Elderly patients with multimorbidity in the home setting: umbrella review on therapeutic non-adherence causes.

OBJECTIVE: The elderly population is the most at risk regarding adherence, especially in the coexistence of multiple diseases. This study aims to detect factors contributing to therapeutic non-adherence in elderly patients in home settings. MATERIALS AND METHODS: A review protocol was developed to conduct the umbrella review using the methodological framework of the Richardson et al study. The search strategy was developed in December 2022 to conduct a systematic search and to perform an Umbrella Review of systematic reviews, meta-analyses and integrative reviews published from 2012 to 2022 in English. RESULTS: A total of 26,038 articles were identified and screened. 18 relevant articles were included in the study. CONCLUSIONS: Therapeutic adherence in elderly patients with comorbidities in polypharmacotherapy at home is a significant problem in public health and health care. Several factors of non-adherence have been identified in the studies reviewed, confirming that the problem is multifactorial. Reducing the number of medications prescribed would appear optimal, although often not possible, as this has been seen to have an immediate positive impact. A multidisciplinary approach makes it possible not to fragment care, ensuring positive feedback on therapeutic adherence.

Comparison across 12 countries on knowledge, attitude, and behavior scores about medication errors in Intensive Care Units: an international study.

OBJECTIVE: The aim of the study was to explore the degree of agreement of intensive care unit nurses working on a set of medication error preventive strategies and to examine possible predictors of nurses' knowledge, attitude and behavior. MATERIALS AND METHODS: Observational, international, and cross-sectional study. Iran, Malta, Spain, Pakistan, Nepal, Qatar, Ecuador, Australia, Finland, Italy, Egypt, and Jordan were the countries included in this survey. To collect data, the Knowledge, Attitude and Behavior in Medication Errors questionnaire was used. A descriptive statistical analysis was performed for the socio-demographic characteristics of the sample and three multiple logistic regressions were performed. RESULTS: The international sample consists of 1383 nurses, of whom 478 (34.6%) were men and 900 (65.1%) were women and their mean age was 35.61 years with a range of 19-61. Descriptive statistics conducted on the international sample show a medium to high degree of agreement among participants concerning some preventive strategies of medication error. In addition, the results of the present study show a strong relationship between positive nurses' attitudes and correct behaviors and/or adequate knowledge, as well as between adequate knowledge and correct behaviors (p< 0.01). CONCLUSIONS: Further studies are needed to explore the issue of medication error concerning nurses' cultural backgrounds, as well as to assess similarities and disparities among international nurses.

Histochemical characterization of the mucins of the alimentary tract of the grass snake, Natrix natrix (Colubridae).

Characterization of mucins in the alimentary tract of the grass snake, Natrix natrix was performed by histochemical (PAS, Alcian Blue, pH 2.5 and pH 1.0, sialidase-Alcian Blue, pH 2.5, HID-AB pH 2.5) and lectin-histochemical (WGA, SWGA, PNA, sialidase-PNA, SBA, sialidase-SBA, DBA, sialidase-DBA, ConA, BSI-B4, AAA, UEA-1, LTA) techniques. Oesophageal lining epithelium consisted of ciliated and goblet cells, with no pluricellular glands. Mannosylated sialosulfomucins were observed. Fundic mucosa of stomach presented surface cells producing sialomucins with terminal sialic acid linked to galactose. In gastric glands neck and oxynticopeptic cells were found. Neck cells had sialomucins with mannose, N-acetylglucosamine, galactose, N-acetylgalactosamine and fucose-α-(1,2)-linked residues. Cytoplasm of oxynticopeptic cells showed N-acetylgalactosamine and fucose residues. Secretion of surface cells in pyloric mucosa was similar to that of fundic ones, differing in having fucose. Goblet cells in the small intestine of N. natrix produced sulfo- and sialomucins, with sialic acid linked to galactose and N-acetylgalactosamine residues. Mucins also presented residues of mannose. Goblet cells in the large intestine presented sulfomucins only, with terminal N-acetylgalactosamine, galactose and N-acetylglucosamine. The glycosylation patterns found are probably related to protection against injuries, gastric juice and microorganisms, both pathogenic and decomposers, as well as to dietary adaptations.

