Implantación del servicio de indicación farmacéutica en farmacia comunitaria en España: INDICA+PRO Implantación (2020-2021) / Implementation of the pharmaceutical indication service in community pharmacies in Spain: INDICA+PRO Implementation (2020-2021)

JUSTIFICACIÓN: INDICA+PRO es un estudio de implantación que tiene como objetivo la incorporación del servicio de indicación farmacéutica (SIF) protocolizado en la práctica diaria de la farmacia comunitaria (FC). Se ha estimado que el 25 % del tiempo del farmacéutico en España se dedica a la atención del paciente con síntomas menores. Tras la evaluación de un estudio de impacto que mostró resultados clínicos, humanísticos y económicos positivos en Valencia, se llevó a cabo el estudio INDICA+PRO Implantación para incrementar dicho impacto a escala nacional.OBJETIVOS: desarrollar y evaluar los resultados de un programa de implantación del SIF en la farmacia comunitaria española.MATERIAL Y MÉTODOS: diseño híbrido de efectividad-implantación tipo 3 con una duración inicial de 14 meses. La intervención constaba de diferentes elementos: procedimiento general del SIF establecido por Foro de Atención Farmacéutica en Farmacia Comunitaria, 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 de los farmacéuticos con el seguimiento de 33 farmacéuticos facilitadores del cambio de práctica. Los pacientes recibieron seguimiento tras 10 días de la consulta en farmacia. Se utilizó un marco teórico para la implantación de servicios en FC. (AU)

Influence of chemical and physical conditions in selection of Gluconacetobacter hansenii ATCC 23769 strains with high capacity to produce bacterial cellulose for application as sustained antimicrobial drug-release supports.

AIMS: Obtain varieties of Gluconacetobacter hansenii from original strain ATCC 23729 with greater efficiency to produce bacterial cellulose (BC) membrane with better dry mass yield for application as support of sustained antimicrobials' drug release. METHODS AND RESULTS: Application of different chemical and physical conditions (pH, temperature and UV light exposure) to obtain different G. hansenii varieties with high capacity to produce BC membranes. Characterization of the G. hansenii variants was performed by scanning electron microscopy (SEM) and optical microscopy of the colony-forming units. BC membrane produced was characterized by SEM, infrared spectroscopy and X-ray diffraction. The BC produced by variants isolated after incubation at 35°C showed elevated dry mass yield and high capacity of retention and sustained release of ceftriaxone antibiotic with the produced BC by original G. hansenii ATCC 23769 strain subjected to incubation at 28°C and with commercial BC. CONCLUSION: The application of different chemical and physical conditions constitutes an important method to obtain varieties of micro-organisms with dissimilar metabolism advantageous in relation to the original strain in the BC production. SIGNIFICANCE AND IMPACT OF THE STUDY: These results demonstrate the importance of in vivo studies for the application, in medicine, of BC membranes as support for antimicrobial-sustained release for the skin wound treatment.

A novel binuclear copper complex incorporating a nalidixic acid derivative displaying a one-dimensional coordination polymeric structure.

The identification of the antibacterial action of nalidixic acid (nx) was central to the development of the quinolone antibacterial compounds. The ability of the nx naphthyridyl ring to interact with and inhibit some proteins has encouraged the investigation of similar structures in the search for more active compounds with less adverse effects. The possibility of structural modification by attachment of other biologically active moieties to the naphthyridyl ring of nx allowed the development of new active antimicrobial molecules. Hydrazone derivatives of nx can be synthesized easily based on the condensation of the hydrazide derivative of nx with the desired aldehyde or ketone. Only a few complexes with nx hydrazone derivatives have been described but for none were the crystal structures elucidated. The synthesis of a new one-dimensional Cu(II) coordination polymer, namely catena-poly[[copper(II)-di-µ-chlorido-copper(II)-{µ-1-ethyl-N'-[(1H-imidazol-4-yl)methylidene]-7-methyl-4-oxo-1,4-dihydro-1,8-naphthyridine-3-carbohydrazidato}-[dimethanolcopper(II)]-{µ-1-ethyl-N'-[(1H-imidazol-3-yl)methylidene]-7-methyl-4-oxo-1,4-dihydro-1,8-naphthyridine-3-carbohydrazidato}] dichloride methanol tetrasolvate], {[Cu3(C16H15N6O2)2Cl2(CH3OH)2]Cl2·4CH3OH}n, with the (1H-imidazol-4-yl)methylidene carbohydrazide derivative of nalidixic acid (denoted h4imi), is presented and its structure is compared to the density functional theory (DFT) optimized structure of free h4imi. The title structure presents an octahedral Cu(II) ion on an inversion centre alternating along a polymer chain with a square-pyramidal Cu(II) ion, with the two Cu(II) centres bridged by two chloride ligands. Hydrogen bonds involving chloride counter-ions and methanol solvent molecules mediate the three-dimensional packing of the polymer. Comparison of the geometrical results from the structure analysis with those derived from a DFT study of the free ligand reveal the differences that arise upon coordination.

