Nonadherence in Hypertension: How to Develop and Implement Chemical Adherence Testing

Nonadherence to antihypertensive medication is common, especially in those with apparent treatment-resistant hypertension (true treatment-resistant hypertension requires exclusion of nonadherence), and its routine detection is supported by clinical guidelines. Chemical adherence testing is a reliable and valid method to detect adherence, yet methods are unstandardized and are not ubiquitous. This article describes the principles of chemical adherence testing for hypertensive patients and provides a set of recommendations for centers wishing to develop the test. We recommend testing should be done in either of two instances: (1) in those who have resistant hypertension or (2) in those on 2 antihypertensives who have a less than 10 mm Hg drop in systolic blood pressure on addition of the second antihypertensive medication. Furthermore, we recommend that verbal consent is secured before undertaking the test, and the results should be discussed with the patient. Based on medications prescribed in United Kingdom, European Union, and United States, we list top 20 to 24 drugs that cover >95% of hypertension prescriptions which may be included in the testing panel. Information required to identify these medications on mass spectrometry platforms is likewise provided. We discuss issues related to ethics, sample collection, transport, stability, urine versus blood samples, qualitative versus quantitative testing, pharmacokinetics, instrumentation, validation, quality assurance, and gaps in knowledge. We consider how to best present, interpret, and discuss chemical adherence test results with the patient. In summary, this guidance should help clinicians and their laboratories in the development of chemical adherence testing of prescribed antihypertensive drugs.

Effects of Piper betle Leaf Extract on Biofilm and Rhamnolipid Formation of Pseudomonas aeruginosa

High mortality rate and antimicrobial resistance are still becoming world-wide problems, due to Pseudomonas aeruginosa’s (P. aeruginosa) virulence and its ability to form biofilm. Biofilm’s formation is affected by the presence of rhamnolipid, whose production is regulated by quorum sensing systems. Piper betle (P. betle) possesses antimicrobial, antioxidant, anti-inflammatory and immunomodulatory properties. The aim of our study is to investigate the effects of P. betle leaf’s extract against biofilm formation and rhamnolipid production of P. aeruginosa. Active compounds of P. betle were identified using plate chromatography. Agar dilution method was used to determine the minimum biofilm inhibitory concentration (MBIC) of methanolic leaf extract of P. betle. A biofilm-producing P. aeruginosa isolate in the polystyrene plate adherence test was selected for confirmation of biofilm production by Scanning Electron Microscopy (SEM), after P. betle administration. Rhamnolipid detection and evaluation were performed by interpreting halo formed around the well. After administration of various concentrations of P. betle leaf extract on the microplate well, it was concluded that the MBIC of P. betle leaf extract on P. aeruginosa was 0.4%. Methanolic extract of P. betle leaf extract at concentration of 0.4% showed that P. aeruginosa could not form biofilm at all, although the bacteria could still aggregate and form a matrix. After linear regression analysis, beta-coefficient was obtained at -0.931 for P. betle leaf extract. It can be concluded that P. betle leaf extract was effective in inhibiting the growth of biofilm and formation of rhamnolipid by P. aeruginosa. The increase in concentration of P. betle leaf extract was inversely proportional to the diameter of the halo rhamnolipid formed. The higher the level of P. betel leaf extract, the smaller the diameter of the halo rhamnolipid formed.