An innovative methodology for the automated morphometric and quantitative estimation of liver steatosis.

The management of liver steatosis, due to its potential evolution towards severe diseases, requires accurate diagnosis. Fatty infiltration in liver diseases is commonly assessed histologically by semi-quantitative methods, which can be subjective. Automated computerized procedures using commercial software for image analysis have also been recently employed. The aim of the study was to develop an innovative automated computerized procedure to accurately evaluate both the morphometry and degree of lipid accumulation in liver. Fatty infiltration was assessed in paraffin- and resin-embedded samples of steatotic livers from rats undergoing 0, 3, 7, 14, and 30-day choline-deficient diet, and from liver biopsy of a morbidly obese patient undergoing bariatric surgery. Specific software was developed, which works with a morphological operator, in addition to a chromatic one to select lipid droplets. The choline-deficient diet induced steatosis with a gradual shift from micro- to macro-vesicular. In paraffin sections, the macrovesicles-to-microvesicles ratio and the degree of steatosis, when using only the chromatic operator, produced overestimates. Results were consistent in both rat and human samples. An improvement of topographic, morphometric and quantitative estimation of fatty liver infiltration is obtained with our software, working with a morphological operator and using semi-thin sections from resin-embedded samples. This innovative procedure may be applied to human liver samples, offering promising diagnostic and prognostic perspectives.

Mucin histochemistry of the digestive tract of the red-legged frog Rana aurora aurora.

Mucous cells from the digestive tract of the red-legged frog, Rana aurora aurora, were examined by standard histochemical methods and by lectin histochemistry. Two different goblet cell types were found in the oesophageal epithelium. Type I cells produced acidic glycoproteins with beta1,4GlcNAc oligomers, Gal beta1,3GalNAc sequences, sulphated esters on internal residues and abundant non-O-acylated terminal sialic acid bound to penultimate GalNAc. These cells also reacted with Con-A after periodate oxidation-borohydride reduction (PCS). Type II goblet cells mainly differed from type I cells in their negative reaction with PCS. Oesophageal glands consisted of mucous and serous cells. Mucous cells produced neutral stable class III mucosubstances with GalNAc, beta1,4GlcNAc and Gal beta1,3GalNAc residues. Gastric surface cells produced sulpho-sialoglycoproteins with Gal beta1,3GalNAc residues and Gal beta1,3GalNAc-sialic acid as terminal sequences. These cells did not contain stable class III mucosubstances. The mucus produced by foveolar cells was similar in composition but did not contain sulphated groups and was rich in GalNAc residues. The fundic glands consisted of mucous neck cells, endocrine cells and oxyntic cells. The neck cells produced neutral mucins containing D-mannose and/or D-glucose, beta1,4GlcNAc oligomers and Gal beta1,3GalNAc terminal dimers and were PCS-positive. Pyloric glands were of the mucus-secreting type, which produced glycoproteins with the same basic features as those produced in fundic neck cells. A single type of intestinal goblet cells produced acidic glycoproteins rich in beta1,4GlcNAc oligomers, sulphated esters on oligosaccharide chains and terminal O-acylated sialic acid bound to penultimate Gal beta1,3GalNAc. The different carbohydrate structures observed along the digestive tract of the frog may reflect specific functions of the mucus.

Lectin histochemistry and ultrastructure of microgranular cells in Cinachyra tarentina (Porifera, Demospongiae).

