferentes, o efeito spillover é maior em magnitude, o que indica que incentivos políticos são importantes para explicar a subprovisão de serviços em saúde, por um lado, e o aumento da provisão de bens em educação, por outro. Nós também constatamos um efeito positivo do FPM sobre votos para o partido do governo federal nas eleições municipais e nacionais, e grande parte desse efeito é explicado pelo spillover do FPM de cidades vizinhas, mostrando que cidades com dependência econômica do governo federal se tornam a base de sustentação e apoio político desse governo. Por fim, nós encontramos um efeito ambíguo do aumento de receita devido ao FPM sobre a competição eleitoral nas eleições municipais, com uma queda da margem de vitória do primeiro colocado e uma redução do número de candidatos, o que pode ser explicado pelo aumento do custo fixo das campanhas locais.

Dominance and Subordination Interactions Among Nestmates in Pre and Post-Emergence Phases of the Basal Eusocial Wasp Mischocyttarus (Monogynoecus) montei (Hymenoptera, Vespidae)

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

The role of chemotactile cues in interspecific interactions among Central-European arthropod communities

In einem Ökosystem beeinflussen sich Tiere gegenseitig in erster Linie durch direkte Interaktionen. Ihr Verhalten kann aber auch indirekt durch chemotaktile Stoffe die andere Tiere in der Umwelt hinterlassen beeinflusst werden. Vergleichbar zu direkten Interaktionen können indirekt ausgelöste Verhaltensänderungen einen starken Einfluss auf Populationsdynamiken und Gemeinschaftsstrukturen eines Ökosystems haben. Obwohl das daran gehegte Interesse der Ökologen in den letzten Jahrzenten stark gestiegen ist, fehlen immer noch Studien, welche über mehrere Arten hinweg versuchen die übergreifende Relevanz von chemotaktilen Stoffen herauszufinden. Im Rahmen meiner Doktorarbeit untersuchte ich daher wie sich mehrere mitteleuropäische Arthropodenarten, abhängig von deren interspezifischen Räuber-Beute- und Konkurrenzbeziehungen, mittels chemotaktiler Stoffe beeinflussen können. Mithilfe unterschiedlicher Verhaltensversuche konnte ich empirisch nachweisen, dass verschiedene Arthropoden chemotaktile Stoffe zu ihrem eigenen Vorteil nutzen können. Außerdem zeigen meine Ergebnisse, dass die Verhaltensänderungen artspezifisch und abhängig von den jeweiligen Lebenszyklen und den damit verbundenen Eigenschaften (z.B. Körpergröße, Häufigkeit oder Rangordnung) der beteiligten Arten sind. Ich vermute daher, dass Arthropoden chemotaktile Stoffe ihrer Gegenspieler wahrnehmen und interpretieren können. Eine Verhaltensänderung scheint jedoch nur dann statt zu finden wenn ein Nichtreagieren starke Fitnesskosten mit sich führen würde. Zusammenfassend zeigen die Ergebnisse meiner Doktorarbeit, wie wichtig es ist, die Bedeutung von chemotaktilen Stoffen innerhalb vieler Arten einer Gemeinschaft zu testen, um die den Verhaltensänderungen zugrundeliegenden Ursachen identifizieren zu können. Dies wiederum stellt die Grundlage, um die ökologische Relevanz von chemotaktilen Stoffen und deren mögliche Effekte auf Ökosystemfunktionen besser zu verstehen.

