RESUMO
Acute pancreatitis is an acute inflammation of the pancreas, with subsequent involvement of surrounding tissues and organ systems. Viral etiology of acute pancreatitis is uncommon; however, multiple viruses have been implicated. Dengue virus has also been found responsible for acute pancreatitis, with possible etiologies linked to direct viral invasion, autoimmune mechanism, or as a complication of dengue shock syndrome. We present a case of a 24-year-old female who presented with epigastric pain and vomiting in the background of a febrile illness and was later diagnosed with mild acute pancreatitis complicating dengue fever.
RESUMO
Macroautophagy, an evolutionary conserved catabolic process in the eukaryotic cell, regulates cellular homeostasis and plays a decisive role in self-engulfing proteins, protein aggregates, dysfunctional or damaged organelles, and invading pathogens. Growing evidence from in vivo and in vitro models shows that autophagy dysfunction plays decisive role in the pathogenesis of various neurodegenerative diseases, including Parkinson's disease (PD). PD is an incurable and second most common neurodegenerative disease characterised by neurological and motor dysfunction accompanied of non-motor symptoms that can also reduce the life quality of patients. Despite the investment in research, the aetiology of the disease is still unknown and the therapies available are aimed mostly at ameliorating motor symptoms. Hence, therapeutics regulating the autophagy pathway might play an important role controlling the disease progression, reducing neuronal loss and even ameliorating non-motor symptoms. In this review, we highlight potential therapeutic opportunities involved in different targeting options like an initiation of autophagy, Leucine-rich repeat kinase 2 (LRRK2) inhibition, mitophagy, lysosomes, lipid metabolism, immune system, gene expression, biomarkers, and also non-pharmacological interventions. Thus, strategies to identify therapeutics targeting the pathways modulating autophagy might hold a future for therapy development against PD.
RESUMO
The purpose of this paper is to provide an overview of the pharmacy practice and initiatives taken by the Australian federal government to ensure the continued supply of essential medicines under the conditions of an emergency response plan for COVID-19. During the pandemic, Australian pharmacists have been working collaboratively with multidisciplinary teams at the frontline to manage the equitable and safe supply of medicines despite the unprecedented situation. Although these presented problems for small pharmacies, social distancing policies were implemented widely to maintain personal and environmental hygiene and reduce the number of face-to-face patient visits. In collaboration with various pharmaceutical stakeholders, the Australian government responded rapidly to ensure equitable and sufficient supply with continued access to therapeutic goods during the pandemic. Additionally, vital policies and practices have been implemented, including supplying regular medicines at government-subsidized prices, a maximum one-month supply of some prescription medicines and purchase limits on over-the-counter medicines (one unit per purchase), medication management reviews through telehealth, electronic and digital prescribing, home delivery of medicines to vulnerable people and those in home isolation and the provision of serious shortage medicine substitution rights to pharmacists. Pharmacists were encouraged to communicate and collaborate with other local pharmacies to ensure that essential pharmacy services met community needs (e.g., opening hours). However, there has been a shortage of some medicines due to supply chain disruption and increased demand due to the pandemic. Higher demand for flu vaccinations, increased work pressure in pharmacies, and severe frustration and anxiety in pharmacy customers were also reported. Vigilance is required to monitor foreseeable shortages of therapeutics goods, particularly in regional pharmacies. There is an opportunity for long-term change to retain certain rights and roles based on the competence shown by pharmacists in this challenging period, such as telephone medication reviews, telehealth for MedsCheck and Diabetes MedsCheck, digital prescription handling and therapeutic substitution.
