Diseño de una herramienta para la clasificación de pacientes en base a su actitud farmacoterapéutica / Design of a tool for classifying patients based on their pharmacotherapeutic attitude

Introducción: la percepción y alivio del dolor exhiben variabilidad entre individuos. Edad, género, etnia, nivel educativo, nivel real de estrés, estado de ánimo o las condiciones médicas pueden modificar la interpretación personal del dolor y las respuestas al tratamiento farmacológico. Estas diferencias pueden desempeñar un papel significativo en los efectos, en ocasiones no deseados, del tratamiento analgésico.Objetivos: definir perfiles tipo de pacientes con Síndrome de Espalda Fallida ante actitudes con la enfermedad, el tratamiento, la asistencia sanitaria y el seguimiento que reciben de sus profesionales sanitarios. Crear herramienta para la identificación del perfil de paciente.Material y métodos: estudio de series de casos clínicos, observacional, descriptivo y transversal. Población de estudio: pacientes Unidad Dolor Hospital Universitario Nuestra Señora de La Candelaria (HUNSC) en Tenerife en 3 fases: recopilación datos historia clínica (F0), visita inicial (F1) y entrevista personal (F2).Resultados: se obtienen 5 tipologías de pacientes según las respuestas a 17 ítems. A partir de estas respuestas, se calculan ecuaciones de regresión para predecir el tipo de paciente. Se agrupan en: “Clásicos”, “Dependientes”, “Críticos”, “Inconscientes” y “Responsables”. Por otro lado, se obtienen dos herramientas con 17 ítems y otra con 7 ítems optimizados a fin de simplificar el proceso.Conclusiones: estas herramientas permiten a la Farmacia Comunitaria (FC) identificar a los pacientes en función de sus características con el fin de poder dirigir estrategias personalizadas para cada uno de ellos.(AU)

Evaluation of three sets of advanced backcrosses of eggplant with wild relatives from different gene pools under low N fertilization conditions.

The development of new cultivars with improved nitrogen use efficiency (NUE) is key for implementing sustainable agriculture practices. Crop wild relatives (CWRs) provide valuable genetic resources for breeding programs aimed at achieving this goal. In this study, three eggplant (Solanum melongena) accessions together with their advanced backcrosses (ABs; BC3 to BC5 generations) were evaluated for 22 morpho-agronomic, physiological, and NUE traits under low nitrogen (LN) fertilization conditions. The ABs were developed with introgressions from the wild relatives Solanum insanum, Solanum dasyphyllum, and Solanum elaeagnifolium. The AB population comprised a total of 25, 59, and 59 genotypes, respectively, with overall donor wild relative genome coverage percentages of 58.8%, 46.3%, and 99.2%. The three S. melongena recurrent parents were also evaluated under control (normal) N fertilization. Reduction of N fertilization in the parents resulted in decreased chlorophyll content-related traits, aerial biomass, stem diameter, and yield and increased NUE, nitrogen uptake efficiency (NUpE), and nitrogen utilization efficiency (NUtE). However, the decrease in yield was moderate, ranging between 62.6% and 72.6%. A high phenotypic variation was observed within each of the three sets of ABs under LN conditions, with some individuals displaying improved transgressive characteristics over the recurrent parents. Using the single primer enrichment technology 5 k probes platform for high-throughput genotyping, we observed a variable but high degree of recurrent parent genome recovery in the ABs attributable to the lines recombination, allowing the successful identification of 16 quantitative trait loci (QTL). Different allelic effects were observed for the introgressed QTL alleles. Several candidate genes were identified in the QTL regions associated with plant growth, yield, fruit size, and NUE-related parameters. Our results show that eggplant materials with introgressions from CWRs can result in a dramatic impact in eggplant breeding for a more sustainable agriculture.

