Angiotensin I-converting enzyme (ACE) plays a pivotal role in whole body fluid balance and the degradation of bradykinin. A common allelic variant with a 287 base pair insert has been identified on the ACE gene. The homozygous insertion genotype (II) corresponds with lower basal serum ACE concentrations compared to the heterozygous (WI) and homozygous wild type genotypes (WW). Higher circulating levels of ACE may decrease vasodilation; affecting blood flow and sweat loss during exercise. A genotype-independent rise in ACE activity following 20 min of exercise has been reported, but the response to prolonged exercise is unknown. The aim was to examine the influence of ACE genotype on the serum ACE response to exercise in the heat. Healthy Caucasian males (n=45, 18–45 y) completed 60 min of cycle exercise at (mean ± SD) 62 ± 5% VO2max in 30.5 ± 0.3°C, with fluid ad libitum. Fluid intake and sweat loss were recorded. Venous blood samples were drawn pre, mid, and postexercise for the determination of serum ACE concentration and ACE genotype. Basal serum ACE concentrations were dependent on ACE genotype (WW: 215 ± 57 ng.ml-1; WI: 158 ± 28 ng.ml-1; II: 106 ± 29 ng.ml-1, P<0.001). Serum ACE concentrations increased at 30 min of exercise to 231 ± 55 ng.ml-1, 166 ± 29 ng.ml-1 and 115 ± 30 ng.ml-1 for WW, WI and II, respectively (P<0.001), and remained elevated post exercise. Serum ACE response was not influenced by ACE genotype (P= 0.321). No differences were found for mean fluid intake (WW: 613 ± 388 ml; WI: 753 ± 385 ml; II: 862 ± 421 ml, P= 0.31), or sweat loss (WW: 1013 ± 257 ml; WI: 1048 ± 254 ml; II: 1257 ± 675 ml, P= 0.28). Serum ACE concentration increased independently of ACE genotype within 30 min exercise at 30.5°C. Coupled with the lack of genotype effect on sweat loss and fluid intake, these results suggest ACE genotype plays little role in fluid balance during exercise.
Background Generic Prescribing is an essential component of prescribing, however it is often overlooked. Use of brand names can led to poor recognition of the correct medications. It can also led to medication error. It is part of the policy of our hospital group that generic prescribing is used at all times. We performed a similar audit in 2018 and 79% of drug kardexes had brand names used. Prescribing education is an integral part of NCHD teaching. We wished to re-audit to determine rates of generic prescribing now. Methods We reviewed all drug kardexes in 14 wards both medical and surgical in a 48 hour period. Each drug was reviewed and if any prescription had brand names, the entire kardex was deemed non-compliant. Results 285 Drug kardexes were assessed across 14 separate wards. 41% were on surgical wards, 59% were on medical wards. 31 (11%) of kardexes had complete generic prescribing. Only 3 kardexes on the surgical ward had complete generic prescribing. Conclusion The low rates of generic prescribing remain an issue in our university teaching hospital. A similar audit was performed in 2018 with average rates of 20% of generic prescribing. This has decreased in the last year. The failure to generic prescribe puts patients at risk of medication error and also increases cost to the HSE. Education on prescribing is part of the NCHD induction, however, 9 months on there continues to be issues with compliance with generic prescribing. Education alone is not enough to improve current practice. The use of e prescribing offers the potential to alleviate this problem.
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