The aim of our study was to compare serum levels and protein tissue of human epidermal growth factor receptor–2 proto-oncogene (HER2) and mucin 1 (MUC1) using an antigen-capture enzyme-linked immunosorbent assay and immunohistochemistry (IHC) in canine mammary carcinomas and investigate how the 2 markers correlate with dogs with metastasis and without metastasis to a regional lymph node. Forty-eight female dogs were selected, including 14 with non-metastatic cancer, 14 with lymph node metastasis, and 20 healthy animals. Serum samples were collected from all the animals and tissues from 28 dogs with malignant mammary tumor with or without metastasis for evaluated HER2 and MUC1 expression. Tissue sample were evaluated for MUC1 and HER2 immunoexpression by IHC. The results showed measurable serum levels of MUC1 and HER2 in all groups. While serum MUC1 levels were significantly higher in animals with metastasis than the other 2 groups, no increase was observed in HER2 serum levels. The MUC1 IHC results showed that only membrane immunostaining was significantly different between the groups. Statistically, there was an association between immunostaining and the serum HER2 levels. Our results indicate that serum concentrations of HER2 and the IHC staining pattern for HER2 in primary tumor do not correlate with the presence of regional metastasis. However, increased concentrations of MUC1 in the serum of dogs with mammary cancer are associated with the presence of metastasis to regional lymph nodes. A membrane pattern of IHC staining for MUC1 in the primary tumor suggests that metastases to regional lymph node are present.

Objective To analyze the frequency of use of potentially inappropriate medication prescribed to elderly at hospital discharge from a public hospital, considering the Brazilian Consensus on Potentially Inappropriate Medication for Elderly, and to identify the associated factors.Methods Patients aged ≥60 years, admitted in clinical and geriatric units of a public hospital were invited to participate in the study. The information about the use of medicines was collected from the patient’s electronic record and through telephone contact. The Brazilian Consensus on Potentially Inappropriate Medication for Elderly was used to classify the medication, regardless of the clinical condition.Results A total of 255 elders were included in this study. The frequency of use of potentially inappropriate medication by elderly was 58.4%. The potentially inappropriate medication use in elderly was positively associated with the presence of depression (odds ratio of 2.208) and polypharmacy (odds ratio of 2.495). The hospitalization in a geriatric unit showed an inverse association with the potentially inappropriate medication use in elderly (odds ratio of 0.513).Conclusion The frequency of potentially inappropriate medication prescription to elderly upon hospital discharge was high. The presence of depression and polypharmacy were directly associated with use of potentially inappropriate medication in the elderly. Admission to the geriatric clinic has become a protection factor for the use of potentially inappropriate medication in elderly. Strategies to improve the elderly pharmacotherapy should implemented aiming at healthcare quality and safety in the transition of care.

The number of older adults in the world is expanding rapidly as a consequence of increased quality of life and technological advances. 1,2 This demographic transition is increasing the prevalence of chronic-degenerative diseases. One of the consequences is higher consumption of medicines, which implies a great challenge for the healthcare system. 3 Given that use of several drugs is needed to treat the multimorbidity commonly seen in older adults, it can be expected that the prevalence of polypharmacy among older adults and the risk of drug interactions will increase substantially. 4 Drug interactions are a common cause of adverse drug reactions among older adults, and these include arrhythmias, acute kidney injury and increased risk of falls. 5-7 A direct correlation between the number of medications and their interactions and the risk of adverse drug reactions has been shown. 4-7 The reasons for this are multifactorial and particularly include age-related changes in the pharmacodynamics and pharmacokinetics of drugs, reduced renal function and lower hepatic clearance. 6-8 At hospital discharge, older adults generally present changes to their drug therapy, with higher numbers of prescribed medications, which leads to higher frequency of drug interactions. 8 Thus, it is essential to know the frequency of these interactions at hospital discharge among older people and their determinants, in order to promote safer use of drugs among older adults.

Older adults have difficulty monitoring their drug therapy in the first thirty days following hospital discharge. This transition care period may trigger hospital readmissions. The study aims to identify the factors associated with the readmission of older adults 30 days after discharge from the perspective of drug therapy. This is a cross-sectional study and hospital admission within 30 days was defined as readmission to any hospital 30 days after discharge. The complexity of the drug therapy was established by the Medication Regimen Complexity Index (MRCI).. Readmission risks were predicted by the "Readmission Risk Score -RRS". The multivariate logistic regression was used to identify factors associated with readmission within 30 days after discharge. Two hundred fifty-five older adults were included in the study, of which 32 (12.5%) had non-elective hospital readmission. A higher number of readmissions was observed with increased RRS value, suggesting a linear gradient effect. The variables included in the final logistic regression model were the diagnosis of cancer (OR=2.9, p=0.031), pneumonia (OR=2.3, p=0.055), and High MRCI (> 16.5) following discharge (OR=1.9, p=0.119). The cancer diagnosis is positively associated with hospital readmissions of older adults within 30 days.

Objective To analyze, from the pharmacotherapy perspective, the factors associated to visits of older adults to the emergency department within 30 days after discharge.Methods A cross-sectional study carried out in a general public hospital with older adults. Emergency department visit was defined as the stay of the older adult in this service for up to 24 hours. The complexity of drug therapy was determined using the Medication Regimen Complexity Index. Potentially inappropriate drugs for use in older adults were classified according to the American Geriatric Society/Beers criteria of 2015. The outcome investigated was the frequency of visits to the emergency department within 30 days of discharge. Multivariate logistic regression was performed to identify the factors associated with the emergency department visit.Results A total of 255 elderly in the study, and 67 (26.3%) visited emergency department within 30 days of discharge. Polypharmacy and potentially inappropriate medications for older adults did not present a statistically significant association. The diagnosis of heart failure and Medication Regimen Complexity Index >16.5 were positively associated with emergency department visits (OR=2.3; 95%CI: 1.04-4.94; p=0.048; and OR=2.1; 95%CI: 1.11-4.02; p=0.011), respectively. Furthermore, the diagnosis of diabetes mellitus and chronic kidney disease were protection factors for the outcome (OR=0.4; 95%CI: 0.20-0.73; p=0.004; and OR=0.3; 95%CI: 0.13-0.86; p=0.023).Conclusion The diagnosis of heart failure and Medication Regimen Complexity Index >16.5 were positively associated with the occurrence of an emergency department visit within 30 days of discharge.

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