Assuntos
COVID-19 , Serviços Comunitários de Farmácia , Farmácias , Farmácia , Medicamentos sob Prescrição , Austrália/epidemiologia , COVID-19/epidemiologia , COVID-19/prevenção & controle , Humanos , Pandemias , Farmacêuticos , Papel ProfissionalRESUMO
Synapses are critical for neuronal communication and brain function. To maintain neuronal homeostasis, synapses rely on autophagy. Autophagic alterations cause neurodegeneration and synaptic dysfunction is a feature in neurodegenerative diseases. In Parkinson's disease (PD), where the loss of synapses precedes dopaminergic neuron loss, various PD-causative proteins are involved in the regulation of autophagy. So far only a few factors regulating autophagy at the synapse have been identified and the molecular mechanisms underlying autophagy at the synapse is only partially understood. Here, we describe Endophilin-B (EndoB) as a novel player in the regulation of synaptic autophagy in health and disease. We demonstrate that EndoB is required for autophagosome biogenesis at the synapse, whereas the loss of EndoB blocks the autophagy induction promoted by the PD mutation LRRK2G2019S. We show that EndoB is required to prevent neuronal loss. Moreover, loss of EndoB in the Drosophila visual system leads to an increase in synaptic contacts between photoreceptor terminals and their post-synaptic synapses. These data confirm the role of autophagy in synaptic contact formation and neuronal survival.
Assuntos
Aciltransferases/metabolismo , Autofagia/genética , Neurônios Dopaminérgicos/metabolismo , Proteínas de Drosophila/metabolismo , Degeneração Neural/metabolismo , Sinapses/metabolismo , Aciltransferases/genética , Animais , Animais Geneticamente Modificados , Neurônios Dopaminérgicos/patologia , Drosophila , Proteínas de Drosophila/genética , Degeneração Neural/genética , Degeneração Neural/patologia , Sinapses/genéticaRESUMO
Automatic quantification of image parameters is a powerful and necessary tool to explore and analyze crucial cell biological processes. This article describes two ImageJ/Fiji automated macros to approach the analysis of synaptic autophagy and exosome release from 2D confocal images. Emerging studies point out that exosome biogenesis and autophagy share molecular and organelle components. Indeed, the crosstalk between these two processes may be relevant for brain physiology, neuronal development, and the onset/progression of neurodegenerative disorders. In this context, we describe here the macros "Autophagoquant" and "Exoquant" to assess the quantification of autophagosomes and exosomes at the neuronal presynapse of the Neuromuscular Junction (NMJ) in Drosophila melanogaster using confocal microscopy images. The Drosophila NMJ is a valuable model for the study of synapse biology, autophagy, and exosome release. By use of Autophagoquant and Exoquant, researchers can have an unbiased, standardized, and rapid tool to analyze autophagy and exosomal release in Drosophila NMJ. Code available at: https://github.com/IreneSaMi/Exoquant-Autophagoquant.
RESUMO
Moringa oleifera, popularly known as a miracle tree or tree of life, has been extensively used as a functional food and nutritional asset worldwide. Ethnomedicinal and traditional uses of M. oleifera indicate that this plant might have a pleiotropic therapeutic efficacy against most human ailments. In fact, M. oleifera is reported to have several pharmacological activities, including antioxidant, antibacterial, antifungal, antidiabetic, antipyretic, antiulcer, antispasmodic, antihypertensive, antitumor, hepatoprotective, and cardiac stimulant properties. Recently, a few experimental studies reported the neuroprotective effects of M. oleifera against Alzheimer's disease, dementia, Parkinson's disease, stroke, and neurotoxicity-related symptoms. In addition, several neuroprotective phytochemicals have been isolated from M. oleifera, which signifies that it can have promising neuroprotective effects. Therefore, this review aimed to explore the current updates and future prospective of neuroprotective efficacies of M. oleifera.
