Microorganisms Involved in Methylmercury Demethylation and Mercury Reduction are Widely Distributed and Active in the Bathypelagic Deep Ocean Waters.

The ocean's mercury (Hg) content has tripled due to anthropogenic activities, and although the dark ocean (>200 m) has become an important Hg reservoir, concentrations of the toxic and bioaccumulative methylmercury (MeHg) are low and therefore very difficult to measure. As a consequence, the current understanding of the Hg cycle in the deep ocean is severely data-limited, and the factors controlling MeHg, as well as its transformation rates, remain largely unknown. By analyzing 52 globally distributed bathypelagic deep-ocean metagenomes and 26 new metatranscriptomes from the Malaspina Expedition, our study reveals the widespread distribution and expression of bacterial-coding genes merA and merB in the global bathypelagic ocean (∼4000 m depth). These genes, associated with HgII reduction and MeHg demethylation, respectively, are particularly prevalent within the particle-attached fraction. Moreover, our results indicate that water mass age and the organic matter composition shaped the structure of the communities harboring merA and merB genes living in different particle size fractions, their abundance, and their expression levels. Members of the orders Corynebacteriales, Rhodobacterales, Alteromonadales, Oceanospirillales, Moraxellales, and Flavobacteriales were the main taxonomic players containing merA and merB genes in the deep ocean. These findings, together with our previous results of pure culture isolates of the deep bathypelagic ocean possessing the metabolic capacity to degrade MeHg, indicated that both methylmercury demethylation and HgII reduction likely occur in the global dark ocean, the largest biome in the biosphere.

Podophyllic Aldehyde, a Podophyllotoxin Derivate, Elicits Different Cell Cycle Profiles Depending on the Tumor Cell Line: A Systematic Proteomic Analysis.

When new antitumor therapy drugs are discovered, it is essential to address new target molecules from the point of view of chemical structure and to carry out efficient and systematic evaluation. In the case of natural products and derived compounds, it is of special importance to investigate chemomodulation to further explore antitumoral pharmacological activities. In this work, the compound podophyllic aldehyde, a cyclolignan derived from the chemomodulation of the natural product podophyllotoxin, has been evaluated for its viability, influence on the cell cycle, and effects on intracellular signaling. We used functional proteomics characterization for the evaluation. Compared with the FDA-approved drug etoposide (another podophyllotoxin derivative), we found interesting results regarding the cytotoxicity of podophyllic aldehyde. In addition, we were able to observe the effect of mitotic arrest in the treated cells. The use of podophyllic aldehyde resulted in increased cytotoxicity in solid tumor cell lines, compared to etoposide, and blocked the cycle more successfully than etoposide. High-throughput analysis of the deregulated proteins revealed a selective antimitotic mechanism of action of podophyllic aldehyde in the HT-29 cell line, in contrast with other solid and hematological tumor lines. Also, the apoptotic profile of podophyllic aldehyde was deciphered. The cell death mechanism is activated independently of the cell cycle profile. The results of these targeted analyses have also shown a significant response to the signaling of kinases, key proteins involved in signaling cascades for cell proliferation or metastasis. Thanks to this comprehensive analysis of podophyllic aldehyde, remarkable cytotoxic, antimitotic, and other antitumoral features have been discovered that will repurpose this compound for further chemical transformations and antitumoral analysis.

Growth rates of marine prokaryotes are extremely diverse, even among closely related taxa.