Effects of coordination mode of 2-mercaptothiazoline on reactivity of Au(I) compounds with thiols and sulfur-containing proteins.

Gold(I) based drugs are interesting for their potential medical use. The relatively facile ligand substitution in linear gold(I) compounds makes the identification of active species complicated. Ligands such as PR3 and CN- are likely to be carrier ligands due to their strong trans-directing properties and will dictate the nature of substitution reactions. The 2-mercaptothiazoline (mtz) ligand is an N,S-heterocyclic compound which presents an exocyclic thiol sulfur as well as a heterocyclic nitrogen. The coordination of mtz to transition metals can be modulated by the trans ligand and complexes with metal bound through the nitrogen and/or the exocyclic sulfur are known. Therefore, the complexes [NCAu(N-mtz)] (N-coordinated) and [(Ph3P)Au(S-mtz)] (S-coordinated) were investigated to compare the influence of CN- and PR3 as well as the coordination mode of the mtz ligand on reactivity with thiols and sulfur-containing proteins. As a further comparison the compound [(Ph3P)AuCN] was also studied. Human serum albumin, egg white lysozyme and, principally, the C-terminal zinc finger (ZF2) of the nucleocapsid NCp7protein of HIV-1 were studied. Results from zinc finger studies show that the coordination structure can determine the reactivity toward biomolecules. Due to ligand scrambling, the complex [NCAu(N-mtz)] forms very reactive species in solution generating [NCyAux-biomolecule] adducts, where x,y≤3. The observation by mass spectrometry of [(CN)Au]-ZF confirms the ability of Au(I) compounds to form [(Ligand)Au] adducts on zinc fingers, in contrast to Au(III), where all ligands are lost upon reaction with the zinc finger. On the other hand, [(Ph3P)Au(S-mtz)] also generates the [(Ph3P)2Au]+ species due to ligand scrambling, that showed lower reactivity, probably due to steric hindrance. For this complex [(Ph3P)Au-biomolecule] and [Au-biomolecule] adducts are dominant. The results corroborate the hypothesis of modulation through coordination as the reactivity clearly depends on not only the ligand, but also the coordination mode.

Surgical management of an epithelioid hemangioendothelioma of the superior vena cava protruding into the right atrium.

Epithelioid hemangioendothelioma (EH) is a rare malignant tumor of vascular origin that often involves soft tissues and visceral organs, and less commonly, large veins. We report a case of EH of the superior vena cava protruding into the right atrium and its surgical management.

[Effect of tinzaparin on survival in non-small-cell lung cancer after surgery. TILT: tinzaparin in lung tumours]. / Effet de la tinzaparine sur la mortalité du cancer bronchique non à petites cellules opéré.

BACKGROUND: Experimental and clinical findings suggest that low molecular-weight heparins may improve overall survival in patients with cancer. The evidence is still limited and additional studies are needed to confirm these preliminary findings. METHODS: Patients with completely resected stage I, II or IIIA (T3N1) histologically confirmed non-small-cell lung cancer will be included in a prospective, controlled, randomized, multicenter open trial. Patients in the control group will receive usual postoperative care including chemotherapy when indicated. Patients in the experimental group will receive tinzaparin given subcutaneously as a daily 100 IU/kg dose for 90 days along with usual postoperative care. Patients will be followed-up for three to eight years. Main end-point is the overall survival. Five hundred and fifty patients are needed to demonstrate a 10% absolute increase in survival in the experimental group. EXPECTED RESULTS: A 10% absolute increase in the survival rate is expected in the patients receiving tinzaparin.

[Broken chest tube into the pleural cavity by a Monod' trocar]. / Section intrapleurale d'un drain thoracique par un trocart de Monod.