Assuntos
Moringa oleifera , Doenças Neurodegenerativas , Plantas Medicinais , Humanos , Doenças Neurodegenerativas/tratamento farmacológico , Extratos Vegetais , Folhas de PlantaRESUMO
Insects are highly successful, in part through an excellent ability to osmoregulate. The renal (Malpighian) tubules can secrete fluid faster on a per-cell basis than any other epithelium, but the route for these remarkable water fluxes has not been established. In Drosophila melanogaster, we show that 4 genes of the major intrinsic protein family are expressed at a very high level in the fly renal tissue: the aquaporins (AQPs) Drip and Prip and the aquaglyceroporins Eglp2 and Eglp4 As predicted from their structure, and by their transport function by expressing these proteins in Xenopus oocytes, Drip, Prip, and Eglp2 show significant and specific water permeability, whereas Eglp2 and Eglp4 show very high permeability to glycerol and urea. Knockdowns of any of these genes result in impaired hormone-induced fluid secretion. The Drosophila tubule has 2 main secretory cell types: active cation-transporting principal cells, wherein the aquaglyceroporins localize to opposite plasma membranes, and small stellate cells, the site of the chloride shunt conductance, with these AQPs localizing to opposite plasma membranes. This suggests a model in which osmotically obliged water flows through the stellate cells. Consistent with this model, fluorescently labeled dextran, an in vivo marker of membrane water permeability, is trapped in the basal infoldings of the stellate cells after kinin diuretic peptide stimulation, confirming that these cells provide the major route for transepithelial water flux. The spatial segregation of these components of epithelial water transport may help to explain the unique success of the higher insects in regulating their internal environments.
Assuntos
Transporte Biológico/fisiologia , Drosophila melanogaster/fisiologia , Túbulos Renais/metabolismo , Água/metabolismo , Animais , Aquagliceroporinas/genética , Aquagliceroporinas/metabolismo , Aquaporinas/genética , Aquaporinas/metabolismo , Permeabilidade da Membrana Celular , Cloretos/metabolismo , Proteínas de Drosophila/genética , Proteínas de Drosophila/metabolismo , Feminino , Técnicas de Silenciamento de Genes , Túbulos Renais/citologia , Masculino , Túbulos de Malpighi/metabolismo , Modelos Animais , Oócitos/metabolismo , Osmorregulação , XenopusRESUMO
Nephrolithiasis is one of the most common kidney diseases, with poorly understood pathophysiology, but experimental study has been hindered by lack of experimentally tractable models. Drosophila melanogaster is a useful model organism for renal diseases because of genetic and functional similarities of Malpighian (renal) tubules with the human kidney. Here, we demonstrated function of the sex-determining region Y protein-interacting protein-1 (Sip1) gene, an ortholog of human Na+/H+ exchanger regulatory factor (NHERF1), in Drosophila Malpighian tubules and its impact on nephrolithiasis. Abundant birefringent calculi were observed in Sip1 mutant flies, and the phenotype was also observed in renal stellate cell-specific RNA interference Sip1 knockdown in otherwise normal flies, confirming a renal etiology. This phenotype was abolished in rosy mutant flies (which model human xanthinuria) and by the xanthine oxidase inhibitor allopurinol, suggesting that the calculi were of uric acid. This was confirmed by direct biochemical assay for urate. Stones rapidly dissolved when the tubule was bathed in alkaline media, suggesting that Sip1 knockdown was acidifying the tubule. SIP1 was shown to collocate with Na+/H+ exchanger isoform 2 (NHE2) and with moesin in stellate cells. Knockdown of NHE2 specifically to the stellate cells also increased renal uric acid stone formation, and so a model was developed in which SIP1 normally regulates NHE2 activity and luminal pH, ultimately leading to uric acid stone formation. Drosophila renal tubules may thus offer a useful model for urate nephrolithiasis.
Assuntos
Túbulos de Malpighi/metabolismo , Nefrolitíase/genética , Nefrolitíase/metabolismo , Fosfoproteínas/metabolismo , Trocadores de Sódio-Hidrogênio/metabolismo , Ácido Úrico/metabolismo , Alopurinol/farmacologia , Animais , Modelos Animais de Doenças , Drosophila melanogaster , Inibidores Enzimáticos/farmacologia , Técnicas de Silenciamento de Genes , Proteínas dos Microfilamentos/metabolismo , Mutação/genética , Nefrolitíase/induzido quimicamenteRESUMO
The insect renal (Malpighian) tubule has long been a model system for the study of fluid secretion and its neurohormonal control, as well as studies on ion transport mechanisms. To extend these studies beyond the boundaries of classical physiology, a molecular genetic approach together with the 'omics technologies is required. To achieve this in any vertebrate transporting epithelium remains a daunting task, as the genetic tools available are still relatively unsophisticated. Drosophila melanogaster, however, is an outstanding model organism for molecular genetics. Here we describe a technique for fluid secretion assays in the D. melanogaster equivalent of the kidney nephron. The development of this first physiological assay for a Drosophila epithelium, allowing combined approaches of integrative physiology and functional genomics, has now provided biologists with an entirely new model system, the Drosophila Malpighian tubule, which is utilized in multiple fields as diverse as kidney disease research and development of new modes of pest insect control.