A histochemical study is described that characterizes microgranular cells of the demosponge Cinachyra tarentina (C. tarentina) with the use of routine staining methods for mucosubstances, lectin histochemistry and electron microscopy. Microgranular cells are rare or absent in other species of sponges, but abundant in this species. Microgranular cells are present in both ectosome and mesohyl, particularly along the canal of the aquiferous system and around spicule holes. Inclusions of microgranular cells and the extracellular matrix were particularly positive for acidic glycoproteins with abundant sulfated ester groups and glycosidic residues containing GalNAc and Galbeta1,3GalNAc. Terminal L-fucose bound to the penultimate GalNAc residues and/or difucosylated oligosaccharides were present as well. Our results suggest that soybean lectin (SBA), peanut lectin (PNA), and winged pea lectin (WPA) are valuable markers for identifying microgranular cells of C. tarentina. Electron microscopy revealed some of the microgranular cells to contain small smooth cytoplasmic vesicles originating from the Golgi complex and few electron-dense granules, others were characterized by numerous secretory granules and vacuoles formed by vesicle fusion and connected with the plasma membrane. Our results suggest that microgranular cells in C. tarentina contribute to the synthesis of glycoprotein components of the extracellular matrix.

Fine structure of the oxynticopeptic cells in the gastric glands of the ruin lizard, Podarcis sicula campestris De Betta, 1857.

The results of an ultrastructural investigation of the gastric glands of the ruin lizard are reported. In this reptile the stomach can be divided into a larger fundus and a smaller pars pilorica. Fundic glands are characterized by three main kinds of cells: mucous, endocrine, and oxynticopeptic; the latter were not observed in the pyloric glands. The morphological features of the oxynticopeptic cells change from the proximal to the distal region of the fundic mucosa. In the proximal region, numerous electron-dense secretory granules, a well-developed granular endoplasmic reticulum, an evident Golgi complex, and a reduced system of smooth-surfaced vesicles and tubules in the apical cytoplasm characterize these cells. In the distal fundic region, oxynticopeptic cells possessed numerous mitochondria and a well-developed smooth-surfaced endoplasmic reticulum, but secretory granules were rare. These data suggest the existence of a gradient in the production of proteolytic enzymes, and perhaps also of hydrochloric acid, along the oral-aboral axis of the stomach. The results are discussed with regard to the evolution of the gastric glands and of the digestive mechanism in vertebrates.

Morphological and histochemical variations of mucous and oxynticopeptic cells in the stomach of the seps, Chalcides chalcides.

Mucous and oxynticopeptic cells in the gastric mucosa of the seps, Chalcides chalcides (Linnaeus, 1758) were examined by standard histochemical staining methods and by lectin histochemistry. The epithelial mucous cells lining the surface of the stomach and the mucous cells of the fundic glands elaborated mainly neutral glycoproteins with beta(1,4)GlcNAc oligomers, GalNAc glycosidic residues and Gal beta1,3GalNAc terminal sequences. The mucous cells of the fundic glands were stained specifically with the Paradoxical Con A method. The mucosecreting cells of the pyloric glands produced neutral glycoproteins, with beta(1,4)GlcNAc oligomers, GalNAc residues and Gal beta1,3GalNAc terminal sequences. Terminal L-fucose bound to the penultimate GlcNAc residues, and/or difucosylated oligosaccharides were also present. The pyloric glands did not stain with the Paradoxical Con A procedure. The morphology of the oxynticopeptic cells changes from the oral to the aboral region of the fundic mucosa. In the oral fundic tract the oxynticopeptic cells showed cytoplasm filled with zymogen granules, while in the aboral fundic region these cells contained few zymogen granules and showed cytoplasm full of empty vesicles, typical of the acid secreting cells. A secretion gradient of proteolytic enzymes and hydrochloric acid along the fundic mucosa of the seps can be hypothesised.

Ultrastructural identification of somatostatin-immunoreactive cells in the pyloric glands of the ruin lizard (Podarcis sicula campestris De Betta) by immunogold staining.

The pyloric glands of a reptile, the ruin lizard (Podarcis sicula campestris De Betta), have been examined by immunocytochemistry and by transmission electron microscopy. There are four main ultrastructural types of enteroendocrine cells whose secretory granules showed similarities to mammalian EC cells (type I), D1 or ECL cells (type II), G cells (type III), and D cells (type IV). Immunogold staining identified and characterized the type IV cells as the somatostatin-storing cells. They were of the open type, with round or ovoid immunoreactive granules of varying electron density.

