Actuaciones del farmacéutico sobre la demanda de medicamentos a través del servicio de indicación farmacéutica: INDICA+PRO Implantación (2020-2021) / Pharmacist actions on medicines demand through the pharmaceutical indication service: INDICA+PRO Implementation (2020-2021)

JUSTIFICACIÓN: en España, las especialidades farmacéuticas publicitarias sólo están disponibles a través de la farmacia comunitaria (FC). Desde 2019, Foro de Atención Farmacéutica en Farmacia Comunitaria (Foro AF-FC) incluye la demanda de medicamento para un síntoma menor a través del servicio de indicación farmacéutica (SIF) y lo simboliza como “Deme esto para…”. El estudio INDICA+PRO Implantación tiene como objetivo implantar el SIF protocolizado en la FC española incluyendo ambas vías de entrada al servicio (consulta de síntoma menor y demanda de medicamento para el mismo).OBJETIVOS: describir la demanda de medicamentos para un síntoma menor atendidas por el farmacéutico comunitario a través del SIF.MATERIAL Y MÉTODOS: el estudio realizado utiliza un diseño híbrido de efectividad-implantación tipo 3 durante 14 meses inicialmente. La intervención implantada constaba de: procedimiento general del SIF establecido por Foro AF-FC, protocolos consensuados entre sociedades médicas (Semergen y SemFyC), asociaciones farmacéuticas (SEFAC y MICOF) y universidad (GIAF-UGR) específicos para 31 síntomas menores incluidos en una plataforma digital (SEFAC e_XPERT®) y la formación y el seguimiento de los farmacéuticos. Se consideraron los pacientes que acudían a FC demandando un medicamento para un síntoma menor incluido en el estudio (dermatológico, digestivo, relacionado con el dolor, respiratorio u otro). Todos los pacientes recibían seguimiento 10 días tras la consulta en FC.RESULTADOS: 14083 consultas fueron registradas por 687 farmacéuticos pertenecientes a 518 FC. Mayor número de consultas por síntoma menor (84,6 %, n=11911) que por demanda de un medicamento concreto fueron atendidas a través del SIF (15,4 %, n=2172). Entre aquellos pacientes que demandaron un medicamento, el 7,7 % (n=168) fueron derivados al médico. (AU)

Papel del farmacéutico comunitario en la quinta y sexta ola de la pandemia de SARS-Cov2 en Cataluña / The role of the community pharmacist in the fifth and sixth waves of the SARS-Cov2 pandemic in Catalonia

JUSTIFICACIÓN: la pandemia de SARS-Cov2 ha colapsado centros de atención primaria y centros de urgencias. Las escuelas han sufrido un gran número de cierres. Durante la quinta ola el Servei Català de la Salut (CatSalut) implicó a las farmacias comunitarias (FC) en el cribado. El 19 de julio de 2021 empezó el Programa de Test de Antígenos Rápido (TAR) en FC financiado por el CatSalut, con el colectivo de ocio de verano. El 29 de julio empezó el Programa de TAR supervisado no financiado en FC. El 13 de septiembre empezó el Programa de TAR financiado en FC para escuelas. Desde el 3 de enero hasta el 28 de febrero de 2022 las farmacias han sido centros de notificación y registro de positivos domiciliarios, tarea voluntaria y no remunerada. OBJETIVOS: valorar los resultados de la intervención de la FC en el cribado de SARS-Cov2 mediante TAR. Conocer la tasa de positividad de los test financiados o no en FC. Conocer el tiempo invertido por los farmacéuticos comunitarios en el registro de los positivos domiciliarios. MATERIAL Y MÉTODO: estudio observacional descriptivo transversal realizado del 19 de julio de 2021 al 28 de febrero de 2022 en 8 farmacias comunitarias acreditadas por el “Consell de Col•legis de Farmacèutics de Catalunya”, a partir de los registros realizados de los resultados a los test de antígeno en la plataforma TARCAT del CatSatut. El análisis estadístico se ha realizado mediante MSExcel. RESULTADOS: se han realizado 4733 TAR con 323 (6,82 %) resultado positivo. Se han realizado 3401 TAR financiados (centros escolares/educativos) con 239 (7,03 %) resultado positivo. Se han realizado 1332 TAR no financiados con 84 (6,31 %) resultado positivo. Se han notificado 2388 positivos domiciliarios con un tiempo medio invertido de 3 minutos 37 segundos, aproximadamente 18 horas por farmacia acreditada sin retribución. (AU)