Marine prokaryotes play crucial roles in ocean biogeochemical cycles, being their contribution strongly influenced by their growth rates. Hence, elucidating the variability and phylogenetic imprint of marine prokaryotes' growth rates are crucial for better determining the role of individual taxa in biogeochemical cycles. Here, we estimated prokaryotic growth rates at high phylogenetic resolution in manipulation experiments using water from the northwestern Mediterranean Sea. Experiments were run in the four seasons with different treatments that reduced growth limiting factors: predators, nutrient availability, viruses, and light. Single-amplicon sequence variants (ASVs)-based growth rates were calculated from changes in estimated absolute abundances using total prokaryotic abundance and the proportion of each individual ASV. The trends obtained for growth rates in the different experiments were consistent with other estimates based on total cell-counts, catalyzed reporter deposition fluorescence in situ hybridization subcommunity cell-counts or metagenomic-operational taxonomic units (OTUs). Our calculations unveil a broad range of growth rates (0.3-10 d-1) with significant variability even within closely related ASVs. Likewise, the impact of growth limiting factors changed over the year for individual ASVs. High numbers of responsive ASVs were shared between winter and spring seasons, as well as throughout the year in the treatments with reduced nutrient limitation and viral pressure. The most responsive ASVs were rare in the in situ communities, comprising a large pool of taxa with the potential to rapidly respond to environmental changes. Essentially, our results highlight the lack of phylogenetic coherence in the range of growth rates observed, and differential responses to the various limiting factors, even for closely related taxa.

Genomic and transcriptomic characterization of methylmercury detoxification in a deep ocean Alteromonas mediterranea ISS312.

Methylmercury (MeHg) is one of the most worrisome pollutants in marine systems. MeHg detoxification is mediated by merB and merA genes, responsible for the demethylation of MeHg and the reduction of inorganic mercury, respectively. Little is known about the biological capacity to detoxify this compound in marine environments, and even less the bacterial transcriptional changes during MeHg detoxification. This study provides the genomic and transcriptomic characterization of the deep ocean bacteria Alteromonas mediterranea ISS312 with capacity for MeHg degradation. Its genome sequence revealed four mer operons containing three merA gene and two merB gene copies, that could be horizontally transferred among distant related genomes by mobile genetic elements. The transcriptomic profiling in the presence of 5 µM MeHg showed that merA and merB genes are within the most expressed genes, although not all mer genes were equally transcribed. Besides, we aimed to identify functional orthologous genes that displayed expression profiles highly similar or identical to those genes within the mer operons, which could indicate they are under the same regulatory controls. We found contrasting expression profiles for each mer operon that were positively correlated with a wide array of functions mostly related to amino acid metabolism, but also to flagellar assembly or two component systems. Also, this study highlights that all merAB genes of the four operons were globally distributed across oceans layers with higher transcriptional activity in the mesopelagic deeper waters. Our study provides new insights about the transcriptional patterns related to the capacity of marine bacteria to detoxify MeHg, with important implications for the understanding of this process in marine ecosystems.

Genomic and phenotypic characterization of 26 novel marine bacterial strains with relevant biogeochemical roles and widespread presence across the global ocean.

Prokaryotes dominate global oceans and shape biogeochemical cycles, yet most taxa remain uncultured and uncharacterized as of today. Here we present the characterization of 26 novel marine bacterial strains from a large isolate collection obtained from Blanes Bay (NW Mediterranean) microcosm experiments made in the four seasons. Morphological, cultural, biochemical, physiological, nutritional, genomic, and phylogenomic analyses were used to characterize and phylogenetically place the novel isolates. The strains represent 23 novel bacterial species and six novel genera: three novel species pertaining to class Alphaproteobacteria (families Rhodobacteraceae and Sphingomonadaceae), six novel species and three new genera from class Gammaproteobacteria (families Algiphilaceae, Salinispheraceae, and Alteromonadaceae), 13 novel species and three novel genera from class Bacteroidia (family Flavobacteriaceae), and one new species from class Rhodothermia (family Rubricoccaceae). The bacteria described here have potentially relevant roles in the cycles of carbon (e.g., carbon fixation or energy production via proteorhodopsin), nitrogen (e.g., denitrification or use of urea), sulfur (oxidation of sulfur compounds), phosphorus (acquisition and use of different forms of phosphorus and remodeling of membrane phospholipids), and hydrogen (oxidation of hydrogen to obtain energy). We mapped the genomes of the presented strains to the Tara Oceans metagenomes to reveal that these strains were globally distributed, with those of the family Flavobacteriaceae being the most widespread and abundant, while Rhodothermia being the rarest and most localized. While molecular-only approaches are also important, our study stresses the importance of culturing as a powerful tool to further understand the functioning of marine bacterial communities.

