Aerobic vaginitis is associated with carbonic anhydrase IX in cervical intraepithelial neoplasia.

The aim of this study was to analyze the association between vaginal microbiota, carbonic anhydrase IX (CAIX) and histological findings of cervical intraepithelial neoplasia (CIN). The study included 132 females, among them 66 were diagnosed with high-grade intraepithelial lesion (CIN2, CIN3, and cancer), 14 with low-grade disease, and 52 assigned to the control group. An interview focused on the behavior risk factors, together with vaginal fluid pH measurement, wet mount microscopy, detection of Chlamydia trachomatis, and Trichomonas vaginalis were performed. After colposcopy, high-grade abnormalities were detected via direct biopsies and treated with conization procedure. Conuses were immuno-stained with CAIX antibody. The histological findings were CIN1 (n = 14), and CIN2+ (included CIN2 (n = 10), CIN3 (n = 49), and cancer (n = 7; squamous cell carcinomas)). Prevalence of bacterial vaginosis (BV) was similar between the groups. Moderate or severe aerobic vaginitis (msAV) was diagnosed more often among CIN2+ (53.0%) than CIN1 (21.4%). Moderate or strong immunostaining of CAIX (msCAIX) was not detected among CIN1 cases. Thus, msAV was prevalent in CAIX non-stained group (p = 0.049) among CIN2 patients. Co-location of msAV and msCAIX was found in CIN3. Regression model revealed that msAV associated with high-grade cervical intraepithelial neoplasia independently from smoking and the number of partners.

Factors, associated with elevated concentration of soluble carbonic anhydrase IX in plasma of women with cervical dysplasia.

Precancerous lesions of human cervix uteri have a tendency for regression or progression. In cervical intraepithelial neoplasia grade 2 (CINII) case there is an uncertainty if a lesion will progress or regress. The carbonic anhydrase IX (CAIX) enzyme is overexpressed in cervical cancer which is more sensitive to radiotherapy. CAIX is associated with poor prognosis in solid hypoxic tumors. The aim of this study was to determine factors related to elevated soluble CAIX (s-CAIX) in high-grade intraepithelial lesion (HSIL) cases. METHODS: Patients diagnosed with HSIL (N = 77) were included into the research group whereas without HSIL (N = 72)-the control group. Concentration of the soluble CAIX (s-CAIX) in plasma was determined by the DIANA ligand-antibody-based method. C. trachomatis was detected from cervical samples by PCR. Primary outcomes were risk factors elevating s-CAIX level in HSIL group. Non-parametric statistical analysis methods were used to calculate correlations. RESULTS: The s-CAIX level in patients with HSIL was elevated among older participants (rs = 0.27, p = 0.04) and with C. trachomatis infection (p = 0.028). Among heavy smokers with HSIL, the concentration of s-CAIX was higher in older women (rs = 0.52, p = 0.005), but was not related to the age of heavy smokers' controls (τ = 0.18 p = 0.40). CONCLUSION: The concentration of s-CAIX was higher among older, heavy smoking and diagnosed with C. trachomatis patients. All these factors increased the risk for HSIL progression.

Provision of pharmaceutical care by community pharmacists across Europe: Is it developing and spreading?

RATIONALE, AIMS, AND OBJECTIVES: Pharmaceutical care involves patient-centred pharmacist activity to improve medicines management by patients. The implementation of this service in a comprehensive manner, however, requires considerable organisation and effort, and indeed, it is often not fully implemented in care settings. The main objective was to assess how pharmaceutical care provision within community pharmacy has evolved over time in Europe. METHOD: A cross-sectional questionnaire-based survey of community pharmacies, using a modified version of the Behavioural Pharmaceutical Care Scale (BPCS) was conducted in late 2012/early 2013 within 16 European countries and compared with an earlier assessment conducted in 2006. RESULTS: The provision of comprehensive pharmaceutical care has slightly improved in all European countries that participated in both editions of this survey (n = 8) with progress being made particularly in Denmark and Switzerland. Moreover, there was a wider country uptake, indicating spread of the concept. However, due to a number of limitations, the results should be interpreted with caution. Using combined data from participating countries, the provision of pharmaceutical care was positively correlated with the participation of the community pharmacists in patient-centred activities, routine use of pharmacy software with access to clinical data, participation in multidisciplinary team meetings, and having specialized education. CONCLUSIONS: The present study demonstrated a slight evolution in self-reported provision of pharmaceutical care by community pharmacists across Europe, as measured by the BPCS. The slow progress suggests a range of barriers, which are preventing pharmacists moving beyond traditional roles. Support from professional bodies and more patient-centred community pharmacy contracts, including remuneration for pharmaceutical care services, are likely to be required if quicker progress is to be made in the future.

