Alivia: implantación del servicio ATRAPADOL en la farmacia comunitaria española / Alivia: implementation of the ATRAPADOL service in Spanish community pharmacies

JUSTIFICACIÓN: el servicio de ayuda al tratamiento del paciente con dolor (ATRAPADOL) es el primer servicio profesional farmacéutico asistencial (SPFA) centrado exclusivamente en personas con dolor superior a 6 semanas de duración, desarrollado por SEFAC para la farmacia comunitaria (FC). La capacitación ALIVIA incluye, además de una formación para el farmacéutico para que sea capaz de desarrollar el servicio ATRAPADOL, una formación complementaria en sintomatología menor y dolor agudo para mejorar el servicio de indicación farmacéutica.OBJETIVOS: implantar el servicio de ayuda al tratamiento del paciente con dolor (ATRAPADOL) en la FC.MATERIAL Y MÉTODOS: para lo que se diseñó el SPFA ATRAPADOL, con tres fases: teórica, práctica y clínica. El servicio consta de 3 visitas durante 3 meses. Para pacientes diagnosticados se realiza seguimiento del dolor; para pacientes sin diagnóstico se realiza cribado/derivación y seguimiento del dolor en visitas sucesivas. Valorándose duración del dolor, diagnóstico, medicamentos, adherencia (Haynes-Sackett), Valoración del dolor Cuestionario McGill para los no diagnosticados; caracterización del dolor (índice de LATTINEN), intensidad de dolor (Escala Visual Analógica (EVA), e intervención farmacéutica. Análisis estadístico MSExcel®.RESULTADOS: 103 farmacéuticos han llegado a la fase clínica de la capacitación del SPFA con 602 registros en SEFAC e_XPERT y 77 de ellos han registrados 3 o más casos. Las provincias con más registros son Alicante (91), Santa Cruz de Tenerife (84), Zaragoza (68) y Madrid (65). De los 602 registros, 372 eran mujeres (61,8 %) y 230 varones (38,2 %); con una edad media de 51 años. Con dolor diagnosticado se han realizado 353 casos (58,6 %), mientras que de dolor no diagnosticado se han realizado 249 casos (41,4 %). (AU)

Cribado de COVID-19 en una farmacia comunitaria / COVID-19 screening in a community pharmacy

JUSTIFICACIÓN: las pruebas rápidas de antígenos (PRA) es una de las herramientas para el control de la progresión de la pandemia de COVID-19. Se considera una herramienta de diagnóstico rápido de casos positivos, útil para conseguir el objetivo de ampliar la capacidad diagnóstica. La agencia española de medicamentos y productos sanitarios (AEMPS) comunica el 30-abril-2021 aprobación y modificación del real decreto 1662/2000 sobre productos sanitarios para diagnóstico in vitro. Por el que las pruebas de autodiagnóstico de la COVID-19 quedan exentas de prescripción. El 22- julio -2021 se inicia la dispensación en Farmacia comunitaria (FC). Una parte de la población necesita ayuda en la realización de las PRA y solicitan la realización de estas por parte del farmacéutico.OBJETIVOS: evaluar la necesidad que tiene la población del farmacéutico en la realización de PRA ya sea en la FC o en domicilio. Conocer el perfil del paciente que solicita dichas pruebas.MATERIAL Y MÉTODO: estudio observacional transversal realizado en una FC de Alcoy por 2 farmacéuticas, (29-10-2021 al 28-02-2022).Se realiza la PRA en la farmacia habilitando una zona, o en domicilio, con medidas de protección necesarias, a todo paciente que lo solicita. Se realiza la prueba con Rapid SARS-COV-2 Antigen Test Card, XIAMEN BOSON BIOTECH CO y se registra en la Plataforma SEFAC e_XPERT: datos demográficos, síntomas (tos seca, fiebre, cefalea, diarrea, fatiga, disnea, mialgia, náuseas, odinofagia,), contacto con positivo COVID 19 y realización de PRA en domicilio. Análisis estadístico con Microsoft ExcelR. (AU)

