Tribulus terrestris and Sport Performance: A Quantitative and Qualitative Evaluation of Its Advertisement and Availability via Online Shopping in Six Different Countries.

Dietary supplements are commonly used among athletes, and the Internet may be an easy source of these products. Tribulus terrestris is an herbal supplement with multiple properties. Of interest to athletes are reports that its consumption can lead to muscle mass gain and a faster recovery process. The objective of this cross-sectional study was to determine the availability of Tribulus terrestris via the Internet in six countries (Canada, Puerto Rico, Russia, Spain, Ukraine, and the United States of America) via a specifically designed computer program. The characteristics of the websites selling this substance, the country from which it can be purchased, the route of administration, and recommendations for its use were analyzed. The results of the study show that this supplement is marketed mainly in Russia, Ukraine, and Spain on many websites that are mostly dedicated to sports products. Just over half of the webpages (59.14%) identified only distribute this supplement within the same country. The main claims for its consumption refer to sports performance benefits, but there are also claims that it may improve male hormone levels and sexual function. Athletes should be encouraged to seek professional advice prior to ingesting this supplement to ensure that it is suitable for their specific training and sports objectives.

Online information and availability of three doping substances (anabolic agents) in sports: role of pharmacies.

Background: The Internet has become an important source for easy access to doping substances, where people and athletes may acquire, outside pharmacies and without a (medical) prescription. These online websites do not always offer quality-assured products, and are outside the regular distribution channels of medicines. The aim of this study was to estimate the availability and accessible information on the Internet about the sale of three doping substances (oxandrolone, DHEA, androstenedione). Methods: Cross-sectional exploratory study, being an observation at a point in time of the online availability of these three doping substances (WADA S1 category: anabolic agents), purchased from Spain, Puerto Rico, Canada, United States, Ukraine and Russia. The characteristics of the websites, the countries the webs sold to, the pharmaceutical forms offered and the recommendations for its use were analyzed by using a computer tool designed ad hoc. Results: There were significant differences between countries in the number of webpages that sold the products (Chi-square test, p < 0.05). Oxandrolone was available for purchase mainly when buying from Spain (27.12%) and Ukraine (26.58%), in websites dedicated to sports (77.26%). For DHEA, most of the pages offered it if the search was done from Canada (23.34%) and Russia (21.44%). Products containing androstenedione or DHEA are claimed to enhance sports performance or for sports use without providing details. Compared to the total number of websites checked, the proportion of pharmacies offering these products was low, ranging from 4.86% for DHEA to 15.79% for androstenedione. Conclusion: The three substances selected are easily available without control through the Internet. Only a small number of websites offering them were online pharmacies, and requested a prescription. Most of the doping substances are purchased from the country where they are requested. Product information described benefits for sports performance, but did not do the same with their side effects. It would be advisable for these products to be sold through pharmacies, to guarantee their quality and provide evidence-based information on their safe use, benefits and risks, and only with a prescription. Athletes should be encouraged to consult health professionals about those supplements suitable for their type of training and sports objectives.

Drug prescription pattern in exotic pet and wildlife animal practice: a retrospective study in a Spanish veterinary teaching hospital from 2018 to 2022.

Exotic companion animals have had an important role in our society since ancient times. Preserving animal health is necessary to do a responsible use of veterinary medicines. This study aimed to describe the prescription patterns of drugs in exotic pets and wildlife animals attending the Veterinary Teaching Hospital of the University of León (HVULE). A retrospective study was carried out between 2018 and 2022. Birds were the largest group of exotic animals attending the HVULE. Visits were related to emergency reasons and for musculoskeletal disorders. One-third of the animals were eventually euthanised. Regarding pharmacological treatments, the most frequently active ingredients used were pentobarbital, isoflurane, meloxicam, and within antibiotics, marbofloxacin (category B in the classification of European Medicines Agency).

Assessing the Expression of Emotions in Breast Cancer Survivors during the Time of Recovery: Perspective from Focus Groups.