Assuntos
Rim/citologia , Rim/metabolismo , Túbulos de Malpighi/citologia , Animais , Modelos Animais de Doenças , Proteínas de Drosophila/genética , Proteínas de Drosophila/metabolismo , Drosophila melanogaster , Nefropatias/metabolismo , Túbulos de Malpighi/metabolismoRESUMO
AIMS AND OBJECTIVES: To explore clinician assessment of patient adherence and identify strategies to improve adherence assessment practices in haemodialysis settings. BACKGROUND: Patients with chronic kidney disease undergoing haemodialysis are typically prescribed complex regimens; as such, they are at high risk of medication nonadherence. Current clinical practices focus on prescribing medications; however, little attention is paid to measuring and ensuring patient adherence to their prescribed treatments. DESIGN: A qualitative study. METHODS: Semi-structured individual interviews were conducted in November and December 2016, with 12 nurses and 6 pharmacists, working in Australian haemodialysis settings. The study was conducted and reported in accordance with COREQ guidelines. RESULTS: Participants were 25-60 years old and had 1-27 years of experience in dialysis. Seven themes related to assessing adherence were identified: prioritisation of resources, interplay between workload and available time, awareness of formalised adherence measures and training deficits, concerns about practicality/suitability of adherence measures, communication of assessment services, patient participation and trust. Three themes related to strategies for improving adherence assessment practices were identified: formalisation of adherence assessment process, integration of assessment processes and tools into routine, and use of multidisciplinary support to assess and promote adherence. CONCLUSIONS: Current adherence assessment practices could be improved through formalisation and integration of the assessment process into dialysis unit policy/procedures. Additionally, as barriers to assessing adherence were identified at organisational, professional and patient levels, there is a need to address barriers from each level in order to improve adherence assessment practices in haemodialysis settings. RELEVANCE TO CLINICAL PRACTICE: This qualitative study highlights the challenges and practical ways by which adherence assessment practices could be improved in haemodialysis settings. This would encourage renal clinicians to actively participate in adherence assessment and promotion activities to ensure patients benefit from their therapies.
Assuntos
Adesão à Medicação/estatística & dados numéricos , Enfermeiras e Enfermeiros/psicologia , Farmacêuticos/psicologia , Diálise Renal/psicologia , Adulto , Austrália , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Diálise Renal/enfermagem , Insuficiência Renal Crônica/terapiaRESUMO
AIMS AND OBJECTIVES: To measure renal nurses' perceptions on assessing medication adherence in patients undergoing dialysis. BACKGROUND: Renal nurses play a vital role in caring for patients undergoing dialysis. Despite the high prevalence of medication nonadherence in chronic dialysis patients, little is known about renal nurses' perceptions and current adherence assessment practices. DESIGN: A cross-sectional survey. METHODS: Participants completed an online survey between March-May 2016. Five psychometric scales were used to measure perception on prevalence and contributors of nonadherence, effective methods of assessment, barriers to assessment and confidence to assess adherence. The survey also captured current adherence assessment practices using a 4-point graded response (1 = do not practice at all to 4 = practice for every patient). RESULTS: A total of 113 dialysis nurses completed the survey. The majority agreed that patients in their unit are nonadherent to their medicines (74.5%, n = 82; median = 8). Most nurses agreed that having dedicated professionals conducting medication history interviews can be effective in identifying nonadherence (88.9%, n = 96; median = 8). Objective assessment through blood results was the most frequently used method to determine nonadherence (83.2%, n = 89), with little attention being paid to patients' self-reports of adherence (55.1%, n = 59). Time constraints, administrative support and patients' disinterest in discussing medication-related issues with the nurses were perceived as barriers to assessing adherence. CONCLUSIONS: Patient self-reported measures to assess adherence were underutilised by the renal nurses, whereas objective blood monitoring was routinely used. Overcoming dialysis nurses' work-related barriers may facilitate the effective monitoring and promotion of medication adherence in chronic dialysis patients. RELEVANCE TO CLINICAL PRACTICE: Results from this study emphasise the need for proper assessment of dialysis patient's medication-taking behaviour during routine dialysis to ensure the benefits of prescribed therapies.