Conocimiento del grado de satisfacción ciudadana por la autorrealización de test COVID- 19 en farmacia comunitaria en la Comunidad Valenciana / Knowledge of the degree of citizen satisfaction with the self-performance of the COVID-19 test in community pharmacies in the Valencian Community

JUSTIFICACIÓN: la Consellería de Sanitat i Salut Pública - Comunitat Valenciana autorizó desde el 11 de enero 2022 la realización de autotest COVID en farmacias comunitarias de esta comunidad a cualquier persona con un cuadro clínico compatible con la COVID-19: de carácter leve, de infección respiratoria aguda de aparición súbita y que curse con tos o dolor de garganta o síntomas nasales, con o sin fiebre. En caso de dar el test positivo, el farmacéutico será responsable de registrar el resultado de dicho autotest en la plataforma electrónica habilitada a tal efecto. Este procedimiento es voluntario para la ciudadanía, y a las 24 h el propio ciudadano puede pedir on line la baja laboral por la COVID. Esta medida tiene como objetivo aliviar la presión asistencial en los centros de atención primaria.OBJETIVOS. Objetivo principal: registrar el grado de satisfacción de los ciudadanos con la medida adoptada por Consellería. Secundario: conocer la participación de los ciudadanos en el autotest COVID19 en farmacias. Ampliar el conocimiento de esta medida para la población, incluída la baja laboral en caso de positividad del test.MATERIAL Y MÉTODOS: en 10 días aleatorizados se invita a cualquier ciudadano que entra en la farmacia a participar en una encuesta sobre la satisfacción de la medida adoptada por la Conselleria sobre la realización de Test- COVID19 en su casa o en la farmacia. En caso positivo si ha podido acceder al sistema de baja laboral automático. La recogida de datos se realizó desde 20 de febrero hasta 1 de marzo de 2022 en 6 farmacias de la Comunidad Valenciana. (AU)

Chromatographic Methods for the Determination of Emerging Contaminants in Natural Water and Wastewater Samples: A Review.

This review is devoted to analytical methods published in the scientific literature in the last 10 years for the determination of emerging contaminants in aquatic media. The article is mainly focused on sample preparation and on instrumental techniques most used for the detection and quantification of the analytes of interest. The sample preparation techniques include classical liquid-liquid extraction and solid-phase extraction, but also recent microextraction techniques such as solid-phase microextraction, stir-bar sorptive extraction, dispersive liquid-liquid microextraction, ultrasound-assisted emulsification microextraction, or microextraction by packed sorbent. Most studies focus on minimizing the number of analysis steps and on the use of the lowest amount of solvents in the sample treatment step. Liquid chromatography and gas chromatography mainly coupled to tandem mass spectrometry are usually the employed analytical techniques. A large number of multiresidue methods are being developed for the determination of several families of these compounds with only one extraction step to minimize sample handling and treatment.

Determination of bisphenols with estrogenic activity in plastic packaged baby food samples using solid-liquid extraction and clean-up with dispersive sorbents followed by gas chromatography tandem mass spectrometry analysis.

Bisphenols (BPs) are a family of chemicals with known endocrine disrupting activity. Bisphenol A (BPA) is the most representative prototype of this group of chemicals. Recently, the use of BPA, a prototype of endocrine disruptors, has been reduced and replaced with structural analogs due to its negative effects on both the environment and consumers. In this work, a new method is presented for the determination of seven BPs, with estrogenic activity in ready-to-eat plastic packaged baby foods. The procedure involves the isolation of the analytes using solid-liquid phase extraction with acetonitrile followed by a clean-up step with a mixture of dispersive-SPE sorbents (C18 and PSA) and magnesium sulphate, to reduce matrix effect from proteins, sugars and lipids. Extraction parameters were optimized using multivariate optimization methods. The compounds were detected and quantified by gas chromatography tandem mass spectrometry (GC-MS/MS). The limits of quantification were between 0.1 and 1.2ngg-1 for the studied analytes. The method was validated using matrix-matched calibration and recovery assays with spiked samples. Recovery rates were between 91% and 110% and % RSD was lower than 13% in all cases. The method has been successfully applied for the determination of these endocrine disrupting chemicals (EDCs) in samples of a novel type of food consumed by pre-schoolers. This is the first study to analyze EDCs in plastic packaged foods consumed by this target group.