Breast cancer has major public health implications, as it is the most frequent malignant tumor and the leading cause of cancer death in women. Survivors have many needs, including strategies to cope with the associated distress. We explore whether focus groups are useful for nurses to obtain information about the emotional state of breast cancer women, and develop strategies for coping with the stress that this disease entails. A qualitative study was carried out, involving 25 focus groups with 83 women treated for breast cancer, recruited from the local Breast Cancer Association (ALMOM). Four open-ended questions were employed, and 60-min discussions were carried out. They were transcribed, analyzed, coded, and the themes identified. Four major themes emerged, including "complex emotional evolution", "emotional isolation", "lack of information" and "inability to give advice". Women admitted that this disease had been a stressful factor for them, causing emotional (anxiety, irritability, anger or guilt) and cognitive disorders (confusion, lack of concentration, forgetfulness). The use of focus groups in breast cancer survivors allows nurses to evaluate the expression of emotions in these women, and collect and share information about their feelings, thoughts and experiences, so that survivors can cope more easily with the stress related to their illness.

Pharmacokinetics of menbutone after intravenous and intramuscular administration to sheep.

Menbutone is a drug currently approved in several European Union (EU) countries to treat digestive disorders in different animal species. The objective of this study was to establish the pharmacokinetic parameters resulting from intravenous (IV) and intramuscular (IM) administration of this drug in sheep. Menbutone was administered to 12 animals at the dose of 10 mg/kg for both IV and IM routes. Plasma samples were collected up to 24 h (15 points, IV route; 14 points, IM route). Concentrations were determined using high-performance liquid chromatography with photodiode-array (PDA) detection, following a method validated according to the EMEA/CHMP/EWP/192217/2009 guideline. Pharmacokinetic data were analyzed by non-compartmental methods. After IV administration, a total clearance (Cl) of 63.6 ± 13.6 mL/h/kg, a volume of distribution at steady-state (Vss) of 259.6 ± 52.7 mL/kg, and an elimination half-life (t½λ) of 6.08 ± 2.48 h were calculated. After IM administration, menbutone peak plasma concentration (Cmax) was 18.8 ± 1.9 µg/mL, the time to reach Cmax (tmax) 3.75 ± 0.45 h, the mean absorption time (MAT) 3.31 ± 1.36 h, and the fraction of dose absorbed (F) 103.1 ± 23.0 %. The results obtained indicate that menbutone absorption after IM administration is quick and complete.

Herbs as an Active Ingredient in Sport: Availability and Information on the Internet.

The use of supplements containing herbal active ingredients in sport has increased in recent years. Their consumption is explained by the benefits they may provide and because their natural origin do not involve health complications, from the point of view of the consumers. The aim of this study is to analyze the availability of four supplements (caffeine, turmeric, ginseng, cannabidiol) on the internet and understand the nature of these websites. A descriptive, observational, and cross-sectional study design was used. A detailed search was carried out with specifically developed software. The searches and data evaluation took 10 days. The websites consulted correspond to those that sell supplements, or some sport websites in the case of the Spanish ones, whereas those in English belong to pharmacies, parapharmacies, or herbalists. It is concluded that the websites do not provide adequate information to ensure proper consumption and lack advice on the choices of supplements and their administration guidelines.

Potentially Inappropriate Medication and Polypharmacy in Nursing Home Residents: A Cross-Sectional Study.

Inappropriate prescribing in the elderly is a risk factor for higher adverse drugs reactions, hospitalisation, and mortality rates. Therefore, it is necessary to identify irrational prescriptions and implement interventions to improve geriatric clinical practices in nursing homes. This study aimed to examine and compare the prevalence of potentially inappropriate medications in nursing home residents using three different updated criteria: 2019 Beers criteria, PRISCUS list, and v2 STOPP criteria, and to determine the prevalence of potential prescribing omissions according to v2 START criteria. A descriptive, observational, and cross-sectional study design was used. A total of 218 residents were involved in this study. Data on drug use were collected from medical charts. Information was screened with the software CheckTheMeds. Potentially inappropriate medications were present in 96.3%, 90.8%, and 35.3% of residents, according to the STOPP, Beers, and PRISCUS criteria or list, respectively. Inappropriate medication was found to be significantly associated with polypharmacy and severe or moderate drug-drug interactions with the three tools and with pathologies and unnecessary drugs only for STOPP criteria. The most frequent inappropriate medications were benzodiazepines and proton pump inhibitors. A regular use of software to review medications in nursing home residents would help to reduce the risk of these drug-related problems.