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)

Proyecto el farmacéutico que necesitas. Carpa de salud 19 abril 2022. L@s farmacéutic@s con la Palma / The pharmacist you need project. Health tent 19 April 2022. Pharmacists with La Palma

INTRODUCCIÓN: la erupción del Volcán de Cumbre Vieja en La Palma. "Este desastre natural ha acarreado a lo largo de tres meses de actividad la muerte de una persona, el desplazamiento de más de 7.000 en una comunidad de algo más de 80.000 residentes, la desaparición de más de 1.200 edificaciones que incluyen viviendas, empresas, colegios, iglesias y hasta cementerios, más de 1.000 hectáreas de terreno de cultivo y la destrucción o deterioro de infraestructuras vitales como carreteras, conducciones eléctricas e hidrológicas. El día a día se ha acompañado de terremotos cotidianos, el rugido y el tremor volcánico, la emisión por el cráter de gases tóxicos, cenizas y piroclastos y el progreso arrasador de la lava incandescente a través de distintas coladas. Evidentemente, esta situación de indefensión y sufrimiento puede originar consecuencias en la salud mental de los afectados, especialmente aquellos más vulnerables como personas con patologías previas, escaso apoyo social o que han sufrido un daño más significativo, tal como se ha visto en otras catástrofes, con la previsible aparición, más o menos diferida, de trastornos como el estrés postraumático, la ansiedad, la depresión o el aumento en el consumo de alcohol y sustancias”.OBJETIVOS: poner de manifiesto, a través de la presencia de los farmacéuticos comunitarios (FC) de Canarias y la acción profesional en las áreas de salud de la carpa, el compromiso de la Sociedad Española de Farmacia Clínica, Familiar y Comunitaria (SEFAC) con la población afectada en la Isla de La Palma con motivo de la erupción del Volcán de Cumbre Vieja del pasado 19 de septiembre de 2021. Ofrecer servicios de educación sanitaria sobre los trastornos de salud derivados de la erupción más prevalentes detectados en las farmacias comunitarias de la isla a través de la labor humanística de escucha, apoyo y motivación del FC como profesional sanitario. (AU)

Servicio de ayuda al tratamiento del paciente con dolor en la farmacia comunitaria española. Resultados del pilotaje / Service to assist the treatment of patients with pain in Spanish community pharmacies. Results of the pilot

JUSTIFICACIÓN: la farmacia comunitaria (FC) debe implicarse en la salud del paciente con dolor, desde la prevención hasta la seguridad del tratamiento farmacológico. Por ello, desarrollado por SEFAC, el servicio profesional farmacéutico asistencial (SPFA) “ayuda al tratamiento del paciente con dolor” (ATRAPADOL), puede ser una herramienta para abordar en la práctica farmacéutica las patologías que cursan con dolor y mejorar la calidad de vida del paciente.OBJETIVOS: detectar/resolver RNM asociados al uso de analgésicos. Reducir no adherencia. Reducir intensidad del dolor. Mejorar la calidad de vida del paciente. Valorar viabilidad del SPFA.MATERIAL&METODOS: estudio multicéntrico, cuasiexperimental sin grupo control. Pacientes >18 años que acuden a la FC, con dolor >6 semanas, se ofrece ATRAPADOL. Diseño: 3 visitas durante 3 meses. Para pacientes diagnosticados se realiza seguimiento del dolor; para pacientes sin diagnostico se realiza cribado/derivación y seguimiento del dolor en visitas sucesivas. Valorándose duración del dolor, diagnóstico, medicamentos, adherencia (Haynes-Sackett), caracterización del dolor (LATTINEN), intensidad de dolor (EVA), calidad de vida (EUROQOL), intervención farmacéutica, tiempo empleado por visita. Análisis estadístico MSExcel®.RESULTADOS: el piloto se prestó a 37 pacientes, 27 tenían diagnóstico previo,10 pacientes no. El tiempo medio empleado fue para 1ª-visita: 41 minutos en pacientes sin diagnóstico frente 39 minutos en pacientes diagnosticados; para 3ª-visita: 26 minutos en ambos grupos. Se detectaron: 54 PRM, (22 % incumplimiento, 15 % automedicación); 29 RNM (51,7 % seguridad). Todos fueron resueltos. Se identificaron como no adherentes 12 pacientes; el principal motivo de no adherencia fue miedo/desinformación, solamente uno refirió olvidos. (AU)