Assuntos
Atitude do Pessoal de Saúde , Adesão à Medicação/estatística & dados numéricos , Enfermagem em Nefrologia , Enfermeiras e Enfermeiros/psicologia , Diálise Renal/enfermagem , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Adesão à Medicação/psicologia , Pessoa de Meia-Idade , Psicometria , Pesquisa Qualitativa , Insuficiência Renal Crônica/psicologia , Insuficiência Renal Crônica/terapia , Inquéritos e Questionários , Adulto JovemRESUMO
Aging is a complex process resulting in (1) a decline in body functions and capacity to withstand environmental stress and (2) an increased susceptibility to diseases including, but not limited to, cardiovascular disorders, diabetes, cancer, and dementia. Among a number of herbal products used to alleviate symptoms associated with aging is Ilex paraguariensis (IP). This product has been reported to have anticancer, anti-inflammatory, and antioxidant activities. However, its effect on an organisms' longevity has not been thoroughly studied to date. Here, we report that 10 mg/mL IP supplementation significantly extended the lifespan of Drosophila. Additionally, IP enhanced flies' ability to resist environmental stress as estimated using starvation, paraquat, and desiccation assays. Additional experiments revealed insignificant changes in weight gain, physical activity, and metabolic profiles such as levels of water, lipid, and protein in flies receiving IP supplementation. Rather, levels of messenger RNA for enzymes that scavenge reactive oxygen species (i.e., superoxide dismutases, catalase, and glutathione peroxidase) were found to be significantly altered despite subtle changes in their catalytic activities. We hope that our research demonstrating IP-induced lifespan extension and related biological mechanisms of this interesting phenomenon will encourage further studies, which may eventually determine whether IP has utility as a novel antiaging agent.
Assuntos
Antioxidantes/farmacologia , Drosophila melanogaster/fisiologia , Ilex paraguariensis/química , Longevidade/efeitos dos fármacos , Extratos Vegetais/farmacologia , Estresse Fisiológico , Animais , Drosophila melanogaster/efeitos dos fármacos , Feminino , Masculino , Espécies Reativas de Oxigênio/metabolismoRESUMO
Background Medication nonadherence is a major problem in chronic kidney failure patients undergoing dialysis. Pharmacists play a vital role in improving medication-related patient outcomes, reducing drug-related problems, and improving medication adherence. However, little is known about how pharmacists assess medication adherence in dialysis patients. Objective To measure pharmacists' perceptions, current practices, and barriers to assessing adherence in dialysis patients. Setting Australian renal-specialised pharmacists. Method An online survey was conducted between March and May 2016. Survey included five psychometric scales measuring perceived prevalence, contributors, effective methods, barriers, and confidence to assess adherence on a 10-point Likert scale (1 = strongly disagree; 10 = strongly agree). Current practices were identified using a 4-point graded response (1 = do not practice; 4 = practice for all). MAIN OUTCOME MEASURE: Perception scores, scale reliability, and responses to current practices questionnaire. Results 41 pharmacists completed the survey (response rate, 91.1%). The majority (91.9%, n = 34; median = 8.0) agreed patients were nonadherent to medication. Time constraints (43.8%, n = 14) and hospital support (31.3%, n = 10) were perceived as barriers to assessment. Objective blood monitoring was frequently used to determine nonadherence (57.1%, n = 16), whereas subjective interviews were rarely conducted (27.6%, n = 8). Though all pharmacists support the presence of dedicated pharmacist for assessing adherence (100.0%, n = 33), only 24.2% were actually performing this function. Conclusion Pharmacists were rarely assigned for adherence assessment in dialysis settings. Established self-report methods were under-utilised compared to objective methods. Future research should investigate the effectiveness of pharmacists' involvement in facilitating adherence promotion and early identification of medication-related issues in dialysis patients.