De Otras Revistas

Fuente: Anales de Pediatría Estudio de la adherencia a la dieta sin gluten en pacientes celiacos Fernández M, Díaz J, Jiménez S, Suárez M, Bousoño C. Anales de Pediatría 94 (2021) 377-384 (doi: 10.1016/j.anpedi.2020.06.017) Introducción: La realización estricta de una dieta sin gluten (DSG) es fundamental para el control de la enfermedad celiaca. El objetivo del estudio fue analizar la adherencia a la DSG en celiacos y evaluar factores que pudieran influir en la misma. Material y métodos: Estudio observacional descriptivo. Se realizó una determinación de péptidos inmunogénicos del gluten (GIP) en heces con método semicuantitativo y se cumplimentó el cuestionario Celiac Dietary Adherence Test. Se recogieron datos sociodemográficos, clínicos y se elaboró una encuesta ad hoc. Resultados: Se incluyeron 80 pacientes. El 92,5% eran adherentes mediante GIP y 86,3% con Celiac Dietary Adherence Test (concordancia aceptable; Kappa: 0,31, p=0,004). El 83,3% de los pacientes con GIP positivos tenía la última determinación de anticuerpos antitransglutaminasa negativos. La edad actual y el tiempo de evolución se asociaron significativamente con la adherencia. Aquellos con GIP positivos tenían de media 5 años más (p=0,0001) y llevaban 52 meses más de DSG (p=0,025). Una cuarta parte de los encuestados consideraba difícil realizar la dieta. El 60% consideraba que la variabilidad en el lugar de comida era importante para inducir transgresiones, siendo las fiestas infantiles el principal lugar donde sucedían (66,7%). Se destaca la escasa variedad (61,4%) y el elevado coste (98,6%) de los alimentos sin gluten. Conclusiones: La adherencia a la DSG es en general, buena. El análisis de GIP permitió detectar a pacientes no adherentes que en otras circunstancias pasarían desapercibidos. Se deben establecer medidas para mantener una buena adhesión de manera prolongada, considerando los factores de riesgo y dificultades detectados. Fuente: Andes Pediátrica Revista Chilena de Pediatría Aumento de horas de pantalla se asocia con un bajo rendimiento escolar Zapata-Lamana R, Ibarra-Mora J, Henriquez-Beltrán M, Sepúlveda-Martin S, Martínez-González L, Cigarroa I. Aumento de horas de pantalla se asocia con un bajo rendimiento escolar. Andes pediatr. 2021;92(4): 565-575 (doi:10.32641/andespediatr.v92i4.3317) Resumen Objetivo: Analizar si el tiempo de pantalla se relaciona con un menor rendimiento académico en escolares de segundo ciclo y determinar diferencias por sexo. Sujetos y Método: Investigación analítica, retrospectiva y transversal en 733 escolares de 5to a 8vo año básico de establecimientos educacionales públicos pertenecientes al estudio “Encuesta de salud y rendimiento escolar de la provincia del Biobío 2018” fueron reclutados. El uso de pantalla fue autoreportado a través de horas diarias frente a televisión, videojuegos e internet. El rendimiento escolar fue medido con las calificaciones en las asignaturas de lenguaje, matemáticas, educación física, promedio general y a través de conductas asociadas a la cognición en el contexto escolar. Para determinar la relación entre tiempo de pantalla y rendimiento escolar se determinó el coeficiente de correlación de Pearson y para medir la influen- cia del sexo y las horas de pantalla en las notas se realizó un ANOVA de dos vías. Resultados: Los escolares pasan 6,1 ± 5,3 h frente a una pantalla diariamente. Los niños pasan más tiempo jugando videojuegos y las niñas más navegando por internet. Tanto niños como niñas que pasan mayor cantidad de horas frente a una pantalla, principalmente jugando videojuegos y navegando por internet presentaron notas más bajas en matemáticas, lenguaje, educación física, promedio general y se perciben con menos memoria, más lentos para resolver problemas matemáticos, con más dificultades para mantener la atención en clases o para resolver tareas complejas. Conclusión: El uso de pantallas se asocia negativamente con el rendimiento académico, así como en las conductas asociadas a la cognición en escolares de ambos sexos. Fuente: Pediatrics Depresión materna y paterna. Síntomas durante la estadía en la Unidad de Cuidados intensivos Neonatal (UCIN) y transición a casa Garfield C F, Lee Y S, Warner-Shifflett L, et al. Maternal and Paternal Depression Symptoms During NICU Stay and Transition Home. Pediatrics. 2021;148(2):e202004274 ResumenObjetivo: Examinar la trayectoria y los factores de riesgo de los síntomas de depresión entre los padres desde el ingreso a la UCIN hasta los 30 días posteriores al alta. Presumimos que las puntuaciones de los síntomas de depresión disminuirían desde la admisión y luego aumentarían desde el alta hasta los 30 días.Métodos: Estudio prospectivo de cohorte longitudinal de bebés prematuros en UCIN. Los padres completaron la Escala de Depresión Postnatal de Edimburgo (EPDS) validada en 4 puntos de tiempo: admisión a la UCIN, alta y 14 días y 30 días después del alta. El cambio de la puntuación de EPDS a lo largo del tiempo y la probabilidad de un resultado positivo (EPDS > 10) se evaluaron mediante modelos de regresión de efectos mixtos.Resultados: De 431 padres inscritos (madres, n = 230 [53%]), el 33% de las madres (n = 57) y el 17% de los padres (n = 21) tuvieron una prueba de detección de EPDS positiva. La diferencia en la puntuación entre madres y padres fue de 1.9 (intervalo de confianza [IC]: 1.3-2.6; P < .0001), con las madres disminuyendo 2.9 puntos (IC: 2.1-3.7; P < .0001) y los padres disminuyendo 1.0 punto (CI: 0.1-2.0; P = 0.04). Con el tiempo, las madres disminuyeron 10.96 veces (IC: 2.99–38.20; P = .0003); los padres disminuyeron a un ritmo no significativo. El análisis de los síntomas depresivos al ingreso o al alta mejoraron a los 30 días (AUC 0.66 en los datos demográficos iniciales solamente frente a 0.841 [P < .0001], y versus 0.801 detección de alta [P < .001]).Conclusiones: Las madres y los padres experimentan diferentes trayectorias de síntomas depresivos desde la UCIN hasta el hogar. Es probable que la detección de la depresión posparto en los padres durante la estadía en la UCIN mejore la identificación de los padres en riesgo de depresión posparto después del alta. La atención centrada en los padres parece justificada.

