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CONTEXT: Psychological distress symptoms in the last days of life often contribute to the overall symptom burden in frail older patients. Good symptom management practices are crucial to ensure high-quality end-of-life care in an aging population, though the best pharmacological approach to treat these psychological symptoms has yet to be established. OBJECTIVES: To identify current evidence-based and practice-based knowledge of pharmacological interventions for the treatment of agitation, delirium, and anxiety during the last days of life in frail older patients. METHODS: A systematic, mixed methods review was performed through MEDLINE via PubMed and EMBASE from inception until February 2022 and updated through March 2023. National and international guideline databases and grey literature were searched for additional studies and guidelines. RESULTS: Four quantitative studies, two non-randomized and two descriptive, were identified. No randomized controlled trials met inclusion criteria. No qualitative studies were withheld. The three consensus-based protocols that were found through citation searching and screening of grey literature did not meet the standards for inclusion. Haloperidol is recommended in consensus-based guidelines for delirium and is widely used, but high-quality evidence about its efficacy is missing. Better control of agitation or refractory delirium might be achieved with the addition of a benzodiazepine. There is no evidence available about the treatment of anxiety in the last days of life in frail older patients. CONCLUSIONS: This mixed methods review demonstrates the lack of good quality evidence that is needed to help clinicians with pharmacological treatment decisions when confronted with psychological symptoms in the last days of life in frail older patients. Population aging will only emphasize the need for further research in this specific population.
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The inhibition effect of the invasive brown seaweed Sargassum muticum extract (ESM), harvested from the Atlantic coast of Morocco, against the corrosion of carbon steel (CS) in 1â¯M HCl medium was studied for the first time using gravimetric, electrochemical and surface techniques. The methanolic crude extract of Sargassum muticum (ESM) is rich in alginate biopolymer. The evaluation corrosion tests showed that this algal extract acts as a good mixed corrosion inhibitor for CS substrate in 1â¯M HCl since inhibition efficiency of 97% was reached with 1â¯g/L of ESM at 303â¯K. AC impedance findings showed that the seaweed extract adding in the corrosive electrolyte increases the polarization resistance and conversely decreases the charge capacitance at the interface. Adsorption of ESM on the substrate surface followed the Langmuir adsorption isotherm. X-ray photoelectron spectroscopy analyses (XPS) demonstrated that the corrosion inhibition mechanism of CS substrate in 1â¯M HCl environment by the investigated algal extract is typical of the chemisorption process and the protective barrier is mainly formed by the adsorbed biological macromolecules.
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Alginatos/química , Técnicas Electroquímicas , Ácido Clorhídrico/química , Sargassum/química , Acero/química , Corrosión , Propiedades de SuperficieRESUMEN
Novel purine-pyrazole hybrids combining thiazoles, thiazolidinones and rhodanines, were designed and tested as 15-LOX inhibitors, potential anticancer and antioxidant agents. All tested compounds were found to be potent 15-LOX inhibitors with IC50 ranging from 1.76 to 6.12⯵M. The prepared compounds were evaluated in vitro against five cancer cell lines: A549 (lung), Caco-2 (colon), PC3 (prostate), MCF-7 (breast) and HepG-2 (liver). Compounds 7b and 8b displayed broad spectrum anticancer activity against the five tested cell lines (IC50â¯=â¯18.5-95.39⯵M). While, compound 7h demonstrated moderate anticancer activity against lung A549 and colon Caco-2 cell lines. Antioxidant screening revealed that six compounds (5a, 5b, 6b, 7b, 7h and 8b) with IC50 ranging from 0.93 to 14.43⯵g/ml were found to be more potent scavengers of 2,2- diphenyl-1-picrylhydrazyl (DPPH) than the reference ascorbic acid with IC50 value of 15.34⯵g/ml. Compounds 7b, 7h and 8b, when evaluated for their antioxidant activity, where found to be potent DPPH scavengers. Moreover, compound 7b displayed twice the potency of ascorbic acid as NO scavenger. Docking study was performed to elucidate the possible binding mode of the most active compounds with the active site of 15-LOX enzyme. Collectively, the purine-pyrazole hybrids having thiazoline or thizolidinone moieties (7b, 7h and 8b) constitute a promising scaffold in designing more potent 15-LOX inhibitors with anticancer and antioxidant potential.