Assuntos
Atitude do Pessoal de Saúde , Adesão à Medicação/psicologia , Farmacêuticos/psicologia , Papel Profissional/psicologia , Diálise Renal/psicologia , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Farmacêuticos/normas , Diálise Renal/normasRESUMO
BACKGROUND: End-stage kidney disease patients undergoing haemodialysis are prescribed with multiple complex regimens and are predisposed to high risk of medication nonadherence. The aims of this study were to explore factors associated with medication adherence, and, to examine the differential perspectives on medication-taking behaviour shown by adherent and nonadherent haemodialysis patients. METHODS: A qualitative exploratory design was used. One-on-one semi-structured interviews were conducted with 30 haemodialysis patients at the outpatient dialysis facility in Hobart, Australia. Patient self-reported adherence was measured using 4-item Morisky Green Levine scale. Interview transcripts were thematically analysed and mapped against the World Health Organization (WHO) determinants of medication adherence. RESULTS: Participants were 44-84 years old, and were prescribed with 4-19 medications daily. More than half of the participants were nonadherent to their medications based on self-reported measure (56.7%, n = 17). Themes mapped against WHO adherence model comprised of patient-related (knowledge, awareness, attitude, self-efficacy, action control, and facilitation); health system/ healthcare team related (quality of interaction, and mistrust and collateral arrangements); therapy-related (physical characteristics of medicines, packaging, and side effects); condition-related (symptom severity); and social/ economic factors (access to medicines, and relative affordability). CONCLUSIONS: Patients expressed a number of concerns that led to nonadherence behaviour. Many of the issues identified were patient-related and potentially modifiable by using psycho-educational or cognitive-behavioural interventions. Healthcare professionals should be more vigilant towards identifying these concerns to address adherence issues. Future research should be aimed at understanding healthcare professionals' perceptions and practices of assessing medication adherence in dialysis patients that may guide intervention to resolve this significant issue of medication nonadherence.
Assuntos
Letramento em Saúde/estatística & dados numéricos , Adesão à Medicação/psicologia , Adesão à Medicação/estatística & dados numéricos , Diálise Renal/estatística & dados numéricos , Insuficiência Renal Crônica/psicologia , Insuficiência Renal Crônica/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Insuficiência Renal Crônica/epidemiologia , Estudos Retrospectivos , Autoadministração/psicologia , Autoadministração/estatística & dados numéricos , Autoeficácia , Tasmânia/epidemiologiaRESUMO
Jujube (Ziziphus Jujuba Mill.) fruit has been utilized as an adjunct to alleviate medical symptoms including, but not limited to, anorexia, fatigue, anxiety and mild diarrhea for centuries. Despite a growing body of literature revealing jujube fruit's health promoting properties such as anti-cancer, anti-inflammation and anti-oxidant effects (shown with cell-based in vitro platforms), there is a paucity of studies systemically examining its impact on whole organisms or throughout the entire course of life utilizing in vivo model systems. Thus, here in this study, we conducted a series of experiments to investigate if jujube fruit can modify an organism's longevity using a live Drosophila model. We found that jujube fruit feeding extended not only lifespan but also healthspan examined by stress assays such as starvation and paraquat treatment. In an effort to shed light on the mechanisms of these jujube-related benefits at the molecular level, we report that messenger RNA (mRNA) levels of 14-3-3ε, a negative FoxO (Forkhead box O transcription factor) regulator, was dramatically diminished while the abundance of d4E-BP mRNA transcript (drosophila eukaryotic translation initiation factor 4E binding protein), a FoxO target gene, was increased, suggesting enhanced FoxO activity with jujube fruit feeding. In conclusion, we hope our results will lead to multidisciplinary research to investigate the potential benefit of jujube fruit as a novel anti-aging agent.
