Beyond lectures and practical courses: Teaching pharmacology using imaginative pedagogical tools.

Pharmacology has broadened its scope considerably in recent decades. Initially, it was of interest to chemists, doctors and pharmacists. In recent years, however, it has been incorporated into the teaching of biologists, molecular biologists, biotechnologists, chemical engineers and many health professionals, among others. Traditional teaching methods, such as lectures or laboratory work, have been superseded by the use of new pedagogical approaches to enable a better conceptualization and understanding of the discipline. In this article, we present several new methods that have been used in Spanish universities. Firstly, we describe a teaching network that has allowed the sharing of pedagogical innovations in Spanish universities. A European experience to improve prescribing safety is described in detail. The use of popular films and medical TV series in biomedical students shows how these audiovisual resources can be helpful in teaching pharmacology. The use of virtual worlds is detailed to introduce this new approach to teaching. The increasingly important area of the social aspects of pharmacology is also considered in two sections, one devoted to social pharmacology and the other to the use of learning based on social services to improve understanding of this important area. Finally, the use of Objective Structured Clinical Evaluation in pharmacology allows to know how this approach can help to better evaluate clinical pharmacology students. In conclusion, this article allows to know new pedagogical methods resources used in some Spanish universities that may help to improve the teaching of pharmacology.

Psychometric analysis of the Nurses' Professional Values Scale-3 Arabic version among student nurses.

AIMS: We sought to establish the psychometric properties of the Nurses' Professional Values Scale-3 Arabic version among student nurses. BACKGROUND: Nurses' professional values are central in the nursing profession; it encompasses principles such as respecting people rights and dignity, compassion, and caring without prejudice. INTRODUCTION: The professional values of student nurses, most specifically in Saudi Arabia and other Arab countries, can hardly be studied due of the lack of a valid and reliable measure that is linguistically and culturally acceptable. METHODS: In this cross-sectional study, we came up with the Arabic version of the tool and tested its psychometric properties among 350 student nurses from two universities in Saudi Arabia. RESULTS: The principal component analysis revealed three distinct factors with eigenvalues above 1.00 and with an explained variance of 70.5%. The computed Cronbach's alpha of the tool was 0.967, while 0.964, 0.960, and 0.886 were computed for activism, caring, and professionalism, respectively. The test-retest scores (n = 85) revealed an Intraclass Correlation Coefficient of 0.827 for the entire scale, 0.826 for the subscale activism, 0.792 for caring, and 0.870 for professionalism. CONCLUSIONS: The Nurses' Professional Values Scale-3 Arabic version had sound psychometric properties when used among Saudi student nurses. IMPLICATION FOR NURSING: The tool can provide an accurate assessment of the professional values of Saudi nursing students and other Arabic-speaking student nurses. IMPLICATION FOR NURSING POLICY: The tool can be utilized by nursing and nursing education policymakers in Saudi Arabia and in other Arab countries in guiding the creation of practice and education policies that gears towards improving nurses' professional values in this part of the world.

Rathke's cleft cyst infections and pituitary abscesses: case series and review of the literature.

PURPOSE: Pituitary abscesses (PAs) are a rare clinical entity which may arise from normal pituitary tissue or underlying lesions within the gland. Rathke's cleft cysts (RCCs) are not commonly associated with the development of PA. METHODS: Retrospective chart review of three patients with PAs within RCCs at a single university center and review of the literature. RESULTS: Three cases are reported. The first case presented with fever and headache and a history of prior surgery due to RCC and a recent respiratory tract infection. The second case had a history of recent skin infections and presented with sudden onset headache and hypopituitarism. In the third case, chronic visual field impairment prompted an ophthalmologic evaluation resulting in a diagnosis of an adenoma and an infected RCC. In all three cases, an endoscopic endonasal approach was performed to drain infected tissue and allowed microbiological identification of gram-positive cocci, followed by treatment with antibiotics for at least three weeks. Cases in the literature are scarce and the diagnosis is usually made intraoperatively due to non-specific manifestations and imaging. PAs arising from underlying pituitary lesions are less common than primary PAs. Differential diagnosis should include pituitary apoplexy, hypophysitis and other cystic lesions. CONCLUSION: PAs occurring in RCCs are infrequent. Clinical manifestations are commonly subacute, without septic symptoms. Imaging is usually non-specific. Preoperative diagnosis is infrequent and a broad differential diagnosis should be considered. Empirical antimicrobial therapy should be initiated and adjusted after obtaining cultures to reduce the rate of recurrence and improve clinical outcomes.