What is the Optimal Method Assessing for Persistent Villous Atrophy in Adult Coeliac Disease?

Background and Aims: Methods of assessing gluten-free diet (GFD) adherence in adults with coeliac disease (CD) include serological testing, dietitian evaluation, questionnaires and repeat duodenal biopsies. Persisting villous atrophy (VA) is associated with CD complications, however gastroscopy with biopsies is expensive and invasive. This study aimed to assess the abilities of a duodenal bulb (D1) biopsy and the Celiac Dietary Adherence Test (CDAT) to detect persisting VA in adults with CD. Methods: A prospective observational study of adult CD patients referred for follow-up duodenal biopsies was performed. Quadrantic biopsies were taken from the second part of the duodenum (D2), in addition to a D1 biopsy. Patients underwent follow-up serological testing, and completed the CDAT and Biagi Score. These non-invasive adherence markers were compared against duodenal histology. Results: 368 patients (mean age 51.0 years, 70.1% female) had D1 and D2 biopsies taken at follow-up gastroscopy. Compared to D2 biopsies alone, additional D1 biopsies increased detection of VA by 10.4% (p<0.0001). 201 patients (mean age 50.3 years, 67.7% female) completed adherence questionnaires and serology. When detecting VA, sensitivities and specificities of these markers were 39.7% and 94.2% for IgA- tTG, 38.1% and 96.4% for IgA-EMA, 55.6% and 52.2% for CDAT and 20.6% and 96.4% for the Biagi score. Conclusions: Bulbar biopsies increase detection of persisting VA by 10.4%. Serology, CDAT and Biagi performed poorly when predicting VA. The gold standard for predicting persisting VA remains repeat biopsy.

Nutritional and Gastroenterological Monitoring of Patients With Celiac Disease During COVID-19 Pandemic: The Emerging Role of Telemedicine and Point-of-Care Gluten Detection Tests

Background and Aims: Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic, telemedicine has been supporting many patients with chronic diseases worldwide. However, data on celiac disease (CeD) nutritional and gastroenterological remote monitoring are scanty. The aims of our study were to verify patients' trust in telemedicine and to evaluate the feasibility of telemedicine in nutritional monitoring.Material and Methods: We used telemedicine in place of the scheduled but not provided follow-up visits during the first lockdown of the COVID-19 pandemic. Patients received a phone call, and televisits were conducted for CeD patients with mild or moderate symptoms and/or with blood alterations. The patient's adherence to the gluten-free diet (GFD) was evaluated according to the Celiac Dietary Adherence Test (CDAT). When gluten contamination was suspected, a point-of-care gluten detection test was prescribed. The patient's trust in telemedicine was assessed, through an adapted version of the Patient Trust Assessment Tool (PATAT) questionnaire, as the percentage of patients giving a score of at least 4 out of 5 on a Likert scale for three selected key statements: “I can trust televisit,” “I can trust that possible problems with the telemedicine service will be solved properly,” and “I feel at ease when working with this website.”Results: One hundred and twelve CeD patients were phone called; among symptomatic patients, 39 out of the 42 scheduled (92.9%) televisits were performed. Among the 39 visits, 34 (87.2%) questionnaires were compiled. The patients included in the study obtained a CDAT score from 7 to 13 (11 ± 2). Gluten detection tests were prescribed to 11 patients, resulting positive in 2. Trust in the telemedicine service was achieved in 94.1, 88.2, and 97.1% for the three selected key statements of the PATAT questionnaire.Conclusion: During the COVID-19 pandemic, telemedicine showed to be feasible and the majority of patients trusted the combined gastroenterological and nutritional televisits. Gluten detection tests demonstrated to be useful tools for the patient and for the caregiver to confirm adherence to the GFD remotely.