Influence of the COVID-19 pandemic on patients receiving oral anticoagulants for the treatment of non-valvular atrial fibrillation.

Background: Frequent monitoring of patients declined during the COVID-19 pandemic, harming patients with chronic diseases who critically needed correct monitoring. We evaluated the impact of the COVID-19 pandemic in patients with non-valvular atrial fibrillation (NVAF) receiving treatment with vitamin K antagonists (VKA) or non-vitamin K antagonist oral anticoagulants (NOAC) in clinical practice in Spain. Methods: This observational, retrospective study analyzed prevalent patients treated with NOAC/VKA on 14/03/2019 (pre-COVID-19 period) and 14/03/2020 (COVID-19 period), who were followed up to 12 months. The study also considered incident patients who started treatment with NOAC/VKA between 15/03/2019 and 13/03/2020 (pre-COVID-19 period) and from 15/03/2020 to 13/03/2021 (COVID-19 period). Demographic characteristics, comorbidities, effectiveness, treatment patterns, and healthcare resource utilization were considered. Results: Prevalent patients amounted to 12,336 and 13,342 patients, whereas 1,612 and 1,602 incident patients were included in the pre-COVID-19 and COVID-19 periods, respectively. Prevalent patients treated with VKA had more strokes, thromboembolism, and major bleeding compared to those receiving NOAC, particularly during the COVID-19 period. NOAC patients had a 12 % lower risk of death than those on treatment with VKA (Hazard ratio = 0.88 [95 % CI: 0.81 - 0.95], p = 0.033). In addition, VKA patients were less persistent after 12 months than NOAC patients (pre-COVID-19 period: 52.1 % vs. 78.9 %, p < 0.001; COVID-19 period: 49.2 % vs. 80.3 %, p < 0.001), and required more healthcare visits and hospitalizations than those on treatment with NOAC. Conclusion: Compared to VKA, NOAC seems to have reduced the incidence of severe events and the use of healthcare resources for NVAF, particularly during the pandemic.

Defining a standard set of health outcomes for patients with relapsing-remitting multiple sclerosis.

BACKGROUND: Standardizing health outcomes is challenging in clinical management, but it also holds the potential for creating a healthcare system that is both more effective and efficient. The aim of the present study is to define a standardized set of health outcomes for managing Relapsing-Remitting Multiple Sclerosis (RRMS). METHODS: The project was led and coordinated by a multidisciplinary scientific committee (SC), which included a literature review, a patient-focused group, three nominal group meetings, and two SC meetings. RESULTS: 36 outcome variables were included in the standard set: 24 clinical (including weight, smoking habit, comorbidities, disability, mobility, diagnosis of secondary progressive multiple sclerosis, relapsed-related variables, radiological variables, cognitive status and disease-related symptoms), nine treatment-related (pharmacological and non-pharmacological information), and 3 related to the impact of RRMS on the patient's life (quality of life, pregnancy desire, work-related difficulties). In addition, experts also agreed to collect 10 case-mix variables that may affect but cannot be controlled as part of the management of the condition: 4 sociodemographic (age, sex, race, and employment status) and 6 clinical (height, date of diagnosis and first episode, serological status, early symptoms, and number of relapses pre-diagnosis). CONCLUSION: The information provided through the present standard set of outcome variables can improve the management of RRMS and promote patient-centred quality care.

Unmasking the physiology of mercury detoxifying bacteria from polluted sediments.