La enfermedad periodontal, diabetes tipo 2 y el riesgo cardiovascular / Periodontal disease, type 2 diabetes and cardiovascular risk

JUSTIFICACIÓN: recientes estudios promovidos por la Federación Dental Internacional y el Consejo General de Dentistas demuestran que existe una relación bidireccional entre la salud oral y la diabetes tipo 2 (DM2). Tanto en la periodontitis como en la DM2, los procesos inflamatorios están aumentados, lo que produce alteraciones microvasculares que provocan que la presencia de una de las dos afecte y empeore el cuadro de la otra enfermedad, lo que puede llevar a un aumento del 20 % del riesgo cardiovascular en estos pacientes. La labor del farmacéutico comunitario podría ayudar a detectar de manera precoz los problemas gingivales y con ello prevenir futuras complicaciones sistémicas derivadas de una enfermedad periodontal (EP) no controlada.OBJETIVO: diseño de un protocolo de cribado para la detección de EP en pacientes con DM2.MATERIAL Y MÉTODOS: se elaboró un protocolo sistematizado "ad hoc" para el desarrollo de una entrevista demográfica, además de una recogida de variables y síntomas de alarma. Fueron seleccionados tras la consulta de documentos hallados mediante una búsqueda bibliográfica en PUBMED, Biblioteca Cochrane Plus y documentos del grupo de Epidemiología de la Sociedad Española de Diabetes. En el registro se incorporaron variables correspondientes a las características de los pacientes: demográficas (edad y sexo), relacionadas con el hábito tabáquico y clínicas (años de tratamiento de la DM2, grupo de fármaco antidiabético, tratamiento cardiovascular, salud dental y sintomatología asociada). RESULTADOS Población diana: pacientes mayores de 18 años que en su plan de tratamiento presenten al menos un medicamento antidiabético frente a DM2. (AU)

Position statement of the Latin American Dysphagia Society for the management of oropharyngeal and esophageal dysphagia during the COVID-19 pandemic.

INTRODUCTION: The SARS-CoV-2 virus that causes the COVID-19 disease is transmitted through the inhalation of droplets or aerosols and inoculation via the oronasal or ocular routes, transforming the management of swallowing disorders into a challenge for healthcare teams, given their proximity to the aerodigestive tract and the high probability of aerosol generation during patient evaluation and treatment. AIM: To provide essential guidance for Latin American multidisciplinary teams, regarding the evaluation and treatment of oropharyngeal and esophageal dysphagia, at the different levels of healthcare. The position statement was formulated for the purpose of maintaining medical service continuity, in the context of a pandemic, and minimizing the propagation and infection risks of the virus. METHODS: Thirteen experts in swallowing disorders were summoned by the Latin American Dysphagia Society to formulate a series of clinical suggestions, based on available evidence and clinical experience, for the management of dysphagia, taking the characteristics of Latin American healthcare systems into account. RESULTS: The position statement of the Latin American Dysphagia Society provides a series of clinical suggestions directed at the multidisciplinary teams that manage patients with oropharyngeal and esophageal dysphagia. It presents guidelines for evaluation and treatment in different contexts, from hospitalization to home care. CONCLUSIONS: The present statement should be analyzed by each team or healthcare professional, to reduce the risk for COVID-19 infection and achieve the best therapeutic results, while at the same time, being mindful of the reality of each Latin American country.

Effect of MBE growth conditions on GaAsBi photoluminescence lineshape and localised state filling.