Simultaneous temporal and spectral analysis of noise-like pulses in a mode-locked figure-eight fiber laser.

We present an experimental study of complex noise-like pulse dynamics in a passively mode-locked figure-eight fiber laser, by performing simultaneous temporal and spectral mapping of the waveform sequences. The simultaneous measurements allow us to relate temporal and spectral events. We found in particular that the evolution of energy and of temporal features such as the number and width of the wave packets is correlated to spectral variations, namely of the central wavelength and bandwidth of the instantaneous spectrum. The simultaneous temporal and spectral measurements also allowed a substantial improvement in the precision of the latter, which was performed using the dispersive Fourier transform method. In particular, this enhanced precision allowed measuring the subtle spectral differences between the two laser outputs and tracking their evolution over the cycles, providing crucial information that allowed to determine the physical phenomena involved in the observed dynamics.

Numerical study of complex dynamics and extreme events within noise-like pulses from an erbium figure-eight laser.

Some complex dissipative dynamics associated with the noise-like pulse (NLP) regime of a passively mode-locked erbium-doped fiber laser are studied numerically. By means of a convenient 3D mapping of the spatio-temporal pulse evolution, for properly chosen dispersion parameters, several puzzling dissipative dynamics of NLPs are identified, including the expelling of sub-packets that move away from the main bunch, the sudden extinction of isolated sub-pulses, the collision between different internal fragments travelling at different speeds, the rising of sub-pulses, the formation of complex trajectories by substructures that first move away and then return to the main bunch, and so on. In addition, the emergence of optical rogue waves (ORWs) within NLPs is also demonstrated numerically; to help understand these behaviors evidenced in the time domain, spectral analyzes were also performed that show, among other things, that the spectrum of a NLP is notoriously distorted when it hosts an ORW phenomenon. These numerical results are consistent with previously published experimental results.

Gain-driven spectral-temporal noise-like pulse dynamics in a passively mode-locked fiber laser.

We study numerically complex noise-like pulse dynamics in a passively mode-locked erbium-doped fiber laser. Wavelength-dependent gain dynamics is modeled as a combination of a three-level and a four-level system, which approximate the gain behavior in the 1530-nm and 1560-nm regions, respectively. The typical deformation of the erbium gain spectrum as it saturates is properly reproduced by this approach. Several puzzling noise-like pulse dynamics that were recently observed experimentally are qualitatively reproduced numerically, in particular slow quasi-periodic energy variations and the emergence and walkoff of wavelength-shifted radiation components. These results clearly reveal that gain dynamics is deeply involved in the onset of such complex temporal and spectral instabilities in these sources.

Phenotypic spectrum of neonatal CHARGE syndrome. / Espectro fenotípico de Síndrome de CHARGE neonatal.

INTRODUCTION: CHARGE syndrome is a genetic disorder of wide phenotypic variability, of autosomal dominant in heritance, caused by pathogenic variants in the CHD7 gene. OBJECTIVE: To describe the broad pheno typic spectrum of neonatal CHARGE syndrome, heterozygous for the CHD7 gene, and the usefulness of genome sequencing in diagnostic confirmation, considering differential diagnoses. CLINICAL CASE: 34-week preterm newborn, with severe prenatal history of polyhydramnios, increased nuchal trans- lucency, and hyperechogenic cardiac focus, with a TORCH study that ruled out congenital infection. Peripheral facial paralysis, choanal atresia, multiple dysmorphisms, congenital heart disease, and bilateral retinochoroidal coloboma were observed at birth. The neuroimaging study showed hypo plasia of the cochlea and bilateral semicircular canals, and pontocerebellar hypoplasia. The auditory evoked potentials showed deep right-sided sensorineural hearing loss and left anacusis. The patient developed hypocalcemia and immunological alterations, confirming hypoparathyroidism and thy mus hypoplasia. The karyogram was normal and 22q11.2 microdeletion was excluded through mul tiplex ligation-dependent probe amplification (MPLA). A pathogenic variant in the CHD7 gene was detected that confirmed the clinical suspicion of CHARGE syndrome. CONCLUSIONS: The overlap of clinical characteristics of CHARGE syndrome requires molecular genetic confirmation, considering differences in evolution, therapies, and recurrence risks with other genetic syndromes.