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Antineoplásicos/farmacología , Antioxidantes/farmacología , Araquidonato 15-Lipooxigenasa/metabolismo , Inhibidores de la Lipooxigenasa/farmacología , Antineoplásicos/síntesis química , Antineoplásicos/química , Antioxidantes/síntesis química , Antioxidantes/química , Compuestos de Bifenilo/antagonistas & inhibidores , Línea Celular Tumoral , Proliferación Celular/efectos de los fármacos , Relación Dosis-Respuesta a Droga , Ensayos de Selección de Medicamentos Antitumorales , Humanos , Inhibidores de la Lipooxigenasa/síntesis química , Inhibidores de la Lipooxigenasa/química , Simulación del Acoplamiento Molecular , Estructura Molecular , Picratos/antagonistas & inhibidores , Purinas/química , Purinas/farmacología , Pirazoles/química , Pirazoles/farmacología , Rodanina/química , Rodanina/farmacología , Relación Estructura-Actividad , Tiazoles/química , Tiazoles/farmacología , Tiazolidinas/química , Tiazolidinas/farmacologíaRESUMEN
OBJECTIVE: To assess the correlation between bacterial pathogens in the adenoid core and the middle meatus, in children with hypertrophied adenoids and chronic or recurrent sinusitis. DESIGN: The study was conducted at Alexandria University Hospitals. We included 103 children aged four to 12 years who were scheduled for adenoidectomy and who had clinical and/or radiological evidence of chronic or recurrent sinusitis. Adenoid core specimens and middle meatal swabs were obtained from every patient and were sent for bacteriological evaluation using standard qualitative and quantitative microbiological techniques. The results were statistically analysed. RESULTS: The bacterial species isolated most frequently from the adenoid core were coagulase-negative staphylococci (40.8 per cent), Staphylococcus aureus (22.3 per cent), Streptococcus pneumoniae (18.4 per cent), Haemophilus influenzae (16.5 per cent) and group A streptococci (15.5 per cent). The bacterial species isolated most frequently from the middle meatus were coagulase-negative staphylococci (41.7 per cent), S aureus (32 per cent), S pneumoniae (28.1 per cent), H influenzae (21.6 per cent) and group A streptococci (19.4 per cent). The adenoid core and middle meatal cultures were both positive for at least one bacterial species in 63 cases, and were both negative in 25 cases. In six cases, a positive adenoid core culture was associated with a negative middle meatal culture. In five cases, a negative adenoid core culture was associated with a positive middle meatal culture (for one or more pathogenic species). Thus, adenoid core culture had a positive predictive value of 91.5 in forecasting the middle meatal culture result, and a negative predictive value of 84.3. CONCLUSION: Apart from its effect on nasal airway patency, adenoidal tissue may function as a bacterial reservoir initiating and maintaining sinus infection in children. These study findings support a potential role for adenoidectomy in the treatment of chronic or recurrent paediatric sinusitis.
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Tonsila Faríngea/microbiología , Cavidad Nasal/microbiología , Rinitis/microbiología , Sinusitis/microbiología , Adenoidectomía , Tonsila Faríngea/patología , Biopsia , Niño , Preescolar , Enfermedad Crónica , Cocos Grampositivos/aislamiento & purificación , Haemophilus influenzae/aislamiento & purificación , Humanos , Valor Predictivo de las Pruebas , RecurrenciaRESUMEN
Hedonic tests are routinely used to assess the acceptance of food products. However, these single tests may not be the best approach for predicting long-term use. The objectives of this study were, first, to check whether a difference from reference score is more sensitive to changes in hedonic scores, second, to assess whether the labeled affective scale (LAM) is more sensitive to differences than the 9-point scale, and third, to assess the effect of repeated exposure on the hedonic scores of neophilic and neophobic panelists for familiar and novel foods. Two groups of 41 panelists were tested with either the 9-point hedonic scale or LAM scale. Panelists received a food neophobia questionnaire and were subsequently classified to neophobic, neophilic, or neutral. Ten foods, including 5 novel and 5 familiar, were used. In each session, 5 to 6 foods were served twice/week for 4 wk. Serving frequency ranged between 1 and 8 times (1, 2, 4, 6, 8). Data analyses were performed 3 times, using either absolute acceptability scores or relative scores, that is, the difference between absolute scores and scores for either the reference (cracker, RELFAM) or a novel food (pickled-ginger, RELNOV) served in every session. The 3 analyses (absolute, RELFAM, and RELNOV) generated similar results with respect to the number of significant differences between foods. There was no major drift in acceptability scores with sessions. A significant food effect was obtained (P < 0.05) and a significant food x neophobia (P < 0.05) was noted for 2 novel foods, pickled ginger, and lychee, whereby neophobic panelists were less accepting of them. Both scales were equally sensitive with some advantages for LAM over the 9-point hedonic scale.