A series of gallium arsenide bismide device layers covering a range of growth conditions are thoroughly probed by low-temperature, power-dependent photoluminescence measurements. The photoluminescence data is modelled using a localised state profile consisting of two Gaussians. Good agreement with the raw data is achieved for all layers whilst fixing the standard deviation values of the two Gaussians and constraining the band gap using X-ray diffraction data. The effects of growth temperature and bismuth beam equivalent pressure on the localised state distributions, and other model variables, are both shown to be linked to emission linewidth and device properties. It is concluded that bismuth rich surface conditions are preferable during growth in order to produce the narrowest emission linewidths with this material. These results also show how the growth mode of a gallium arsenide bismide layer can be inferred ex-situ from low-temperature photoluminescence measurements.

Development and validation of the Ibadan Simplified Developmental Screening chart.

Background: Developmental assessment remains an integral part of the routine evaluation of the wellbeing of every child. Children in resource-poor countries are not routinely assessed for signs of developmental delay and developmental disorders are frequently overlooked. A major gap exists in the availability of culturally appropriate and cost-effective developmental screening tools in many low and middle income countries (LMICs) with large populations. Objective: To bridge the existing gap, we describe the process of the development and validation of the Ibadan Simplified Developmental Screening (ISDS) chart, for routine developmental screening in Nigerian children. Methods: We developed an item pool across 4 domains of development namely, the gross motor, vision-fine motor, communication and socio-behavioural domains. The ISDS chart consists of 3-4 item questions for each domain of development, and responses are to be provided by the caregiver. Each chart is age-specific, from 6 weeks to 12 months. A total score derived from the summation of the scores in each domain are plotted on the ISDS scoring guide with a pass or fail score. Each child was evaluated by the Ages and Stages Questionnaire as the standard. Results: A total of 950 infants; 453 males and 497 females were enrolled. The estimates of internal consistency between the two instruments ranged between 0.7-1.0. Using the ASQ as the gold standard, the ISDS chart demonstrated a sensitivity of 98.8%, 78.4% and 99.7% in the gross motor, communication and the social and emotional domains respectively, for detecting infants who might require further assessment for developmental delays. Conclusion: The indigenous tool fills a major gap in the need for cost-effective interventions for developmental monitoring in LMICs. Future work should include the deployment of the tool in the wider population, using digital health approaches that could underpin policy making in the region.

[Position statement of the Latin American Dysphagia Society for the management of oropharyngeal and esophageal dysphagia during the COVID-19 pandemic]. / Posicionamiento de la Sociedad Latinoamericana de Disfagia para el manejo de la disfagia orofaríngea y esofágica durante la pandemia COVID-19.

INTRODUCTION: The SARS-CoV-2 virus that causes the COVID-19 disease is transmitted through the inhalation of droplets or aerosols and inoculation via the oronasal or ocular routes, transforming the management of swallowing disorders into a challenge for healthcare teams, given their proximity to the aerodigestive tract and the high probability of aerosol generation during patient evaluation and treatment. AIM: To provide essential guidance for Latin American multidisciplinary teams, regarding the evaluation and treatment of oropharyngeal and esophageal dysphagia, at the different levels of healthcare. The position statement was formulated for the purpose of maintaining medical service continuity, in the context of a pandemic, and minimizing the propagation and infection risks of the virus. METHODS: Thirteen experts in swallowing disorders were summoned by the Latin American Dysphagia Society to formulate a series of clinical suggestions, based on available evidence and clinical experience, for the management of dysphagia, taking the characteristics of Latin American healthcare systems into account. RESULTS: The position statement of the Latin American Dysphagia Society provides a series of clinical suggestions directed at the multidisciplinary teams that manage patients with oropharyngeal and esophageal dysphagia. It presents guidelines for evaluation and treatment in different contexts, from hospitalization to home care. CONCLUSIONS: The present statement should be analyzed by each team or healthcare professional, to reduce the risk for COVID-19 infection and achieve the best therapeutic results, while at the same time, being mindful of the reality of each Latin American country.

Differential analysis of the bacterial community in colostrum samples from women with gestational diabetes mellitus and obesity.