Predictors of Saudi nursing students' attitudes towards environment and sustainability in health care.

AIM: This study aimed to investigate the predictors of Saudi nursing students' attitudes towards the environment and sustainability in health care. BACKGROUND: With rising temperature and decreasing annual rainfall, Saudi Arabia is threatened by the harmful effects of climate change on its population. In response to these threats, the Ministry of Health adapted sustainable development and environmental preservation in their National E-Health strategy. INTRODUCTION: To implement these policies successfully, healthcare practitioners should be educated on how climate change could impact human health negatively. METHODS: A secondary analysis of 280 questionnaires from baccalaureate nursing students of a university in Hail City, Saudi Arabia, was completed. The New Ecological Paradigm (NEP) Scale and Sustainability Attitudes in Nursing Survey 2 (SANS-2) were used to investigate the predictors of student attitudes towards the environment and sustainable development in health care. RESULTS: The NEP score indicated moderate pro-environment attitudes, whereas the SANS-2 mean score showed very positive attitudes towards sustainability in health care. Learning about the environment and related issues in the nursing programme, raising climate change awareness and attending environment-related seminars and training positively influenced the environmental and sustainability attitudes of nursing students. DISCUSSION: Saudi nursing students moderately manifested pro-environment attitudes but exhibited extremely positive attitudes towards sustainability in health care. The results support the need to strengthen the education of nursing students about environmental and sustainability concepts and the inclusion of these topics in the nursing curricula. CONCLUSION: The study underscores the critical role of enriching the awareness of nursing students on environmental issues and concerns and sustainability in health care. IMPLICATIONS FOR NURSING AND NURSING POLICY: The findings of this study can support the inclusion of course contents, which deal specifically with environmental health and sustainability practices, in the creation of new policies directed towards curricular revision.

Nurses' perceived spiritual climate of a hospital in Saudi Arabia.

AIM: This study investigated the spiritual climate of a hospital in Saudi Arabia as perceived by nurses. BACKGROUND: A spiritually conducive environment improves patient, nurse and organizational outcomes. Despite being important, no studies have investigated this area in the Muslim-dominated Middle Eastern countries. INTRODUCTION: A snapshot on the degree of spiritual climate perception may provide insight into the aspects that may need improvement and may become basis for the creation of health and nursing policies directed towards creating a spiritually-accepting and respecting clinical workplace. METHOD: A sample of 219 nurses employed in a 500-bed capacity hospital in Saudi Arabia was included in this cross-sectional study utilizing the spiritual climate scale. RESULTS: The nurses perceived their hospital's spiritual climate to be fair. The item 'I am encouraged to express spirituality in this clinical area' received the lowest mean, whereas the item 'My spiritual views are respected in this clinical area' received the highest mean. Being Saudi, having less total experience as a nurse, and having greater total experience as a nurse in Saudi Arabia and in the present hospital positively influenced the perception of the spiritual climate among nurses. CONCLUSION: The findings stress the need to improve the spiritual climate in the hospital. IMPLICATIONS FOR NURSING AND NURSING POLICY: Hospitals are recommended to create policies to implement interventions geared towards creating a spiritually-friendly environment. Hospitals are encouraged to create a safe place where nurses can freely express their spirituality regardless of preference or religious denomination. Spiritual education may be provided by hospitals as part of continuing education. Managers may also focus on the existential spirituality of nurses, especially for spiritually-sensitive environments such as Saudi Arabia.

Psychometric assessment of the cultural capacity scale Spanish version in Chilean nursing students.

