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JAMA Network Open Jun 2024Potentially inappropriate medication (PIM) exposes patients to an increased risk of adverse outcomes. Many lists of explicit criteria provide guidance on identifying PIM...
IMPORTANCE
Potentially inappropriate medication (PIM) exposes patients to an increased risk of adverse outcomes. Many lists of explicit criteria provide guidance on identifying PIM and recommend alternative prescribing, but the complexity of available lists limits their applicability and the amount of data available on PIM prescribing.
OBJECTIVE
To determine PIM prevalence and the most frequently prescribed PIMs according to 6 well-known PIM lists and to develop a best practice synthesis for clinicians.
DESIGN, SETTING, AND PARTICIPANTS
This cross-sectional study used anonymized electronic health record data of Swiss primary care patients aged 65 years or older with drug prescriptions from January 1, 2020, to December 31, 2021, extracted from a large primary care database in Switzerland, the FIRE project. Data analyses took place from October 2022 to September 2023.
EXPOSURE
PIM prescription according to PIM criteria operationalized for use with FIRE data.
MAIN OUTCOMES AND MEASURES
The primary outcomes were PIM prevalence (percentage of patients with 1 or more PIMs) and PIM frequency (percentage of prescriptions identified as PIMs) according to the individual PIM lists and a combination of all 6 lists. The PIM lists used were the American 2019 Updated Beers criteria, the French list by Laroche et al, the Norwegian General Practice Norwegian (NORGEP) criteria, the German PRISCUS list, the Austrian list by Mann et al, and the EU(7) consensus list of 7 European countries.
RESULTS
This study included 115 867 patients 65 years or older (mean [SD] age, 76.0 [7.9] years; 55.8% female) with 1 211 227 prescriptions. Among all patients, 86 715 (74.8%) were aged 70 years or older, and 60 670 (52.4%) were aged 75 years or older. PIM prevalence among patients 65 years or older was 31.5% (according to Beers 2019), 15.4% (Laroche), 16.1% (NORGEP), 12.7% (PRISCUS), 31.2% (Mann), 37.1% (EU[7]), and 52.3% (combined list). PIM prevalence increased with age according to every PIM list (eg, according to Beers 2019, from 31.5% at age 65 years or older to 37.4% for those 75 years or older, and when the lists were combined, PIM prevalence increased from 52.3% to 56.7% in those 2 age groups, respectively). PIM frequency was 10.3% (Beers 2019), 3.9% (Laroche), 4.3% (NORGEP), 2.4% (PRISCUS), 6.7% (Mann), 9.7% (EU[7]), and 19.3% (combined list). According to the combined list, the 5 most frequently prescribed PIMs were pantoprazole (9.3% of all PIMs prescribed), ibuprofen (6.9%), diclofenac (6.3%), zolpidem (4.5%), and lorazepam (3.7%). Almost two-thirds (63.5%) of all PIM prescriptions belonged to 5 drug classes: analgesics (26.9% of all PIMs prescribed), proton pump inhibitors (12.1%), benzodiazepines and benzodiazepine-like drugs (11.2%), antidepressants (7.0%), and neuroleptics (6.3%).
CONCLUSIONS AND RELEVANCE
In this cross-sectional study of adults aged 65 or older, PIM prevalence was high, varied considerably depending on the criteria applied, and increased consistently with age. However, only few drug classes accounted for the majority of all prescriptions that were PIM according to any of the 6 PIM lists, and by considering this manageable number of drug classes, clinicians could essentially comply with all 6 PIM lists. These results raise awareness of the most common PIMs and emphasize the need for careful consideration of their risks and benefits and targeted deprescribing.
Topics: Humans; Switzerland; Aged; Cross-Sectional Studies; Primary Health Care; Potentially Inappropriate Medication List; Female; Male; Inappropriate Prescribing; Aged, 80 and over; Prevalence; Practice Patterns, Physicians'
PubMed: 38904960
DOI: 10.1001/jamanetworkopen.2024.17988 -
Materials (Basel, Switzerland) May 2024Biochar enriched with metals has an increased potential for sorption of organic and inorganic pollutants. The aim of the research was to identify the possibility of...