Gestational Diabetes Mellitus (GDM) and obesity affect the functioning of multiple maternal systems and influence colonization of the newborn gastrointestinal through the breastmilk microbiota (BMM). It is currently unclear how GDM and obesity affect the human BMM composition. Here, we applied 16S-rRNA high-throughput sequencing to human colostrum milk to characterize BMM taxonomic changes in a cohort of 43 individuals classified in six subgroups according to mothers patho-physiological conditions (healthy control (n = 18), GDM (n = 13), or obesity (n = 12)) and newborn gender. Using various diversity indicators, including Shannon/Faith phylogenetic index and UniFrac/robust Aitchison distances, we evidenced that BMM composition was influenced by the infant gender in the obesity subgroup. In addition, the GDM group presented higher microbial diversity compared to the control group. Staphylococcus, Corynebacterium 1, Anaerococcus and Prevotella were overrepresented in colostrum from women with either obesity or GDM, compared to control samples. Finally, Rhodobacteraceae was distinct for GDM and 5 families (Bdellovibrionaceae, Halomonadaceae, Shewanellaceae, Saccharimonadales and Vibrionaceae) were distinct for obesity subgroups with an absolute effect size greater than 1 and a q-value ≤ 0.05. This study represents the first effort to describe the impact of maternal GDM and obesity on BMM.

Modelling temperature dynamics in sewer systems - comparing mechanistic and conceptual modelling approaches.

The vast majority of the energy consumed for urban water services is used to heat tap water. Heat recovery from wastewater is consequently an area of rapidly growing concern, both in research and by commercial interest, promoting the path towards a circular economy. To facilitate a system-wide evaluation of heat recovery from wastewater, this paper compares two one-dimensional models (mechanistic and conceptual) that can describe wastewater temperature dynamics in sewer pipe systems. The models are applied to successfully predict downstream wastewater temperature for sewer stretches in two Swedish cities (Linköping and Malmö). The root mean squared errors for the mechanistic model (Linköping Dataset1 - 0.33 °C; Linköping Dataset2 - 0.28 °C; Malmö - 0.40 °C) and the conceptual model (Linköping Dataset1 - 0.32 °C; Linköping Dataset2 - 0.20 °C; Malmö - 0.44 °C) indicate that both models have similar predictive capabilities, encouraging the use of conceptual models to reduce data requirements and model calibration efforts. Both models are freely distributed and can be easily integrated with wastewater generation and treatment models to facilitate system-wide wastewater temperature dynamics analysis.

Colgajo muscular de esternocleidomastoídeo para el manejo de perforación esofágica tardía: reporte de dos casos / Muscle flap of sternocleidomastoid for the management of late esophageal perforation: report of two cases

Resumen Introducción: La perforación esofágica es una complicación poco frecuente en la cirugía de columna cervical por vía anterior, sin embargo, puede tener graves consecuencias cuando hay demoras en diagnóstico y tratamiento. Casos Clínicos: Presentamos dos casos clínicos de pacientes con perforación esofágica secundaria a cirugía de columna cervical por vía anterior. Se usaron para su reparación colgajo muscular de esternocleidomastoideo (ECM). Conclusión: La perforación esofágica secundaria a cirugía de columna cervical es poco frecuente, variable desde el punto de vista clínico, el TC y estudio radiológico contrastado son fundamentales en el diagnóstico de esta patología. El colgajo muscular ECM en estos casos es una herramienta fiable y extremadamente útil debido a sus características anatómicas, fácil disección quirúrgica y baja morbilidad asociada.

Introduction: Esophageal perforation is a rare complication in cervical spine surgery by anterior way, however it can have serious consequences when there are delays in diagnosis and treatment. Cases Report: We present two clinical cases of patients with esophageal perforation secondary to cervical spine surgery by anterior way. Sternocleido-mastoid muscle flaps were used for repair. Conclusion: Esophageal perforation secondary to cervical spine surgery is rare, clinically variable, CT and radiologic study are fundamental in the diagnosis of this pathology. The Sternocleidomastoid muscle flap in these cases is a reliable and extremely useful tool due to its anatomical characteristics, easy surgical dissection and low associated morbidity.