Impact of vitrification on the mitochondrial activity and redox homeostasis of human oocyte.

STUDY QUESTION: Do the extreme conditions of vitrification affect mitochondrial health and reactive oxygen species (ROS) levels of human oocytes? SUMMARY ANSWER: Vitrification of discarded human oocytes shifts the intracellular redox potential towards oxidation but does not alter the mitochondrial potential or intracellular ROS levels. WHAT IS KNOWN ALREADY: Recent studies have reflected increased ROS levels in warmed young oocytes and have highlighted the temporal dynamic loss of mitochondrial potential that could, therefore, lead to a decrease in ATP production, impairing embryo development. Mitochondrial function can also be evaluated in vivo by the FAD/NAD(P)H autofluorescence ratio, which reflects the respiratory chain activity and is considered as a marker of the intracellular redox state. STUDY DESIGN, SIZE, DURATION: A total of 629 discarded Metaphase II (MII) oocytes collected from June 2013 to April 2014 were included in this control (fresh oocytes, n= 270) versus treatment (vitrified oocytes, n= 359) study. PARTICIPANTS/MATERIALS, SETTING, METHODS: Discarded MII oocytes were donated to research by young (<27 years old) and reproductively aged (>36 years old) women who underwent ovarian stimulation for IVF at a university-affiliated private fertility clinic. Redox state was assessed by measuring the FAD/NAD(P)H autofluorescence ratio, while ROS and mitochondrial activity were reported by in vivo labelling with carboxy-H2DCFDA and JC-1, respectively. MAIN RESULTS AND THE ROLE OF CHANCE: Young and aged oocytes showed high and similar survival rates (81.8 versus 83.1%, not significant). Confocal microscopy revealed that the FAD/NAD(P)H ratio was significantly higher in vitrified oocytes than in fresh oocytes, suggesting a significant shift towards the oxidized state in oocytes after vitrification, regardless of the maternal age. Mitochondrial distribution was not affected by vitrification. Furthermore, it was not possible to resolve any difference in mitochondrial potential using JC-1 potentiometric dye or in reactive oxygen species (ROS) production (assessed with H2-DCFDA staining) between fresh and vitrified oocytes. Therefore, measurement of intracellular redox potential by autofluorescence imaging may be a more sensitive method to assess oxidative stress or mitochondrial demise in human oocytes because it showed a higher resolving power than JC-1 staining and displayed less variability than H2-DCFDA staining. LIMITATIONS, REASONS FOR CAUTION: Owing to sample availability, MII discarded oocytes (in vitro matured oocytes and unfertilized oocytes 20 h after ICSI) were included in the study. These discarded oocytes do not necessarily reflect the physiological condition of the MII human oocyte. WIDER IMPLICATIONS OF THE FINDINGS: Although vitrified oocytes yield comparable clinical outcomes compared with fresh oocytes, lower cleavage and blastocyst rates can be observed during in vitro culture. Data here obtained suggest that the redox state of human oocytes could be affected by vitrification. Therefore, the importance of adding protective antioxidant molecules to the vitrification solution and to the post-warming culture medium to improve embryo cleavage deserves some research. STUDY FUNDING/COMPETING INTERESTS: This research project was supported by the Valencian Government (Val+i+D program, M.N.-C.), INCLIVA Foundation for health research (G.S.-A.) and by the University of L'Aquila and Regione Abruzzo ('Reti per l'Alta Formazione' - P.O.F.S.E. Abruzzo 2007-2013 G.D.E.). No conflicts of interest were declared.

Online, social media and mobile technologies for psychosis treatment: a systematic review on novel user-led interventions.