Marine sediments polluted from anthropogenic activities can be major reservoirs of toxic mercury species. Some microorganisms in these environments have the capacity to detoxify these pollutants, by using the mer operon. In this study, we characterized microbial cultures isolated from polluted marine sediments growing under diverse environmental conditions of salinity, oxygen availability and mercury tolerance. Specific growth rates and percentage of mercury removal were measured in batch cultures for a selection of isolates. A culture affiliated with Pseudomonas putida (MERCC_1942), which contained a mer operon as well as other genes related to metal resistances, was selected as the best candidate for mercury elimination. In order to optimize mercury detoxification conditions for strain MERCC_1942 in continuous culture, three different dilution rates were tested in bioreactors until the cultures achieved steady state, and they were subsequently exposed to a mercury spike; after 24 h, strain MERCC_1942 removed up to 76% of the total mercury. Moreover, when adapted to high growth rates in bioreactors, this strain exhibited the highest specific mercury detoxification rates. Finally, an immobilization protocol using the sol-gel technology was optimized. These results highlight that some sediment bacteria show capacity to detoxify mercury and could be used for bioremediation applications.

Revisiting the mercury cycle in marine sediments: A potential multifaceted role for Desulfobacterota.

Marine sediments impacted by urban and industrial pollutants are typically exposed to reducing conditions and represent major reservoirs of toxic mercury species. Mercury methylation mediated by anaerobic microorganisms is favored under such conditions, yet little is known about potential microbial mechanisms for mercury detoxification. We used culture-independent (metagenomics, metabarcoding) and culture-dependent approaches in anoxic marine sediments to identify microbial indicators of mercury pollution and analyze the distribution of genes involved in mercury reduction (merA) and demethylation (merB). While none of the isolates featured merB genes, 52 isolates, predominantly affiliated with Gammaproteobacteria, were merA positive. In contrast, merA genes detected in metagenomes were assigned to different phyla, including Desulfobacterota, Actinomycetota, Gemmatimonadota, Nitrospirota, and Pseudomonadota. This indicates a widespread capacity for mercury reduction in anoxic sediment microbiomes. Notably, merA genes were predominately identified in Desulfobacterota, a phylum previously associated only with mercury methylation. Marker genes involved in the latter process (hgcAB) were also mainly assigned to Desulfobacterota, implying a potential central and multifaceted role of this phylum in the mercury cycle. Network analysis revealed that Desulfobacterota were associated with anaerobic fermenters, methanogens and sulfur-oxidizers, indicating potential interactions between key players of the carbon, sulfur and mercury cycling in anoxic marine sediments.

Sequential administration of paricalcitol followed by IL-17 blockade for progressive refractory IgA nephropathy patients.

There is no established treatment for progressive IgA nephropathy refractory to steroids and immunosuppressant drugs (r-IgAN). Interleukin 17 (IL-17) blockade has garnered interest in immune-mediated diseases involving the gut-kidney axis. However, single IL-17A inhibition induced paradoxical effects in patients with Crohn's disease and some cases of de novo glomerulonephritis, possibly due to the complete Th1 cell response, along with the concomitant downregulation of regulatory T cells (Tregs). Seven r-IgAN patients were treated with at least six months of oral paricalcitol, followed by the addition of subcutaneous anti-IL-17A (secukinumab). After a mean follow-up of 28 months, proteinuria decreased by 71% (95% CI: 56-87), P < 0.001. One patient started dialysis, while the annual eGFR decline in the remaining patients [mean (95% CI)] was reduced by 4.9 mL/min/1.73 m2 (95% CI: 0.1-9.7), P = 0.046. Circulating Th1, Th17, and Treg cells remained stable, but Th2 cells decreased, modifying the Th1/Th2 ratio. Intriguingly, accumulation of circulating Th17.1 cells was observed. This novel sequential therapy appears to optimize renal advantages in patients with r-IgAN and elicit alterations in potentially pathogenic T helper cells.

