Appropriateness of proton pump inhibitors prescription in patient admitted to hospital: An observational study.

OBJECTIVES: The objective of this study was to assess the relevance of proton pump inhibitors prescribing in patients entering a ward with a clinical pharmacist and therefore identifying inappropriate prescribing. METHODS: A prospective study was conducted for 4 months. Patients admitted to the hospital for elective or emergency surgery, who had medication reconciliation performed by the clinical pharmacy team and who were prescribed proton pump inhibitors before admission were included. The indication for the proton pump inhibitors was collected from the patient or inferred from the medical history. The compliance of the prescriptions with the marketing authorization indications and the duration of treatment and dose was analyzed. The indications were classified into 3 groups: compliant with marketing authorization, off label but relevant use, and strictly off label use. RESULTS: During the study period, 100 patients were included among whom only 29% had a PPI prescription that did fully comply with the recommendations. Among the twenty-three prescriptions that did not comply with the recommendations in terms of indication, 15 were not relevant at all. Among the 65 prescriptions relevant for indication, 36 were not compliant with dose or duration recommendations. 59% of the total number of patients reported that they had never tried to stop treatment. CONCLUSIONS: Our study highlights the need for regular reassessment of proton pump inhibitors prescriptions. Multi-disciplinary collaboration on the appropriate use of this class of medication as well as increased awareness among general practitioners and hospital doctors is essential.

A high calorie diet induces type 2 diabetes in the desert sand rat (Psammomys obesus).

Diabetes mellitus type 2 is a major factor for cardiovascular diseases. The toxic effects of chronic hyperglycemia involve many alterations in the vascular tissue, including atherosclerosis. The pathogenesis of atherosclerosis in the diabetic syndrome (DS-II) has not been fully elucidated. A better understanding of the progress of DS-II at the level of the aorta could help us to identify inhibitors of atherosclerosis. Studies have shown that obesity and high calorie diet (HCD) are associated with the development of DS-II, however the lack of naturally occurring experimental models of DS-II have impaired to directly address these issues. We hypothesize that a HCD induces DS-II. This study (15 months duration) is designed to determine if HCD induces DS-II in the desert sand rat (Psammomys obesus; P. obesus). We also evaluated the histopathology of the aorta in animals fed with a laboratory chow pellets ad libitum (hypercaloric) and in control (animals fed with the naturally occurring hypocaloric diet; halophile plants). The weight and blood chemistry (glucose, lipids, and insulin levels) were evaluated periodically (once per week), and the histology of the aortas of these animals were assessed every 3 months for up to 12 months, during the development of DS-II. This study demonstrates that 40% of the animals in HCD develop DS-II at 3 months. Histological characterization demonstrates the typical alterations observed in atherosclerosis, i.e., alteration of the elastic fibers of the media layer and enrichment in collagen and glucosaminoglycans. This study demonstrates that P. obesus is an excellent animal model to study the progression of DS-II and the development of atherosclerosis.

Coracoid bone block fixation with cortical buttons: An alternative to screw fixation?

BACKGROUND: The purpose of this study was to evaluate suture button fixation in a bone block (Bristow and Latarjet) procedure. We hypothesize that (1) cortical button fixation will allow predictable and reproducible bone union and (2) minimize the complications reported with screw fixation. MATERIALS AND METHODS: Seventy patients (mean age, 27 years) underwent an arthroscopic bone block procedure with a guided surgical approach and suture button fixation for recurrent anterior shoulder instability. There were two groups of patients: 35 Bristow procedures (group A) and 35 Latarjet procedures (group B). Bone graft union and positioning accuracy were assessed by postoperative computed tomography imaging at 2 weeks and 6 months, respectively. RESULTS: The coracoid graft was positioned below the equator in 93% and strictly tangential to the glenoid surface in 94% of the cases. Bone healing was observed in 83% of the cases (58/70) with 74% bone union in group A and 91% in group B. Neurologic and hardware complications, classically reported with screw fixation, were not observed with this novel fixation method. CONCLUSIONS: (1) Suture button fixation can be an alternative to screw fixation, obtaining bone block union, (2) in the lying position (Latarjet) bone healing was better than in the standing position (Bristow), and (3) complications classically reported with screw fixation were not observed. LEVEL OF EVIDENCE: Level IV.

Exploring the potential of gold(III) cyclometallated compounds as cytotoxic agents: variations on the C

A series of novel (C^N) cyclometallated Au(III) complexes of general formula [Au(py(b)-H)L(1)L(2)](n+) (py(b)-H = C^N cyclometallated 2-benzylpyridine, L(1) and L(2) being chlorido, phosphane or glucosethiolato ligands, n = 0 or 1) have been synthesized and fully characterized using different techniques, including NMR, IR and far-IR, mass spectrometry, as well as elemental analysis. The crystal structure of one compound has been solved using X-ray diffraction methods. All compounds were tested in vitro in five human cancer cell lines including the lung, breast, colon and ovarian cancer cells. For comparison purposes, all compounds were also tested in a model of healthy human cells from the embryonic kidney. Notably, all new compounds were more toxic than their cyclometallated precursor bearing two chlorido ligands, and the derivative bearing one phosphane ligand presented the most promising toxicity profile in our in vitro screening, displaying a p53 dependent activity in colorectal cancer HCT116 cells. Finally, for the first time C^N cyclometallated gold(III) complexes were shown to be potent inhibitors of the zinc finger protein PARP-1, involved in the mechanism of cisplatin resistance.