BACKGROUND: Internet and mobile-based interventions provide a unique opportunity to deliver cost-effective, accessible, time-unlimited support to people with psychosis. The aims of this study were to systematically compile and analyze the evidence on the acceptability, feasibility, safety and benefits of online and mobile-based interventions for psychosis. METHODS: Systematic review of peer-reviewed studies examining the usability, acceptability, feasibility, safety or efficacy of user-led, Internet or mobile-based interventions, with at least 80% of participants diagnosed with schizophrenia-spectrum disorders. RESULTS: Of 38 potentially relevant articles, 12 were eligible for inclusion. Interventions included web-based psycho-education; web-based psycho-education plus moderated forums for patients and supporters; integrated web-based therapy, social networking and peer and expert moderation; web-based CBT; personalized advice based on clinical monitoring; and text messaging interventions. Results showed that 74-86% of patients used the web-based interventions efficiently, 75-92% perceived them as positive and useful, and 70-86% completed or were engaged with the interventions over the follow-up. Preliminary evidence indicated that online and mobile-based interventions show promise in improving positive psychotic symptoms, hospital admissions, socialization, social connectedness, depression and medication adherence. CONCLUSIONS: Internet and mobile-based interventions for psychosis seem to be acceptable and feasible and have the potential to improve clinical and social outcomes. The heterogeneity, poor quality and early state of current research precludes any definite conclusions. Future research should investigate the efficacy of online and mobile interventions through controlled, well-powered studies, which investigate intervention and patient factors associated with take-up and intervention effects.

[Forensic neuropsychology at the challenge of the relationship between cognition and emotion in psychopathy]. / La neuropsicología forense ante el reto de la relación entre cognición y emoción en la psicopatía.

INTRODUCTION: The relationship between frontal lobe damage and criminality is especially complex. The neural substrates of psychopathic behavior seem to involve structural and functional abnormalities in the frontal lobes and the limbic system. AIM. To analyze the repercussions that brain structural and functional abnormalities in psychopathic individuals may have for forensic neuropsychology. DEVELOPMENT: Consistent evidence indicate that response inhibition problems in psychopathic subjects are linked to structural or functional damage in the frontal cortex. Furthermore, the prefrontal cortex, along with the amygdala and the hippocampus forms the limbic system, which is an important neural substrate of emotion processing; therefore the psychopath's capacity of affective processing could also be impaired. The theoretical frameworks of the somatic marker and mirror neuron hypotheses, along with the empirical study of executive functions may contribute to explain the inability of the psychopathic subjects to feel empathy, which is one of the main inhibitors of violence and antisocial behavior. CONCLUSIONS: The relationship between frontal lobe dysfunction and antisocial behavior arises an important legal issue. In order to consider some type of minor liability in the case of psychopaths it is suggested to gather further research data about the relationship between frontal lobe dysfunction and the ability to inhibit antisocial behavior by making an adequate use of empathy and emotional ties.

La neuropsicología forense ante el reto de la relación entre cognición y emoción en la psicopatía / Forensic neuropsychology at the challenge of the relationship between cognition and emotion in psychopathy

Introducción. La relación entre daño en el lóbulo frontal y criminalidad es particularmente compleja. El sustrato anatómico subyacente al comportamiento psicopático se refleja en diferencias estructurales y funcionales vinculadas al lóbulo frontal. Objetivo. Analizar las repercusiones de las alteraciones estructurales y funcionales del lóbulo frontal en los sujetos psicópatas para la neuropsicología forense. Desarrollo. Hay un cuerpo de investigación coherente que sugiere que los problemas de inhibición de los psicópatas se vinculan con daños estructurales o funcionales en la corteza frontal. Por otra parte, laamígdala, el hipocampo y la corteza prefrontal se integran en el sistema límbico, que gobierna la expresión de las emociones, por lo que los psicópatas también podrían ver afectada su capacidad de procesamiento afectivo. Las hipótesis de los marcadoressomáticos y de las neuronas espejo, junto con el estudio de la función ejecutiva, podrían revelar las deficiencias de los psicópatas para experimentar empatía, que es uno de los principales inhibidores de la violencia y la conducta antisocial. Conclusiones. La conexión entre disfunción del lóbulo frontal y comportamiento antisocial plantea una importante cuestiónforense. En el caso de los psicópatas, para que se pueda considerar algún tipo de menor responsabilidad legal se sugiere seguir acumulando datos de investigación de la relación entre disfunción del lóbulo frontal y capacidad de inhibir la conducta antisocial haciendo un correcto uso de la empatía y de los vínculos emocionales