Interactions among chronic and acute impacts on coral recruits: the importance of size-escape thresholds

Newly settled recruits typically suffer high mortality from disturbances, but rapid growth reduces their mortality once size-escape thresholds are attained. Ocean acidification (OA) reduces the growth of recruiting benthic invertebrates, yet no direct effects on survivorship have been demonstrated. We tested whether the reduced growth of coral recruits caused by OA would increase their mortality by prolonging their vulnerability to an acute disturbance: fish herbivory on surrounding algal turf. After two months' growth in ambient or elevated CO2 levels, the linear extension and calcification of coral (Acropora millepora) recruits decreased as CO2 partial pressure (pCO2) increased. When recruits were subjected to incidental fish grazing, their mortality was inversely size dependent. However, we also found an additive effect of pCO2 such that recruit mortality was higher under elevated pCO2 irrespective of size. Compared to ambient conditions, coral recruits needed to double their size at the highest pCO2 to escape incidental grazing mortality. This general trend was observed with three groups of predators (blenny, surgeonfish, and parrotfish), although the magnitude of the fish treatment varied among species. Our study demonstrates the importance of size-escape thresholds in early recruit survival and how OA can shift these thresholds, potentially intensifying population bottlenecks in benthic invertebrate recruitment.

Interactions among enzymes of the Arabidopsis flavonoid biosynthetic pathway

Flavonoids are secondary metabolites derived from phenylalanine and acetate metabolism that perform a variety of essential functions in higher plants. Studies over the past 30 years have supported a model in which flavonoid metabolism is catalyzed by an enzyme complex localized to the endoplasmic reticulum [Hrazdina, G. & Wagner, G. J. (1985) Arch. Biochem. Biophys. 237, 88–100]. To test this model further we assayed for direct interactions between several key flavonoid biosynthetic enzymes in developing Arabidopsis seedlings. Two-hybrid assays indicated that chalcone synthase, chalcone isomerase (CHI), and dihydroflavonol 4-reductase interact in an orientation-dependent manner. Affinity chromatography and immunoprecipitation assays further demonstrated interactions between chalcone synthase, CHI, and flavonol 3-hydroxylase in lysates from Arabidopsis seedlings. These results support the hypothesis that the flavonoid enzymes assemble as a macromolecular complex with contacts between multiple proteins. Evidence was also found for posttranslational modification of CHI. The importance of understanding the subcellular organization of elaborate enzyme systems is discussed in the context of metabolic engineering.

Protein–protein interactions among the Aux/IAA proteins

The plant hormone indoleacetic acid (IAA) transcriptionally activates early genes in plants. The Aux/IAA family of early genes encodes proteins that are short-lived and nuclear-localized. They also contain a putative prokaryotic βαα DNA binding motif whose formation requires protein dimerization. Here, we show that the pea PS-IAA4 and Arabidopsis IAA1 and IAA2 proteins perform homo- and heterotypic interactions in yeast using the two-hybrid system. Gel-filtration chromatography and chemical cross-linking experiments demonstrate that the PS-IAA4 and IAA1 proteins interact to form homodimers in vitro. Deletion analysis of PS-IAA4 indicates that the βαα containing acidic C terminus of the protein is necessary for homotypic interactions in the yeast two-hybrid system. Screening an Arabidopsis λ-ACT cDNA library using IAA1 as a bait reveals heterotypic interactions of IAA1 with known and newly discovered members of the Arabidopsis Aux/IAA gene family. The new member IAA24 has similarity to ARF1, a transcription factor that binds to an auxin response element. Combinatorial interactions among the various members of the Aux/IAA gene family may regulate a variety of late genes as well as serve as autoregulators of early auxin-regulated gene expression. These interactions provide a molecular basis for the developmental and tissue-specific manner of auxin action.

Genetic interactions among cytoplasmic dynein, dynactin, and nuclear distribution mutants of Neurospora crassa.