Dispensación de fentanilo y tapentadol en farmacia comunitaria: adherencia farmacoterapéutica en dolor no oncológico / Dispensing of fentanyl and tapentadol in community pharmacy: Therapeutic adherence in non-cancer pain

INTRODUCCIÓN: durante los últimos años ha existido un aumento en la prescripción y dispensación de opioides y una elevada prevalencia de pacientes con dolor crónico no oncológico. Objetivo principal; evaluar adherencia farmacoterapéutica de pacientes con dolor no oncológico en tratamiento con fentanilo o tapentadol. Material/MÉTODOS: estudio observacional, descriptivo, transversal realizado por 139 farmacéuticos comunitarios. Población diana: mayores de 18 años que acuden a la farmacia comunitaria con prescripción de fentanilo o tapentadol. Las variables recogidas fueron edad, sexo, patología, carácter crónico/agudo, indicación, motivo del dolor, principios activos dispensados (conocimiento de posología, administración, posibles reacciones adversas), adherencia (Test de Haynes-Sackett), intensidad del dolor (Escala Visual Analógica), e intervención del farmacéutico. Para medir la adherencia se utilizó el test de Haynes-Sackett, que permite detectar pacientes no adherentes, conocer las dificultades que tienen en el uso de fentanilo o tapentadol y ofrecer recomendaciones para mejorar el uso de estos tratamientos y minimizar los problemas de falta de adherencia. La evaluación del dolor se realizó solo a los pacientes en tratamiento de continuación; determinando el valor medio mediante la medición a través de la EVA del dolor. RESULTADOS: el análisis de la adherencia con el test de Haynes-Sackett mostró que 358 pacientes (87,1 %) no tuvieron dificultad para tomarse/ponerse tratamiento, y 53 pacientes (12,9 %) sí presentaron dificultad, de los cuales, un 77 % son mayores de 70 años y un 79 % son mujeres. Los principales motivos de la no adherencia en la población del estudio fueron: ser persona dependiente, tener dificultad en la colocación y tener problemas de adhesión del parche de fentanilo. La evaluación media del dolor en los pacientes del estudio fue de 6,1 puntos en la EVA; un 44,5 % de los pacientes presenta valores de EVA superior a 6 puntos, para los pacientes no adherentes el valor promedio de la EVA fue 6,6 mientras que para los pacientes adherentes fue 6. Para los pacientes con tratamiento crónico, refirieron un 41 % tener el dolor controlado, 53 % presentó mejora de su capacidad funcional y 57 % mejora de su calidad de vida. En un 37,9 % de los tratamientos de continuación se manifestaron reacciones adversas. La principal reacción adversa fue el estreñimiento presente en un 23,6 % de pacientes con tratamientos crónicos. El 53,9 % de los pacientes respondió sí a querer un Servicio Profesional Farmacéutico Asistencial (SPFA) de abordaje del dolor crónico. CONCLUSIONES: la mayoría de pacientes son adherentes. El principal motivo de no adherencia fue ser una persona dependiente. El valor promedio de EVA fue de 6 puntos. Los pacientes no alcanzan un control adecuado del dolor, aunque reconocen tener mejor capacidad funcional y calidad de vida. En casi un 40% de los tratamientos de continuación se manifestaron reacciones adversas. La mitad de los pacientes demanda un servicio profesional farmacéutico asistencial en dolor