Lipotransferencia por decantación asistida con células madre del tejido adiposo para el rejuvenecimiento facial

Introducción: El mito de rejuvenecer o ser bello eternamente es un sueño que la humanidad siempre ha compartido en muchas leyendas. Objetivo: Evaluar los resultados de la lipotransferencia por decantación asistida con células madre del tejido adiposo para el rejuvenecimiento facial. Métodos: Se realizó un estudio descriptivo, prospectivo y longitudinal de 35 pacientes seleccionados por muestreo aleatorio simple, en el Servicio de Cirugía Plástica del Hospital Hermanos Ameijeiras de La Habana, desde septiembre de 2019 hasta igual periodo de 2022. Resultados: En la casuística, la edad media fue de 46,5 ± 11,5 años con valores mínimo de 34 y máximo de 57 años; 48,6 % se encontraban en el grupo etario de 50-59 años. Se constató un predominio del fototipo cutáneo II (60,0 %); en pacientes sanos, el mayor porcentaje con grado de envejecimiento fue el de tipo III (57,1 %). Prevalecieron las arrugas finas en reposo y líneas más profundas con expresión facial (40,0 %) en quienes recibirían lipotransferencia asistida. Posterior al tratamiento se constató mejoría en todos los pacientes; ninguno presentó complicación. La evaluación de este procedimiento resultó ser buena (94,3 %). Conclusiones: La lipotransferencia es un procedimiento mínimamente invasivo con ventajas en cuanto a histocompatibilidad, durabilidad y menor número de complicaciones; tiene una elevada tasa de aceptación. El resultado final favorable, la seguridad y la efectividad se observan en la satisfacción del paciente.

Introduction: The myth to rejuvenate or to be eternally beautiful is a dream that the humanity has always shared in many legends. Objective: To evaluate the results of lipotransference by assisted decantation with stem cells of adipose tissue for the facial rejuvenation. Methods: A descriptive, prospective and longitudinal study was carried out with 35 patients selected by simple random sampling in the Plastic Surgery Service of Hermanos Ameijeiras Hospital in Havana city, from September, 2019 to the same month in 2022. Results: In the case material, the mean age was of 46,5 ± 11,5 years with minimum values of 34 and maximum 57 years; 48.6% was in the 50-59 age group. A prevalence of the II cutaneous phototype was verified (60.0%); in healthy patients, the highest percentage with aging degree was that of type III (57.1%). There was a prevalence of fine wrinkles in rest and deeper lines with facial expression (40.0%) in those who would receive assisted lipotransference. After the treatment improvement was verified in all the patients; none presented complication. The evaluation of this procedure was good (94.3%). Conclusions: Lipotransference is a minimumly invasive procedure with advantages as for histocompatibility, durability and smaller number of complications; it has a high rate of acceptance. The favorable final result, security and effectiveness are observed in the patient's satisfaction.

Gluteoplastia de aumento con implantes intramusculares para el mejoramiento del contorno corporal / Augmentation gluteoplasty with intramuscular implants to improve the physical measurement i:en

Introducción: La región glútea ha sido considerada una de las zonas más observadas tanto en mujeres como en hombres y constituye un ícono representativo de belleza corporal. En los últimos años se ha incrementado el deseo de las féminas de aumentar esta región anatómica con implantes. Objetivo: Determinar los resultados estéticos de la gluteoplastia de aumento con implantes intramusculares. Métodos: Se realizó un estudio prospectivo, longitudinal y descriptivo de 25 mujeres que acudieron a la consulta externa del Servicio de Cirugía Plástica del Hospital Clínico-Quirúrgico Hermanos Ameijeiras, desde agosto de 2016 hasta febrero de 2019, para solicitar el aumento de su región glútea con implantes. Resultados: En la serie predominaron el grupo etario de 31 a 40 años (36,0 %) y el fototipo de piel III (88,0 %); asimismo, solo 6 pacientes presentaron complicaciones (24,0 %), entre las cuales sobresalieron el seroma (20,8 %), la asimetría (12,5 %) y la dehiscencia de la sutura (8,3 %). Se observó un aumento significativo de la proyección glútea después de la intervención (α=0,05) y los resultados fueron buenos en la mayoría de las integrantes de la muestra (84,0 %). Conclusiones: La gluteoplastia de aumento con implantes intramusculares es un procedimiento seguro y ofrece resultados estéticos favorables.

