Medication prescribing and administration in nursing homes

Objective: to examine the key determinants of pharmaco-epidemiology in Australian nursing homes. Design: a cross-sectional survey of medication use in 998 residents in 15 nursing homes in Southern Queensland and Northern New South Wales, Results: the total, laxative, digoxin/diuretic, benzodiazepine and psycholeptic medication prescribed and administered to residents of nursing homes was affected to differing extents by age and gender, the nursing home, resident functional disability and medical practitioner. Resident Classification Instrument (RCI) category and nursing home were the dominant determinants for prescribing and administration of the total drugs, laxative, benzodiazepine and psycholeptic medications. In contrast, the resident use of digoxin and/or diuretics was dependent on the resident age and on the functional disability (RCI category) of the resident but not medical practitioner or nursing home. Approximately 30% of medications were prescribed on a pro re nata (p.r.n.) basis and administered at the discretion of registered nurses. Conclusion: nursing home culture is a major determinant of the variability in medication use between residents, particularly for those medications often prescribed for p.r.n. use. The nursing home does not account for variation in the use of digoxin and/or diuretics which are prescribed on a non-discretionary basis.

Association of bowel movement frequency and use of laxatives with the occurrence of symptomatic gallstone disease in a prospective study of women

OBJECTIVES: The authors prospectively examined the association between bowel movement frequency (used as a proxy for intestinal transit), laxative use, and the risk of symptomatic gallstone disease. METHODS: A total of 79,829 women, aged 36–61 yr, without a history of symptomatic gallstone disease and free of cancer, responded to a mailed questionnaire in 1982 that assessed bowel movement frequency and use of laxatives. Between 1984 and 1996, 4,443 incident cases of symptomatic gallstone disease were documented. Relative risks (RRs) of symptomatic gallstone disease and 95% confidence intervals (CIs) were calculated using logistic regression. RESULTS: After controlling for age and established risk factors, the multivariate RRs were, compared to women with daily bowel movements, 0.97 (95% CI 0.86–1.08) for women with bowel movements every third day or less, and 1.00 (95% CI 0.91–1.11) for women with bowel movement more than once daily. No trend was evident. As compared to women who never used laxatives in 1982, a significant modest inverse association was seen for monthly laxative use, with a multivariate RR of 0.84 (95% CI 0.72–0.98), and weekly to daily laxative use was associated with a RR of 0.88 (95% CI 0.78–1.02). CONCLUSIONS: These findings do not support an association between infrequent bowel movements and risk of symptomatic gallstone disease in women, and indicate that simple questions directed at bowel movement frequency are unlikely to enhance our ability to predict risk of symptomatic gallstone disease. The slightly inverse association between use of laxatives and risk of symptomatic gallstone disease may be due to a mechanism that is not related to bowel movement frequency.

Aspectos químicos, biológicos e etnofarmacológicos do gênero Cassia

Species of Cassia are widely distributed in tropical and subtropical regions throughout the world, and have been extensively investigated chemically and pharmacologically.They are known to be a rich source of phenolic derivatives, most of them with important biological and pharmacological properties. Some Asian, African and Indian tribes use these species as a laxative, purgative, antimicrobial, antipyretic, antiviral and anti-inflammatory agent. Among a number of other classes of secondary metabolites, such as anthracene derivatives, antraquinones, steroids and stilbenoids, biologically active piperidine alkaloids are an especially important bioactive class of compounds that showed to be restricted to a small group of Cassia species. In this paper we present an overview of the chemical, biological and ethnopharmacological data on Cassia piblished in the literature.

Use of erythromycin for the treatment of severe chronic constipation in children

The efficacy of erythromycin was assessed in the treatment of 14 children aged 4 to 13 years with refractory chronic constipation, and presenting megarectum and fecal impaction. A double-blind, placebo- controlled, crossover study was conducted at the Pediatric Gastroenterology Outpatient Clinic of the University Hospital. The patients were randomized to receive placebo for 4 weeks followed by erythromycin estolate, 20 mg kg-1 day-1, divided into four oral doses for another 4 weeks, or vice versa. Patient outcome was assessed according to a clinical score from 12 (most severe clinical condition) to 0 (complete recovery). At enrollment in the study and on the occasion of follow-up medical visits at two-week intervals, patient score and laxative requirements were recorded. During the first 30 days, the mean ± SD clinical score for the erythromycin group (N = 6) decreased from 8.2 ± 2.3 to 2.2 ± 1.0 while the score for the placebo group (N = 8) decreased from 7.8 ± 2.1 to 2.9 ± 2.8. During the second crossover phase, the score for patients on erythromycin ranged from 2.9 ± 2.8 to 2.4 ± 2.1 and the score for the patients on placebo worsened from 2.2 ± 1.0 to 4.3 ± 2.3. There was a significant improvement in score when patients were on erythromycin (P < 0.01). Mean laxative requirement was lower when patients ingested erythromycin (P < 0.05). No erythromycin-related side effects occurred. Erythromycin was useful in this group of severely constipated children. A larger trial is needed to fully ascertain the prokinetic efficacy of this drug as an adjunct in the treatment of severe constipation in children.