AIM: To assess the psychometric properties of the Cultural Capacity Scale Spanish version in Chilean nursing students. BACKGROUND: The increased diversity in healthcare facilities and the current shortage of local nursing workforce in Chile present a significant challenge to the nursing education to train future competent local nurses. To facilitate cultural competence development among Chilean nursing students, it is necessary to regularly assess their cultural competence, which necessitates a culturally adapted valid and reliable tool. METHODS: A convenience sample of 502 Chilean nursing students was surveyed in this cross-sectional study using the culturally adapted scale. Reliability of the instrument was established by internal consistency and stability reliability, while validity was established by content and construct. RESULTS: The Cronbach's α value of the entire scale was 0.95, and the test-retest reliability was 0.85. The Corrected Item-Total Correlations ranged from 0.45 to 0.78. The tool manifested an excellent content and construct validity. The exploratory factor analysis confirmed a single factor of the scale. DISCUSSION: The tool demonstrated evidence of internal consistency, stability reliability, content validity and construct validity. The study provided cross-cultural evidence for the potential application of this scale in Chile and other Spanish-speaking countries. CONCLUSION: The Cultural Capacity Scale Spanish version demonstrated sound psychometric properties for assessing the cultural competence of Chilean nursing students. LIMITATIONS: The sample was restricted to one university, and the tool was only used in Chilean nursing students. IMPLICATIONS FOR NURSING POLICY: The establishment of the Spanish version of the tool will facilitate accurate and timely monitoring of the cultural competence among Chilean nursing students and other Spanish-speaking nursing students and nurses, which can inform the creation of nursing policies aimed at ensuring cultural competence development.

Cultural competence among nursing students in Saudi Arabia: a cross-sectional study.

AIM: This study assessed the cultural competence of nursing students in a Saudi University. BACKGROUND: With the current situation of immigration in Saudi Arabia, the cultural diversity in healthcare facilities is anticipated to grow. This presents a great challenge to the members of the healthcare team. METHODS: A cross-sectional study was conducted among 272 nursing students in a Saudi university using a self-administered questionnaire consisting of two parts, namely the respondents' demographics and cultural background information sheet and the Cultural Capacity Scale Arabic version. RESULTS: The respondents showed the highest competence in their ability to demonstrate communication skills with culturally diverse patients and lowest in the familiarity with health- or illness-related cultural knowledge or theory. Gender, academic level, clinical exposure, prior diversity training, the experience of taking care of culturally diverse patients and patients belonging to special population groups were significant factors that could likely to influence cultural competence. DISCUSSION: The findings suggest that the Saudi nursing students possess the ability to provide culturally appropriate nursing care to patients with a diverse cultural background. CONCLUSIONS: Despite the good cultural competence reflected in this study, some aspects in ensuring a culturally competent care rendered by Saudi nursing students need to be improved. IMPLICATIONS FOR NURSING & HEALTH POLICY: With the country's Saudization policy in health care (replacing foreign nurses with Saudi nurses), the findings can be used in designing training and interventions to meet the needs of Saudi nursing students regarding cultural competence development, which is integral in their preparation to assume their future roles as nurses. Policy guidelines, such as including cultural competency training and foreign languages training as mandatory continuing education for nurses, as well as integrating cultural competency and foreign languages in the prelicensure curriculum, should be developed and implemented in Saudi Arabia and other countries.

High energy noise-like pulsing in a double-clad Er/Yb figure-of-eight fiber laser.

In this work, we study a 215-m-long figure-of-eight fiber laser including a double-clad erbium-ytterbium fiber and a nonlinear optical loop mirror based on nonlinear polarization evolution. For proper adjustments, self-starting passive mode-locking is obtained. Measurements show that the mode-locked pulses actually are noise-like pulses, by analyzing the autocorrelation, scope traces and the very broad and flat spectrum extending over a record bandwidth of more than 200 nm, beyond the 1750 nm upper wavelength limit of the optical spectrum analyzer. Noise-like pulsing was observed for moderate and high pump power preserving the same behavior, reaching pulse energies as high as 300 nJ, with pulse durations of a few tens of ns and a coherence length in the order of 1 ps. Stable fundamental mode locking as well as harmonic mode locking up to the 6th order were observed. The bandwidth was further extended to more than 450 nm when a 100-m piece of highly nonlinear fiber was inserted at the laser output. The enhanced performances obtained compared to other similar schemes could be related to the absence of a polarizer in the present setup, so that the state of polarization along the cavity is no longer restricted.

