ABSTRACT
OBJECTIVES: To perform a list agreed by Argentinean experts and adapted to the local context containing potentially inappropriate (PI) medications in old people (OP) usingthe Delphi consensus technique optimized for this subject. METHODS: A preliminary list of potentially inappropriate medications (PIM) was drawn up based on foreign PIM lists and a selective search in the scientific literature. The iterative Delphi process was used to submit the active pharmaceutical ingredients (APIs) of the preliminary PIM list to the panel of Argentinean experts. The analysis of theanswers to determine the arrival to the consensus was carried out applying three criteria specially defined for this purpose. RESULTS: After two Delphi rounds, it was not reached agreement about 12 APIs. The List of explicit criteria for PIAPIs for use in OP (IFAsPIAM List) was finally constituted by 128 APIs corresponding to 9 groups of the ATC classification system to which they were organized. In addition to each API, information justifying the unfavorable benefit/risk profile and therapeutic alternatives or recommendations/precautions was recorded. The group with the most PI APIs was N (NervousSystem) (60; 47%) followed by groups C (Cardiovascular) and M (Musculoskeletal). CONCLUSION: This study presents the first Latin American list of PIM in OP developed using an expert consensus technique. The IFAs PIAM List would contribute to the rational use of drugs in elderly population, constituting a valuable tool in Argentinean public health.
Subject(s)
Delphi Technique , Inappropriate Prescribing/prevention & control , Potentially Inappropriate Medication List/statistics & numerical data , Aged , Argentina , Consensus , Humans , Practice Patterns, Physicians' , Risk AssessmentABSTRACT
Kappa-casein (kappa-CN) is a milk phospho-glycoprotein that plays an important role in the electrostatic and steric stabilization of casein micelles suspensions. kappa-CN characteristics such as its aminoacidic composition and its high denaturalization temperature make this protein an excellent nutrient. The enzymatic destabilization of kappa-CN is the basis of cheese and yoghurt manufacture. In this paper, modifications on the kappa-CN aggregation process by hydrolysis with chymosin derived from the initial protein state and the presence of sucrose and lactose were studied. Our study shows that, during its self-association, kappa-CN opens its conformation by raising the exposition of hydrophobic regions to the medium. Hence, the initial polymerization or association state of kappa-CN affects on the aggregation stage after the enzymatic action of chymosin. The inhibition of aggregation when the protein was previously associated suggests that the region which participates in the aggregation of p-kappa-CN particles, would be the one involved in the self-association during the heating of kappa-CN samples. Sucrose and lactose also affect the aggregation of proteolized particles of kappa-CN. Furthermore, the nature and the concentration of the added sugars had significant influence on the protein aggregation process.