Drug-Related Problems and Polypharmacy in Nursing Home Residents: A Cross-Sectional Study.

At present, 19.2% of the Spanish population is aged 65 or older. Polypharmacy is a frequent condition among the elderly, especially in those living in nursing homes, which is associated with adverse outcomes, such as adverse drug events or drug-drug interactions. This study aimed to assess the pattern of polypharmacy in a nursing home in Leon, one of Spain's most ageing regions, and its relationship with different drug-related problems. A descriptive, observational, and cross-sectional study design was used; 222 residents were involved in this study. Data on drug use were collected from medical charts. Information was screened with the software CheckTheMeds, BOT PLUS and Drug-Reax. Residents were on a median of 7 medicines. Polypharmacy and inappropriate medications were present in 78.8% and 96.8% of residents, respectively. Drug-related problems were present in almost all the populations evaluated. Drug-drug interactions were very common in participants (81.1%), being severe/moderate in 24.7%. A high prevalence of polypharmacy and drug-related problems in the nursing home population assessed has been observed. A significantly higher risk of suffering drug-drug interactions was revealed for increasing polypharmacy and anticholinergic risk. A regular evaluation of drug prescribing in nursing home residents is necessary to minimize drug-related problems risk.

Improvement of Albendazole Bioavailability with Menbutone Administration in Sheep.

The pharmacokinetic interaction between a benzimidazole (albendazole, ABZ) and a choleretic drug (menbutone, MEN) was evaluated in sheep. The plasma disposition of albendazole sulfoxide (ABZSO, active metabolite) and albendazole sulfone (ABZSO2, inactive metabolite) was investigated following an oral administration of albendazole (ABZ) (5 mg/kg) alone or with menbutone (MEN) (intramuscular, 10 mg/kg). Blood samples were collected over 3 days post-treatment, and drug plasma concentrations were measured by high performance liquid chromatography (HPLC). ABZSO was measured from 0.5 to 48 h, and ABZSO2 from 2 to 60 h. No parent drug was detected at any sampling time. Mean maximum plasma concentration (Cmax) and the area under the plasma concentration-time curve (AUC) were 12.8% and 21.5% higher for ABZSO when ABZ and MEN were administered together, which indicates a significant increase in the amount absorbed. The rate of absorption was not modified, with similar values for the time to reach Cmax (tmax) (11.5 h with ABZ + MEN and 10.7 h with ABZ treatment), although no significant differences were observed for these latter pharmacokinetic parameters. Regarding ABZSO2, Cmax, AUC and tmax values were similar after both treatments (ABZ or ABZ + MEN). The results obtained indicate that co-administration of ABZ and MEN may be an interesting and practical option to increase the efficacy of this anthelmintic.

Use of medicinal plants by veterinary practitioners in Spain: A cross-sectional survey.

Medicinal plants have been used in veterinary medicine since ancient times, and they are gaining importance in Eastern Europe. The aim of this study was to conduct a survey on the use of medicinal plants in Spain. A cross-sectional study with an online questionnaire was carried out among Spanish small animal veterinarians, to evaluate the use patterns of medicinal plants and attitudes of professionals toward it. 313 veterinarians took part in the study. Most of them were female (80.2%) and age ranged 35-49 (49.5%). 80.3% of respondents use phytotherapy. Musculoskeletal and gastrointestinal disorders were those most frequently treated, with cannabis, aloe and thyme the most often medicinal plants used. The most common pattern of user was women working in clinics.

Distribution of Flumequine in Intestinal Contents and Colon Tissue in Pigs after Its Therapeutic Use in the Drinking Water.