Biochar enriched with metals has an increased potential for sorption of organic and inorganic pollutants. The aim of the research was to identify the possibility of using biochar composites produced on the basis of waste plant biomass and waste FFH (ferryferrohydrosol) containing iron atoms, after CO capture. The composites were produced in a one-stage or two-stage pyrolysis process. Their selected properties were determined as follows: pH, ash content, C, H, N, O, specific surface area, microstructure and the presence of surface functional groups. The produced biochar and composites had different properties resulting from the production method and the additive used. The results of experiments on the removal of methylene blue (MB) from solutions allowed us to rank the adsorbents used according to the maximum dye removal value achieved as follows: BC1 (94.99%), B (84.61%), BC2 (84.09%), BC3 (83.23%) and BC4 (83.23%). In terms of maximum amoxicillin removal efficiency, the ranking is as follows: BC1 (55.49%), BC3 (23.51%), BC2 (18.13%), B (13.50%) and BC4 (5.98%). The maximum efficiency of diclofenac removal was demonstrated by adsorbents BC1 (98.71), BC3 (87.08%), BC4 (74.20%), B (36.70%) and BC2 (30.40%). The most effective removal of metals Zn, Pb and Cd from the solution was demonstrated by BC1 and BC3 composites. The final concentration of the tested metals after sorption using these composites was less than 1% of the initial concentration. The highest increase in biomass on prepared substrates was recorded for the BC5 composite. It was higher by 90% and 54% (for doses of 30 g and 15 g, respectively) in relation to the biomass growth in the soil without additives. The BC1 composite can be used in pollutant sorption processes. However, BC5 has great potential as a soil additive in crop yield and plant growth.
PubMed: 38893909
DOI: 10.3390/ma17112646 -
Journal of Environmental Health Science... Jun 2024Society's support upon chemicals over the last few decades has led to their increased production, application and discharge into the environment. Wastewater treatment...
UNLABELLED
Society's support upon chemicals over the last few decades has led to their increased production, application and discharge into the environment. Wastewater treatment plants (WWTPs) contain a multitude of these chemicals such us; pharmaceutical compounds (PCs). Often, their biodegradability by activated sludge microorganisms is significant for their elimination during wastewater treatment. In this paper the focus is laid on two PCs carbamazepine (CBZ) and diclofenac (DCF) and their main transformation products (TPs). Laboratory degradation tests with these two pharmaceuticals using activated sludge as inoculum under aerobic conditions were performed and microbial metabolites were analyzed by liquid chromatography-mass spectrometry (LC/MS-MS). In two different Mixed liquid Suspended Solids (MLSS) concentrations the biodegradability by activated sludge of CBZ and DCF were evaluated. Also, this article proposes a decision support system to optimize the prediction process of this type of pharmacological compounds. A study and analysis of the techniques of Support Vector Machine, Random Forest, Decision Trees and Multilayer Perceptron Network is carried out to select the most reliable and accurate predictor for the decision system. There are not significant differences in the removal of DCF with 30 mg MLSS/L and 60 mg MLSS/L. DCF was better removed than CBZ in all experiments studied. The TP detected in the samples were mainly 4-OH-DCF for DCF and 10, 11 EPOXICBZ for CBZ. The results show that the best models are obtained with Random Forest and Multilayer Perceptron Network techniques, with a model fit of more than 95% for both carbamazepine and diclofenac metabolites. Obtaining a root means square errors of 0.80 µg/L for the metabolite 4-OH-DCF for DCF with the technique Random Forest and a root means square errors of 1.13 µg/L for the metabolite 10, 11 EPOXICBZ for CBZ with the Multilayer Perceptron Network technique.
SUPPLEMENTARY INFORMATION
The online version contains supplementary material available at 10.1007/s40201-023-00890-x.
PubMed: 38887771
DOI: 10.1007/s40201-023-00890-x -
American Journal of Translational... 2024Formulate a gel and test its scientific efficacy for treating musculoskeletal ailments with or without phonophoresis.
OBJECTIVE
Formulate a gel and test its scientific efficacy for treating musculoskeletal ailments with or without phonophoresis.
METHODS
Gel was made from leaf extract (30:70 aqueous-methanolic). A pragmatic, community-based, double-blinded randomized clinical study (IRCT20230202057310N1) was undertaken on 380 pre-diagnosed individuals with 1st and 2nd-grade musculoskeletal injuries, divided into four parallel groups (n = 95 per group): Group I got phonophoresis-applied 10% gel. Group II got phonophoresis-applied diclofenac diethylammonium 2% gel. 10% gel was superficially massaged onto Group III. Group IV received a superficial massage with diclofenac diethylammonium 2% gel. Color, stability, pH, spreadability, beginning of pain relief, discomfort, stiffness, and activities of daily living were recorded using the Numeric Pain Rating Scale (NPRS) and Western Ontario and McMaster Universities Arthritis Index (WOMAC) Scale. Methods included phytochemical analysis, molecular docking, and antioxidant quantification using 2,2-diphenylpicrylhydrazyl (DPPH), nitric oxide (NO), and superoxide dismutase (SOD) tests.
