[The importance of the logistic warehouse in pandemic period: the experience of the USL Umbria 1 (Perugia, Italy) during covid-19.] / L'importanza del magazzino logistico in periodo di pandemia: l'esperienza dell'USL Umbria 1 durante covid-19.

The pandemic period has generated major problems in the pharmacies of hospitals and local health care companies regarding the distribution of drugs to patients undergoing treatment with chronic drugs. This is because the patient, during the lockdown, was forced to leave the house and go several miles away to reach the place where the drug was dispensed. Moreover, very often, the place was placed in covid-19 hospitals, like the one in Perugia, and was also a risk for the patient himself. The logistical organization allows, in addition to the advantages of traceability, efficiency and savings, with the arrival of the drug at home, a very high patient compliance that also translates into greater security in a pandemic period. To the Usl Umbria 1 of Perugia (Italy) has been centralized the activity of warehouse for all the South area that includes three hospitals and four sanitary districts. Such warehouse, through computerized procedure, guarantees the direct distribution with sending of the medicines directly to the district of belonging of the patient. In this way the patient was not forced to make long and risky trips to continue their chronic therapies. Moreover, this logistic warehouse has also allowed to cope with the correct management of many medicinal specialties that have been used against the SARS-CoV-2 virus avoiding their temporary deficiency for patients already on therapy according to the normal therapeutic indications (anti-inflammatory, antiretroviral and immunomodulatory). This paper aims to demonstrate how logistical organization is of vital importance for a National Health System that has to face increasing costs, ensure the traceability of all processes and, last but not least, survive a worldwide pandemic period.

Coronavirus Covid-19 y dolor crónico: incertidumbres / Covid-19 coronavirus and chronic pain: uncertainties

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Availability of emergency drugs and equipment in general and specialist dental settings in Babol, Iran.

AIM: Medical emergencies can frequently happen in dental settings and it is critical to outfit the clinic by emergency drugs and equipment. The aim of this study was to evaluate the emergency drugs and equipment in general and specialist dental settings in Babol, Iran. MATERIALS AND METHODS: A questionnaire containing closed ended questions about the available emergency drugs and equipment was used in this descriptive-analytical study. Data were subjected to descriptive analysis using SPSS 18.0 to identify the most frequent drugs and equipment. Chi-square and t-test were used to evaluate the correlation between the variables. p < 0.05 was considered statistically significant. RESULTS: One hundred and twelve dentists answered the questionnaire. The most available drug and equipment were epinephrine (67%) and single use syringe (81.3%) respectively. Significant correlation was found between degree of education and availability of first group of emergency drugs and between sex and possession of second group of emergency equipment (p < 0.05). CONCLUSION: Degree of availability of emergency drugs and equipment was moderate to low and training about emergencies should be included in the didactic topics of universities and workshops. CLINICAL SIGNIFICANCE: Information about emergency drug and equipment would help to manage the unwanted emergency situations.

Alternative sources of omega-3 fats: can we find a sustainable substitute for fish?

Increasing demand for eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) containing fish oils is putting pressure on fish species and numbers. Fisheries provide fish for human consumption, supplement production and fish feeds and are currently supplying fish at a maximum historical rate, suggesting mass-scale fishing is no longer sustainable. However, the health properties of EPA and DHA long-chain (LC) omega-3 polyunsaturated fatty acids (PUFA) demonstrate the necessity for these oils in our diets. EPA and DHA from fish oils show favourable effects in inflammatory bowel disease, some cancers and cardiovascular complications. The high prevalence of these diseases worldwide indicates the requirement for alternative sources of LC-PUFA. Strategies have included plant-based fish diets, although this may compromise the health benefits associated with fish oils. Alternatively, stearidonic acid, the product of α-linolenic acid desaturation, may act as an EPA-enhancing fatty acid. Additionally, algae oils may be a promising omega-3 PUFA source for the future. Algae are beneficial for multiple industries, offering a source of biodiesel and livestock feeds. However, further research is required to develop efficient and sustainable LC-PUFA production from algae. This paper summarises the recent research for developing prospective substitutes for omega-3 PUFA and the current limitations that are faced.