Flumequine concentrations in plasma, colon tissue and intestinal contents were evaluated in 12 healthy pigs after oral administration (12 mg/kg every 24 h for 5 consecutive days in drinking water). Plasma, colon tissue and intestinal content samples were collected from animals sacrificed on days 3, 6 and 7. Concentrations were measured by high performance liquid chromatography after having validated the method, following the European Medicines Agency (EMA) requirements. The drug was not detected in any plasma sample. In colon tissue, concentrations were higher on day 3 (0.230 ± 0.033 µg/g, descending colon; 0.156 ± 0.093 µg/g, ascending colon) than on day 6 (0.187 ± 0.123 µg/g, descending colon; 0.107 ± 0.007 µg/g, ascending colon). Concentrations were considerably higher in intestinal contents, again on day 3 (1.349 ± 1.401 µg/g, descending colon; 0.591 ± 0.209 µg/g, ascending colon) than on days 6 (0.979 ± 0.346 µg/g, descending colon; 0.595 ± 0.075 µg/g, ascending colon) and 7 (0.247 ± 0.172 µg/g, descending colon; 0.172 ± 0.086 µg/g, ascending colon). Measured concentrations were lower than those effective against the most common intestinal pathogenic microorganisms in swine and, more specifically, Brachyspira hyodysenteriae.

Prevalence and Associated Factors of Polypharmacy in Nursing Home Residents: A Cross-Sectional Study.

In Spain, there has been a progressive increase in aging. Specifically, Leon has been one of the Spanish provinces with the highest aging index. Polypharmacy is highly prevalent among the elderly, with significant consequences for safety. The aim of this study was to assess the consumption of drugs in a nursing home in the province of Leon and establish the relationship between polypharmacy and the most common comorbid diseases. A descriptive, observational, and cross-sectional study design was used. Residents' information and treatments were collected by reviewing on medical charts, completed with clinical information obtained from the physician of the nursing home. The mean age of residents was 86.8 years, and 63.8% were female. Mean medical consumption amounted to 7.02 prescriptions. Polypharmacy was observed in 54.9% of residents, and excessive polypharmacy in 22.1%. The most commonly used medications (ATC classification) were those acting on the cardiovascular system (84.4%) and the nervous system (82.8%). A high-level of drug consumption was observed in the nursing home. Interventions should focus on those residents hospitalized the last year and with recent contact with a general practitioner. There is a need to develop a comprehensive monitoring system to assess the quality of prescriptions for nursing home residents.

Availability of Antibiotics for Veterinary Use on the Internet: A Cross-Sectional Study.

The misuse or overuse of antibiotics can favor the emergence of antimicrobial resistance, with a direct impact on human and animal health as well as on ecosystems. In this work, we have analyzed the web pages in which antibiotics for veterinary use can be purchased online. By using a specifically developed software, we carried out a detailed search to know if each individual antibiotic and the families included in the OIE list of antimicrobial agents of veterinary importance (in English and in Spanish) were sold, reviewing the offers according to the administration route and the species for which the antibiotics were intended. The greatest offer of antibiotics was for those compounds considered critically important by OIE. In the search in English, penicillins were available on 55.8% of the sites, tetracyclines on 55.0%, and fluoroquinolones on 52.7%. In Spanish, the families with the greatest presence were fluoroquinolones (67.9% of the sites), tetracyclines (67.9% of the sites), and penicillins (65.4% of the sites). Regarding individual antibiotics, the most offered in both searches were amoxicillin (49.6% of the sites in English and 57.7% in Spanish) and doxycycline (46.5% of the sites in English and 53.8% in Spanish). Most offers were for oral and parenteral administration and intended for cats and dogs and for bovines.

The Online Sale of Antibiotics for Veterinary Use.

Antibiotics are essential medicines against infectious diseases in both humans and animals. An inappropriate use of antibiotics can impair animal health and enhance the risk of bacterial resistance, as well as its transfer from animals to humans. The objective of this study was to assess the possibility of purchasing antibiotics for veterinary use on the internet, to evaluate if a prescription is required, and to determine the availability of drugs classified as the highest priority critically important antimicrobials (HP-CIA). The Google and Bing search engines and both simple and complex search strings in Spanish and in English were used. The simple search string was "buy veterinary antibiotics". Complex searches used wildcards and specific syntax. The searches carried out in Spanish revealed that 50% of websites operated in South America, and 65% of websites did not require a valid prescription. Fluoroquinolones were offered in 84% of these websites (45% without prescription), macrolides were offered in 63% of these websites (43% without prescription), and 3rd- and 4th-generation cephalosporins in 54% of these websites (38% without prescription). For the searches in English, 57% of these websites operated in the United States of America (USA), and 55% of them did not require a prescription. Fluoroquinolones were offered in 79% of these websites (49% without prescription), macrolides were offered in 72% of these websites (45% without prescription), and 3rd- and 4th-generation cephalosporins were offered in 49% of these websites (27% without prescription). Therefore, it is easy to illegally access antibiotics via the internet.