Introduction: Gluteal region has been considered one of the most observed areas either in women as in men and constitutes a representative icon of corporal beauty. In the last years the desire of women to increase this anatomical region with implants has been increased. Objective: To determine the aesthetic results of the augmentation gluteoplasty with intramuscular implants. Methods: A prospective, longitudinal and descriptive study of 25 women that went to the Plastic Surgery Service outpatient consultation of Hermanos Ameijeiras Clinical Surgical Hospital was carried out from August, 2016 to February, 2019, to request the increase of the gluteal region with implants. Results: In the series there was a prevalence of the 31 to 40 age group (36.0%) and the skin phototype III (88.0%); also only 6 patients presented complications (24.0%), among which seroma (20.8%), asymmetry (12.5%) and anastomotic dehiscence (8.3%) were notable. A significant increase of the gluteal projection after the intervention was observed (α =0.05) and the results were good in most of the members of the sample (84.0%). Conclusions: The augmentation gluteoplasty with intramuscular implants is a safe procedure and offers favorable aesthetic results.

Evaluación de la experiencia del paciente conun modelo de atención farmacéutica telemática coordinada entre farmacia hospitalaria y farmaciarural. Proyecto TELÉMACO / Assessing patient experience with a Telepharmacy model coordinated in the hospital and rural pharmacy setting: The TELEMACO project

Objetivo: Determinar la variación en la experiencia del paciente con unmodelo de atención farmacéutica coordinada entre farmacia hospitalariay farmacia rural especializado y el rural de atención comunitaria, basadoen la incorporación de la Telefarmacia.Método: Estudio analítico experimental de intervención antes-después. Paradesarrollar el proyecto se realizarán una serie de procedimientos comunes eindispensables, basados en la metodología capacidad-motivación-oportunidad, en cada uno de los centros.Se diseñará una aplicacion informática de Telefarmacia que contemplará,entre otras, las siguientes funcionalidades: historial de caracterización y priorización farmacoterapéutica de los pacientes; agenda de visitas programadasy registro de visitas no programadas; muro de comunicación genérica entreparticipantes; chat de mensajería instantánea entre pacientes y profesionales;videollamadas; monitorización de la adherencia a la medicación y valoración de cuestionarios de resultados reportados por pacientes.Se incluirán: pacientes mayores de 18 años; en seguimiento habitual en consultas externas de farmacia hospitalaria durante más de 6 meses previo al inicio del estudio; que se encuentren en situación estable desde el punto de vistafarmacoterapéutico (sin cambios de tratamientos en los últimos 6 meses). (AU)

Objective: To determine variation in patient experience with a model ofTelepharmacy coordinated in the specialist hospital and rural pharmacysetting.Method: A pre-post experimental analytical study. A set of commonessential pharmacy tasks based on the capacity-motivation-opportunitymethod will be performed in each participating site.A a Telepharmacy software will be designed to include the followingfunctionalities: history of patient pharmaceutical profiling and prioritization; scheduled appointment book; unscheduled visit record; generic participant communication wall; patient-professional instantaneous messagingchat; video calls; monitoring of treatment adherence; and evaluation ofpatient-reported outcomes.Inclusion criteria: age older than 18 years; being on regular hospital pharmacy follow-up for the last 6 months; using a stable drug therapy (withouttreatment changes in the last 6 months); using a chronic hospital outpatientprescription (any prescription valid for at least 6 months); living in any ofthe municipalities served by the participating pharmacies or using theservices of a participating pharmacy located near the usual place ofresidence; granting informed consent prior to inclusion in the study. A48-week follow-up will be performed of each patient. The primary endpoint will be variation in patient experience, as assessedusing the “Instrumento de Evaluación de la eXperiencia del PAciente Crónico” scale at baseline and at the end of the follow-up period.Conclusions: The incorporation, development and implementation ofa coordinated Telepharmacy care model will help us determine whetherthis model is useful in improving patient follow-up and communication withpharmacy professionals at different levels of healthcare. (AU)