Aula de Salud: Cómo ser farmacéutica comunitaria también fuera de la farmacia

JUSTIFICACIÓN: la promoción de la salud y la prevención de las enfermedades son funciones básicas del farmacéutico comunitario. Desde el mostrador de la farmacia, se pueden llevar a cabo de una forma personalizada, pero las actividades formativas impartidas por farmacéuticos comunitarios fuera de la farmacia suponen un valor añadido a la farmacia comunitaria dando visibilidad al farmacéutico como formador de la población en temas de salud pública. Estas actividades formativas pueden ser parte de programas educativos organizados por sociedades o colegios profesionales, como actividades más modestas organizadas por la propia farmacia.OBJETIVOS: describir el servicio de educación sanitaria que se ofrece en nuestra farmacia, actividades ofrecidas a la población bajo el nombre de “Aula de Salud”.MATERIAL Y MÉTODOS: cuando se presenta algún programa educativo organizado por el COF o alguna otra entidad, nos inscribimos y ofrecemos el servicio a quien vaya dirigido (escuelas, AMPAs, asociaciones de pacientes…). Las actividades formativas se publicitan a través de las redes sociales y cartelería en la farmacia. Se imparten en escuelas, centros cívicos, asociaciones de pacientes o en la pequeña aula de la propia farmacia. Los asistentes rellenan un cuestionario de satisfacción después de cada charla.RESULTADOS: durante el último año hemos realizado 7 actividades formativas, todas presenciales. (AU)

Modeling the gelatinization-melting transition of the starch-water system in pulses (lentil, bean and chickpea).

Cooking-induced conversion of starch, the major carbohydrate in pulses, is crucial for the digestibility of the seed. The gelatinization-melting transition of lentil, bean and chickpea starches was studied using Differential Scanning Calorimetry at different temperatures (T values ranged from 20 to 160 °C) and water contents (X from 0.2 to 3 kg kg-1 db). Gelatinization and melting endotherms were successfully modeled as two desummed Gaussian functions. This modeling enabled to generate the degree of starch conversion for any T and X conditions, a valuable indicator that could be used in predictive cooking models. As previously reported for melting, the temperature of gelatinization was found to depend on moisture in a way that can be modeled using the Flory-Huggins equation. The results suggest that starch undergoes melting transition irrespective of water content. The similar starch conversion diagram for the three pulses suggest that starches have similar thermal behavior.

Transfer kinetics of labeled aroma compounds from liquid media into coffee beans during simulated wet processing conditions.

The transfer kinetics of three labelled compounds (butanal, 2-phenyethanol, isoamyl acetate) was studied from a liquid medium into the coffee beans during simulated wet processing using four media (M) (M1: contained dehulled beans, M2: contained demucilaginated beans, M3: contained depulped beans, M4: contained depulped beans with yeast). Trials were carried out at 25 °C, under agitation and for five time periods (0, 6, 12, 24 and 48 h), and then the labelled volatiles were analyzed by SPME-GC-MS. The three labelled molecules were transferred into the coffee beans with different mass transfer rates; reaching at 12hrs in the M4, 0.2 ± 0.03, 11.2 ± 0.66 and 1.3 ± 0.04 µg/g of coffee respectively for butanal, 2-phenyethanol and isoamyl acetate. The parchment resistance significantly affected the mass transfer of the 2-phenylethanol. Butanal and isoamyl acetate underwent metabolic reactions, which decreased their amount in the coffee beans. Furthermore, an interaction between molecules and the yeast was observed and decreased significantly the butanal's transfer.

International Society of Cardiovascular Infectious Diseases Guidelines for the Diagnosis, Treatment and Prevention of Disseminated Mycobacterium chimaera Infection Following Cardiac Surgery with Cardiopulmonary Bypass.

