[Implementation of a territorial hospital pharmacy (PUI) ensuring a robotized nominative dispensation of treatments for two external sites: A dependent old people's home (EHPAD) and a follow-up care institution (SSR)]. / Carnet de bord pour la mise en place d'une PUI territoriale assurant une dispensation nominative robotisée des traitements pour deux sites extérieurs : Un EHPAD et un SSR.

The territorial hospital pharmacy (PUI) of the West of Paris, dispenses treatments for a follow-up care instituion (SSR) and a dependent old people's home (EHPAD) via a hospital pharmacy equipped with an automatic machine producing dry oral forms packaged in labeled pillboxes. This project was completed with the support of the Regional Health Agency (ARS) and aims to secure the medication circuit. The methodology for qualifying the computer system and production, the implementation of the medication circuit and the inter-site logistical organization are presented. The prescription software was interfaced with the management software, which is itself interfaced with the robot's, and with the automatic machine's software. Tests and developments allowed to convert dispensing units into prescription units over a period of time. Also, the drugs consumed by these two institutions allowed to establish the therapeutic booklet and drug provision as well as anticipating the automaton filling. Medical devices, solutions and narcotics are exclusively managed as supplies with a specific circuit. Treatments are dispensed weekly (pillboxes and off-robot). For the SSR, an additional daily production concerns the entries of new patients and the modifications of treatment. Automation saves time and security, but human intervention is involved on a daily basis. The institutions have adopted the new organization over about 6 months and the production activity is now smoothed out. In the next few weeks, two other EHPADs with 100 patients will be integrated into the PUI territorial. One of the main challenges is to integrate them into our pre-existing organization, while maintaining their habits.

Oxford-AstraZeneca COVID-19 vaccine: need of a reasoned and effective vaccine campaign.

OBJECTIVES: A strong COVID-19 vaccine campaign is needed to reach the herd immunity and reduce this pandemic infection. STUDY DESIGN: In the Foch Hospital, France, in February 2021, 451 healthcare workers were vaccinated by a first dose of AstraZeneca vaccine. METHODS: Adverse effects were reported to our pharmaco-vigilance circuit, by an online and anonymous questionnaire following the first weeks of the vaccinal campaign to healthcare workers. RESULTS: Two hundred seventy-four (60.8%) of them reported multiple adverse effects. Main adverse effects reported were feverish state/chills (65.7%), fatigue/physical discomfort (62.4%), arthralgia/muscle pain (61.0%) and fever (44.5%). CONCLUSIONS: On March 2021 many European countries suspended AstraZeneca vaccine for one week due to safety uncertainty. Thus, confidence in its efficacy is undermined. However, the benefit/risk balance is clearly in favor of vaccination.

Bismuth subsalicylate nanoparticles with anaerobic antibacterial activity for dental applications.

In recent years, nanomaterials have been used in the medical-dental field as new alternative antimicrobial agents. Bismuth subsalicylate (BSS) has been used as an antimicrobial agent, but the effect of BSS in the form of nanoparticles (BSS-nano) as a potential antimicrobial agent has not been tested, in specific against bacteria responsible for periodontal disease. The aim of this study was to evaluate the antibacterial effect of BSS-nano against oral anaerobic bacteria and to assess the safety of BSS-nano by evaluating their cytotoxicity in human gingival fibroblast (HGF-1) cells. BSS-nano were synthesized by laser ablation and were previously physico-chemically characterized using in vitro assays. The antibacterial activity was measured using the tetrazolium-based XTT assay, and cytotoxicity was determined using lactate dehydrogenase (LDH) and MTS assays in HGF-1 cells. Transmission electron microscopy of HGF-1 exposed to BSS-nano was also performed. BSS-nano was shown to have a primary size of 4-22 nm and a polygonal shape. Among the tested bacterial strains, those with a greater sensitivity to BSS-nano (highest concentration of 21.7 µg ml-1) were A. actinomycetemcomitans, C. gingivalis, and P. gingivalis. BSS-nano at a concentration of 60 µg ml-1 showed low cytotoxicity (6%) in HFG-1 cells and was mainly localized intracellularly in acidic vesicles. Our results indicate that the concentration of BSS-nano used as an effective antibacterial agent does not induce cytotoxicity in mammalian cells; thus, BSS-nano can be applied as an antibacterial agent in dental materials or antiseptic solutions.

Volatile compounds secreted by Brindley's glands of adult Triatoma infestans: identification and biological activity of previously unidentified compounds.