Long-term treatment for emotional distress in women with breast cancer.

PURPOSE: Breast cancer patients have many needs, including strategies to cope with the associated distress, during and after cancer treatment. Establishing and implementing adequate social and emotional support for these women, to reduce the detrimental effects of stress resulting from their treatment and disease, is the need of the hour. This study aims to assess how women, diagnosed and treated for breast cancer, combat emotional stress using mechanisms of coping and control and emotional defense, as well as to identify potential groups among them, with different long-term patterns and needs. METHODS: 98 patients belonging to a local breast cancer support association (ALMOM), were enrolled in this study. A questionnaire specifically designed for them was administered, and its internal consistency and reliability assessed. A hierarchical clustering was employed to classify the women. The questionnaire focused on four sections, including personal feelings, coping strategies, environmental influences and maladaptive coping. RESULTS: An adequate internal reliability was obtained with Cronbach's α near or greater than 0.60. Personal feelings were significant and clearly correlated with coping strategies and maladaptive coping. Three groups of women with different patterns of emotional characteristics and needs were identified: positivist, unsafe, and hopeless women, with different long-term emotional needs to be satisfied. CONCLUSIONS: Psychological therapeutic interventions should be maintained in many breast cancer patients over time, even after treatment completion, in order to consolidate adaptive and sustainable responses.

Influence of Plantago ovata husk (dietary fiber) on the bioavailability and other pharmacokinetic parameters of metformin in diabetic rabbits.

BACKGROUND: Metformin is an oral hypoglycemic agent frequently used in patients with type 2 diabetes. In this study, we have investigated the influence of the dietary fiber Plantago ovata husk on the pharmacokinetics of this drug when included in the diet, as well as when administered at the same time as metformin. METHODS: Six groups of 6 rabbits were used. Groups 1 to 3 were fed with standard chow and groups 4 to 6 with chow supplemented with fiber (3.5 mg/kg/day). Groups 1 and 4 received metformin intravenously (30 mg/kg). Groups 2 and 5 received metfomin orally (30 mg/kg), and number 3 and 6 were treated orally with metformin (30 mg/kg) and fiber (300 mg/kg). RESULTS: The changes caused by the inclusion of fiber in the feeding were more important in groups that received oral metformin. In this way, metformin oral bioavailability showed an increase of 34.42% when rabbits were fed with supplemented chow. CONCLUSIONS: Plantago ovata husk increased the amount of absorbed metformin when included in the diet (significant increase in AUC), and delayed its absorption when administered at the same time (significant increase in tmax).

Study of the protective effect on intestinal mucosa of the hydrosoluble fiber Plantago ovata husk.

BACKGROUND: Several studies have indicated that dietary fiber may have a protective effect on gastrointestinal mucosa. The aim of this study was to evaluate the protective action of the soluble fiber Plantago ovata husk against intestinal damage. METHODS: To evaluate the anti-ulcerogenic effect on duodenal mucosa of the soluble fiber Plantago ovata husk, low-dose acetylsalicylic acid (10 mg/kg) was given orally to animals once daily for 14 or 28 days with and without Plantago ovata husk (100 mg/kg). 24 h after final dosing duodenal samples were removed for anatomopathological evaluation. Villi were examined by both light and scanning electron microscopy. RESULTS: Acetylsalicylic acid induced severe lesions in duodenal mucosa of rabbits, including erosions, epithelium disorganization, and cell vacuolization, increasing as well the amount of mononuclear and caliciform cells. Damage was much more severe in animals treated for 28 days. In groups receiving Plantago ovata husk, a significant attenuation of acetylsalicylic acid-induced lesions was already observed in group treated for 14 days, becoming more evident in those treated for 28 days, all of them with duodenal cytoarchitecture normal and similar to control animals. CONCLUSIONS: These findings suggest that Plantago ovata husk may protect intestinal mucosa probably by limiting acetylsalicylic acid penetration into epithelial cells, although further studies are needed to confirm the same effect in other experimental models of induced mucosal damage and to elucidate the mechanisms of fiber protection.