Complex dynamics of a fiber laser in non-stationary pulsed operation.

Conventional mode locking is characterized by the generation of a stable train of optical pulses. Even in the noise-like pulsing regime of fiber lasers, sometimes described as partial mode locking, a periodic train of waveforms is still generated. In this work we study the dynamics of a figure-eight fiber laser away from the stable noise-like pulsing regime. By analyzing sequences of time-domain measurements performed with ns resolution, we reveal a wide range of puzzling dynamics, in which sub-structures emerge and drift away from the main bunch, decay or grow in a step-like manner, before vanishing abruptly. In some cases, sub-packets also concentrate in the central part of the period, forming one or multiple wide clouds that merge or split over time scales of seconds or minutes. Spontaneous transitions between these multiple states occur in a non-periodic manner, so that no quasi-stationary behavior is found over long time scales. These results provide a dramatic illustration of the extremely rich dynamics taking place in fiber lasers at the frontier of mode locking.

Dynamics of noise-like pulsing at sub-ns scale in a passively mode-locked fiber laser.

We report an original noise-like pulse dynamics observed in a figure-eight fiber laser, in which fragments are continually released from a main waveform that circulates in the cavity. Particularly, we report two representative cases of the dynamics: in the first case the released fragments drift away from the main bunch and decay over a fraction of the round-trip time, and then vanish suddenly; in the second case, the sub-packets drift without decaying over the complete cavity round-trip time, until they eventually merge again with the main waveform. The most intriguing result is that these fragments, as well as the main waveform, are formed of units with sub-ns duration and roughly the same energy.

Antiplatelet effect of new lipophilic hydroxytyrosol alkyl ether derivatives in human blood.

PURPOSE: To investigate the in vitro antiplatelet and anti-inflammatory effects of five alkyl hydroxytyrosol (HT) ether derivatives in human whole blood and compare these effects with those of HT. METHODS: Blood samples from healthy volunteers were incubated with HT and HT alkyl ether derivatives (ethyl, butyl, hexyl, octyl and dodecyl). Maximum intensity of platelet aggregation was induced with collagen, arachidonic acid or ADP. Calcium-induced thromboxane B(2) and nitric oxide production, LPS-induced prostaglandin E(2) and nitric oxide production and LPS-induced interleukin 1ß production were measured. RESULTS: All compounds inhibited platelet aggregation, thromboxane B(2) and inflammatory mediators in a concentration-dependent manner. The concentrations of each compound that inhibited the corresponding variable by 50 % compared to control samples (IC(50)) were in the range of 10(-7)-10(-6) M for HT hexyl ether; for the other compounds, these values were in the range of 10(-5) M. The IC(50) for thromboxane B(2) production was in the range of 10(-4) M. The effects of HT alkyl ether derivatives were greater than those of HT. These compounds increased nitric oxide production. There was no direct relationship between the effects of these compounds and alkyl chain length. Maximum effects were observed in the C4-C6 range. CONCLUSIONS: Alkyl ether derivatives of HT exert antiplatelet and anti-inflammatory effects that are greater than those of HT.

Socioeconomic, health-care access and clinical determinants of disease severity in Multiple Sclerosis in Chile.