Mycobacterial infection-related morbidity and mortality in patients following cardiopulmonary bypass surgery is high and there is a growing need for a consensus-based expert opinion to provide international guidance for diagnosing, preventing and treating in these patients. In this document the International Society for Cardiovascular Infectious Diseases (ISCVID) covers aspects of prevention (field of hospital epidemiology), clinical management (infectious disease specialists, cardiac surgeons, ophthalmologists, others), laboratory diagnostics (microbiologists, molecular diagnostics), device management (perfusionists, cardiac surgeons) and public health aspects.

Ability to predict the development of surgical site infection in cardiac surgery using the Australian Clinical Risk Index versus the National Nosocomial Infections Surveillance-derived Risk Index.

Surgical site infection (SSI) is a major infectious complication that increases mortality, morbidity, and healthcare costs. There are scores attempting to classify patients for calculating SSI risk. Our objectives were to validate the Australian Clinical Risk Index (ACRI) in a European population after cardiac surgery, comparing it against the National Nosocomial Infections Surveillance-derived risk index (NNIS) and analyzing the predictive power of ACRI for SSI in valvular patients. All the patients that who underwent cardiac surgery in a tertiary university hospital between 2011 and 2015 were analyzed. The patients were divided into valvular and coronary groups, excluding mixed patients. The ACRI score was validated in both groups and its ability to predict SSI was compared to the NNIS risk index. We analyzed 1,657 procedures. In the valvular patient group (n: 1119), a correlation between the ACRI score and SSI development (p < 0.05) was found; there was no such correlation with the NNIS index. The area under the receiver-operating characteristic curve (AUC) was 0.64 (confidence interval [CI] 95%, 0.5-0.7) for ACRI and 0.62 (95% CI, 0.5-0.7) for NNIS. In the coronary group (n: 281), there was a correlation between ACRI and SSI but no between NNIS and SSI. The ACRI AUC was 0.70 (95% CI, 0.5-0.8) and the NNIS AUC was 0.60 (95% CI, 0.4-0.7). The ACRI score has insufficient predictive power, although it predicts SSI development better than the NNIS index, fundamentally in coronary artery bypass grafting (CABG). Further studies analyzing determining factors are needed.

2016 Expert consensus document on prevention, diagnosis and treatment of short-term peripheral venous catheter-related infections in adult.

The use of endovascular catheters is a routine practice in secondary and tertiary care level hospitals. Short peripheral catheters have been found to be associated with the risk of nosocomial bacteremia resulting in morbidity and mortality. Staphyloccus aureus is mostly associated with peripheral catheter insertion. This Consensus Document has been elaborated by a panel of experts of the Spanish Society of Cardiovascular Infections in cooperation with experts from the Spanish Society of Internal Medicine, Spanish Society of Chemotherapy and Spanish Society of Thoracic-Cardiovascular Surgery and aims at define and establish the norm for management of short duration peripheral vascular catheters. The document addresses the indications for insertion, catheter maintenance and registry, diagnosis and treatment of infection, indications for removal and stresses on continuous education as a driver for quality. Implementation of this norm will allow uniformity in usage thus minimizing the risk of infection and its complications.

An Update on Heart Transplantation in Human Immunodeficiency Virus-Infected Patients.

Cardiovascular diseases have become a significant cause of morbidity in patients with human immunodeficiency virus (HIV) infection. Heart transplantation (HT) is a well-established treatment of end-stage heart failure (ESHF) and is performed in selected HIV-infected patients in developed countries. Few data are available on the prognosis of HIV-infected patients undergoing HT in the era of combined antiretroviral therapy (cART) because current evidence is limited to small retrospective cohorts, case series, and case reports. Many HT centers consider HIV infection to be a contraindication for HT; however, in the era of cART, HT recipients with HIV infection seem to achieve satisfactory outcomes without developing HIV-related events. Consequently, selected HIV-infected patients with ESHF who are taking effective cART should be considered candidates for HT. The present review provides epidemiological data on ESHF in HIV-infected patients from all published experience on HT in HIV-infected patients since the beginning of the epidemic. The practical management of these patients is discussed, with emphasis on the challenging issues that must be addressed in the pretransplant (including HIV criteria) and posttransplant periods. Finally, proposals are made for future management and research priorities.