Freeze-fracture study of the intramembrane particle density in the aortic smooth muscle cell plasmalemma of rabbits fed an atherogenic diet.

The density of intramembrane particles (IMP) of the arterial smooth muscle cell (SMC) plasmalemma was studied by freeze-fracture methods in rabbits fed an atherogenic diet. After 3 weeks of diet, no change in the IMP E face density was observed but the IMPs of the P face decreased by about 50%. Among the various functions of IMPs, they are also believed to be responsible for mechanical adhesion between adjacent cells and cell-cell interactions. That is why the modification of their frequency observed in this study may be assumed to induce the non-recognition of SMC between each other. Thus, they become free from each other and migrate into the subendothelial space. This is one of the important initial conditions leading to atherosclerosis. Therefore, by this freeze-fracture study, our hypothesis about the involvement of SMC in the earlier stages of atherogenesis is confirmed.

[Electron microscopic studies of lumbar sympathetic chains resected for arteritis of the lower limbs (author's transl)]. / Etude en microscopie électronique des sympathiques lombaires réséqués pour artérite des membres inférieurs

Eighteen lumbar sympathetic chains resected for lower limb arteritis are examined on electron microscopy. A comparative study of the nature of lesions is done for diabetics and non-diabetics. Development of vascular lesions, clearly accelerated in the diabetic does not coincide with neurological lesions. These are much more frequent in diabetics, which explains the increased failure rate of lumbar sympathectomy in this disease as the result of lumbar sympathectomy depends on the state of nervous tissue. Examination of the state of nervous tissue. Examination of this tissue could therefore help establish a surgical prognosis.

Modification of the selected method for the determination of serum iron. Substitution of bathophenanthroline by ferene S.

The previously selected method (1977) for the measurement of iron in human serum has been modified by the working group on Iron and Iron-Transport Proteins (Sociéte Française de Biologie Clinique). Ferene S is used as the chromogen, it is more sensitive and cheaper than bathophenanthroline. The sample size has been reduced from 2 to 0.5 ml. No interference could be shown with high concentrations of bilirubin, copper or hemoglobin.

Ultrastructure of mouse intestinal mucosa and changes observed after long term anthraquinone administration.

In an attempt to study the relative toxicity of anthraquinonic laxatives on intestinal mucosa, we compared in mice the effects of fruit pulp containing sennosides A and B with those of a free anthraquinone, 1-8 dihydroxyanthraquinone. Observations have been made with transmission electron microscopy (EM) after 16 weeks of treatment with the two drugs. Although the doses used in this study were equipotent in terms of laxative activity, no damage to the intestinal tissue was observed with the sennosides. A number of changes, however, were detected in intestinal nervous tissues of all the animals treated with 1-8 dihydroxyanthraquinone, mainly in the form of vacuolisation of the axons, formation of lysosomal structures and in some cases appearances of fibrillar degeneration.

Long-term mucosal alterations by sennosides and related compounds.

Sennosides and related compounds are presumed to be severe cell poisons after prolonged ingestion. Some histological and ultrastructural studies in animals and man with such laxative misuse have revealed myenteric plexus and colonic epithelium injuries; but others have failed to point out identical data. In a first histological and ultrastructural study in mouse, we were unable to find any intestinal mucosa injury after long-term sennoside ingestion. In a second long-term experiment, we compared the effects of sennosides and 1,8-dihydroxyanthraquinone (synthetic anthracene derivative) on the mouse jejunum and colon. Electron microscopic observations showed nervous myenteric plexus abnormalities only in 1,8-dihydroxyanthraquinone-treated animals. These results suggest that sennosides have a good intestinal mucosa tolerance as opposed to aglycosidic-related compounds.

[Time and theophylline influence on the quantitative variations of the glomerular basement membrane ferritin pathway (author's transl)]. / Etudes des variations quantitatives du passage de la ferritine au niveau de la membrane basale glomérulaire en fonction du temps et sous l'influence de la théophylline.

A fine quantitative evaluation of ferritin aggregates in rat GBM permits to counts 5.08 +/- 1.51 and 18.30 +/- 3.21 g/cm2, respectively 30 and 60 min after ferritin injection; likewise, 30 min after ferritin administration, 5.08 +/- 1.51 and 17.11 +/- 3.9 g/cm2, respectively in normal and theophylline-treated animals.

[Effect of theophylline on the glomerular pathway of ferritin macromolecules in rats].

The present microscopic study evaluates the quantitative variations of ferritin particules density within the glomerular ultrastructures after theophyllin perfusion in the Rat. The ferritin particules density increases 3,65 times in the glomerular basement membrane and decreases 3,28 times in the glomerular capillary lumen. So, theophyllin increases considerably the glomerular pathway of the protein macromolecules. This results confirm the increased volumic flow (Jv) and macro-solutes flow (Js') noted with clearance methods and urinary excretion studies.

[Transglomerular passage of protein macromolecules in the rat : attempt at quantitative evaluation using ferritin]. / Etude de passage transglomérulaire des macromolécules protéiques chez le Rat: essai d'évaluation quantitative au moyen de la ferritine.

The present microscopic study evaluates precisely the density of ferritin-particules in several substructures of the glomerular barrier, particularly the endothelial barrier, and the glomerular basement membrane, 15 and 60 minutes after the injection of the tracer. This quantitative method opens the way to numerous studies on the pathway of this protein-tracer through the glomerular substructures in the normal and pathologic rat.