Translation, cultural adaptation and validation of the revised patients' attitudes towards deprescribing (rPATD) questionnaire in Romanian older adults.

BACKGROUND: Deprescribing is part of ensuring appropriate medication use and may reduce medication-related harm. Capturing the beliefs and attitudes of patients towards deprescribing by using a validated tool may support optimizing medication use in practice. OBJECTIVES: To translate, culturally adapt and validate the revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire in Romanian and to investigate the attitudes and beliefs of older adults towards deprescribing. METHODS: The rPATD questionnaire was translated using forward-backward translation into Romanian and culturally adapted. The psychometric properties were evaluated in older adults ≥65 years of age. Structural validity was assessed by item load on factors using an exploratory factor analysis (EFA) which was compared to the original English version and the internal consistency by Cronbach's alpha. Construct validity was evaluated by calculating the Spearman's rank correlation coefficients between the factor scores obtained using the revised version of the Romanian rPATD and scores on the Beliefs about Medicines Questionnaire (BMQ) Specific Concerns Romanian version. Floor and ceiling effect were also examined. RESULTS: We translated the questionnaire and administered it to 224 participants (median age 72 years [interquartile range: 68.0; 77.0]). In the EFA individual items loaded onto 4 factors, grouped similarly to the English version (Involvement, Burden, Appropriateness, Concerns about Stopping factors). Two items from each of the Involvement and Appropriateness factors were removed to improve factor loading and avoid cross-loading. The Cronbach's alpha values for the 4 factors ranged between 0.522 and 0.773. The scores for Burden and Concerns about Stopping factors were found to be positively correlated with BMQ Specific Concerns score. We identified a ceiling effect for one of the four factors (Involvement) and no floor effects. CONCLUSIONS: The Romanian rPATD was validated in 4 factor structure similar to the original English questionnaire. The Romanian version of the questionnaire may support the health care professionals in Romania to initiate and support patient-centered deprescribing.

Multi-site validation of shipping noise maps using field measurements.

Underwater radiated noise from shipping is globally pervasive and can cause deleterious effects on marine life, ranging from behavioural responses to physiological effects. Acoustic modelling makes it possible to map this noise over large areas and long timescales, and to test mitigation scenarios such as ship speed reduction or spatial restrictions. However, such maps must be validated against measurements to ensure confidence in their predictions. This study carried out a multi-site validation of the monthly and annual shipping noise maps for 2019 produced as part of the Joint Monitoring of Ambient Noise in the North Sea (JOMOPANS) programme. Spectral, spatial, and temporal differences between predictions and measurements were analysed, with differences linked to uncertainty in model input data and additional sources of anthropogenic noise in the measurements. Validating shipping noise models in this way ensures they can be applied with confidence in future management decisions to address shipping noise pollution.

An investigation of the concomitant use of angiotensin-converting enzyme inhibitors, non-steroidal anti-inflammatory drugs and diuretics.

OBJECTIVE: To determine in retrospective data the prevalence at hospital discharge of co-prescribing angiotensin-converting enzyme inhibitors (ACE-I) and non-steroidal anti-inflammatory drugs (NSAIDs) and ACE-I/NSAIDs and diuretics and to identify factors associated with the co-prescription. Secondary, we evaluated the extent of serum creatinine and potassium monitoring in patients treated with ACE-I and these associations and determined the prevalence of values above the upper normal limit (UNL) in monitored patients. PATIENTS AND METHODS: Hospitalized patients with ACE-I in their therapy at discharge were included in 3 groups as follows: ACE-I, DT (double therapy with ACE-I and NSAIDs) and TT (triple therapy with ACE-I, NSAIDs and diuretics) groups. We evaluated differences on demographic characteristics, co-morbidities, medications, laboratory monitoring and quantified the patients with serum creatinine and potassium levels above the UNL using descriptive statistics. Logistic regression analysis with backward elimination was performed to identify significant predictors of combination therapy. RESULTS: Of 9960 admitted patients, 1214 were prescribed ACE-I, 40 were prescribed ACE-I/NSAIDs and 22 were prescribed ACE-I/NSAIDs/diuretics (3.13% and 1.72%, respectively, of the patients prescribed with ACE-I). Serum creatinine and potassium were monitored for the great majority of patients from all groups. The highest percentage of hyperkalemia was found in the DT group (10% of the patients) and of serum creatinine above UNL in the TT group (45.45%). The logistic regression final model showed that younger patients and monitoring for potassium were significantly associated with combination therapy. CONCLUSIONS: The prevalence of patients receiving DT/TT was relatively low and their monitoring during hospitalization was high. Factors associated with the combinations were younger patients and patients not tested for serum potassium.

Cerebrospinal fluid and serum immunoglobulins and C3 in Creutzfeldt-Jakob disease.

We determined the concentrations of IgA, IgG, and C3 in spinal fluid and IgA, IgG, IgM, and C3 in serum from seven patients with histologically revified Creutzfeldt-Jakob disease. The mean total protein content in spinal fluid was significantly higher than in controls. The increased mean concentrations of IgA, IgG, and C3 in spinal fluid, and their respective mean percentages in spinal fluid, suggest a passage of IgG and C3 from blood into spinal fluid, and a possible production of IgA within the central nervous system.

The concentration of alpha-1-antitrypsin in cerebrospinal fluid and serum in a series of 40 intracranial tumors.

Forty patients with histologically proved intracranial tumors were submitted to preoperative lumbar and venous punctures. The concentration of alpha-1-antitrypsin in the serum and in cerebrospinal fluid was determined by radial immunodiffusion technique. In the series, both serum and cerebrospinal fluid alpha-1-antitrypsin concentrations are significantly higher than the mean normal values. No statistical differences are observed in serum alpha-1-antitrypsin levels between benign and malignant tumors, but cerebrospinal fluid alpha-1-antitrypsin is significantly increased in the group of malignant tumors if cases undergoing steroid treatment are excluded. The diagnostic value of alpha-1-antitrypsin determinations in groups of patients with intracranial tumors is suggested.

Diltiazem: nuevo vasodilatador coronario. / Diltiazem: new coronary vasodilator

El diltiazem es un derivado benzotiazepinico estudiado farmacologicamente como potente vasodilatador coronario y preconizado en el tratamiento de la angina de pecho Los estudios preliminares muestran buena absorcion, rapida biotransformacion y la presencia de escasas reacciones adversas, tales como trastornos gastrointestinales, hipotension ortostatica y bradicardia. Las dosis habitualies oscilian entre 60 y 120 mg. orales cada 8 horas

Peptidos cerebrales. / Brain peptides

El cerebro de mamiferos contiene pepticos, enkephalinas y endorfinas, que tienen propiedades farmacologicas similares a las de la morfina. La evidencia que estos pepticos, metabolitos de la hormona hipofisaria beta lipotrofina, afectan profundamente el humor y la conducta y son secretadas en respuesta al atreas, sugiere que pueden actuar como neurotransmisores y que juegan un papel importante en la homeostasis del sistema nervioso central y en actividad relacionada con el dolor

Metformina: hipoglucemiante oral de alternativa. / Metformin: an alternative of oral hypoglicemia agent

La metformina es un hipoglicemiante biguanidico de uso oral, con grandes ventajas en el tratamiento de los pacientes diabeticos estables adultos obesos. En esta publicacion se revisan diversos aspectos farmacologicos de sus propiedades, efectos clinicos, usos y manifestaciones colaterales. Tambien se compara con otros antidiabeticos orales de uso corriente