RESULTS
gel worked better than diclofenac gel in phonophoresis and massage, with regard to NPRS P<0.001, WOMAC pain P<0.001, WOMAC stiffness P<0.003, and WOMAC activities of daily living (ADLs) P<0.001. There were also significant differences in pain, stiffness, and ADLs. showed significant (P<0.005-0.001) results.
CONCLUSION
gel relieved pain and inflammation in musculoskeletal injury patients. gel is natural, cheap, and easy to make. Better drug absorption may explain the effectiveness of phonophoresis.
PubMed: 38883366
DOI: 10.62347/VMJO7002 -
Journal of Pharmacy & Bioallied Sciences Apr 2024Considerable focus has been directed toward green synthesis as a dependable, sustainable, and environmentally friendly approach for synthesizing various nanomaterials. ,...
BACKGROUND
Considerable focus has been directed toward green synthesis as a dependable, sustainable, and environmentally friendly approach for synthesizing various nanomaterials. , a quickly grown pantropical weed, has been used widely for its anti-inflammatory and antimicrobial activity in traditional medicine. The development of strontium-based nanoparticles and nanoparticles linked with strontium has garnered attention in recent years due to their established utility in diverse domains such as effective drug distribution, bioimaging, cancer treatment, and advancements in bone engineering.
AIMS AND OBJECTIVES
To examine the green synthesise of strontium nanoparticles using Mimosa pudica and its anti-inflammatory activity.
MATERIAL AND METHODS
-mediated strontium nanoparticles' anti-inflammatory activity was tested using bovine serum albumin denaturation assay, egg albumin denaturation assay, and membrane stabilization assay with diclofenac sodium as the standard. Result: In all three assays, increasing concentration of -mediated strontium nanoparticles exhibited an increasing anti-inflammatory effect, which was similar to the standard diclofenac sodium.
CONCLUSION
Consequently, this holds promise as a new potential anti-inflammatory agent in forthcoming applications.
PubMed: 38882793
DOI: 10.4103/jpbs.jpbs_586_23 -
Water Research Jun 2024Wastewater treatment plants (WWTPs) are essential for maintaining a good water quality of surface waters. However, WWTPs are also associated with water quality...
Wastewater treatment plants (WWTPs) are essential for maintaining a good water quality of surface waters. However, WWTPs are also associated with water quality deterioration and hydro-morphological alteration. Riverine communities respond to these stressors with changes in their community structure, abundance and diversity. In this study, we used a dataset of 94 monitoring sites across North Rhine-Westphalia, Germany to investigate the influence of WWTPs on the water quality and hydro-morphological quality in river sections downstream of WWTP effluents. More specifically, we analyzed the effects of the percentage of WWTP effluents (in relation to median base flow) on four stressor groups (physico-chemistry, micropollutants, hydrological and morphological alteration) using Linear Mixed Models (LMM). Furthermore, we assessed the impact of a selection of twelve ecologically relevant stressor variables reflecting water quality deterioration and hydro-morphological alteration on reference fish communities using Canonical Correspondence Analysis (CCA). The percentage of WWTP effluents was correlated with water quality, especially with toxic units of a wide range of pharmaceuticals including diclofenac, venlafaxine and sulfamethoxazole (R² up to 0.54) as well as specific pesticides (e.g., terbutryn: R² = 0.33). The correlation of percent WWTP effluents with hydro-morphological alteration was weaker and most pronounced for the frequency of high flow (R² = 0.24) and flow variability (R² = 0.19). About 40 % of the variance in the fish community structure were explained by 12 stressor variables in the CCA models. Water quality and hydrological, but not morphological stressors showed strong albeit highly variable effects on individual fish species. The results indicate that water quality degradation and hydrological alteration are important factors determining the ecological status of fish communities. In this context, WWTP effluents can impose relevant point sources of pollution that affect water quality but also cause alterations of the hydrological regime. Further management measures addressing both stressor groups are needed to improve the ecological status.
PubMed: 38880012
DOI: 10.1016/j.watres.2024.121914 -
Iranian Journal of Microbiology Apr 2024is an opportunistic pathogen causing nosocomial infections. Diclofenac is an anti-inflammatory drug that is considered a non-antibiotic drug. This study assessed the...
BACKGROUND AND OBJECTIVES
is an opportunistic pathogen causing nosocomial infections. Diclofenac is an anti-inflammatory drug that is considered a non-antibiotic drug. This study assessed the antibacterial and antibiofilm effects of diclofenac and levofloxacin/diclofenac combination against levofloxacin resistant isolates.
MATERIALS AND METHODS
Minimum inhibitory concentration was determined using broth microdilution method for levofloxacin, diclofenac, and levofloxacin/diclofenac combination. Biofilm forming capacity and biofilm inhibition assay were determined. Relative gene expression was measured for efflux pump genes; , and genes and biofilm related genes , and without and with diclofenac and the combination.
