Opioids and constipation therapy in the last week of life: Their impact on patients,caregivers, and the location of death

The use of opioids to control pain at the end of life may cause constipation, a symptom that can negatively influence the well-being of patients and caregivers. The main aim of this study was to evaluate the impact of constipation on symptomatic control and patients’ overall quality of life at this stage. A particular focus was placed on opioids. We also intended to investigate whether constipation and caregiver fatigue is related to the place of death (hospital vs home). The approach of 121 patients followed in 2021 in their last week of life by a home team specialized in palliative care was analyzed in an observational, retrospective, non-interventional study. The patients were followed up for an average of 39.7 days. A total of 82.6% wished to die at home, which occurred in 74% of the cases. The constipation prevention protocol reduced constipation by 55.1%. It seems that morphine is more related with constipation and tapentadol seems to reduce constipation induced by opioids. Patients tended to die in hospitals when their caregivers were exhausted; however, it was not possible to determine a cutoff point using the Zarit scale, which was used to assess caregiver burden. Constipation in the last week of life does not seem to influence the well-being of patients or their caregivers significantly and the individualization of intensive treatment of constipation is needed. Different opioids have different probabilities of causing adverse effects such as constipation. Future special support mechanisms can be created and activated for the most tired caregivers to avoid exhaustion and promote death at home, if that is the patient’s will.     

Physical and Thermal Properties Analysis of Hematite for Thermal Heat Storage

Energy sustainability represents an important research topic for aiding decreasing energy dependence and slowing down climate changes. In this context, solutions using thermal energy storage through rock start to emerge, due to its natural benefits, when compared to more polluting alternatives. To understand whether a rock material can be considered a good thermal energy storage material for such solutions, it is necessary to evaluate the physical, chemical and thermal properties of such materials. Therefore, it becomes essential to understand how heat propagates in the rock and how voids influence the thermal properties. To achieve these goals, hematite ore from Moncorvo, Northeastern Portugal was used, in particular, to study the effect of grain size on thermal properties for three different sized lots. Chemical and physical changes between heated and unheated lots were detected using X-ray diffraction and particle size, as well as X-ray fluorescence analysis. Regarding thermal properties, a hot wire method approach was used with seven thermocouples. Additionally, a thermal inversion model to simulate the heat exchanges was also proposed, allowing changing the properties of the constituents, to fit the theoretical and experimental temperature curve. Furthermore, the model reveals how heat propagates inside the reservoir filled with hematite ore.     

Uncertainty management for individuals with Lynch Syndrome: Identifying and responding to healthcare barriers

ObjectiveExamine the uncertainty management process of individuals with Lynch syndrome (LS).Methods19 phone interviews were conducted with individuals with LS. The interview guide included questions on family communication, risk perceptions, and uncertainty management. Data were analyzed using the constant comparison method to code for emergent themes.ResultsQualitative analysis found individuals with LS tried to manage their uncertainty through preventive care, but were often confounded by healthcare barriers. Healthcare barriers included cost and insurance issues, absence of coordinated care, insufficient provider knowledge, and lack of patient-centered communication. Participants reported increased uncertainty and anxiety due to these barriers and used alternative uncertainty management strategies such as advocating for themselves with providers, seeking information online, and communicating with family for emotional support.ConclusionHealthcare barriers identified in this study exacerbated uncertainty and anxiety for individuals with LS and challenged their ability to engage in preventive care. In response, participants used alternative uncertainty management strategies to reduce their uncertainty, which may have unintended negative consequences.Practice implicationsFindings support the need for providers to partner with specialists in genetics and/or LS to better care for individuals with LS. Findings highlight opportunities for interventions in healthcare to better support individuals with LS.     

The influence of a diet based on flaxseed,an omega-3 source,during different developmental periods,on the blood pressure of rats submitted to stress

Objective: This study aimed to investigate a flaxseed diet during different developmental periods, and its effect on the blood pressure of rats submitted to stress.

Methods: Fifty-six male rats (F₁), born from 14 rats (F₀), were divided into seven groups (n?=?8): flaxseed group (FG); flaxseed group gestation and lactation (FG-GL); flaxseed group weaning (FG-W); flaxseed group weaning and stress (FG-WS); flaxseed group stress (FG-S); flaxseed group gestation lactation and weaning (FG-GLW), and control Group (CG). Stress protocol was undertaken for 1 month. Blood pressure was analysed before and after the stress protocol. The left adrenal glands and serum corticosterone levels were analysed.

Results: Systolic blood pressure before stress was lower in all groups with flaxseed diet compared with the CG (p?=?.00001). After stress, CG showed higher blood pressure compared with FG, FG-GL, and FG-GLW (p?=?.004). The levels of corticosterone were lower in the FG between all groups (p?p?Conclusions: Results suggest a possible factor from a flaxseed diet against the effects of stress on a blood pressure in all periods of life but especially in the gestation and lactation periods.     

Prosthetic mitral valve thrombosis,malfunction, and paroxysmal mitral regurgitation

Intermittent dysfunction of mechanical mitral valve prosthesis is an uncommon condition. It carries serious clinical implications if unrecognized. Here, we present a case of a 28‐year‐old female with a history of rheumatic multivalvular disease, for which she had undergone double valve replacement and tricuspid annuloplasty. Six months later, she presented with heart failure. Clinical examination revealed intermittent loss of closing clicks followed by a pansystolic murmur at the apex, suggestive of mitral prosthetic valve dysfunction. We highlight the echocardiographic findings of paroxysmal mitral valvular regurgitation secondary to prosthetic valve malfunction secondary to prosthetic valve thrombosis.