Potentially inappropriate medications use in community-based aged patients: a cross-sectional study using 2012 Beers criteria

Background

Potentially inappropriate medications (PIMs) should be avoided by the aged population. The aim of this study was to assess the prevalence of PIMs among Lebanese aged outpatients using Beers criteria of 2012. The secondary objectives were to identify the correlates of the PIMs use and to compare the PIMs prevalence rates as per Beers criteria of 2003 and 2012.

Methods

This cross-sectional observational study was conducted among aged outpatients of different accredited community pharmacies across Lebanon. Data were collected through a validated questionnaire. The Beers criteria of 2012 were used to evaluate PIMs. The association between PIMs used and independent variables were analyzed by logistic regression. The differences between PIMs use according to Beers criteria 2003 and 2012 were calculated using chi-squared and McNemar’s tests.

Results

A total of 248 outpatients were analyzed. We identified 112 (45.2%) out of 248 patients taking PIMs. The leading classes of medications identified to cause PIMs were those acting on the central nervous system (71.4%). The factors associated with PIMs use were age, osteoporosis, Alzheimer/dementia, diabetes, and alcohol consumption. PIMs use increased significantly between Beers criteria 2003 and 2012 (Chi-squared test, P<0.001; McNemar’s test, P<0.001).

Conclusion

Our study showed a high prevalence of PIMs use in Lebanon, which is associated with various correlates. Education of health care providers and medication review should be considered to improve medication safety of older adults.

Serum 25 hydroxyvitamin D in employees of a Middle Eastern university hospital

BACKGROUND

The Middle East registers the highest rate of vitamin D deficiency worldwide. In Lebanon, previous studies looked at this deficiency in schoolchildren, university students, young adults and postmenopausal women. However, no previous study was performed in hospital workers. The objective of our study was to evaluate vitamin D status in a Beirut hospital center and to look at the potential factors influencing these measurements.

METHODS

This cross-sectional study was performed on hospital employees who came for a regular checkup at the primary health-care department. 25(OH)D measurements were performed using the Dia-Sorin chemiluminescent assay.

RESULTS

392 subjects (318 women and 74 men) were included in the study. The mean age of the participants was 41.02 ± 11.3 years. The mean 25(OH)D level was 15.61 ± 7.91 ng/ml, with no significant difference according to gender. There were no significant correlations between 25(OH)D and both BMI and age, but 25(OH)D was significantly associated with educational level (p = 0.03). There was a significant difference in 25(OH)D levels according to season (p < 0.001) and a significant association between 25(OH)D and the reported weekly hours of sun exposure (r = 0.1, p = 0.032), but not with the reported sunscreen use. Fish consumption was positively associated with 25(OH)D levels (p = 0.018), while milk, dairy product or egg consumption did not achieve any significant relationship. In a stepwise linear regression analysis, fish consumption and season were the only independent predictors of 25(OH)D levels (p = 0.007 and p = 0.0001 respectively).

CONCLUSION

Vitamin D deficiency is common among hospital workers. This finding reinforces the need for vitamin D supplementation in these high-risk populations.

[Androgen test: comparison of a low test and a high test in the development of the penis in male pseudohermaphroditism]

BACKGROUND

The androgen sensitivity test used in male pseudohermaphroditism for clinical assessment of the androgen sensitivity and prediction of penile development is an important element in choice of gender. However, there is a wide range of testosterone dosage and no standardized test.

METHODS AND PATIENTS

Two doses (2.5 mg and 100 mg) of testosterone heptylate were used in six cases of male pseudohermaphrodism with sexual ambiguity and small penis (ages 6 to 18 months). The clinical results were compared with those of the study of androgen receptors.

RESULTS

In two cases, both low-dose and high-dose tests resulted in only minimal changes in the penis. In two cases, the low-dose test gave a good result which was confirmed by the high-dose test; on the other hand, in two cases, the low-dose test was considered to be negative whereas the high-dose test led to the development of a normal-sized penis. In all cases except one, there was good concordance between the results of study of androgen receptors and those of the clinical test.

CONCLUSION

The high-dose androgen test is thus useful in both diagnosis and treatment and facilitates the gender assignment.

Intramuscular injections of slow-release lanreotide (BIM 23014) in acromegalic patients previously treated with continuous subcutaneous infusion of octreotide (SMS 201-995)

Nine acromegalic patients (five females and four males), mean age 50 +/- 4 years, presented macroadenomas (N = 7), microadenoma (N = 1) or normal computed tomography scans (N = 1). Patients were treated with continuous subcutaneous infusion of octreotide (range 200-600 micrograms/day). Following a washout period of 7 days, the patients were injected im with 30 mg slow-release lanreotide every 10 days for the first month and then twice monthly. In case of elevated growth hormone (GH) levels at 3 months, the patients were injected every 10 days for the next three months. Plasma GH and insulin-like growth factor I (IGH-I) decreased in all patients during octreotide treatment. After 6 months of octreotide treatment, seven patients were considered as well controlled (mean 8 h GH < 5 micrograms/l, IGF-I normal) whereas in two patients the mean 8-h GH and/or IGF-I levels remained increased. Serum GH and IGH-I increased after octreotide withdrawal. In one patient, serum GH and IGF-I increased during slow-release lanreotide administration and injections were stopped after 45 days. After 3 months of lanreotide, three patients were well controlled while in five patients GH or IGF-I levels were not normalized. At 6 months, five patients were injected twice monthly and three patients had one injection every 10 days. Six patients were well controlled and in two patients the mean 8-h GH level remained increased. The pituitary tumor volume decreased by 20-30% in two patients during octreotide, as well as in one other during slow-release lanreotide therapy.(ABSTRACT TRUNCATED AT 250 WORDS)