BACKGROUND: MS severity may be affected by genetic, patient-related, disease-related and environmental factors. Socioeconomic status, including income and healthcare access, amongst others, may also have a role in affecting diagnostic delay or therapy prescription. In Chile, two main healthcare systems exist, public-healthcare and private-healthcare, nonetheless universal care laws (e.g., access to High Efficacy Therapy-HET), including both systems, have been recently enacted for people with MS. OBJECTIVE: To assess the role of Socioeconomic Conditions (SEC), clinical variables and public health policies on the impact of disease severity of MS patients in Chile. METHODS: Multicentric, observational, cross-sectional study including patients from two reference centres (1 national reference centre from the private-health system and 1 regional reference centre from the public-health system). SEC and clinical variables included healthcare insurance (private or public), subclassification of health insurance according to monthly income, sex, age at onset, diagnostic delay, disease duration, diagnosis before HET law (as a proxy of HET delay), and current HET treatment. Progression Index (PI), EDSS ≥6.0 and Progressive MS diagnosis were used as outcome measures. Multivariable binary logistic regression was performed. RESULTS: We included 604 patients (460 private-health, 144 public-health), 67% women, 100% white/mestizo, 88% RRMS, mean age 42±12 years, mean age at onset 32±11 years, mean disease duration 10±6 years, median diagnostic delay 0 (0-34) years, 86% currently receiving any DMT, 55% currently receiving HET, median EDSS at last visit of 2.0 (0-10), and median PI 0.17 (0-4.5). Lower monthly income was associated with higher EDSS and higher PI. In the multivariable analysis, public-healthcare (OR 10.2), being diagnosed before HET-law (OR 4.89), longer diagnostic delay (OR 1.26), and older age at onset (OR 1.05) were associated with a higher risk of PI>0.2, while current HET (OR 0.39) was a protective factor. Diagnosis before HET-law (OR 7.59), public-healthcare (OR 6.49), male sex (OR 2.56), longer disease duration (OR 1.2) and older age at onset (OR 1.1) were associated with a higher risk of Progressive MS. Public-healthcare (OR 5.54), longer disease duration (OR 1.14) and older age at onset (OR 1.08) were associated with a higher risk of EDSS ≥6.0 while current treatment with HET had a trend as being a protective factor (OR 0.44, p = 0.05). CONCLUSION: MS severity is impacted by non-modifiable factors such as sex and age at onset. Interventions focused on shortening diagnostic delay and encouraging early access to high-efficacy therapies, as well as initiatives that may reduce the disparities inherent to lower socioeconomic status, may improve outcomes in people with MS.

Effects of terutroban, a thromboxane/prostaglandin endoperoxide receptor antagonist, on retinal vascularity in diabetic rats.

BACKGROUND: The aim of the present study is to investigate the effectiveness of terutroban, a selective antagonist of the thromboxane/prostaglandin endoperoxide receptor, in preventing retinal ischaemia in a model of diabetes in rats. METHODS: Experimental diabetes was induced with streptozotocin. Rats were distributed into five groups (n = 20): (1) non-diabetic rats, (2) rats with diabetes (DR) treated with vehicle, (3) DR treated with aspirin (2 mg/kg/day p.o.), (4) DR treated with terutroban (5 mg/kg/day p.o.), (5) DR treated with terutroban (30 mg/kg/day p.o.). The follow-up period was 3 months. The main assessment was the percentage of retinal surface covered with vessels permeable to peroxidase. Platelet aggregation, aortic prostacyclin and nitric oxide production, plasma levels of lipid peroxides (thiobarbituric-acid-reactive substances) and 3-nitrotyrosine and serum levels of IL-6 were evaluated. RESULTS: Diabetes induced a reduction in retinal vascularity (76.9%), aortic prostacyclin (37.8%) and nitric oxide production (35.0%), and increased platelet aggregation, lipid peroxides, 3-nitrotyrosine. When compared with vehicle-treated DR, terutroban increased the percentage of retinal surface covered by PVPP (38% for terutroban-5 and 61% for terutroban-30), aortic prostacyclin (188% for terutroban-5 and 146% for terutroban-30) and nitric oxide production (320% for terutroban-5 and 390% for terutroban-30). Moreover, terutroban reduced platelet reactivity (27.8­95.1%, according to the inducer), lipid peroxides (60.7% for terutroban-5 and 50.0% for terutroban-30), 3-nitrotyrosine (43.8% for terutroban-5 and 36.8% for terutroban-30) and IL-6 concentration (18.0% for terutroban-30). The effect of terutroban in retinal, nitrosative and aortic parameters was significantly higher than that of aspirin. CONCLUSIONS: Terutroban significantly protected retinal vascularity from ischaemia in experimental diabetes, and this result could be attributed not only to its antiplatelet/antithrombotic activities but also to its vascular properties.

Spatio-temporal dynamics of phytoplankton community in a well-mixed temperate estuary (Sado Estuary, Portugal).