Hypoglycemic and hypolipidemic potential of a high fiber diet in healthy versus diabetic rabbits.

The aim of this study was to investigate potential hypoglycaemic and hypolipidemic effects of Plantago ovata husk included in the diet, in healthy and diabetic rabbits. We also examined the effects of this fiber in other biochemical parameters. Two groups of 18 rabbits were used. The first group was fed with standard chow and the second with chow supplemented with Plantago ovata husk (3.5 mg/kg/day). On day 14 diabetes mellitus was induced by the intravenous administration of alloxan (80 mg/kg). After an oral glucose load (3 g), glucose, insulin, and other biochemical parameters were determined on day 14 (healthy rabbits) and on day 28 (diabetic rabbits). In healthy rabbits, fiber did not modify glucose or insulin levels but decreased significantly total cholesterol, LDL-cholesterol, atherogenic index, and glycosylated hemoglobin. In diabetic rabbits, fiber was more beneficial in mild diabetics than in severe diabetics with significant decreases in glucose levels and increases in insulin concentrations. In these animals fiber caused an important reduction in cholesterol, indicating a beneficial effect of Plantago ovata husk in diabetic rabbits. Although further studies in patients are necessary, we think that Plantago ovata husk offers interesting perspectives to be administered to patients with diabetes mellitus.

Effects of slowed gastrointestinal motility on levodopa pharmacokinetics.

Autonomic disorders are often seen in Parkinson's disease, with disturbances of the gastrointestinal tract occurring most frequently. These disorders, mainly a delay in gastric emptying and slowed gastrointestinal motility, can modify the pharmacokinetics and effectiveness of drugs used to treat Parkinson's disease and administered orally. In this study, we evaluated in a rabbit model the pharmacokinetics of levodopa (administered with carbidopa) in the context of gastrointestinal motility slowed by the administration of an anticholinergic drug. Levodopa+carbidopa (20:5mg/kg) and the anticholinergic biperiden (100 microg/kg) were orally administered to rabbits over one of two time periods (7 or 14 days) to verify the stabilization of levodopa concentrations. The values of the area under the curve (AUC) and C(max) were higher on the final day of treatment with an increase in AUC of 25% on day 7 and 33.4% on day 14; for C(max), the increase was 15% on day 7 and 12.8% on day 14. The values of AUC and C(max) were lower than those obtained when levodopa was administered to rabbits with normal gastrointestinal motility. The values obtained for C(min) (baseline sample obtained before administration) also increased with treatment duration (24% and 47.4% on days 7 and 14, respectively). These values were higher than those obtained in the absence of anticholinergic administration. We conclude that, under our experimental conditions of slowed gastrointestinal motility, levodopa absorption diminishes, and final concentrations and C(min) are higher than under conditions of normal motility.

Effects of dietary factors on levodopa pharmacokinetics.

IMPORTANCE OF THE FIELD: Levodopa is the most effective treatment for Parkinson's disease, so it is important to understand the pharmacokinetic and pharmacodynamic features of this drug. Considering the pharmacokinetics of levodopa and the factors that can modify it are essential for the clinician when prescribing levodopa products in order to maximize their therapeutic effects. AREAS COVERED IN THIS REVIEW: This paper reviews the studies carried out evaluating the interaction between levodopa and dietary factors. WHAT THE READER WILL GAIN: The reader will gain a greater understanding of the different dietary factors that can affect levodopa pharmacokinetics and, thus, the therapeutic response that is obtained with this drug in several situations. TAKE HOME MESSAGE: An understanding of the pharmacokinetics of any drug is crucial for the establishment of its optimal therapeutic regimen, but this assumes a special importance with levodopa, due to its extensive presystemic metabolism, rapid absorption in the proximal small intestine and short plasma half-life. Major problems with levodopa treatment are the fluctuations in clinical response experienced in patients with advanced Parkinson's disease that sometimes are related to the peripheral pharmacokinetics of levodopa. Studies of levodopa interactions are very important to improve patient response to this drug.