Estratègies prèvies al sacrifici que poden afectar el benestar animal i la qualitat de la carn de porcs de diferent genotip RYRI

The main objective of this thesis was to study (i) the effect of the fasting and lairage on carcass and technological meat quality and (ii) the inclusion of magnesium (MgCO3 and MgSO4) and/or tryptophan during 5 days before slaughtering pigs as a strategy to decrease stress levels and improve meat quality, with two different porcine RYR1 genotypes (NN and nn). An adequate combination of fasting and lairage period is recommended. A supplement of MgCO3 or Trp did not improve meat quality under minimal stressful ante mortem conditions; and MgSO4 had a laxative effect on pigs supplemented with it. When including nn pigs to the herd, it is recommended to consider the supplements’ combination of tryptophan and a source of Mg (avoiding MgSO4) to alleviate the negative effect of the stress and to improve technological meat quality.

Excess burden of constipation in Parkinson's disease: A pilot study

An analysis was undertaken of clinic-based questionnaires that asked people with Parkinson's disease and a control group of older people without a known neurological condition about their experiences of constipation. People with Parkinson's disease report higher constipation on a validated objective measure, the Rome criterion (59% vs. 20.9%); a behavioral indicator, laxative-taking (38.4% vs. 14.2%); and subjective self-report of being always or often concerned by it (33.4% vs. 6.1%). Many people with Parkinson's disease experience constipation problems but they may not bring these to the attention of their healthcare providers. More research is required to understand the causes and management options. (C) 2006 Movement Disorder Society.

Adverse gastrointestinal effects of arginine and related amino acids

Oral supplements of arginine and citrulline increase local nitric oxide (NO production in the small intestine and this may be harmful under certain circumstances. Gastrointestinal toxicity was therefore reviewed with respect to the intestinal physiology of arginine, citrulline, ornithine, and cystine (which shares the same transporter) and the many clinical trials of supplements of the dibasic amino acids or N-acetylcysteine (NAC. The human intestinal dibasic amino acid transport system has high affinity and low capacity. L-Arginine (but not lysine, ornithine, or D-arginine) induces water and electrolyte secretion that is mediated by NO, which acts as an absorbagogue at low levels and as a secretagogue at high levels. The action of many laxatives is NO mediated and there are reports of diarrhea following oral administration of arginine or ornithine ihine. The clinical data cover a wide span of arginine intakes f rom 3 g/d to > 100 g/d, but the standard of reporting adverse effects (e.g. nausea, vomiting, and diarrhea) was variable. Single doses of 3-6 g rarely provoked side effects and healthy athletes appeared to be more susceptible than diabetic patients to gastrointestinal symptoms at individual doses >9 g. This may relate to an effect of disease on gastrointestinal motility and pharmacokinetics. Most side effects of arginine and NAC occurred at single doses of >9 g in adults >140 mg/kg) often when part of a daily regime of similar to>30 g/d (>174 mmol/d). In the case of arginine, this compares with the laxative threshold of the nonabsorbed disaccharide alcohol, lactitol (74 g or 194 mmol). Adverse effects seemed dependent on the dosage regime and disappeared if divided doses were ingested (unlike lactitol). Large single doses of poorly absorbed amino acids seem to provoke diarrhea. More research is needed to refine dosage strategies that reduce this phenomenon. It is suggested that dipeptide forms of arginine may meet this criterion.