Estuaries are highly productive ecosystems, which are strongly affected by several anthropogenic pressures. Phytoplankton is a key element for assessing the ecological quality status in these transitional waters. Moreover, understanding physico-chemical and biological drivers is crucial to disentangle their effect on the structure of phytoplankton community. The present work aims to study the effect of the main physico-chemical drivers on the phytoplankton community structure and dynamics in a temperate well-mixed estuary (Sado Estuary). Four sampling stations were analyzed monthly in three regions of the estuary, from 2018 to 2019. Surface water samples were collected to analyze the phytoplankton community and several concomitant physico-chemical parameters. Temperature, turbidity, salinity, and nutrients availability were the drivers that best explained the spatio-temporal patterns observed in the phytoplankton community. The upper estuary was characterized by higher phytoplankton cell abundances and biomass. Three phytoplankton groups stood out in the characterization of the estuarine assemblages: diatoms, cryptophytes, and dinoflagellates. Diatoms were the dominant group most of the year, being dominated by small cell species (single and chain-forming) upstream, and by larger chain-forming species downstream. Cryptophytes had a high contribution to the community in the inner regions of the estuary, while dinoflagellates contributed more for the community composition downstream, where high abundances of harmful algal species were sporadically found. Previous studies on the phytoplankton community dynamics in this estuary are limited to the 1990s. Thus, the present study provides insight into changes in the dominant phytoplankton groups of the Sado Estuary in the last 25 years, namely an increase in cryptophytes over diatoms in the inner estuarine regions, and an increase in dinoflagellates near the estuary mouth.

Differences in the in vitro antiplatelet effect of dexibuprofen, ibuprofen, and flurbiprofen in human blood.

BACKGROUND: In this study, we compared the in vitro pharmacodynamic profile of dexibuprofen, ibuprofen, and flurbiprofen to identify possible differences in antiplatelet activity. METHODS: In whole blood samples from healthy volunteers, we measured platelet aggregation induced by adenosine diphosphate, collagen and arachidonic acid, platelet thromboxane B(2) (TxB(2)), lipopolysaccharide-induced prostaglandin E(2), leukocyte 6-keto-prostaglandin F(1α) (PGF(1α)), and nitric oxide induced by both constitutive and inducible pathways before and after incubation with increasing concentrations of acetylsalicylic acid, dexibuprofen, ibuprofen, or flurbiprofen. The concentration that inhibited (IC(50)) or increased each variable by 50% was calculated. RESULTS: All 3 drugs inhibited platelet aggregation in a dose-dependent manner, TxB(2), prostaglandin E(2), and 6-keto-PGF(1α), and increased calcium-induced nitric oxide production. Dexibuprofen showed greater antiplatelet potency than ibuprofen and flurbiprofen, and its profile was similar to that of aspirin. For example, IC(50) values for arachidonic acid-induced platelet aggregation were 0.85 ± 0.06 µM for dexibuprofen, 14.76 ± 1.22 µM for ibuprofen, 6.39 ± 0.51 µM for flurbiprofen, and 0.38 ± 0.03 µM for aspirin. All drugs inhibited both thromboxane and prostacyclin synthesis, but the IC(50) anti-TxB(2)/IC(50) anti-6-keto-PGF(1α) ratio was 0.21 ± 0.03 for dexibuprofen, 1.05 ± 0.08 for ibuprofen, 0.79 ± 0.11 for flurbiprofen, and 0.46 ± 0.06 for aspirin. All drugs increased calcium-dependent nitric oxide production. CONCLUSIONS: The aryl propionic acid derivative dexibuprofen was the most potent antiplatelet drug, and its pharmacodynamic profile is similar to aspirin.

Refractory epilepsy associated with anti-ribosomal P antibodies successfully treated with topiramate.

We report the case of a 25-year-old woman who developed temporal lobe epilepsy associated with systemic lupus erythematosus (SLE). Serum and cerebrospinal fluid samples showed high titers of anti-ribosomal P (anti-P) antibodies with negative anti-NMDAR antibodies. She was receiving prednisone and azathioprine, with normalization of SLE serum markers, but without changes in titers of anti-P antibodies. No seizure control was achieved using valproic acid, levetiracetam and lamotrigine. However, she had a selective response to topiramate, an AMPAR blocker, maintained during 6 years of follow-up. We discuss the pathophysiology of this autoimmune epilepsy associated with high titer anti-P antibodies.