Medication Use Quality and Safety in Older Adults: 2018 Update

Improving the quality of medication use and medication safety is an important priority for prescribers who care for older adults. The objective of this article was to identify key articles from 2018 that address these issues. In addition, we selected four of these articles to annotate, critique, and discuss their broader implications for clinical practice. The first study highlights a cluster‐randomized trial that utilized a pharmacist‐led education‐based intervention delivered to both patients and physicians to deprescribe four types of inappropriate medications (sedative‐hypnotics, first‐generation antihistamines, selective nonsteroidal anti‐inflammatory drugs, and glyburide). The second study, a nested case‐control study using data from within the UK Clinical Practice Research Datalink, examined the association between anticholinergic exposure, overall and by anticholinergic medication class, and dementia risk in 40 770 older adults. The third study, a longitudinal cohort study of 1028 Swedish older adults, examined the association between antihypertensive medications and incident dementia. The last study was a randomized, double‐blind, placebo‐controlled trial that investigated the effect of daily low‐dose aspirin (100 mg) for primary prevention on cardiovascular events and major hemorrhage in 19 144 community‐dwelling older adults. Collectively, this current article provides insight into the pertinent topics of medication use quality and safety in older adults and helps raise awareness about optimal prescribing in older adults. J Am Geriatr Soc 67:2458–2462, 2019     

Plasma lipoproteins in visceral leishmaniasis and their effect on Leishmania‐infected macrophages

This work aimed at investigating the lipid profile of zoonotic visceral leishmaniasis (VL) patients’ sera and the effect of lipoproteins on the in vitro production of tumour necrosis factor‐α (TNF‐α), interleukin (IL)‐6, IL‐10 and IL‐12 by Leishmania infantum‐infected and uninfected macrophages. Lipids were quantified in 26 VL patients’ sera and 26 healthy controls from a VL endemic area. The patients’ sera had higher triglyceride and very low density lipoprotein (VLDL) levels, and much lower apolipoprotein A1, total cholesterol, low density lipoprotein (LDL) and high density lipoprotein (HDL) levels than the control sera. Lipoprotein fractions were obtained by ultracentrifugation of sera. The addition of LDL and HDL to Leishmania‐infected and uninfected macrophages, in physiological concentrations, enhanced the production of IL‐6 and IL‐10, but not of IL‐12. LDL stimulated the production of TNF‐α only in infected macrophages, whereas HDL stimulated the production of lower amounts of TNF‐α in both infected and uninfected macrophages. VLDL stimulated only the production of IL‐10. It is proposed herein that LDL may influence the development of VL by promoting the production of TNF‐α by infected macrophages. A decrease in plasma LDL in some VL patients (to 20 mg/mL or less); however, would tend to reduce the production of TNF‐α and therefore to limit the development of immune‐mediated pathology, not withstanding the fact that it would perhaps increase the permissiveness of macrophages to Leishmania growth.     

大连市英那河水库库区污染源清理及效果

目的探讨水库库区污染源清理的方法和效果.方法于2002年对大连市英那河水库库区的猪圈、牲口圈、厕所、院坑、坟墓等污染源清理后,计算污染源面积,采集清理后未消毒的土壤样品,用生石灰或漂白粉消毒后的土壤样品.按照GB 7959-1987<粪便无害化卫生标准>进行评价.结果每座牲口圈、猪圈、厕所、禽舍、院坑、坟墓的污染源面积分别为77.4、74.2、31.7、32.1、36.3、158.5 m2.选用生石灰和漂白粉进行消毒.猪圈污染源清理后未消毒和清理清理后消毒的土壤样品大肠埃希菌值、蠕虫卵合格率分别为85.94%和90.31%,96.88%和99.38%.消毒前后的土壤样品大肠埃希菌值合格率(x2=11.58,P＜0.005)、蠕虫卵合格率(P＜0.005)差异均有统计学意义.库区各类污染源清理后消毒的土壤样品大肠埃希菌值(95.78%)和蠕虫卵合格率(99.85%)接近库区山坡荒地土壤对照样品(大肠埃希菌值和蠕虫卵合格率均为100%).结论库区污染源采取清理与药物消毒联合应用,能够保障污染源清理达到清洁土壤的卫生指标.     

Ganglioneuroma of the terminal ileum. An unusual case of occult gastrointestinal bleeding

Occult gastrointestinal (GI) bleeding from small-bowel tumors is relatively uncommon, and bleeding from neural tumors is rare. A case of chronic bleeding from a ganglioneuroma that led to ileal ulceration is presented. This case documents the important role of exploratory celiotomy and thorough exploration of the abdomen in carefully selected patients with occult GI blood loss. In this case, a complete preoperative evaluation was negative, but a nondirected celiotomy resulted in diagnosis and successful treatment.     

Structure-activity requirements for hypotension and alpha-adrenergic receptor blockade by analogues of atropine

The hypotensive action of various antimuscarinic compounds structurally related to atropine was studied in conscious, unanesthetized rats. The alpha-adrenolytic activity of these agents was assessed both in vivo (blockade of norepinephrine-induced pressor response) and in vitro (displacement of [3H]WB-4101 binding). Benztropine, homatropine and hyoscyamine caused hypotension and produced alpha-adrenergic receptor blockade similar to atropine. Other analogues were either inactive (atroscine, scopolamine, tropic acid and tropine) or evoked nonspecific changes in blood pressure and lacked alpha-adrenolytic activity (benactyzine, eucatropine, methylatropine, methylhomatropine and methylscopolamine). Based on these data, we propose the following structure-activity relationship for hypotension and alpha-adrenolytic activity: (a) the tropine moiety is inactive unless it is attached to another group by an ester linkage, (b) chemical modification of the tropine moiety, including quaternization, decreases potency, (c) the d-stereoisomer appears to be more potent than the corresponding 1-form.