Fosfomycin plus ß-Lactams as Synergistic Bactericidal Combinations for Experimental Endocarditis Due to Methicillin-Resistant and Glycopeptide-Intermediate Staphylococcus aureus.

The urgent need of effective therapies for methicillin-resistant Staphylococcus aureus (MRSA) infective endocarditis (IE) is a cause of concern. We aimed to ascertain the in vitro and in vivo activity of the older antibiotic fosfomycin combined with different beta-lactams against MRSA and glycopeptide-intermediate-resistant S. aureus (GISA) strains. Time-kill tests with 10 isolates showed that fosfomycin plus imipenem (FOF+IPM) was the most active evaluated combination. In an aortic valve IE model with two strains (MRSA-277H and GISA-ATCC 700788), the following intravenous regimens were compared: fosfomycin (2 g every 8 h [q8h]) plus imipenem (1 g q6h) or ceftriaxone (2 g q12h) (FOF+CRO) and vancomycin at a standard dose (VAN-SD) (1 g q12h) and a high dose (VAN-HD) (1 g q6h). Whereas a significant reduction of MRSA-227H load in the vegetations (veg) was observed with FOF+IPM compared with VAN-SD (0 [interquartile range [IQR], 0 to 1] versus 2 [IQR, 0 to 5.1] log CFU/g veg; P = 0.01), no statistical differences were found with VAN-HD. In addition, FOF+IPM sterilized more vegetations than VAN-SD (11/15 [73%] versus 5/16 [31%]; P = 0.02). The GISA-ATCC 700788 load in the vegetations was significantly lower after FOF+IPM or FOF+CRO treatment than with VAN-SD (2 [IQR, 0 to 2] and 0 [IQR, 0 to 2] versus 6.5 [IQR, 2 to 6.9] log CFU/g veg; P < 0.01). The number of sterilized vegetations after treatment with FOF+CRO was higher than after treatment with VAN-SD or VAN-HD (8/15 [53%] versus 4/20 [20%] or 4/20 [20%]; P = 0.03). To assess the effect of FOF+IPM on penicillin binding protein (PBP) synthesis, molecular studies were performed, with results showing that FOF+IPM treatment significantly decreased PBP1, PBP2 (but not PBP2a), and PBP3 synthesis. These results allow clinicians to consider the use of FOF+IPM or FOF+CRO to treat MRSA or GISA IE.

Enterococcal endocarditis revisited.

The Enterococcus species is the third main cause of infective endocarditis (IE) worldwide, and it is gaining relevance, especially among healthcare-associated cases. Patients with enterococcal IE are older and have more comorbidities than other types of IE. Classical treatment options are limited due to the emergence of high-level aminoglycosides resistance (HLAR), vancomycin resistance and multidrug resistance in some cases. Besides, few new antimicrobial alternatives have shown real efficacy, despite some of them being recommended by major guidelines (including linezolid and daptomycin). Ampicillin plus ceftriaxone 2 g iv./12 h is a good option for Enterococcus faecalis IE caused by HLAR strains, but randomized clinical trials are essential to demonstrate its efficacy for non-HLAR EFIE and to compare it with ampicillin plus short-course gentamicin. The main mechanisms of resistance and treatment options are also reviewed for other enterococcal species.

Digestibility prediction of cooked plantain flour as a function of water content and temperature.

The effect of temperature (T=55-120°C) and water content (X1=1.4-2.0 kg kg(-1) dry basis) on the gelatinization and digestibility of plantain flour (Dominico Harton genotype) were investigated. The degree of plantain starch gelatinization (α) was measured by DSC and modelled as a function of T and X1, using the Weibull model. Rapidly digestible starch (RDS) and resistant starch (RS) fractions were evaluated for different α values. An appropriate dimensionless variable was introduced to the analyzed and modelled RDS and RS as a function of α. Starch gelatinization begins at a temperature above 59.6 ± 0.5°C and α is strongly dependent on T in non-limiting water conditions. The combined effects of T and X1 on the RDS and RS can be explained by α. We demonstrate that various heat treatments and water contents lead to the same α, with the same RDS and RS values.

One-year outcome following biological or mechanical valve replacement for infective endocarditis.