RESULTS
Diclofenac demonstrated MIC of 1 mg/ml. The combination-with ½ MIC diclofenac-showed synergism where levofloxacin MIC undergone 16-32 fold decrease. All the isolates that overexpressed and showed a significant decrease in gene expression in presence of diclofenac or the combination. The mean percentage inhibition of biofilm formation with diclofenac and the combination was 40.59% and 46.49%, respectively. This agreed with biofilm related genes expression investigations.
CONCLUSION
Diclofenac showed an antibacterial effect against The combination showed synergism, significant reduction in biofilm formation and in the relative level of gene expression. Furthermore, it can potentiate the levofloxacin activity or revert its resistance.
PubMed: 38854979
DOI: 10.18502/ijm.v16i2.15349 -
The Science of the Total Environment Jun 2024Drugs are chemical compounds used to treat and improve organic dysfunctions caused by diseases. These include analgesics, antibiotics, antidepressants, and...
Drugs are chemical compounds used to treat and improve organic dysfunctions caused by diseases. These include analgesics, antibiotics, antidepressants, and antineoplastics. They can enter aquatic environments through wastewater streams, where their physico-chemical properties allow metabolites to distribute and accumulate. Current climate change and associated extreme weather events may significantly impact these substances' toxicity and aquatic organisms' sensitivity. Among the chemicals present in aquatic environments is the non-steroidal anti-inflammatory drug diclofenac (DIC), which the EU monitors due to its concentration levels. This study investigated the influence of temperature (control at 17 °C vs. 21 °C) on the effects of DIC (0 μg/L vs. 1 μg/L) in the mussel species Mytilus galloprovincialis. Significant results were observed between 17 and 21 °C. Organisms exposed to the higher temperature showed a decrease in several parameters, including metabolic capacity and detoxification, particularly with prolonged exposure. However, in some parameters, after 21 days, the M. galloprovincialis showed no differences from the control, indicating adaptation to the stress. The results of this study confirm that DIC concentrations in the environment, and particularly when combined with increased temperatures, can produce oxidative stress and adversely affect many parameters in M. galloprovincialis. This study also validates this species as a bioindicator for assessing environmental contamination with DIC. Beyond its direct impact on aquatic organisms, the presence of pharmaceuticals like DIC in the environment highlights the interconnectedness of human, animal, and ecosystem health, underscoring the One Health approach to understanding and mitigating environmental pollution.
PubMed: 38848913
DOI: 10.1016/j.scitotenv.2024.173809 -
Annals of Medicine and Surgery (2012) Jun 2024Kidney damage can result from various factors, leading to structural and functional changes in the kidney. Acute kidney injury (AKI) refers to a sudden decline in kidney... (Review)
Review
INTRODUCTION
Kidney damage can result from various factors, leading to structural and functional changes in the kidney. Acute kidney injury (AKI) refers to a sudden decline in kidney function, while chronic kidney disease involves a gradual deterioration lasting more than 3 months. Mechanisms of renal injury include impaired microcirculation, inflammation, and oxidative stress. Cysteinyl-leukotrienes (CysLTs) are inflammatory substances contributing to tissue damage. Montelukast, a leukotriene receptor antagonist, has shown potential renoprotective effects in experimental models of kidney injury.
METHODS
The authors conducted a scoping review using PubMed, Scopus, and Web of Science databases to identify relevant studies investigating the impact of montelukast on renal diseases. Articles published until 2022 were included and evaluated for quality. Data extraction and analysis were performed based on predetermined inclusion criteria.
RESULTS
The scoping review included 30 studies from 8 countries. Montelukast demonstrated therapeutic effects in various experimental models of nephrotoxicity and AKI induced by agents such as cisplatin, lipopolysaccharide, diclofenac, amikacin, , cyclosporine, methotrexate, cobalt-60 gamma radiation, doxorubicin, and cadmium. Studies involving human subjects with nephrotic syndrome, pyelonephritis, and other renal diseases also reported positive outcomes with montelukast treatment. Montelukast exhibited anti-inflammatory, anti-apoptotic, antioxidant, and neutrophil-inhibiting properties, leading to improved kidney function and histopathological changes.
CONCLUSIONS
Montelukast shows promise as a renoprotective medication, particularly in early-stage kidney injury. Its ability to mitigate inflammation, oxidative stress, and neutrophil infiltration contributes to its therapeutic effects. Further research is needed to explore the clinical applications and mechanisms underlying the renoprotective action of montelukast.
PubMed: 38846849
DOI: 10.1097/MS9.0000000000002085