Engagement of adenosine A2 receptors suppresses several leukocyte functions. In the present study, we examined the effect of adenosine on the inhibition of leukotriene B4 (LTB4) synthesis in heparinized human whole blood, pretreated with lipopolysaccharide (LPS) and tumour necrosis factor α (TNF‐α) and stimulated with the chemotactic peptide, N‐formyl‐Met‐Leu‐Phe (FMLP). The FMLP‐induced synthesis of LTB4 in whole blood pretreated with LPS and TNF‐α was dose‐dependently inhibited by adenosine analogues in the following order of potency; 5′(N‐ethyl)carbox‐ amidoadenosine (NECA) ≅ CGS 21680 > 2‐Cl‐adenosine > N6‐cyclopentyladenosine (CPA), indicating the involvement of the adenosine A2 receptor subtype. The IC50 values for NECA, CGS 21680, 2‐Cl‐ adenosine, and CPA were 6nM, 9nM, 180nM, and 990 nM, respectively. Dipyridamole, an agent that blocks the cellular uptake of adenosine by red cells and causes its accumulation in plasma, also inhibited the synthesis of LTB4 in LPS and TNF‐α‐treated whole blood stimulated by FMLP; moreover, this inhibition was reversed upon addition of adenosine deaminase. A highly selective antagonist of the adenosine A2 receptor, 8‐(3‐chlorostyryl)caffeine (CSC), reversed the inhibition of LTB4 synthesis by 2‐Cl‐adenosine and dipyridamole in LPS and TNF‐α‐treated whole blood, stimulated by FMLP. LTB4 synthesis in whole blood originates predominantly from neutrophils and to a lesser extent from monocytes. 2‐Cl‐adenosine also inhibited the synthesis of LTB4 induced by FMLP in these isolated LPS and TNF‐α‐treated cells; however, 2‐Cl‐adenosine was a more potent inhibitor of LTB4 synthesis in neutrophils than monocytes. The present data demonstrate that adenosine, acting through A2 receptors, exerts a potent inhibitory effect on the synthesis of LTB4 and thus contribute to the understanding of its anti‐inflammatory properties.
We conducted a chart review on all patients who had received home telemonitoring after an admission for heart failure at the University of Ottawa Heart Institute. During a 5 year period (2005-2009) a total of 645 patients had home monitoring. A total of 594 patients met the inclusion criteria for the study and were divided into two groups: Group 1 (<75 years of age) contained 350 patients and Group 2 (≥75 years of age) contained 244 patients. There was no significant difference between the groups in the mean duration of follow-up by the telemonitoring team: it was 126.5 days in Group 1 and 125.4 days in Group 2 (P = 0.89). There were no significant differences between the groups in the number of times that titration of diuretic medications occurred, the number of times that titration of cardiac medications occurred, the number of interventions for abnormal vital signs or the number of times that patients were called by the telemonitoring staff. Emergency room visits, hospitalizations and the number of deaths were also not different between two groups. Thus in the telemonitoring programme, the pattern of usage by older patients was similar to that of the younger ones. Based on the present study, the elderly do not require more resources nor do they require them for longer.
Background. Falls and hip fractures are an increasing health threat to older people who often never return to independent living. This study examines the management of bone health in an acute care setting following a hip fracture in patients over age 65. Methods. Retrospective chart review of all patients admitted to a tertiary health facility who suffered a recent hip fracture. Results. 420 charts of patients admitted over the course of a year (May 1, 2007–April 31, 2008) were reviewed. Thirty-seven percent of patients were supplemented with calcium on discharge, and 36% were supplemented with vitamin D on discharge. Thirty-one percent were discharged on a bisphosphonate. Conclusion. A significant care gap still exists in how osteoporosis is addressed despite guidelines on optimal management. A call to action is required by use of multifaceted approaches to bridge the gap, ensuring that fracture risk is minimized for the aging population.
BackgroundEvidence indicates that care experiences for complex HF patients could be improved by simple organizational and process changes, rather than complex clinical mechanisms. This survey identifies care gaps and recommends simple changes.MethodsThe study utilized both quantitative and qualitative methods at The Ottawa Hospital, Geriatric Medical Unit (GMU) during a three-month period.ResultsNineteen patients (average age 85, 12 female) surveyed. Twelve participants lived alone. Fourteen lived in own home. Four patients had formal home-care services. Fifteen relied on family. Gaps were identified in in-patient practice, discharge plan, and discharge summary implementation feedback. Only five participants had seen a cardiologist or a specialist. Half of the patients did not know if they were on a special Heart-Failure (HF) diet. Participants did not recall receiving information on life expectancy but were comfortable discussing EoL care and dying. HF-specific management recommendations were mentioned in only 37% of discharge summaries to primary care providers (PCPs).ConclusionThe results provide the starting point for a quality assurance and process re-engineering program in GMU. Organization change is needed to develop and integrate a cardiogeriatric clinical framework to allow the cardiologist, geriatrician, and PCP to actively work as a team with the patient/caregiver to develop the optimal care plan pre- and post-discharge.
Background: Population ageing is happening fast in low and middle income countries, and the number of people with dementia is increasing, which is an important cause of daily activity limitations, needs of care, aside from generate high socioeconomic costs. This study aims to estimate the contribution of dementia to disability and dependence in older Mexicans. Methods: Cohort study of 1753 participants aged 65 and over, with a median follow up of 3.03 years. Socio demographic characteristics were evaluated at baseline, as well self-reported health problems (hypertension; diabetes; stroke; arthritis; and eye, hearing, and stomach problems). Severe disability and dependence were ascertained at baseline and at follow up. We used a competingrisks regression model to estimate the effects of dementia on disability and dependence, adjusted by age, sex, marital status, level of education, income and number of assets. We also estimated the population-attributable risk (PAR) of dementia for disability and dependence. Results: People with dementia at baseline were more likely to have severe disabilty at follow-up (adj RR 2.86 (95% CI: 1.83-4.49), and these associations were even higher for dependence ) at follow-up. Around 4.2% (95% CI: 3.1-5.2) of cases of severe disability, and 5% (95% CI: 4.8%-5.1) of dependence could be avoided if cases of dementia could be treated or prevented. Conclusions: Public health interventions for reducing dementia incidence also have important benefits reducing incidence of disability and dependence among older adults.
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