Adecuación de la prescripción de antiinflamatorios no esteroideos y gastroprotección en atención primaria / Prescribing non-steroidal antiinflammatory drugs and gastrointestinal protection in primary care

Objetivo. Valorar la adecuación de laprescripción de antiinflamatorios noesteroideos (AINE) y la gastroprotecciónasociada a su uso.Diseño. Estudio descriptivo, transversal.Emplazamiento. Centro de Atención Primariade La Mina (Barcelona).Participantes. De las 4.054 personas conprescripción de AINE, se seleccionó unamuestra aleatoria estratificada por facultativode 500 pacientes.Mediciones principales. Las variablesdependientes fueron la adecuación de laprescripción de AINE y gastroprotección.Las variables independientes fueron: edad,sexo, enfermedades previas, tratamientosconcomitantes, tipo y número de AINE,motivo y tipo de prescripción del AINE. Lasvariables se recogieron de la historia clínica.Resultados. Se incluyó a 476 pacientescon prescripción de AINE. El 63,4% eranmujeres y la media ± desviación estándarde edad fue 47,9 ± 18,1 años. Los AINEmás prescritos fueron ibuprofeno (60,3%),diclofenaco (23,1%) y naproxeno (4%). Elmotivo de prescripción más frecuente fue laafección del aparato locomotor (45,4%). Lasprescripciones fueron adecuadas en el 44,7%(intervalo de confianza [IC] del 95%, 40,2-49,3) e inadecuadas en el 23,5% (IC del 95%,19,8-27,6). La inadecuación en mayores de65 años fue del 49,5%, mientras que enmenores de 65 años fue del 15,6%. Lagastroprotección fue inadecuada en el 28,2%(IC del 95%, 22,7-35,7); el 12,8% por excesoy el 16% por defecto. En el análisismultivariable, la probabilidad deinadecuación de los AINE es 5,45 vecesmayor en los pacientes de 65 años o másque en los menores.Conclusiones. La prescripción de AINEy la gastroprotección pueden considerarseinadecuadas en una cuarta parte de lospacientes. La edad avanzada es el principalfactor de riesgo de prescripción inadecuada

Objective. To assess whether prescribingnon-steroidal anti-inflammatory drugs(NSAIDs) is adequate for gastrointestinalprotection associated with NSAID use.Design. Cross-sectional descriptive study.Setting. Primary Care Centre in La Mina,Barcelona, Spain.Participants. A random sample of 500patients, stratified by doctor was selectedfrom a total of 4504 patients with anNSAID prescription.Main measurements. The dependent variableswere the adequacy of NSAID prescriptionand gastrointestinal protection. Theindependent variables were: age, sex,concomitant treatments, type and numberof NSAIDs. The variables were collectedfrom the clinical history.Results. The 476 patients included with anNSAID prescription had a mean age of 47.9(18.1) years, and 63.4% were women. TheNSAIDs most prescribed were, ibuprofen(60.3%), diclofenac (23.1%), and naproxen(4.0%). The most common reason forprescribing the NSAID was locomotorsystem pathology; 45.4%. The prescriptionwas adequate in 44.7% (95% CI, 40.2-49.3),and inadequate in 23.5% (95% CI, 19.8-27.6). It was inadequate in 49.5% of patientsover 65 years, while in under 65 year-olds16.5% were inadequate. Gastrointestinalprotection was inadequate in 28.2% (95%CI, 22.7-35.7); 12.8% excessive and 16%insufficient. In the multivariate analysis, theinadequacy probability of NSAIDs is 5.45times greater in patients of 65 or more yearsthan in younger patients.Conclusions. NSAID prescribing andgastrointestinal protection can be consideredto be inadequate in 25% of patients.Advanced age is a major risk factorin inadequate prescribing

Effect of in vitro and in vivo aerosolized treatment with geniposide on tracheal permeability in ovalbumin-induced guinea pigs.