BACKGROUND: Nearly half of patients require cardiac surgery during the acute phase of infective endocarditis (IE). We describe the characteristics of patients according to the type of valve replacement (mechanical or biological), and examine whether the type of prosthesis was associated with in-hospital and 1-year mortality. METHODS AND RESULTS: Among 5591 patients included in the International Collaboration on Endocarditis Prospective Cohort Study, 1467 patients with definite IE were operated on during the active phase and had a biological (37%) or mechanical (63%) valve replacement. Patients who received bioprostheses were older (62 vs 54years), more often had a history of cancer (9% vs 6%), and had moderate or severe renal disease (9% vs 4%); proportion of health care-associated IE was higher (26% vs 17%); intracardiac abscesses were more frequent (30% vs 23%). In-hospital and 1-year death rates were higher in the bioprosthesis group, 20.5% vs 14.0% (p=0.0009) and 25.3% vs 16.6% (p<.0001), respectively. In multivariable analysis, mechanical prostheses were less commonly implanted in older patients (odds ratio: 0.64 for every 10years), and in patients with a history of cancer (0.72), but were more commonly implanted in mitral position (1.60). Bioprosthesis was independently associated with 1-year mortality (hazard ratio: 1.298). CONCLUSIONS: Patients with IE who receive a biological valve replacement have significant differences in clinical characteristics compared to patients who receive a mechanical prosthesis. Biological valve replacement is independently associated with a higher in-hospital and 1-year mortality, a result which is possibly related to patient characteristics rather than valve dysfunction.

Changes in the treatment of Enterococcus faecalis infective endocarditis in Spain in the last 15 years: from ampicillin plus gentamicin to ampicillin plus ceftriaxone.

The aim of this study was to assess changes in antibiotic resistance, epidemiology and outcome among patients with Enterococcus faecalis infective endocarditis (EFIE) and to compare the efficacy and safety of the combination of ampicillin and gentamicin (A+G) with that of ampicillin plus ceftriaxone (A+C). The study was a retrospective analysis of a prospective cohort of EFIE patients treated in our centre from 1997 to 2011. Thirty patients were initially treated with A+G (ampicillin 2 g/4 h and gentamicin 3 mg/kg/day) and 39 with A+C (ampicillin 2 g/4 h and ceftriaxone 2 g/12 h) for 4-6 weeks. Increased rates of high-level aminoglycoside resistance (HLAR; gentamicin MIC ≥512 mg/L, streptomycin MIC ≥1024 mg/L or both) were observed in recent years (24% in 1997-2006 and 49% in 2007-2011; p 0.03). The use of A+C increased over time: 1997-2001, 4/18 (22%); 2002-2006, 5/16 (31%); 2007-2011, 30/35 (86%) (p <0.001). Renal failure developed in 65% of the A+G group and in 34% of the A+C group (p 0.014). Thirteen patients (43%) in the A+G group had to discontinue treatment, whereas only one patient (3%) treated with A+C had to discontinue treatment (p <0.001). Only development of heart failure and previous chronic renal failure were independently associated with 1-year mortality, while the individual antibiotic regimen (A+C vs. A+G) did not affect outcome (OR, 0.7; 95% CI, 0.2-2.2; p 0.549). Our study shows that the prevalence of HLAR EFIE has increased significantly in recent years and that alternative treatment with A+C is safer than A+G, with similar clinical outcomes, although the sample size is too small to draw firm conclusions. Randomized controlled studies are needed to confirm these results.

Tricuspid valve surgery.

INTRODUCTION: The tricuspid valve has been taken as a non-critical valve in terms of acute or late mortality in a number of conditions. Tricuspid functional regurgitation is a cause of late operations with an increased morbidity. A number of techniques have been described and used in clinical practice in the past forty years and include simple suture techniques and the use of support for annuloplasty with the use of different types of prosthetic rings. The experience accumulated over the years indicates that tricuspid annuloplasty is mandatory to improve late results, which are superior, in general, to replacement of the valve. METHODS: The role of echocardiography in defining surgical planning, intraoperative results and follow-up is reviewed as echocardiography is a fundamental tool in cardiac surgery. Surgery for isolated lesions of the tricuspid valve has not received much attention and herein we report the results of the follow-up of a limited series of patients undergoing isolated tricuspid surgery. RESULTS: The correlation between echocardiographic measurements and surgical measurements was confirmed and was helpful at the time of the confirmation of repair (r=0.53). Forty-seven patients (18 repair, 29 replacement) underwent isolated surgery. Results of isolated tricuspid repair seemed to be superior when compared to those of tricuspid replacement. Survival was 20.7% for tricuspid valve replacement (N=18) and 50% for tricuspid valve repair (N=29) (p=0.04). Freedom from reoperation was 94.4±5.4% for repair and 67.3±12.1% for replacement (p= 0.0011). CONCLUSIONS: The tricuspid valve continues to be a surgical challenge.