Immunohistochemical investigations on the pyloric glands of the ruin lizard (Podarcis sicula campestris de Betta).

Mucous cells and enteroendocrine cells of the pyloric region of the ruin lizard (Podarcis sicula campestris De Betta) have been examined by lectin histochemical and immunohistochemical methods. Binding to five plant lectins (Canavalia ensiformis, Con A; Triticum vulgare, wheat germ, WGL; Lotus tetragonolobus, winged pea, WPL; Glycine max, soybean, SBL; Arachis hypogaea, peanut, PNL) was performed to characterize glycoconjugates in the secretory products of superficial and glandular mucous cells. Lectin histochemistry revealed the presence of N-acetyl-D-galactosamine, D-galactose and N-acetyl-D-glucosamine in the pyloric superficial cells. Mucous glandular cells mainly contained neutral glycoproteins with terminal residues of galactose, N-acetyl-D-glucosamine and N-acetyl-D-galactosamine. These cells did not react with Con A after periodate oxidation-sodium borohydride reduction (Paradoxical Con A staining). In the pyloric glands three different types of endocrine cells were identified immunohistochemically: gastrin-, serotonin- and somatostatin-immunoreactive cells; VIP-, bombesin- or cholecystokinin-immunoreactive cells have not been found in the pyloric mucosa.

Characterization of secretory cell glycoconjugates in the alimentary tract of the ruin lizard (Podarcis sicula campestris De Betta) by means of lectin histochemistry.

Secretory cell glycoconjugates of the alimentary canal of the ruin lizard (Podarcis sicula campestris De Betta) were characterized by traditional staining methods and by lectin histochemistry. The goblet cells of the upper esophagus produced sialo- and sulfomucins, while those of the lower esophagus mainly contained sulfomucins. Lectin histochemistry demonstrated the presence of N-acetyl-D-glucosamine and terminal sialic acid. The epithelial mucous cells lining the surface of the stomach and the gastric pits contained neutral glycoproteins with glycosidic residues of N-acetyl-D-galactosamine, D-glucose, D-mannose, D-galactose, and N-acetyl-D-glucosamine. The mucous cells of the gastric glands produced neutral glycoproteins that contained stable class-III mucosubstances, as revealed by Paradoxical Con A staining, with terminal residues of L-fucose and D-galactose. They can be similar to the true neck cells of the gastric pits of other vertebrates. The goblet cells of the small intestine produced acidic glycoproteins with glycosidic residues of N-acetyl-D-glucosamine, sulfated esters on internal residues and terminal sialic acid. In the large intestine, there is a predominance of sulfated mucosubstances with D-galactose, N-acetyl-D-glucosamine, and N-acetyl-D-galactosamine. The microheterogeneity of mucins of the digestive tract, as proved by lectin histochemistry, is probably connected to their different functions.

Lectin histochemistry of secretory cell glycoconjugates in the nasal mucosa of Podarcis sicula campestris De Betta (Reptilia, Lacertidae).

Histochemical study by traditional staining methods (AB, PAS, HID) and by the use of five peroxidase-labelled lectins (ConA, WGL, WPL, SBL, PNL) were carried out to characterize glycoconjugates in the secretory cells of the nasal mucosa of the Lacertid lizard Podarcis sicula campestris De Betta. The mucus covering the nasal epithelium is produced by the supporting cells and the Bowman glands in the olfactory area, and by typical goblet cells and, probably, a second type of secretory cell, in the non-sensory area. Neutral glycoconjugates containing N-acetyl-D-glucosamine and terminal N-acetyl-D-galactosamine, D-mannose and D-glucose residues were present in the secretory product of the Bowman glands. L-fucose and D-galactose were absent. In the supporting cells the secretory product consisted mainly of sulfated glycoproteins containing D-galactose, N-acetyl-D-galactosamine, N-acetyl-D-glucosamine, D-mannose, D-glucose, but not L-fucose. Glycoconjugates containing terminal sialic acid and penultimate D-galactose were present in typical goblet cells as was N-acetyl-D-glucosamine.