INTRODUCTION: In recent years there has been an increase on prescription and dispensation of opioids and high prevalence of patients with chronic non-oncological pain. Main objective; evaluate the pharmacotherapy adherence of patients with non-cancer pain treated with fentanyl or tapentadol. MATERIAL/ METHODS: Observational, descriptive and transverse study performed by 139 community pharmacists. Target population: people over 18 years old that come to com-munity pharmacy with a prescription of fentanyl or tapentadol. The collected variables were age, sex, pathology, chronic/acute character, indication, reason of pain, dispensed active principles (knowledge of posology, administration, possible adverse reactions), adherence (Haynes-Sackett Test), pain intensity (Visual Analog Scale), and the pharmacist’s intervention. Haynes-Sackett test was used to measure the adherence, which allows detecting non-adherent patients, knowing the difficulties related with the use fentanyl or tapentadol and offering recommendations to improve the use of these treatments and minimize the problems of lack of adherence. The pain evaluation was carried out only in continuation care treatment; determining the average value using the VAS pain measuring system. RESULTS: The adherence analysis using Haynes-Sackett showed 358 patients (87.1%) without difficulties to take/put on treatment while 53 patients (12.9%) did present difficulties, of which 77% were older than 70 years old and 79% were women. The main reasons for the non-adherence in the studied population were: being de-pendent people, having difficulties in the placement and having adhesion problems with fentanyl patches. The average pain measure evaluation in the studied patients was 6.1 points in VAS; 44.5% of patients presented VAS values above 6 points, for the non-adherent patients the average VAS value was 6.6 while for the adherent patients was 6.In patients with chronic treatment, the 41% had controlled pain, 53% presented an improvement in their functional capacity and the 57% had improved their quality life. Adverse reactions were manifested in the 37.9% of the continuation care treatments. The main adverse reaction was the constipation, present in the 23.6% of the patients with chronic treatments.53.9% of the patients answered affirmative to be under Assistance Pharmaceutical Professional Service of boarding chronic pain. CONCLUSIONS: Most of patients were adherent. The main reason for non-adherence was to be a dependent person. VAS average value was 6 points and patients did not reach to an adequate pain control, although they recognize a better functional capacity and quality of life. Almost 40% of the continuation care treatments manifested adverse reactions. Half of the patients demanded Assistance Pharmaceutical Professional Service in pain

Multidisciplinary total eradication therapy (TET) in men with newly diagnosed oligometastatic prostate cancer.

To evaluate the outcomes of total eradication therapy (TET), designed to eradicate all sites of visible cancer and micrometastases, in men with newly diagnosed oligometastatic prostate cancer (OMPCa). Men with ≤ 5 sites of metastases were enrolled in a prospective registry study, underwent neoadjuvant chemohormonal therapy, followed by radical prostatectomy, adjuvant radiation (RT) to prostate bed/pelvis, stereotactic body radiation therapy (SBRT) to oligometastases, and adjuvant hormonal therapy (HT). When possible, the prostate-specific membrane antigen targeted 18F-DCFPyL PET/CT (18F-DCFPyL) scan was obtained, and abiraterone was added to neoadjuvant HT. Twelve men, median 55 years, ECOG 0, median PSA 14.7 ng/dL, clinical stages M0-1/12 (8%), M1a-3/12 (25%) and M1b-8/12 (67%), were treated. 18F-DCFPyL scan was utilized in 58% of cases. Therapies included prostatectomy 12/12 (100%), neoadjuvant [docetaxel 11/12 (92%), LHRH agonist 12/12 (100%), abiraterone + prednisone 6/12 (50%)], adjuvant radiation [RT 2/12 (17%), RT + SBRT 4/12 (33%), SBRT 6/12 (50%)], and LHRH agonist 12/12 (100%)]. 2/5 (40%) initial patients developed neutropenic fever (NF), while 0/6 (0%) subsequent patients given modified docetaxel dosing developed NF. Otherwise, TET resulted in no additive toxicities. Median follow-up was 48.8 months. Overall survival was 12/12 (100%). 1-, 2-, and 3-year undetectable PSA's were 12/12 (100%), 10/12 (83%) and 8/12 (67%), respectively. Median time to biochemical recurrence was not reached. The outcomes suggest TET in men with newly diagnosed OMPCa is safe, does not appear to cause additive toxicities, and may result in an extended interval of undetectable PSA.

In vitro screening of technical lignins to determine their potential as hay preservatives.