Introduction. The relationship between frontal lobe damage and criminality is especially complex. The neural substrates of psychopathic behavior seem to involve structural and functional abnormalities in the frontal lobes and the limbic system. Aim. To analyze the repercussions that brain structural and functional abnormalities in psychopathic individuals may havefor forensic neuropsychology. Development. Consistent evidence indicate that response inhibition problems in psychopathic subjects are linked to structural or functional damage in the frontal cortex. Furthermore, the prefrontal cortex, along with theamygdala and the hippocampus forms the limbic system, which is an important neural substrate of emotion processing; therefore the psychopath’s capacity of affective processing could also be impaired. The theoretical frameworks of the somatic marker and mirror neuron hypotheses, along with the empirical study of executive functions may contribute to explain the inability of the psychopathic subjects to feel empathy, which is one of the main inhibitors of violence and antisocial behavior. Conclusions. The relationship between frontal lobe dysfunction and antisocial behavior arises an important legal issue. In order to consider some type of minor liability in the case of psychopaths it is suggested to gather further research data about the relationship between frontal lobe dysfunction and the ability to inhibit antisocial behavior by making an adequate use of empathy and emotional ties

[Guidelines for the scientific and professional development of forensic neuropsychology]. / Pautas para el desarrollo científico y profesional de la neuropsicología forense.

AIMS: The principal aims of this review are: (a) to offer a perspective of the principal challenges that forensic neuropsychology handles in its scientific and professional development, and the empirical advances that have been developed to deal with these challenges; and (b) analyze the potential effects of these advances on the application of the discipline in the Spanish legal system. DEVELOPMENT: With the purpose of reaching these challenges, a series of methodological strategies and instruments, along with specific recommendations about the use of currently available procedures and the development of new procedures, have been generated within the context of forensic neuropsychology. In this paper, we will review: the advances carried out in the different issues of interest that currently handles the development of the discipline, including: the estimation of premorbid functioning, the development of base rates and norms for forensic populations, the detection of malingerers, the ecological validity of instruments, and the creation of professional practices; we will analyze the potential application of these advances to the assessment of the Spanish forensic population; and we will study the principal application areas of forensic neuropsychology within the Spanish legal context. CONCLUSIONS: Forensic neuropsychology is an emergent discipline that is placed in a key moment of its scientific and professional development. This development should be anchored in the application of specific scientific, professional, and academic strategies.

Resistencia aeróbica en futbolistas de categoría cadete y juvenil / Aerobic endurance in cadete and junior soccer players

De entre los distintos componentes de la condición física es sin duda la resistencia aeróbica uno de los más determinantes para el futbolista actual. Este estudio analiza los valores de potencia aeróbica (VO2max) y capacidad aeróbica (umbral anaeróbico) según la edad, categoría y demarcación ocupada en el terreno de juego. Se realiza una prueba de esfuerzo a 287 futbolistas de categoría cadete y juvenil. Para hallar los umbrales ventilatorios se utiliza el método de los equivalentes ventilatorios. Se determina el VO2max cuando alcanza la meseta de consumo máximo de oxígeno. El rango de valores medios de VO2max se sitúa entre los 54,9ñ4,5 ml/kg/min hallados en el grupo de 17 años y los 57,8ñ6,5 ml/kg/min encontrados en el grupo de 14 años. El rango de valores medios de umbral anaeróbico se sitúa entre el 87,3ñ4,6 por ciento del VO2max encontrado en el grupo de 14 años y el 83,8ñ5,4 por ciento del VO2max encontrado en el grupo de 18 años. La potencia aeróbica (VO2max) muestra una tendencia descendente con el aumento de la edad y el paso de categoría. La capacidad aeróbica (umbral anaeróbico) no experimenta diferencias con el paso de la edad y categoría (AU)

Thrombolysis with recombinant tissue plasminogen activator during cardiopulmonary resuscitation in fulminant pulmonary embolism. A case series.