The International E-vita Open Registry: data sets of 274 patients.

AIM: After the introduction of the hybrid stent-graft "E-vita-open" by the Essen group in 1/2005 for one stage repair of complex thoracic aortic disease, the International E-vita open Registry was founded in 2008 to study the principles of this treatment algorithm and to control reported favorable single center results on a large patient data set basis up to six years after the first clinical implant. METHODS: Retrospective data work-up after prospective data acquisition was achieved by institution of the International E-vita open Registry with anonymous registration and calculation at Essen University Hospital. From January 2005 to December 2010, 274 patients (mean age 60; 74% males) with complex aortic disease, 190 with aortic dissection (88 acute (AAD), 102 chronic aortic dissection (CAD), and 84 with complex thoracic aortic aneurysm (TAA) were included in the studied. RESULTS: Eighty-one out of 274 (30%) patients underwent emergency surgery. Stent-graft deployment and arch replacement (238 total, 36 subtotal) was performed under selective antegrade cerebral perfusion (75 min mean). Cardiopulmonary bypass (CPB) and cardiac arrest times were mean 235 and 134 minutes, respectively. In-hospital mortality was 15% (40/274), 18% for AAD, 13% for CAD, and 14% for TAA. New strokes were observed in 6% (16/274), spinal cord injury in 8% (22/274). The false lumen (FL) was evaluated throughout the first hospital stay and at a median follow up time of 59 months after surgery. From the first follow up CT-examination to the last, thoracic complete FL thrombosis increased from 83% to 93% in AAD, from 72% to 92% in CAD. Full exclusion of the aneurysmal disease was achieved in 77% (61/79) during the primary hospital stay. CONCLUSION: Favorable single center results could be confirmed by an International community of cardiac surgical centers in regard to hospital mortality and morbidity, as well as a low postoperative complication rate and exclusion of false lumen in aortic dissection.

Variability of grain quality in sorghum: association with polymorphism in Sh2, Bt2, SssI, Ae1, Wx and O2.

To ensure food security in Africa and Asia, developing sorghum varieties with grain quality that matches consumer demand is a major breeding objective that requires a better understanding of the genetic control of grain quality traits. The objective of this targeted association study was to assess whether the polymorphism detected in six genes involved in synthesis pathways of starch (Sh2, Bt2, SssI, Ae1, and Wx) or grain storage proteins (O2) could explain the phenotypic variability of six grain quality traits [amylose content (AM), protein content (PR), lipid content (LI), hardness (HD), endosperm texture (ET), peak gelatinization temperature (PGT)], two yield component traits [thousand grain weight (TGW) and number of grains per panicle (NBG)], and yield itself (YLD). We used a core collection of 195 accessions which had been previously phenotyped and for which polymorphic sites had been identified in sequenced segments of the six genes. The associations between gene polymorphism and phenotypic traits were analyzed with Tassel. The percentages of admixture of each accession, estimated using 60 RFLP probes, were used as cofactors in the analyses, decreasing the proportion of false-positive tests (70%) due to population structure. The significant associations observed matched generally well the role of the enzymes encoded by the genes known to determine starch amount or type. Sh2, Bt2, Ae1, and Wx were associated with TGW. SssI and Ae1 were associated with PGT, a trait influenced by amylopectin amount. Sh2 was associated with AM while Wx was not, possibly because of the absence of waxy accessions in our collection. O2 and Wx were associated with HD and ET. No association was found between O2 and PR. These results were consistent with QTL or association data in sorghum and in orthologous zones of maize. This study represents the first targeted association mapping study for grain quality in sorghum and paves the way for marker-aided selection.