Catalysts for Methane Steam Reforming Reaction: Evaluation of CeO2 Addition to Alumina-Based Washcoat Slurry Formulation

The effect of the addition of CeO2 to alumina-based washcoat slurry formulation on the methane steam reforming (MSR) reaction was investigated. Five Al2O3-CeO2-based washcoat slurries, differing from each other in the Al2O3/CeO2 ratio (nominal ratio equal to ∞, 0.042, 0.087, 0.250, 0.667) were prepared, dried and calcined; the resulting powders were loaded with nickel as an active metal and the obtained catalysts were tested in MSR reaction. Five cylindrical silicon carbide (SiC) monoliths were washcoated with the prepared slurries and their mechanical resistance was evaluated through the ultrasound adherence test. The activity tests results highlighted the best performance in terms of methane conversion and hydrogen selectivity of the powder catalyst, with the Al2O3/CeO2 percentage nominal ratio equal to 0.042. A structured catalyst was finally prepared by loading a SiC monolith with the most active catalytic formulation and tested in MSR reaction. The performance of the structured catalyst was evaluated in terms of methane conversion and its stability was verified in a time-on-stream test, which allowed for the evaluation of the carbon formation rate; furthermore, its activity was characterized by the estimation of the kinetic parameters. The results highlighted the beneficial effect of ceria addition on the catalytic activity; moreover, compared with data of the literature, the calculated carbon formation rate demonstrated a good resistance of the catalyst to coke formation.

Celiac Dietary Adherence Test and Standardized Dietician Evaluation in Assessment of Adherence to a Gluten-Free Diet in Patients with Celiac Disease

Adherence to a gluten-free diet (GFD) is currently the mainstay of treatment strategy for celiac disease (CD). The aim of our study was measuring a GFD adherence in CD patients using two newly validated methods of dietary assessment—Standardized Dietician Evaluation (SDE) and the Celiac Dietary Adherence Test (CDAT). Ninety-two adults with CD were evaluated by a registered dietitian with extensive experience with the use of SDE and CDAT. Duodenal biopsy was performed and blood was drawn for serum anti-endomysial, anti-deamidated gliadin peptide and anti-tissue transglutaminase antibodies in forty four of those patients. The results of CDAT and SDE were very convergent, but SDE scores better correlated with serologic and histologic findings. As many as 24–52% of study participants did not adhere well enough to a GFD. Insufficient adherence to a GFD in CD patients is still a significant problem. The knowledge about gluten content in food ingredients and additives is very low among adults with CD. SDE is the most accurate method in assessing compliance with a GFD and is especially helpful in determining hidden sources of gluten. The CDAT may be a fast tool for screening for a GFD adherence in CD patients.

Análisis experimental y teórico del ensayo de adherencia capa – sustrato en un acero DIN UC1 tratado termoquímicamente por borurización

In this work, the effect of the boronizing thermochemical treatment on the adherence and surface morphology of the boride layer formed in DIN UC1 steel was evaluated. The process was carried out by packing at the temperature of 1273 K, at the times of 4800, 6000, 7200 and 14400 seconds. The HRC adherence test based on the VDI 1398 standard, was simulated in COMSOL 5.0®; analysing the effect of the thickness of the boride layer and the roughness on the Von Mises stress, in addition to the stress on the indentation footprint; in which it was observed that by increasing the thickness of the layer from 22.2 to 37.8 µm the stresses increased, and therefore the adhesion of the layer on the substrate improved, which causes only the formation of microcracks. On the other hand, in the greater layer thickness (60.04 µm) the layer delaminates. Therefore, for an industrial application of DIN UC1 steel treated thermochemically by borurization, layer thicknesses up to 37.8 µm are recommended.