Monitorización de las superficies de trabajo de medicamentos peligrosos en los Servicios de Farmacia. Documento de consenso. Guía de práctica farmacéutica de la Sociedad Española de Farmacia Hospitalaria (SEFH) / Monitoring contamination of hazardous drug compounding surfaces at hospital pharmacy departments. A consensus Statement. Practice guidelines of the Spanish Society of Hospital Pharmacists (SEFH)

Objetivo: Establecer unas recomendaciones, en base a la evidencia disponible, para la monitorización de la contaminación de superficies en las áreasde elaboración de medicamentos peligrosos de los Servicios de Farmacia.Método: A partir de una revisión bibliográfica en las bases de datosMedline y Embase desde enero de 2009 a julio de 2019, así como de laconsulta de documentos de estándares y recomendaciones de organizaciones sanitarias, un comité de expertos de la Sociedad Española de FarmaciaHospitalaria ha definido una serie de prácticas seguras sobre manipulaciónde medicamentos peligrosos y monitorización de superficies de trabajo. Lasdecisiones de recomendación se tomaron por consenso entre el grupo deexpertos teniendo en cuenta las recomendaciones encontradas, la situaciónen nuestro entorno y los costes asociados a la monitorización.Resultados: Se han definido 10 recomendaciones estructuradas enocho secciones. Se incluyen aspectos relacionados con los medicamentos a monitorizar; localizaciones a monitorizar; momento de la toma demuestras; determinación del riesgo y plan de muestreo; técnicas analíticas;umbrales de contaminación; plan de acción según los resultados del muestreo y descontaminación. (AU)

Objective: To establish a series of recommendations based on available evidence for monitoring surface contamination in the areas devoted tocompounding hazardous drugs in pharmacy departments.Method: Based on a literature search in the Medline and Embase databases (search period: January 2009 to July 2019), as well as on a reviewof standards and recommendations issued by different healthcare organizations, a committee of experts from the Spanish Society of Hospital Pharmacists defined a series of safe practices for handling hazardous drugsand monitoring compounding work surfaces. Recommendation decisionswere adopted by consensus among the members of the expert group,considering the recommendations reviewed, the monitoring situation inSpanish hospital departments, and the associated costs.Results: Ten recommendations were formulated, structured into eight sections. They include aspects related to the drugs to be monitored; the areasto be monitored; when samples should be taken; risk determination andpreparation of a sampling protocol; analytical techniques; contaminationthresholds; and design of an action plan based on the sampling anddecontamination results obtained. (AU)

Cuando todo era urgente / When everything was urgent

No disponible

La Sociedad Española de Farmacia Hospitalaria ante la especialidad única / The Stand of the SEFH Toward a Single Speciality

No disponible

Recommendations for the future management of thrombocytopenia in patients with liver cirrhosis: A modified RAND/UCLA appropriateness method / Recomendaciones para el futuro manejo de la trombocitopenia en pacientes con cirrosis hepática: una versión modificada de la Metodología RAND/UCLA

Objective The lack of consensus and specific guidelines, and the introduction of new treatments in thrombocytopenia management in liver cirrhosis patients, required a series of recommendations by experts to improve knowledge on this disease. This study's aim was to improve the knowledge around thrombocytopenia in liver cirrhosis patients, in order to contribute to the generation of future evidence to improve the management of this disease. Patients and methods A modified version of the RAND/UCLA appropriateness method was used. The scientific committee, a multidisciplinary team of 7 experts in managing thrombocytopenia in liver cirrhosis patients, identified the expert panel, and participated in elaborating the questionnaire. Thirty experts from different Spanish institutions were invited to answer a 48-item questionnaire covering 6 areas on a nine-point Likert scale. Two rounds were voted. The consensus was obtained if >77.7% of panelists reached agreement or disagreement. Results A total of 48 statements were developed by the scientific committee and then voted by the experts, resulting in 28 defined as appropriate and completely necessary, relating to evidence generation (10), care circuit, (8), hemorrhagic risk assessment, decision-making and diagnostic tests (14), professionals’ role and multidisciplinary coordination (9) and patient education (7). Conclusions This is the first consensus in Spain on the management of thrombocytopenia in liver cirrhosis patients. Experts indicated several recommendations to be carried out in different areas that could help physicians make better decisions in their clinical practice (AU)