OBJECTIVE: To describe our outcomes using thrombolysis during the cardiopulmonary resuscitation (CPR) of patients in cardiorespiratory arrest (CA) caused by fulminant pulmonary embolism (FPE). DESIGN: A case series. SETTING: Intensive care units of a district hospital and a referral centre. PATIENTS: Six patients that suffered CA secondary to an FPE. INTERVENTIONS: Administration of recombinant tissue plasminogen activator during usual CPR manoeuvres when there was a strong suspicion of FPE. Permission for the thrombolytic therapy was sought from family members in all cases. RESULTS: Four out of the six patients survived and remain symptom-free. The thrombolysis was not associated with any fatal complications. CONCLUSIONS: Early thrombolysis during CPR manoeuvres for CA apparently caused by an FPE may reduce the mortality rate among these patients.

Efficacy of thrombolysis in patients with acute myocardial infarction requiring cardiopulmonary resuscitation.

OBJECTIVE: To evaluate the efficacy and safety of systemic thrombolysis administered to resuscitated patients after cardiac arrest (CA) due to an acute myocardial infarction (AMI), through a study of their mortality and haemorrhagic complications. DESIGN: We studied a retrospective cohort of patients with ischaemic heart disease gathered from the database of the Spanish multi-centre project "Analysis of Delay in AMI" (ARIAM). SETTING: Intensive care (ICU) and coronary care (CCU) units of 77 Spanish hospitals. PATIENTS AND PARTICIPANTS: The study period was from 1 January 1995 to 1 January 2000, when 22,922 patients were included in the ARIAM database register; 13,704 were diagnosed with AMI and we studied 303 of these AMI patients admitted after resuscitation for CA. MEASUREMENTS AND RESULTS: Of the 303 patients studied, 228 were male (75.25%); the mean age was 64.57 +/- 12.48 years. Systemic thrombolysis was administered to 67 patients (group I) and the remaining 236 patients were managed without this treatment (group II). The ICU/CCU mortality rate of the series was 39.93 % (121 patients); that of group I was 17.91% (12 patients) and that of group II 46.18% (109 patients) (P < 0.00001). Group I required less mechanical ventilation (group I, 42.85% vs group II, 80.76 %; P < 0.00001) and fewer cardiopulmonary resuscitation attempts (33.34% vs 60.98%, P < 0.0001). Group I also showed a lower incidence of cardiogenic shock (14.28% vs 39.01%, P < 0.0001) and anoxic encephalopathy (8.62% vs 39.89% P = 0.006). There were no fatal haemorrhagic complications in either group. Logistic regression analysis showed the administration of thrombolysis to be an independent variable that protected against mortality. CONCLUSIONS: The administration of thrombolysis to patients with AMI who require resuscitation may be efficacious in reducing mortality and is safe, with no increase in haemorrhagic complications.

Miniexamen neurológico en el traumatismo craneoencefálico grave / Neurologic mini-examination in severe cranio-encephalic trauma

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Carcinoma de células esmeriladas de cérvix. Estudio de un caso con análisis inmunohistoquímico / Glassy cell carcinoma of the cervix. Study of a case with immunohistochemical profile

Propósito: Describir un estudio anatomoclínico de un tipo infrecuente de carcinoma adenoescamoso pobremente diferenciado de cérvix, incidiendo en el perfil inmunohistoquímico de éste. Material y métodos: Se trata de una mujer de 59 años que presenta una tumoración polipoide en cérvix, que se extirpa, procediendo a su estudio anatomopatológico, que aporta el diagnóstico de carcinoma de células de citoplasma esmerilado. Se realiza tratamiento quirúrgico con histerectomía y doble anaexectomía. La paciente está libre de evidencia de enfermedad a los 6 meses del diagnóstico. Resultados: Tumoración de estirpe epitelial (E.M.A., AE1-AE3, Cam 5.2 y C.E.A positivas) que se dispone en nidos y cordones sólidos separados por estroma fibrovascular con abundante infiltrado linfoide. Los nidos tumorales muestran celularidad con notable atipia y característico aspecto esmerilado de citoplasma. Conclusiones: Se realiza una aportación al estudio de las características inmunohistoquímicas de esta infrecuente neoplasia (AU)

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