We report the case of a 56-year-old man who presented a section of a chest drain into the pleural cavity. Following an oesogastrectomy with coloplasty for oesophageal carcinoma, the patient developed a pleural effusion. During the implementation of pleural drainage, the intrathoracic drain tip was sectioned. The patient underwent a thoracotomy to remove the foreign body. The drain was probably cut during device removal through the particularly cutting trocar. This observation strengthens the need to refrain from withdrawing the movement tube through a Monod trocar.

[Multiple myxomata: about one case]. / Myxomes multiples: à propos d'un cas.

Among the primitive cardiac tumours, myxoma is the most common. This benign tumour is sometimes described in the context of Carney's syndrome, in which cardiac myxoma, cutaneous myxoma, lentigo and pigmentary nevus cutaneous lesions, endocrine disorders, and testicular, thyroid and hypophyseal tumours are associated. The cardiac myxomata observed are multiple, recurrent, and involve the four cardiac chambers, with a peak incidence at 25 years of age. These observations may exist in a familial context, linked to an autosomal dominant genetic factor, localized on the 17q2 chromosome with polymorphism of the PRKAR1a gene. As in the case of sporadic myxoma, rapid surgical treatment with cardio-pulmonary bypass is indicated, bearing in mind the increased risk of thromboembolic phenomena and sudden death from valvular encroachment. We report a case of bi-atrial myxoma observed in the context of Carney's syndrome.

[Complications of pulmonary resection]. / Les complications des résections pulmonaires.

INTRODUCTION: Surgical pulmonary resection remains the most effective treatment of non-small cell lung cancer which is its principal indication. Peri-operative mortality remains fairly high and is associated with post operative complications. BACKGROUND: Complications can involve all the thoracic organs: lung, pleura, bronchi and chest wall and also the heart, blood vessels, nervous system and digestive tract. Individually, but often in combination, these complications can lead to post-operative respiratory failure which has a poor prognosis. Beside the pulmonary conditions that are familiar to the respiratory physician other factors add to the morbidity, notably: age, cardiovascular disease and neo-adjuvent therapies. Many of these complications can be explained by the operative procedure: extent of resection, lymph node dissection, adhesions, dissection of the mediastinum etc. These factors should be considered at an early stage in order to achieve prompt diagnosis and management. Broncho-pleural fistulae present major problems on account of both their prognosis and difficult management. CONCLUSION: Many complications, especially cardiovascular, should be anticipated by the pre-operative investigations. Pneumonectomy remains a procedure with high morbidity and mortality. The risk factors should be taken into account when making a decision on surgical treatment.

Post-mediastinitis ventricle rupture: closing the chest without closing the heart?

Right ventricular rupture following mediastinitis is an unusual but potentially life-threatening complication of cardiac surgery, related to the "open" debridement technique. There are few reports of complex surgical management including repair of the tear and wound closure with omentoplasty or muscle flap with ECC. We report the case of a patient with a right ventricular rupture complicating mediastinitis, which was successfully treated by direct closure of the chest wall without repairing the ventricle tearing and without ECC. We believe that it can be a quick and effective solution at first attempt, and may be a successful and definitive treatment.

[Management of thymic cysts]. / Prise en charge des kystes thymiques.

OBJECTIVE: The thymic cysts are rare tumors of the neck and anterior mediastinum. The management of these patients in our institution is reported. Minimally invasive procedures are discussed. PATIENTS AND METHODS: Six patients operated in our institution within ten years, with a follow-up of 7.1 +/-3.7 years are studied retrospectively. RESULTS: There were four women and two men with an average of 39.8 +/-16.5 years. The tumor was found on chest radiograph in four asymptomatic patients, one took medical advice for laryngeal discomfort and another for dysphagia and dyspnea. The tumor was localized in the anterior mediastinum in three cases, in the cervicomediastinal site in two cases and in the cervical site in one case. CT scan was practiced in three patients with a mediastinal tumor and MR imaging in one of them. In patients with cervical or cervicomediastinal tumor, a cervical echography was practiced. All patients were operated on: three by cervicotomy, one by sternotomy, one by partial upper mini-sternotomy and one by right lateral video-assisted mini-thoracotomy. Histology confirmed benign epithelial thymic cyst. CONCLUSION: There is no specific marker of thymic cysts. Only the surgical management, leads to precise the diagnosis and to treat these tumors. No mortality, no complications or recurrences are reported. The minimally invasive surgery takes an interesting place for thoracic location, to explore and treat these benign mediastinal lesions.