Cytoplasmic dynein is a multisubunit, microtubule-associated, mechanochemical enzyme that has been identified as a retrograde transporter of various membranous organelles. Dynactin, an additional multisubunit complex, is required for efficient dynein-mediated transport of vesicles in vitro. Recently, we showed that three genes defined by a group of phenotypically identical mutants of the filamentous fungus Neurospora crassa encode proteins that are apparent subunits of either cytoplasmic dynein or dynactin. These mutants, designated ropy (ro), display abnormal hyphal growth and are defective in nuclear distribution. We propose that mutations in other genes encoding dynein/dynactin subunits are likely to result in a ropy phenotype and have devised a genetic screen for the isolation of additional ro mutants. Cytoplasmic dynein/dynactin is the largest and most complex of the cytoplasmic motor proteins, and the genetic system described here is unique in its potentiality for identifying mutations in undefined genes encoding dynein/dynactin subunits or regulators. We used this screen to isolate > 1000 ro mutants, which were found to define 23 complementation groups. Unexpectedly, interallelic complementation was observed with some allele pairs of ro-1 and ro-3, which are predicted to encode the largest subunits of cytoplasmic dynein and dynactin, respectively. The results suggest that the Ro1 and Ro3 polypeptides may consist of multiple, functionally independent domains. In addition, approximately 10% of all newly isolated ro mutantsdisplay unlinked noncomplementation with two or more of the mutants that define the 23 complementation groups. The frequent appearance of ro mutants showing noncomplementation with multiple ro mutants having unlinked mutations suggests that nuclear distribution in filamentous fungi is a process that is easily disrupted by affecting either dosage or activity of cytoplasmic dynein, dynactin, and perhaps other cytoskeletal proteins or regulators.

Cooperative interactions among afferents govern the induction of homosynaptic long-term depression in the hippocampus.

Prolonged periods of low-frequency stimulation have been shown to produce a robust, long-term synaptic depression (LTD) in both hippocampus and visual cortex. In the present study we have examined the extent to which interactions among afferents govern the induction of homosynaptic LTD in young-adult rats in hippocampal region CA1 in vitro. Field excitatory postsynaptic potentials were assessed before and after conditioning stimulation consisting of two 10-min trains of low-frequency stimulation (LFS; 1 Hz) of the Schaffer collateral/commissural pathway. LFS at an intensity producing a 0.5-mV response did not produce significant synaptic depression. However, LFS administered at a higher intensity resulted in significant input-specific LTD of a 0.5-mV test response. Picrotoxin, which also facilitates depolarization of CA1 neurons, significantly enhanced the magnitude of LTD after LFS at 0.5 mV. In addition, LFS at 0.5 mV in normal perfusion medium (no picrotoxin) produced only small changes in synaptic efficacy when either of two converging pathways was conditioned separately but produced a robust LTD when both pathways were conditioned simultaneously. This cooperative LTD was reversibly blocked by prior administration of 100 microM DL-aminophosphonovaleric acid but not by 20 microM nimodipine. Taken together, these results suggest that cooperative interactions among afferents contribute to voltage-dependent processes underlying the induction of homosynaptic LTD.

The branching gene RAMOSUS1 mediates interactions among two novel signals and auxin in pea

In Pisum sativium, the RAMOSUS genes RMS1, RMS2, and RMS5 regulate shoot branching via physiologically defined mobile signals. RMS1 is most likely a carotenoid cleavage enzyme and acts with RMS5 to control levels of an as yet unidentified mobile branching inhibitor required for auxin inhibition of branching. Our work provides molecular, genetic, and physiological evidence that RMS1 plays a central role in a shoot-to-root-to-shoot feedback system that regulates shoot branching in pea. Indole-3-acetic acid (IAA) positively regulates RMS1 transcript level, a potentially important mechanism for regulation of shoot branching by IAA. In addition, RMS1 transcript levels are dramatically elevated in rms3, rms4, and rms5 plants, which do not contain elevated IAA levels. This degree of upregulation of RMS1 expression cannot be achieved in wild-type plants by exogenous IAA application. Grafting studies indicate that an IAA-independent mobile feedback signal contributes to the elevated RMS1 transcript levels in rms4 plants. Therefore, the long-distance signaling network controlling branching in pea involves IAA, the RMS1 inhibitor, and an IAA-independent feedback signal. Consistent with physiological studies that predict an interaction between RMS2 and RMS1, rms2 mutations appear to disrupt this IAA-independent regulation of RMS1 expression.