Granskning av riktlinjer vid Sveriges förlossningskliniker gällande sfinkterskada i samband med förlossning : Innehållsanalys med en kombination av en deduktiv och induktiv ansats

Background: Sphincter injury is serious complication in connection to vaginal childbirth. Desire to avoid vaginal birth again is seen in women who previously suffered from a sphincter injury. Objective: To identify and evaluate obstetric guidelines in Sweden regarding sphincter injury in relation to childbirth Method: Content analysis with a combination of a deductive and inductive approach. Results: The most frequently occurring risk factors and prevention with help of perineal protection were described in the guidelines. The physician made diagnosis and repaired the sphincter injury at the theatre.  Complications such as coital pain and anal incontinence were described in the guidelines. Paracetamol and diclofenac was most common analgesic regimen given for pain. Prophylaxis such as antibiotic treatment and laxative were common. Information given to women was described. Follow-up by physician, midwife and physiotherapist was recommended after four weeks to six months. For future birth a cesarean section was recommended. Conclusion: The guidelines were constructed in the same way and had to a large extent similar content. The authors of the present work recommend a national guideline.

Análise botânica, química e biológica comparativa entre flores das espécies sambucus nigra L. e sambucus australis cham. & Schltdt. e avaliação preliminar da estabilidade

Flores das espécies Sambucus nigra, de origem européia, e Sambucus australis, nativa da América do Sul (Caprifoliaceae), denominadas sabugueiro e sabugueirodo- brasil, respectivamente, são utilizadas popularmente sob forma de infusão, como antiinflamatórias, laxativas e para condições febris resultantes de afecções do trato respiratório. Estudos prévios para S. nigra indicam compostos fenólicos como principais constituintes químicos, sendo estes relacionados às principais atividades biológicas avaliadas. Objetivando comparar esta espécie com Sambucus australis, foram realizadas análises botânicas macro e microscópicas das flores, identificando as principais diferenças entre as espécies, tais como o número de lóculos no ovário e presença de idioblastos cristalíferos em algumas estruturas, e observando os possíveis contaminantes (pedicelos). Também foram determinados os parâmetros farmacopéicos: cinzas totais e perda por dessecação. Após a análise química, foi escolhido o flavonóide rutina como marcador das espécies, para realizar análises quantitativas nas 31 amostras adquiridas e / ou coletadas, utilizando método de CLAE previamente validado. Soluções hidroetanólicas apresentaram maior capacidade de extração do produto alvo. Os limites mínimos de rutina observados para ambas as espécies foram de aproximadamente 0,65%. Também foram quantificados, por método espectrofotométrico, os flavonóides totais expressos em quercetina, sendo 0,93% e 1,46% os teores mínimos determinados para S.nigra e S. australis, respectivamente. O estudo da estabilidade acelerada (50°C ± 90% U.R.), avaliando a degradação dos constituintes químicos presentes permitiu sugerir a cinética de degradação de segunda ordem para da rutina nas duas espécies. Comparações de atividades biológicas das espécies foram realizadas pelos ensaios das atividades antiinflamatória (inibição do edema em pata de rato induzido por carragenina) e antioxidante (DPPH). Os resultados para o primeiro ensaio demonstraram ação equivalente em ambas as espécies para extratos hidroetanólicos a 80% (86% de inibição) e aquosos (81%), com atividade semelhante ao padrão indometacina (~83%); para a atividade antioxidante os extratos hidroetanólicos a 80% foram mais ativos (CE50 = 16 μg/ml) que os aquosos (CE50 = 27 μg/ml) em S. australis, e ambos extratos, superiores ao 28 extrato padronizado Gingko biloba (CE50 = 40 μg/ml) e aos extratos de S. nigra (CE50= 50 μg/ml – hidroetanólico e CE50= 32 μg/ml – aquoso).

Efeito de extratos vegetais na parasitemia do Trypanosoma cruzi e na biodistribuição do pertecnetato de sódio (Na99mTcO4)

Artemisia vulgaris (AV) is an antihelmintic and antimalarial drug; Aloe vera(babosa) acts as antidiabetic, laxative and anti-inflammatory; Benznidazole (BZ) is a trypanocidal of Trypanosoma cruzi (TC). Technetium-99m (99mTc) has been used in nuclear medicine to obtain diagnostic images. This study evaluated the plant effects in TC parasitemia and in the biodistribution of 99mTc in mice. Twenty mice were infected by TC. At the peak of parasitemia, 5 mice received babosa; 5 received AV and 5 received BZ. The parasitemia was determined in 0, 2, 4 and 6 h of drugs administration. Five infected mice without drugs, 5 mice without TC and the group treated with AV, received 99mTc. The radioactivity was calculated. Infected mice that received babosa reduced significantly (p<0.05) the parasitemia. The percentage of activity (%ATI) decreased significantly in the AV group. These results indicate that babosa possibly is an anti-TC drug and AV reduces the %ATI probably due to its biological effects