Objetivo La falta de consenso y guías específicas, y la introducción de nuevos tratamientos para el manejo de la trombocitopenia en pacientes con cirrosis hepática, requerían recomendaciones expertas para mejorar el conocimiento sobre dicha patología. El objetivo de este estudio es mejorar el conocimiento sobre la trombocitopenia en pacientes con cirrosis hepática de cara a contribuir en la generación de futuras evidencias que mejoren el manejo de esta patología. Metodología Ae utilizó una versión modificada de la metodología Delphi RAND/UCLA. El comité científico, formado por 7 expertos en el manejo de la trombocitopenia en pacientes con cirrosis hepática, identificó un panel de expertos y participó en la elaboración del cuestionario de recomendaciones. Treinta expertos de diferentes hospitales españoles fueron invitados a responder al cuestionario. Los expertos respondieron a 48 ítems divididos en 6 áreas en una escala Likert de 9 puntos. La votación tuvo lugar en 2 rondas, en las que se obtuvo consenso siempre y cuando >77,7% de los panelistas alcanzasen acuerdo o desacuerdo. Resultados Cuarenta y ocho recomendaciones fueron elaboradas por el comité científico para su votación por parte del panel de expertos. Finalmente 28 recomendaciones fueron consideradas apropiadas y completamente necesarias: 10 de ellas relativas a la generación de evidencia; 8 al circuito de cuidados; 14 a la evaluación de riesgo hemorrágico, la toma de decisiones y los test diagnósticos; 9 al papel de los profesionales y la coordinación multidisciplinar, y 7 a la educación de los pacientes. Conclusiones Se trata del primer consenso español en el manejo de la trombocitopenia en pacientes con cirrosis hepática. Los expertos definieron un amplio número de recomendaciones que podrían contribuir a la toma de decisiones clínicas y a la mejora en el manejo de estos pacientes en la práctica clínica real (AU)

El uso de neumoperitoneo preoperatorio progresivo en el tratamiento de hernia gigante de la pared abdominal / (The use of progressive preoperative pneumoperitoneum as treatment in giant abdominal wall hernia)

Resumen La cirugía para la corrección de las hernias ventrales gigantes, con pérdida de domicilio abdominal, representa un reto importante debido a la gran cantidad de comorbilidades potenciales. En esta patología se produce una migración de los órganos abdominales hacia el saco herniario; eventualmente, se atrofian los elementos de la pared y al tratar de retornarlos a su posición normal, se puede provocar múltiples efectos adversos en el paciente. Por eso, se debe realizar una cuidadosa planificación, preoperatoriamente. El uso de neumoperitoneo preoperatorio progresivo, permite una adaptación más adecuada desde el punto de vista fisiológico, tanto a nivel sistémico, como en la capacidad abdominal, para tolerar el retorno de los contenidos que han perdido su domicilio. Se presenta aquí el caso de una paciente femenina de 58 años, con una hernia ventral gigante con pérdida de domicilio abdominal, en cuyo manejo se utilizó la introducción preoperatoria progresiva de neumoperitoneo, descrita por primera vez por Goñi Moreno, en 1940.

Abstract Surgery for the correction of giant ventral hernias, with loss of abdominal domain, represents a major challenge due to the large number of potential comorbidities. In this pathology there is a migration of the abdominal organs to the hernia sac; eventually, the elements of the wall undergo atrophy and when trying to return the organs to their normal position, it can cause multiple adverse effects in the patient. Therefore, a careful planning must be carried out preoperatively. The use of progressive preoperative pneumoperitoneum, allows a more adequate adaptation from the physiological point of view, both at a systemic level, as in the abdominal capacity, to tolerate the return of contents that have lost their domain. We present here the case of a 58 year old female patient, with a giant ventral hernia with loss of abdominal domain, in whose management, the introduction of progressive preoperative pneumoperitoneum was used, described for the first time by Goñi Moreno, in 1940.