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Análisis de los Alimentos , Alimentos/normas , Adulto , Afecto , Culinaria , Ingestión de Alimentos/fisiología , Ingestión de Alimentos/psicología , Conducta Exploratoria , Preferencias Alimentarias , Frutas , Humanos , Hambre , Reconocimiento en Psicología , Encuestas y Cuestionarios , Gusto , VerdurasRESUMEN
We demonstrated the surface composite character down to the nanometer scale of SiO(2)-CeO(2) composite high surface area materials, prepared using 5 nm colloidal CeO(2) nanoparticle building blocks. These materials are made of a homogeneous distribution of CeO(2) nanoparticles in thin layers of SiO(2), arranged in a hexagonal symmetry as shown by small-angle X-ray scattering and transmission electron microscopy. Since the preparation route of these composite materials was selected in order to produce SiO(2) wall thickness in the range of the CeO(2) nanoparticle diameter, these materials display surface nanorugosity as shown by inverse chromatography. Accessibility through the porous volume to the functional CeO(2) nanoparticle surfaces was evidenced through an organic acid chemisorption technique allowing quantitative determination of CeO(2) surface ratio. This surface composite nanostructure down to the nanometer scale does not affect the fundamental properties of the functional CeO(2) nanodomains, such as their oxygen storage capacity, but modifies the acid-base properties of the CeO(2) surface nanodomains as evidenced by Fourier transform IR technique. These arrays of accessible CeO(2) nanoparticles displaying high surface area and high thermal stability, along with the possibility of tuning their acid base properties, will exhibit potentialities for catalysis, sensors, etc.
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By hydrolysis of an ethanolic gallium nitrate solution, gamma-Ga2O3 was prepared as a single-phase polymorph having a specific surface area of 160 m2 g(-1). Surface acidity and basicity of this material was studied by IR spectroscopy, using pyridine, 2,6-dimethylpyridine, acetonitrile, and carbon dioxide as spectroscopic probe molecules. For comparison, a gamma-Al2O3 sample having a surface area of 290 m2 g(-1) was also studied. On partially hydroxylated gamma-Ga2O3, the main O-H stretching bands were found at 3693 (sharp) and at 3660-3630 cm(-1) (broad), and the material proved (by adsorbed dimethylpyridine) to have a weak Brønsted acidity. Surface Lewis acidity of gamma-Ga2O3 was revealed (mainly) by adsorbed pyridine, which gave the characteristic IR absorption bands of Lewis-type adducts at 1612, 1579, 1488, and 1449 cm(-1) (values noted under an equilibrium pressure of 1 Torr at room temperature); the corresponding Lewis acid centers (coordinatively unsaturated Ga3+ ions) were found to be weaker, although more abundant, than those present on the surface of gamma-Al2O3 (unsaturated Al3+ ions). Another significant difference between gamma-Ga2O3 and gamma-Al2O3 is the smaller thermal stability of pyridine and 2,6-dimethylpyridine Lewis adducts formed on the gallium oxide. The surface basicity of gamma-Ga2O3 was studied by using carbon dioxide and deuterated acetonitrile as IR probe molecules. Adsorbed CO2 gave carbonate and hydrogen-carbonate surface species similar to those formed by gamma-Al2O3. Adsorbed acetonitrile gave rise to acetamide species, which revealed the basic character of surface O2- ions. These acetamide species were found to be more abundant on gamma-Ga2O3 than on gamma-Al2O3.