Genotoxicity assessment of Garcinia achachairu Rusby (Clusiaceae) extract in mammalian cells in vivo

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Uso de psyllium para controle de constipação em cães

psyllium (Plantago psyllium) é um vegetal comumente utilizado como adjuvante no tratamento de afecções que resultam em constipação. Com o objetivo de melhor compreender os efeitos dessa fibra em cães, foram realizados dois experimentos. O primeiro avaliou, em cães sadios, inclusões de 0%, 2% e 4% de semente integral moída de psyllium à dieta (com base na matéria natural). Para tanto, foram empregados oito cães da raça Beagles adultos, os quais receberam as dietas experimentais por oito dias. Verificou-se aumento linear da umidade das fezes com a adição de teores crescentes de psyllium (R²=0,54 e P=0,0012), sem alteração do escore fecal e número de defecações por dia. O segundo experimento incluiu avaliação da opinião de 24 proprietários cujos cães receberam suplementação de 2% de psyllium como parte do tratamento de afecções que causaram constipação. Dos proprietários incluídos, 19 (79,2%) relataram melhora da defecação de seus cães durante a administração da fibra. Quinze (62,5%) observaram que as fezes dos animais, antes ressecadas ou endurecidas, tornaram-se normais ou pastosas. Os resultados comprovaram para cães os efeitos laxativos do psyllium já descritos na medicina humana, indicando seu uso no tratamento de suporte de enfermidades que levam à constipação.

Avaliação do extrato de Momordica charantia em Salmonella typhimurium: Mutagenicidade e antimutagenicidade

In the last years some natural products has been described as supressors of the mutagenic process in bacteria, the antimutagenics. The literature reference that in most of the countries, the population makes use of medicinal plants. The plant Momordica charantia (Cucurbitaceae) is original from Africa being used popularly as purgative, antirheumatic and for skin problems, burns and hemorrhoids. The present work had as objective to evaluate the mutagenic and antimutagenic activities of the ethanolic extract of M. charantia in Salmonella/microsome assays using TA100, TA98 and TA102 strains. It was verified that the extract did not present mutagenic activity when evaluated in different concentrations (0.64, 1.27, 2.55 and 3.84 mg/plate) but acted as antimutagenic agent against the mutations induced by the sodium azide (TA100,-S9), 4-nitro-phenylenediamine (TA98, -S9), daunomycin (TA102, +S9) 2-anthramine (TA100 and TA98, +S9) and 2-aminofluorene (TA102, +S9). When the metabolic activation (+S9) was used, the percentage of inhibition of the mutagenicity varied in the range of 31%-96%, while in absence of metabolizing system (-S9), the maximum percentage of inhibition of the mutagenicity was 44%. In that way, we can conclude that the metabolites found in the extract has potential to protect the genetic material against the damages induced by different chemical agents.

Aspectos químicos, biológicos e etnofarmacológicos do gênero Cassia

Species of Cassia are widely distributed in tropical and subtropical regions throughout the world, and have been extensively investigated chemically and pharmacologically.They are known to be a rich source of phenolic derivatives, most of them with important biological and pharmacological properties. Some Asian, African and Indian tribes use these species as a laxative, purgative, antimicrobial, antipyretic, antiviral and anti-inflammatory agent. Among a number of other classes of secondary metabolites, such as anthracene derivatives, antraquinones, steroids and stilbenoids, biologically active piperidine alkaloids are an especially important bioactive class of compounds that showed to be restricted to a small group of Cassia species. In this paper we present an overview of the chemical, biological and ethnopharmacological data on Cassia piblished in the literature.

Constipação intestinal

It was reviewed the definition, mechanisms and classification of functional constipation. The diagnostic resources available were showed and it was underlined the importance to investigate and exclude the multiple causes of secondary constipation. The therapy was divided in general measures, like diet and specialized, involving laxatives and others alternatives. It was commented the different categories of laxatives, their actions and adverse effects. It was concluded that the best approach to functional defecatory disorder is biofeedback. Otherwise, for defecatory disturbance caused by mechanical obstruction and refractory constipation due to slow transit the therapeutical option is surgery.