Volatile emissions of adult male Triatoma infestans were collected on non-polar SPME fibers and analyzed by gas chromatography linked to a mass spectrometer. A complex mixture of 16 short-chain esters and acids were identified. The composition of short-chain aliphatic acids (ethanoic to nonanoic acids) was similar to previously reported results. The most abundant aliphatic acid was 2-methylpropanoic acid, constituting 18% of the total volatile content. Also abundant were the esters 2- and 3-methylbutyl 2-methylpropanoate, which constituted 30% and 22%, respectively, of the total volatile content. A similar pattern of compounds was observed in the volatiles secreted by dissected male Brindley's glands; however, in this case, 2- and 3-methylbutan-1-ol were detected which were not found in live insect volatile emissions. Large variability in volatile composition was also observed among the glands excised from different insects. Electroantennographic (EAG) evaluation of the components of Brindley's gland showed significant responses for 2- and 3-methylbutyl 2-methylpropanoate compared to controls. The mixture of volatiles secreted by excised Brindley's glands and the isolated 2- and 3-methylbutyl 2-methylpropanoate had repellent effects on both male and female T. infestans, possibly associated with a defensive strategy.

Corneal disease in patients with chronic renal insufficiency undergoing hemodialysis.

PURPOSE: To evaluate alterations of the corneal endothelium in patients undergoing hemodialysis for renal insufficiency. METHODS: Sixty-six patients undergoing hemodialysis received a complete ophthalmologic examination. The state of the endothelium was assessed using pachymetry and specular microscopy. The group of patients undergoing dialysis was divided according to the time of dialysis, aluminum, product of calcium and phosphate in blood, and parathyroid hormone to analyze the influence of these factors. The possible presence of iron and aluminum in the aqueous humor of patients who underwent and those who did not undergo hemodialysis was also estimated. RESULTS: Patients undergoing hemodialysis did not have significant corneal edema. Cell density was significantly lower in patients undergoing dialysis than in patients not undergoing dialysis; this reduction appeared to be associated with length of dialysis and was unrelated to serum aluminum and calcium levels. Patients undergoing dialysis did not have cell polymorphism or polymegethism, although there was a tendency toward increased polymegethism with length of dialysis. Aluminum and iron were not increased in the aqueous humor of patients undergoing dialysis. CONCLUSIONS: The alteration of the endothelium that we found is not related to the elements studied. It is possibly the result of another product dissolved in the anterior chamber or to the alterations of the anterior segment that these patients are known to have.

[Liver disease associated with hypernephroma. A case report (author's transl)]. / Hepatopatía asociada al hipernefroma. A propósito de un caso.

The observation of a non-metastatic reactive hepatopathy associated with a hypernephroma in a 39-year-old man who had had fever for 4 months led to a review of the literature and an analysis of basically three aspects of the disorder: a) The various manifestations of carcinoma of the kidney, which include a large number of paraneoplastic clinical symptoms (polycythemia, anemia, prolonged fever, hypercalcemia, hypertension, nefropathy, loss of salt, peripheral neuropathy, and amyloidosis); b) an alteracion of hepatic function known since 1961 which is characterized by an abnormal retention of sulfobromophthalein, increase of alkaline phosphatase, prothrombin decrease, dysproteinemia with hypoalbuminemia, and alpha2-globulin increase. It may or may not be accompanied by enlargement of the liver. c) Criteria of operability of the primary tumor.

[Blood cholesterol in patients with cancer]. / Colesterol sérico en pacientes neoplásicos.

In a retrospective, descriptive and observational study realized between 1995 and January 1997 the seric levels cholesterol of 610 patients with cancer and 61 healthy ones, who were used as controls were revised. The serum cholesterol observed in the patients with cancer were lower than the ones observed in the healthy controls. These differences show and statistical significance. We could see in our study that cholesterol were lower in patients with disseminate disease than in the ones with localize disease and that had and statistical value. The number of patients included in each type of tumor, the seric cholesterol were lower than the ones obtained in the control group apart from the patients with metastasis in and unknown origin tumor which have not been significant.

[Intralymphatic administration of adoptive (LAK) immunotherapy in the treatment of patients with metastatic cancer resistant to conventional therapies]. / Administración intralinfática de inmunoterapia adoptiva (LAK) en el tratamiento de enfermos afectos de cáncer metastásico y resistentes a las terapéuticas convencionales.