Our objectives were to evaluate technical lignins for their antifungal properties against 3 molds and 1 yeast causing hay spoilage, and their ability to preserve ground high-moisture alfalfa hay nutritive value in vitro. In experiment 1, 8 technical lignins and propionic acid (PRP; positive control) were tested at a dose of 40 mg/mL. The experiment had a randomized complete block design (RCBD, 4 runs) and a factorial arrangement of 3 molds × 10 additives (ADV). The effects of the ADV on yeast were evaluated separately with a RCBD. Sodium lignosulfonate (NaL) and PRP were the only treatments with 100 ± 2.8% inhibition of fungi. In experiment 2, the minimum inhibitory concentration (MIC) for selected lignins and PRP were determined. At pH 4, NaL had the lowest MIC across the molds (20-33.3 mg/mL) and magnesium lignosulfonate (MgL) for the yeast (26.7) among the lignins. However, PRP had MIC values that were several-fold lower across all fungi (1.25-3.33). In experiment 3, a RCBD (5 blocks) with a 3 (ADV; NaL, MgL, and PRP) × 4 (doses: 0, 0.5, 1, and 3% wt/wt fresh basis) factorial arrangement of treatments was used to evaluate the preservative effects of ADV in ground high-moisture alfalfa hay inoculated with a mixture of the fungi previously tested and incubated under aerobic conditions in vitro. After 15 d, relative to untreated hay (14.9), dry matter (DM) losses were lessened by doses as low as 1% for NaL (3.39) and 0.5% for PRP (0.81 ± 0.77%). The mold count was reduced in both NaL at 3% (3.92) and PRP as low as 0.5% (3.94) relative to untreated hay (7.76 ± 0.55 log cfu/fresh g). Consequently, sugars were best preserved by NaL at 3% (10.1) and PRP as low as 0.5% (10.5) versus untreated (7.99 ± 0.283% DM), while keeping neutral detergent fiber values lower in NaL (45.9) and PRP-treated (45.1) hays at the same doses, respectively, relative to untreated (49.7 ± 0.66% DM). Hay DM digestibility was increased by doses as low as 3% for NaL (67.5), 1% MgL (67.0), and 0.5% PRP (68.5) versus untreated hay (61.8 ± 0.77%). The lowest doses increasing neutral detergent fiber digestibility relative to untreated hay (23.3) were 0.5% for MgL and PRP (30.5 and 30.1, respectively) and 1% for NaL (30.7 ± 1.09% DM). Across technical lignins, NaL showed the most promise as a potential hay preservative. However, its effects were limited compared with PRP at equivalent doses. Despite not having an effect on preservation, MgL improved DM digestibility by stimulating neutral detergent fiber digestibility. This study warrants further development of NaL under field conditions.

Investigation on Sb distribution for InSb/InAs sub-monolayer heterostructure using TEM techniques.

InSb/InAs sub-monolayer (SML) nanostructures such as SML quantum dots offer sharper emission spectra, a better modal gain and a larger modulation bandwidth compared to its Stranski-Krastanov counterpart. In this work, the Sb distribution of SML InSb layers grown by migration enhanced epitaxy has been analyzed by transmission electron microscopy (TEM) techniques. The analysis of the material by diffraction contrast in 002 dark field conditions and by atomic column resolved high angle annular dark field-scanning TEM reveal the presence of a low Sb content InSbAs continuous layer with scarce Sb-rich InSbAs agglomerates. The intensity profiles obtained by both techniques point to Sb segregation during growth. This segregation has been quantified using the Muraki segregation model obtaining a high segregation coefficient R of 0.81 towards the growth direction. The formation of a continuous InSbAs wetting layer as a result of a SML deposition of Sb on the InAs surface is discussed.

[Focal epileptic seizures mimicking a stroke: neuroimaging and electroencephalographic correlations]. / Crisis epilépticas focales que imitan un ictus: neuroimagen y correlaciones electroencefalográficas.

TITLE: Crisis epilépticas focales que imitan un ictus: neuroimagen y correlaciones electroencefalográficas.