Guido R. Zanni

Telomeres: unlocking the mystery of cell division and aging.

Telomeres are DNA sequences that cap the ends of chromosomes, protecting them from fraying and fusing together during replication. During replication, telomeres lose some of their genetic material but are repaired by the ribonucleoprotein telomerase. Both telomeres and telomerase are linked to cell senescence and apoptosis, and research suggests they play key roles in aging, cancer, hereditary syndromes, and chronic diseases. Several theories of aging are reviewed along with the potential impact of telomerase in developing new treatments.

Medical apps worth having.

Medical applications (apps) for smart phones have grown in popularity, with minimal oversight by regulatory agencies. A few Web-based resources exist that evaluate apps using peer review or certification standards. Eight clinical apps are presented along with brief explanations of each. Many users believe apps improve patient care and clinical decision-making, but until additional research is conducted, these assertions remain untested assumptions.

Psoriasis: issues far more serious than cosmetic.

Psoriasis-the most prevalent autoimmune disease in the United States-is a chronic, relapsing disease with variable clinical features and triggers that are both genetic and environmental. Psoriasis is an independent risk factor for mortality and is linked to numerous comorbidities, including cardiovascular disease, clinical depression, diabetes, cancer, Crohns disease, hypertension, obesity, metabolic syndrome, liver disease, infections, dyslipidemia, and osteoporosis. While there is no cure, topical medications, phototherapy, traditional systemic agents, and biologics offer a wide array of options for management of symptoms. A combination of agents is frequently needed for moderate-to-severe cases, and positive long-term outcomes require medication adherence. Significant knowledge gaps exist on disease onset and progression along with a lack of comparative-effectiveness research on treatment regimens.

Telemedicine: sorting out the benefits and obstacles.

Telemedicine (TM)-providing health services and information via a telecommunications device to patients or colleagues separated by distance-holds the promise of improving access to care, diagnosis and assessment, patient monitoring, treatment adherence, and positive health outcomes. TM is still evolving, and numerous obstacles must be overcome before it reaches its full potential. Major obstacles include licensure and reimbursement issues along with the development of TM care standards. While many studies have addressed TMs effectiveness, findings, although positive, are tempered because of small sample size and other methodological problems. Successful TM is clinically driven where a need is first identified and then a TM solution fulfills that clinical need.

Patients Large and Small: Role of the Pharmacist in Veterinary Medicine

Courtney is a guardian in a group home. If you ask, she (and many others in the same situation) would insist her home’s residents are family. Today, Preston, who is 4, has diarrhea. She calls the clinic, and pleads, “I know it’s Friday evening, but Preston has had diarrhea all afternoon. Can I bring him?” The office manager agrees readily, suggesting she bring a stool sample. When Courtney and Preston arrive, everyone greets him by name or with a friendly pat. The doctor sees Preston quickly, and tells Courtney to keep him on clear fluids for the night. He also calculates an appropriate dose of Pepto-Bismol, and they head for home. Saturday morning, the clinic doctor calls to report that he’s called in a prescription for an antibiotic. As always, Courtney is very pleased with her encounter. This doctor cares for almost everyone in the household. Ginger, who has some age-related dementia, joined the family 2 years ago. She’s done well recently on a new drug. Allie, a 2-year-old insulin-dependent diabetic, is scheduled next week for dental hygiene and a simultaneous umbilical repair. This full-service clinic offers preventive and ongoing care, emergency service, imaging…. Courtney herself would trust this doctor with her life. Courtney thinks it’s species discrimination that she can’t be seen there; Preston is a Heinz 57 mutt, Ginger is a golden retriever, and Allie is a gray tiger-striped cat. Courtney’s good experience ends at the pharmacy. When she picks up Preston’s prescription and asks for counseling, the pharmacist is dumbfounded. Is this an appropriate dose? Can it be mixed with food? What adverse effects should they watch for?

Thermal burns and scalds: clinical complications in the elderly.

Burns are categorized as superficial, superficial partial thickness, deep partial thickness, and full thickness. Superficial burns heal spontaneously; more serious burns require treatment. Elders are disproportionately affected, and advanced age is associated with poorer outcomes, partially because of thin skin and preexisting conditions. Clinical complications are common in elderly burn victims. Treatments two stages, acute care and follow-up care, are discussed. Severe burns can result in significant scarring and painful contractures, and victims are at increased risk for depression and related psychiatric problems. The majority of elders suffering from severe burns are transferred to long-term care and rehabilitation facilities for follow-up care. Most burns are preventable, and burns occurring in long-term care facilities require investigation.

Treating obesity in older adults: different risks, different goals, different strategies.

Almost 70% of adults 60 years of age and older are overweight according to the National Health and Nutrition Examination Survey 2005-2006. While being overweight is linked to numerous comorbidities and functional impairment, few studies have addressed obesity in elders, and even fewer have addressed sarcopenic obesity. Elder obesity requires different strategies, partly because most approved weight-reduction agents and/or surgical interventions are contraindicated in older adults. Strategies and objectives for weight loss are discussed along with the consultant pharmacists role.

Low back pain: eliminating myths and elucidating realities.

Most people have experienced the aches and inconvenience of low back pain. Although the causes can be hard to pin down, treatment can be very simple.

Autopsy: Coaxing Secrets From the Dead: Every drug is a poison; every poison, a drug.

The word “autopsy” was derived from the Greek autopsia, meaning “to see with ones eyes.” Throughout most of history, autopsy findings were limited to what could be deduced from the evidence available to the naked eye. Today, x-ray and medical technology augment the pathologists eyes, allowing more than just visual examination of bodies. Autopsy is the gold standard for ascertaining cause of death in American medicine, serving to confirm pathology, clinical diagnoses, and the appropriateness of pre-death treatments. Autopsy findings wind their way to practicing pharmacists via circuitous routes. Researchers and toxicologists use autopsy findings to monitor how drugs really work over the short and long terms. Regulators and legislators connect autopsy findings with police reports, medication error reports, and case reports to develop new labeling or implement stricter laws. Medical chemists use the same findings to seek new and better drugs. Language: en

Locating useful patient brochures and handouts.

Educational handouts are becoming routine in health care, helping promote health literacy in patients and their caregivers. To be effective, handouts must be tailored to various target audiences. This article discusses several Web sites that provide accurate information for conditions commonly seen in long-term care.