Between January, 1990 and May, 1991, we administered LAK immunotherapy using the intralymphatic route to 25 patients with metastatic cancer resistant to conventional therapies. In the preparation of the immunotherapy, we followed the technique described by Pizza G. et al. The age of our patients ranged between 50 and 75 years and their Karnofsky's indexes were above 70%. The histological type of the metastasis were determined by Rx, ECO and/or CAT before and after the administration of the immunotherapy. In the intralymphatic administration, we followed the technique described by Pizza G. et al. The immunological therapy was administered on days 1, 21, 90 and 111 and the clinical response was assessed by RC, RP, EE and F. The immunological behaviour of the host was assessed through the determination of lymphoid populations (CD2, CD4, CD5 and CD8) and cytolytic cells were studied with monoclonal antibodies CD and CD16. Such immunological study was carried out before the administration of each immunotherapy series. In 7 out of 25 patients (28%), we were able to administer the four LAK series. Such patients were subsequently studied, observing that, although tumoral lesions did not increase in size, they did not disappear and, thus, they were classified as clinically stable. Clinical and analytical toxicity was null. The immunological study did not show any statistically significant changes and the activity of cytotoxic cells (NK) was not modified.

[The intralymphatic administration of adoptive immunotherapy (LAK) in the treatment of patients with metastatic cancer and resistant to conventional therapies. Apropos 50 patients]. / Administración intralinfática de inmunoterapia adoptiva (LAK) en el tratamiento de enfermos de cáncer metastásico y resistentes a las terapéuticas convencionales. A propósito de 50 enfermos.

Between January 1990 to December 1993, we administered LAK immunotherapy using intralymphatic route to 50 patients with metastatic cancer resistant to conventional therapies. In the preparations of the immunotherapy, followed the technique described by Pizza G. et al. The age of our patients ranged between 50 to 75 years and their Karnosfsky's indexes were above 70%. The histological type of the metastasis was determined by cytology and the size by Rx, ECO and/or TAC before and after the administration of the immunotherapy. In the intralymphatic administration, we followed the technique described by Pizza G. et al. The immunological therapy was administrated on days 1, 21, 90 and 111 and the clinical responses were assessed by RC, RP, SD and F. The immunological behaviour of the host was assessed through the determination of lymphoid populations (CD2, CD3, CD4, CD5 and CD8) and natural killer cells were studied with monoclonal antibodies CD3 and CD16. Such immunological study was carried out before the administration of each immunotherapy series. In 12 out of 50 patients (24%), we were able to administer the four LAK series. Such patients were subsequently studied, observing that although tumoral lesions did not increase in size, they did not disappear and, thus, they were classified as clinical stables. Clinical and analytical toxicity were null. The immunological study showed changes in immunological parameters, however these changes were not statistically significant.

Factores clínicos que influyen en la probabilidad diagnóstica pretest de trombosis venosa profunda en pacientes ambulatorios / Clinical factors that influence the pre-test diagnostic probability of deep vein thrombosis in out-patients

INTRODUCCIÓN: Los signos y síntomas de la trombosis venosa profunda (TVP) en las extremidades suelen ser inespecíficos y a menudo influidos por la comorbilidad del paciente. OBJETIVO: Análisis de variables clínicas de los pacientes con sospecha clínica de un primer episodio de TVP en Atención Primaria. MATERIAL Y MÉTODOS: Estudio observacional transversal y analítico de pacientes ambulatorios con sospecha de un primer episodio de TVP en extremidades inferiores. Se correlacionan los factores de riesgo y comorbilidades con la confirmación diagnóstica de TVP mediante ecografía-doppler. RESULTADOS: Se estudió a 116 pacientes, de los cuales en 22 (18,9%) se confirmó el diagnóstico. Las comorbilidades más frecuentes fueron la hipertensión, la hipercolesterolemia y la diabetes tipo 2. Solo la presencia de un diagnóstico alternativo probable y la inmovilización prolongada se asociaron con la exclusión o el diagnóstico final de TVP, respectivamente. Las enfermedades del aparato locomotor conllevaron una mayor probabilidad de falsa sospecha de TVP y el único signo clínico que se correlacionó con el diagnóstico fue la tumefacción de la extremidad afecta. CONCLUSIONES: En la práctica clínica, la tumefacción o el antecedente de parálisis de la extremidad nos ha de hacer sospechar firmemente una TVP. Sin embargo, la presencia de un posible diagnóstico alternativo prácticamente descartará dicha enfermedad

INTRODUCTION: Deep vein thrombosis (DVT) has unspecific signs and symptoms that are often influenced by the comorbidity of the patient. OBJECTIVE: To analyze the clinical features and the associated comorbidity of patients with symptoms compatible with a first DVT in a Primary Care setting. MATERIAL AND METHODS: Observational, cross-sectional and analytical study of patients with a first episode of suspected DVT. The risk factors and comorbidities are correlated with the DVT diagnostic confirmation by ultrasound. RESULTS: A total of 116 patients were included, of whom 22 had DVT (18,9%) confirmed by ultrasound. The most frequent associated comorbidities were hypertension, hypercholesterolemia, and type 2 diabetes mellitus. Only the presence of an alternative diagnosis more likely than DVT and the lower extremity immobilization were associated with the exclusion or confirmation of the diagnosis, respectively. Musculoskeletal diseases were correlated with a greater probability of a false suspicion of DVT. The only sign associated with the final diagnosis was the swelling of lower limbs. CONCLUSIONS: In clinical practice, swelling or a history of limb paralysis should lead to the suspicion of DVT. However, the presence of a possible alternative diagnosis could rule out this disease

Impact of the fungicide carbendazim in freshwater microcosms. I. Water quality, breakdown of particulate organic matter and responses of macroinvertebrates.