Assuntos
Drosophila/imunologia , Tolerância Imunológica/imunologia , Longevidade/imunologia , Extratos Vegetais/administração & dosagem , Estresse Fisiológico/imunologia , Ziziphus/química , Administração Oral , Animais , Proteínas de Drosophila/imunologia , Feminino , Frutas/química , Regulação da Expressão Gênica no Desenvolvimento/efeitos dos fármacos , Regulação da Expressão Gênica no Desenvolvimento/imunologia , Tolerância Imunológica/efeitos dos fármacos , Longevidade/efeitos dos fármacos , Estresse Fisiológico/efeitos dos fármacosRESUMO
BACKGROUND: The impact of medication regimen complexity on adherence in hemodialysis patients is unknown. We investigated regimen complexity, perceived burden of medicines (PBM) and health-related quality of life (HR-QoL) as potential predictors of adherence. METHODS: Adult (≥18 years) hemodialysis patients were included. Data on medication regimen complexity index (MRCI), self-reported and objective adherence, comorbidity index, PBM and HR-QoL were obtained using established measures. Sociodemographic and clinical characteristics were collected during interviews and by reviewing medical records. Predictors of adherence were determined using logistic regression. RESULTS: Fifty-three out of 70 hemodialysis patients participated (response rate 75%; male 58.5%; age 67.9 ± 11.5 years). The mean MRCI, HR-QoL and PBM scores were 27.0 ± 10.9, 0.70 ± 0.13 and 1.7 ± 0.6, respectively. Based on self-reports, 43.4% (n = 23) were adherent, whereas for a subset of patients analyzed using objective measure (n = 33), much lower adherence rate was observed (27.3%, n = 9). The self-reported and objective measures were significantly correlated (r = 0.43, p = 0.01). Older age was the only significant predictor of self-reported adherence (OR 1.05; 95% CI 1.00-1.11) whereas older age (OR 1.10; 95% CI 1.00-1.21), higher comorbidity (OR 1.58; 95% CI 1.03-2.42) and MRCI (OR 1.14; 95% CI 1.02-1.27) were independent predictors of objective adherence. CONCLUSIONS: The findings of this exploratory study suggest that older patients with high comorbidities and highly complex regimen are more likely to be adherent based on an objective measure. Future research is needed using objective measures of adherence suitable for all patients and reflecting all medications.
Assuntos
Falência Renal Crônica/terapia , Adesão à Medicação/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: End-stage kidney disease (ESKD) patients are often prescribed multiple medications. Together with a demanding weekly schedule of dialysis sessions, increased number of medicines and associated regimen complexity pre-dispose them at high risk of medication nonadherence. This review summarizes existing literature on nonadherence and identifies factors associated with nonadherence to medication therapy in patients undergoing haemodialysis. METHODS: A comprehensive search of PubMed, Embase, CINAHL, PsycInfo, and Cochrane Database of Systematic Reviews covering the period from 1970 through November 2014 was performed following a predefined inclusion and exclusion criteria. Reference lists from relevant materials were reviewed. Data on study characteristics, measures of nonadherence, prevalence rates and factors associated with nonadherence were collected. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines was followed in conducting this systematic review. RESULTS: Of 920 relevant publications, 44 were included. The prevalence of medication nonadherence varied from 12.5% to 98.6%, with widespread heterogeneity in measures and definitions employed. Most common patient-related factors significantly associated with nonadherence were younger age, non-Caucasian ethnicity, illness interfering family life, being a smoker, and living single and being divorced or widowed. Similarly, disease-related factors include longevity of haemodialysis, recurrent hospitalization, depressive symptoms and having concomitant illness like diabetes and hypertension. Medication-related factors such as daily tablet count, total pill burden, number of phosphate binders prescribed and complexity of medication regimen were also associated with poor adherence. CONCLUSIONS: A number of patient-, disease-, and medication-related factors are associated with medication nonadherence in haemodialysis patients. Clinicians should be aware of such factors so that adherence to medications can be optimised in haemodialysis patients. Future research should be directed towards well-designed prospective longitudinal studies developing standard definitions and validating available measurement tools, while focusing on the role of additional factors such as psychosocial and behavioural factors in predicting nonadherence to medications.