The primary objective of this study was to investigate the effect of geniposide, a potent anti-inflammatory, on ovalbumin-antigen-induced tracheal permeability and transepithelial electrical resistance in guinea pigs. Two weeks after sensitization with ovalbumin (100 mg/ml), the permeability of guinea-pig tracheas was evaluated by flux measurements using the transcellular tracer, [(14)C]estradiol, and the paracellular tracer, [(14)C]mannitol. The effect of extracellular Ca(2+) with geniposide was also studied, using deletion of Ca(2+) in the donor chamber. The in vivo treatment effect of aerosolized geniposide on tracheal permeability in the ovalbumin-sensitized guinea pigs was also evaluated. The results indicate that tight junction permeability of ovalbumin-sensitized trachea was significantly dose dependent and decreased by geniposide (1-10 mM), as evidenced by substantial recovery of transepithelial electrical resistance and decreased transepithelial permeability of [(14)C]mannitol at (1.32+/-0.12) x 10(-5) cm/s. The effect of combination of the removal of extracellular Ca(2+) with geniposide had no effect on tight junction permeability of ovalbumin-sensitized trachea and revealed that transepithelial electrical resistance and junction permeability did not recover. In addition, the cAMP levels and phosphodiesterase activity were not significantly influenced in ovalbumin-sensitized tracheal tissues after geniposide treatment. Inhaled geniposide (50 mM, 30 min after ovalbumin sensitization) significantly restored junction permeability induced by ovalbumin (100 mg/ml, 2 min). Junction permeability did not recover on pretreatment with geniposide (50 mM for 30 min over 16 days consecutive before ovalbumin sensitization) after exposure of conscious guinea pigs to aerosol ovalbumin. In conclusion, geniposide has inhibitory effects on ovalbumin-induced junction permeability and recovery of transepithelial electrical resistance in guinea pig trachea, showing its potential as anti-asthma therapy.

[Management of atopic dermatitis]. / Prise en charge de la dermatite atopique.

Management of atopic dermatitis should be based on cooperation among the physician, the child and the parents. There is no "radical" treatment that can eradicate the signs of this chronic affliction, which most often regresses during the first years of life. The aim of treatment is thus to combat infectious factors and to treat flares. In most cases, simple, daily and careful attention, using anti-infectious treatment, anti-inflammatory treatment by local corticosteroid application, and palliating skin dryness will assure the child of normal quality of life.

Availability of over-the-counter drugs for arthritis in Sao Paulo, Brazil.

Seventy pharmacies located in Sao Paulo were randomly selected and visited. Seven researchers posed as ordinary clients presenting with a standardized complaint of symptoms according to a scenario previously defined. The client asked for medicines to relieve his/her pain or discomfort. After the seller's suggestion the client asked for 2 drugs randomly selected from a drug list containing 30 trademarked drugs commonly prescribed to arthritis patients. These drugs should be available only on prescription. In only 12.8% of the pharmacies did the seller initially suggest the client see a physician. The sellers "prescribed' non-steroid anti-inflammatory drugs (NSAID), vitamins, analgesics (AN) and corticosteroids (CO) in respectively 42.8, 20.0, 14.3 and 5.7% of the visits. From the drug list, the client secured 67.7% of the NSAID, 65.0% of the CO and 20.0% of the sedatives without presenting a prescription. Pharmacy sellers usually comply with the clients demands. Future studies should aim at the evaluation of interventions to reduce the availability of the over-the-counter drugs for arthritis.

When topical hydrocortisone became an OTC drug in Sweden--a study of the users and their information sources.

On 1 October 1983 hydrocortisone skin ointments in Sweden were declared OTC drugs and were made available without prescription. These preparations, however, were restricted to pharmacy-only sales. The effect of this reform was studied via telephone interviews with samples of customers who had bought hydrocortisone skin ointments, both with and without prescription. The aim of the study was to analyse the reform from the user's point of view. The interviews were conducted at four points in time: before the reform, during the month after the reform, 9 months and 6 years after the change. The total sales of hydrocortisone ointments have increased in the period from 1983 to 1989, both in terms of number of packages and in weight. Most of the background variables of the OTC users did not change over time. However, the percentage of the OTC group who had university education was high at the time of the reform but decreased later. It was found that journal articles were the most frequently used source of information about preparation availability at the time of the reform. However, their importance decreased over time and pharmacy personnel and nurses had become the most important sources 6 years after the reform. Pharmacy personnel had also become the most important source on brand selection and on how to use the preparation 6 years after the reform. An individual tended to use the same source of information about availability, brand selection and how to use the preparation. Those with university education had seen and used written material more often than those without such a background.

Switching drugs from prescription-only to over-the-counter availability: economic benefits in the United Kingdom.

Recent years have seen suggestions that legislation restricting certain drugs to prescription-only availability should be relaxed. This paper estimates the economic benefits of such changes, with specific reference to two drugs recently switched in the United Kingdom: Ioperamide and 1% topical hydrocortisone. The findings suggest that making these products available from the pharmacy without a prescription has resulted in substantial benefits by reducing costs to consumers and saving general practitioners' time. In view of these benefits, the disadvantages of such changes should be evaluated.