Obstructive intramural coronary amyloidosis and papillary muscle rupture.

Mitral papillary muscle rupture is usually caused by ischaemia as a complication of myocardial infarction. In a 76 year old patient with no significant disease or major cardiovascular risk factors, papillary muscle rupture was caused by obstructive intramural coronary amyloidosis, an unusual cause.

[A case of atypical cryptogenic organising pneumonitis during pregnancy]. / Un cas atypique de pneumopathie organisée cryptogénique au cours d'une grossesse.

Cryptogenic organising pneumonitis (COP) is now a well defined clinico-pathological entity. It may be idiopathic or secondary to infection, a drug reaction or a connective tissue disorder. Corticosteroid treatment is remarkably effective. We describe a case of COP occurring during the course of an acute respiratory distress syndrome in a pregnant woman. The unusual association of blood and pulmonary eosinophilia leads us to envisage a borderline form of COP and eosinophilic pneumonitis. Other unusual features were the poor response to steroids and the rapid improvement following death of the foetus.

[Radial artery aneurysm: an unusual complication of radial artery catheterization]. / L'anévrisme de l'artère radiale: une complication inhabituelle du cathétérisme radial.

Percutaneous arterial cannulation is systematically used in cardiac surgery and reanimation for hemodynamic monitoring. It was frequently used in coronarography. Risk factors for occurrence of radial aneurysm after catheterization may include advanced age, longer duration of catheterization, hospitalization duration, and general infection with Staphylococcus aureus. We report an uncommon case of radial artery aneurysm, after cardiac surgery. We operated the patient with a good result.

[Rupture of ascending aortic aneurysm revealing Takayasu's arteritis]. / Rupture d'un anévrisme de l'aorte ascendante révélant une artérite de Takayasu.

Takayasu's disease is rare in Western countries. It is most often revealed by stenosing lesions, aneurysmal attacks being less frequent, generally multifocal, and associated with stenoses. An isolated aneurysmal attack of the ascending aorta is exceptional. It is a deleterious factor in the disease process, and one of the causes of death in this disease. We report a case of isolated aneurysm of the ascending aorta extending to the aortic arch, undergoing emergency surgery at the rupture phase, revealing Takayasu's arteritis. Classically, isolated, asymptomatic, small aneurysms without lesions of other branches are slow to evolve with prolonged corticosteroid therapy. Our observation was contrary to these data, with rapid growth in a major inflammatory context, and rupture. It would seem important to rapidly diagnose and treat Takayasu's disease aneurysms of the ascending aorta, given their progressive potential. In a young female the signs of parietal thickening of the aneurysm must provoke diagnosis and treatment rapidly.

[Operable lung cancer and synchronous adrenal masses: role of laparoscopic adrenalectomy combined with pulmonary resection]. / Cancer bronchique opérable et lésion surrénalienne synchrone: intérêt du traitement cumulé associant surrénalectomie sous coelioscopie et exérèse pulmonaire.

STUDY AIM: Assessment of laparoscopic adrenalectomy in the management of operable non-small cell lung cancer (NSCLC) associated with solitary and synchronous adrenal mass. PATIENTS AND METHODS: In a retrospective study, we reviewed 3 patients with operable NSCLC proved by pulmonary biopsy and an isolated synchronous adrenal mass shown by abdominal CT scan. We first performed a laparoscopic adrenalectomy followed by pulmonary resection. RESULTS: All patients had a laparoscopic adrenalectomy without any conversion or treatment-related death. Hospitalization stay ranged from 5 to 6 days. A left pneumonectomy has been performed immediately after this first hospitalization in 2 cases and after a first cycle of chemotherapy in the third case. Pathologic examination showed a NSCLC adrenal metastasis in 2 cases and an adrenocortical adenoma in the last case. During the follow-up 2 patients died of other distant metastasis and a mediastinal lymph node recurrence has been diagnosed in the third patient, actually treated by a second line chemotherapy. CONCLUSION: Despite those bad results that concern patients T3 M+ in 2 cases, laparoscopic adrenalectomy seems to be very interesting in selected cases. Considering that pulmonary resection can be done after, it represents a mean of diagnosis at least better than fine needle aspiration biopsy. Laparoscopic adrenalectomy might also be considered in the resection of a synchronous and isolated metastasis as a way to improve survival.