Lack of pharmacist-physician communication associated with nimesulide-induced oligohydramnios during pregnancy.

CASE: The consequences of medication errors can be serious, especially in pregnant women. When decision-making is critical, physician-pharmacist communication has the potential to improve patient safety. In this report, we describe the case of a pregnant woman who developed oligohydramnios after taking nimesulide for neuropathic pain. The drug was improperly prescribed by a family physician and mistakenly dispensed by a community pharmacist. Oligohydramnios was observed during ultrasound examination and an iatrogenic cause was suspected. This case is presented to raise awareness that patient safety is threatened because of a lack of physician-pharmacist communication, especially for pregnant patients. CONCLUSION: Healthcare professionals are continually at-risk for making errors at work. Effective inter-professional communication should be an organisational tool to prevent adverse events for pregnant women.

Experiences of community pharmacists advising pregnant women.

BACKGROUND: Recent studies have shown that pharmacists provide healthcare advice to pregnant women, and that they can play an important role in maternal care. However, pharmacists have faced challenges in advising mothers and coordinating with physicians. OBJECTIVE: To explore the experiences of community pharmacists in advising pregnant women at Lithuanian community pharmacies. SETTING: Community pharmacies in Lithuania. METHODS: Community pharmacists (n = 27) were recruited for semistructured face-to-face interviews from June 2012 to March 2013. A qualitative and descriptive study based on the content analysis approach was used for data collection and analysis. MAIN OUTCOME MEASURE: Thematic coding of Lithuanian community pharmacist interview content. RESULTS: Three main areas emerged: topics of advice-giving, provision of information, and barriers to advice-giving. The question of whether to interact with the physician connected to all of these areas. Pharmacists described different practices about the advice they gave and how they gave it. Lack of knowledge and skills, both about pregnancy and about patient-physician-pharmacist interaction, were a clear barrier to care for pregnant women in community pharmacies. CONCLUSION: Respondents were comfortable giving advice in clear situations, and found it challenging to do so otherwise. Improving the physician-pharmacist-patient communication environment and providing education and training programmes for pharmacists is necessary to reduce stress and to overcome barriers in advising pregnant women.

[Analysis of possibilities of pharmaceutical care elements implementation in Lithuanian community pharmacies]. / Farmacines rupybos elementu igyvendinimo Lietuvos visuomenes vaistinese galimybiu analize.

OBJECTIVE: Objective of this survey--possibilities of implementation of pharmaceutical care elements in daily work of Lithuanian community pharmacies. All pharmacists have to ensure the best quality of pharmaceutical services which they render to their patients. Pharmacists also must improve the quality of pharmaceutical services, according to recommendations of pharmaceutical care. For a start they should implement at least separate elements of pharmaceutical care if they are going to provide pharmaceutical care services in their community pharmacies in the future. That's why this survey was designed to clarify the possibilities of implementation of separate pharmaceutical care elements in to daily work of community pharmacies. MATERIAL AND METHODS: Material of this survey--pharmaceutical services rendered in Lithuanian community pharmacies. This survey has an analytical character and was accomplished with questionnaire. Chiefs of community pharmacies were asked to complete of questionnaire. We gave 150 questionnaires and received answers from 128 pharmacists. RESULTS: After gathered data analysis we found out that only 2% of pharmacies are almost prepared and well equipped for provision of pharmaceutical care services; however, they still have to rearrange their facilities. CONCLUSIONS: Lithuanian community pharmacies are not ready to work according to recommendations of pharmaceutical care today. Some elements of pharmaceutical care (such as blood pressure measurement, provision of written information for patient, etc.) are already implemented by almost all Lithuanian community pharmacies. If pharmacists want to provide pharmaceutical care services they should create a database of patient medication records in pharmacy. Unfortunately Lithuanian pharmacists do not have such databases today. Only with such databases there is a possibility to render pharmaceutical services of the best quality.