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There are few clinical data concerning the use of fluconazole, a triazole antifungal agent with in vitro activity against Blastomyces dermatitidis, in the treatment of human blastomycosis. We conducted a multicenter, randomized, open-label pilot trial comparing two daily doses of fluconazole (200 mg and 400 mg) in the treatment of non-life-threatening, non-CNS blastomycosis. Twenty-four patients were enrolled in the study, and 23 patients were evaluable for efficacy analysis. Overall, treatment of 15 (65%) of 23 patients was successful, including eight (62%) of 13 who received 200 mg daily and seven (70%) of 10 who received 400 mg daily. The mean duration of therapy for successfully treated patients was 6.7 months. Of the six patients whose prior antifungal therapy had failed, all six eventually responded to fluconazole treatment. We conclude that fluconazole (200 mg to 400 mg daily) given for at least 6 months is moderately effective treatment for blastomycosis.
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Blastomicosis/tratamiento farmacológico , Fluconazol/uso terapéutico , Adolescente , Adulto , Anciano , Femenino , Fluconazol/administración & dosificación , Fluconazol/efectos adversos , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Estudios Prospectivos , Resultado del TratamientoRESUMEN
BACKGROUND: Amphotericin B has long been the standard treatment for candidemia, but its use is complicated by its toxicity. More recently, fluconazole, a water-soluble triazole with activity against candida species and little toxicity, has become available. We conducted a multicenter randomized trial that compared amphotericin B with fluconazole as treatment for candidemia. METHODS: To be eligible, patients had to have a positive blood culture for candida species, a neutrophil count > or = 500 per cubic millimeter, and no major immunodeficiency. Patients were randomly assigned to receive either amphotericin B (0.5 to 0.6 mg per kilogram of body weight per day) or fluconazole (400 mg per day), each continued for at least 14 days after the last positive blood culture. Outcomes were assessed by a group of investigators blinded to treatment assignment. RESULTS: Of the 237 patients enrolled, 206 met all entry criteria. The most common diagnoses were renal failure, nonhematologic cancer, and gastrointestinal disease. There was no statistically significant difference in outcome: of the 103 patients treated with amphotericin B, 81 (79 percent) were judged to have been treated successfully, as were 72 of the 103 patients treated with fluconazole (70 percent P = 0.22; 95 percent confidence interval for the difference, -5 to 23 percent). The bloodstream infection failed to clear in 12 patients in the amphotericin group and 15 in the fluconazole group; the species most commonly associated with failure was Candida albicans. There were 41 deaths in the amphotericin group and 34 deaths in the fluconazole group (P = 0.20). Intravascular catheters appeared to be the most frequent source of candidemia. There was less toxicity with fluconazole than with amphotericin B. CONCLUSIONS: In patients without neutropenia and without major immunodeficiency, fluconazole and amphotericin B are not significantly different in their effectiveness in treating candidemia.
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Anfotericina B/uso terapéutico , Candidiasis/tratamiento farmacológico , Fluconazol/uso terapéutico , Fungemia/tratamiento farmacológico , Anfotericina B/efectos adversos , Candidiasis/mortalidad , Catéteres de Permanencia/efectos adversos , Femenino , Fluconazol/efectos adversos , Estudios de Seguimiento , Fungemia/microbiología , Fungemia/mortalidad , Humanos , Masculino , Persona de Mediana Edad , Neutropenia , Resultado del TratamientoRESUMEN
Several new 1,3,4-thiadiazole, imidazo[2,1-b]1,3,4-thiadiazole and thiadiazole[3,2-al]pyrimidine derivatives of benzimidazole were synthesized. The compounds were obtained from 1-ethyl or benzyl 2-(2-amino-1,3,4-thiadiazol-5-yl)thiomethylbenzimidazole. The antimicrobial activity of the prepared compounds was studied.