Effects of chronic application of the fungicide Derosal(R) (active ingredient carbendazim) were studied in indoor macrophyte-dominated freshwater microcosms. The concentrations (0, 3.3, 33, 100, 330 and 1000 µg/l) were kept at a constant level for 4 weeks. This paper is the first of a series of two, and describes the fate of carbendazim and its effects on water quality parameters, breakdown of POM, and responses of macroinvertebrates. Carbendazim proved very persistent in the water layer. Values for t(12) varied between 6 and 25 weeks, and decreased with the treatment level. Significant effects on water quality parameters (DO, pH, alkalinity, conductivity) could not be demonstrated. After 4 weeks of incubation, the breakdown of Populus leaves was significantly slower at the two highest carbendazim concentrations. The macroinvertebrate community was seriously affected by carbendazim application, with Oligochaeta, Turbellaria, Hirudinea and some Crustacea as the most sensitive groups. The snail Bithynia decreased in numbers, but other gastropods increased in numbers. Safety factors as proposed by the Uniform Principles (European Union) for the risk assessment of pesticides, to be multiplied with toxicity data of the standard test species (Daphnia, fish, algae), appeared to ensure adequate protection of sensitive populations present in the microcosms.

Must patients over 65 be haemodialysed?

This manuscript consists of a study of the results of 26 end stage renal failure (ESRF) patients, who commenced regular haemodialysis treatment (RHDT) from the age of 65 onwards (65-85) and who have been undergoing this treatment for periods ranging from 7 years to 3 months. These results are to be compared with those obtained from another group of 26 patients whose age ranged between 40 and 55 and who were treated with the same policy. The following parameters are compared: mortality, morbidity, life-style, cardiovascular situation, hypotension in haemodialysis, vascular access, anaemia, osteoarticular and peripheral nervous disorders, hypertension. We have not found any significant differences between both groups, besides a higher morbidity for patients over 65. Therefore, we recommend the inclusion of the older patients into RHDT programmes.

Immunologic impairment in patients with non-lymphoid cancer: correlation with the tumoral stage, response to treatment and survival.

The cellular immunity has been studied in 121 patients by solid nonlymphoid tumors, and in 50 healthy patients, 11 with benign tumors, with the use of techniques of in vivo dinitrochlorobenzene (DNCB) and in vitro lymphocyte response to phytohemagglutinin to observe the correlation between both tests and the clinical stage of the disease, the response to chemotherapy and surgery, prognosis, and survival. Patients with anergy presented tumoral irresectability, lack of response to chemotherapy, advanced disease, and limited survival. In the patients with good immune response, the disease was limited, responding with greater frequency to therapy and presenting a higher rate of survival. Consequently, the immunologic study of a neoplastic patient can guide us toward a therapeutic behavior and a prognosis.

Criterios de derivación entre niveles asistenciales de pacientes con patología vascular. Documento de consenso semFYC-SEACV / Criteria for between-care-level referrals of patients with vascular disease. semFYC-SEACV consensus document

La Sociedad Española de Medicina Familiar y Comunitaria (semFYC) y la Sociedad Española de Angiología y Cirugía Vascular (SEACV) han elaborado, mediante un grupo de trabajo conjunto, un documento de derivación entre niveles asistenciales de los pacientes con las principales patologías vasculares: enfermedad arterial periférica, insuficiencia venosa y pie diabético. Se han definido las responsabilidades y habilidades requeridas de cada nivel asistencial y también los criterios de derivación mutua, así como los de priorización. La elaboración de este documento consensuado pretende aportar una herramienta eficiente que asegure la continuidad en la asistencia sanitaria, respetando siempre las particularidades y necesidades específicas de cada zona sanitaria(AU)

The Spanish Society of Family and Community Medicine (semFYC) and the Spanish Society of Angiology and Vascular Surgery (SEACV), through a Joint Working Group, have prepared a document on between care-level referrals of patients with the main vascular diseases; peripheral arterial disease, venous insufficiency, and diabetic foot. The responsibilities and skills required at each care level have been defined, as well as the criteria for mutual referral and how to prioritise them. The preparation of this consensus document attempt to provide an efficient tool that may ensure the continuity of health care, always respecting the specific characteristics and needs of each health care area(AU)