Assuntos
Falência Renal Crônica/terapia , Adesão à Medicação , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Adesão à Medicação/estatística & dados numéricos , Pessoa de Meia-Idade , Polimedicação , Diálise Renal , Fatores de Risco , Adulto JovemRESUMO
Dietary restriction (DR) is known to be one of the most effective interventions to increase stress resistance, yet the mechanisms remain elusive. One of the most obvious DR-induced changes in phenotype is an increase in locomotor activity. Although it is conceptually perceivable that nutritional scarcity should prompt enhanced foraging behavior to garner additional dietary resources, the significance of enhanced movement activity has not been associated with the DR-dependent increase of stress resistance. In this study, we confirmed that flies raised on DR exhibited enhanced locomotive activity and increased stress resistance. Excision of fly wings minimized the DR-induced increase in locomotive activity, which resulted in attenuation of the DR-dependent increase of stress resistance. The possibility that wing clipping counteracts the DR by coercing flies to have more intake was ruled out since it did not induce any weight gain. Rather it was found that elimination of reactive oxygen species (ROS) that is enhanced by DR-induced upregulation of expression of antioxidant genes was significantly reduced by wing clipping. Collectively, our data suggests that DR increased stress resistance by increasing the locomotor activity, which upregulated expression of protective genes including, but not limited to, ROS scavenger system.
Assuntos
Restrição Calórica , Atividade Motora/fisiologia , Estresse Fisiológico , Animais , Antioxidantes/metabolismo , Drosophila , Proteínas de Drosophila/genética , Proteínas de Drosophila/metabolismo , Feminino , Masculino , Espécies Reativas de Oxigênio/metabolismo , Aumento de PesoRESUMO
Aging is defined as a collective process that alters organism's functional capacity and appearance over the course of life. Apart from an increase in susceptibility to many diseases, aging affects the cellular system that is responsible for decoding painful stimuli. Yet, aging-associated molecular mechanisms of pain perception remains elusive. Using Drosophila, we showed a decrease in temperature tolerance and a reduction in high temperature thermal avoidance with aging. Locomotor activity assay demonstrated that the age-dependent changes in heat nociception did not stem from the general decline in muscular activity. However, we identified pain-related gene expression alteration with aging. We anticipate that our findings would help opening a new window onto developing the optimal pain treatment for the elderly.
RESUMO
OBJECTIVES: The aims of this study were to evaluate the quality of randomized controlled trial (RCT) abstracts published in the field of oncology and identify characteristics associated with better reporting quality. STUDY DESIGN AND SETTING: All phase III trials published during 2005-2007 [before Consolidated Standards of Reporting Trials (CONSORT)] and 2010-2012 (after CONSORT) were searched electronically in MEDLINE/PubMed and retrieved for review using an 18-point overall quality score (OQS) for reporting based on the CONSORT for Abstract guidelines. Descriptive statistics followed by multivariate linear regression were used to identify features associated with improved reporting quality. RESULTS: The mean OQS was 8.2 (range: 5-13; 95% confidence interval (CI): 8.0, 8.3) and 9.9 (range: 5-18; 95% CI: 9.7, 10.2) in the pre- and post-CONSORT periods, respectively. The method for random sequence generation, allocation concealment, blinding details, and funding sources were missing in pre-CONSORT abstracts and insufficiently reported (<20%) in post-CONSORT abstracts. A high impact factor (P < 0.001) and the journal of publication (P < 0.001) were independent factors that were significantly associated with higher reporting quality on multivariate analysis. CONCLUSION: The reporting quality of RCT abstracts in oncology showed suboptimal improvement over time. Thus, stricter adherence to the CONSORT for Abstract guidelines is needed to improve the reporting quality of RCT abstracts published in oncology.