Intervenciones farmacéuticas en usuarios de benzodiacepinas durante la pandemia COVID-19 / Pharmaceutical interventions in benzodiazepine users during the COVID-19 pandemic

Introducción: la Intervención Farmacéutica busca optimizar y racionalizar el uso, la efectividad y la seguridad de los medicamentos dispensados resolviendo problemas relacionados con el medicamento (PRM) y resultados negativos asociados a la medicación (RNM).Objetivo: evaluar las Intervenciones Farmacéuticas realizadas a usuarios de benzodiacepinas durante la pandemia COVID-19 desde una Farmacia Comunitaria.Método: estudio prospectivo observacional, descriptivo y transversal (código AEMPS: DAA-CLO-2020-01) de las Intervenciones Farmacéuticas llevadas a cabo por una farmacia comunitaria tinerfeña entre agosto 2020 y febrero 2021.Resultados: un total de 306 Intervenciones Farmacéuticas fueron realizadas sobre 127 pacientes. La educación sanitaria y la información personalizada sobre el medicamento fueron las Intervenciones Farmacéuticas mayoritarias tras detectar entre los pacientes un alto grado de desconocimiento sobre las benzodiacepinas usadas. Las Intervenciones Farmacéuticas que se acompañan de derivación al médico alcanzan el 37,8 % tras detectar PRM y/o RNM o identificar al paciente como candidato para deprescripción. Estas derivaciones incluyen a los pacientes con un estado de depresión muy alto según el test Euroqol 5D-3L. La Intervención Farmacéutica con derivación al Servicio de Seguimiento Farmacoterapéutico se realiza en el 3,1 % de los pacientes. El grado de aceptación de la Intervención Farmacéutica por parte de los pacientes alcanza el 98,4 %.Conclusiones: el alto porcentaje de aceptación de las Intervenciones Farmacéuticas refuerza el valor de la Farmacia Comunitaria en la optimización y racionalización del uso de benzodiacepinas y fortalece el vínculo farmacéutico-paciente. La pandemia COVID-19 dificultó la colaboración farmacéutico-médico, a pesar de la existencia de protocolos telemáticos de comunicación entre sanitarios.(AU)

Speciation within the Anopheles gambiae complex: high-throughput whole genome sequencing reveals evidence of a putative new cryptic taxon in 'far-west' Africa.

The two main Afrotropical malaria vectors - Anopheles coluzzii and An. gambiae - are genetically distinct and reproductively isolated across West Africa. However, populations at the western extreme of their range are assigned as "intermediate" between the two species by whole genome sequence (WGS) data, and as hybrid forms by conventional molecular diagnostics. By exploiting WGS data from 1,190 specimens collected across west Africa via the Anopheles gambiae 1000 Genomes network, we identify a novel putative taxon in the far-west (provisionally named Bissau molecular form), which did not arise by admixture but rather originated at the same time as the split between An. coluzzii and An. gambiae. Intriguingly, these populations lack insecticide resistance mechanisms commonly observed in the two main species. These findings lead to a change of perspective on malaria vector species in the far-west region with potential for epidemiological implications, and a new challenge for genetic-based mosquito control approaches.

Impact of a Community Pharmacy Pharmacotherapy Follow-up (PTF) service in patients using opioid analgesic.

The use of prescribed major opioid analgesics (fentanyl, tapentadol, morphine and oxycodone and combinations) for non-cancer chronic pain is fraught with risks that may generate Negative Medicine Outcomes (NMO). Among the factors associated with these risks, those related to the patient's characteristics and aberrant behavior, the treatment conditions, and the prescription health settings should be evaluated with the aim of minimizing unsafety during the health care process. The present study addresses, from a community pharmacy, the analysis of Drug Related Problems (DRP) and Negative Medicine Outcomes (NMO) in patients using these major opioid analgesics while it aims to demonstrate the role of pharmaceutical care interventions in promoting safety during the use of these molecules. A three step Pharmacotherapeutic Follow-up (PFT) protocol was designed to prevent, detect, and solve DRP and NMO associated with the use of opioid analgesics. 74.6% of the patients used opioid analgesics to treat musculoskeletal pain. Polypharmacy with benzodiazepines (61.9%); antidepressants (57.1%) and antiepileptics (30.2%) was detected in patients using these opioids. The Morisky-Green Adherence test revealed that 30.2% were nonadherent. It was observed, with statistical significance, that in all patients (63), the impact of the 14-week PFT supervised by the community pharmacist achieved an overall reduction in the prevalence of DRP and NMO. While the reduction in the number of DRPs reached 66.7%. Community pharmacies are a strategic point to promote and implement effective opioid stewardship due to both their central role in healthcare services and frequent interaction with patients.

Real world data on outcomes of anti-CD38 antibody treated, including triple class refractory, patients with multiple myeloma: a multi-institutional report from the Canadian Myeloma Research Group (CMRG) Database.

Multiple myeloma (MM) remains incurable despite the availability of novel agents. This multi-center retrospective cohort study used the Canadian Myeloma Research Group Database to describe real-world outcomes of patients withanti-CD38 monoclonal antibody (mAb) refractory MM subsequently treated with standard of care (SoC) regimens. Patients with triple class refractory (TCR) disease (refractory to a proteasome inhibitor, immunomodulatory drug, and anti-CD38 mAb) were examined as a distinct cohort. Overall, 663 patients had disease progression on anti-CD38 mAb therapy, 466 received further treatment (346 with SoC regimens were included, 120 with investigational agents on clinical trial and were excluded). The median age at initiation of subsequent SoC therapy of 67.9 (range 39.6-89.6) years with a median of 3 prior lines (range 1-9). The median PFS and OS from the start of subsequent therapy was 4.6 (95% CI 4.1-5.6) months and 13.3 (95% CI 10.6-16.6) months, respectively. The median PFS and OS of patients with TCR disease (n = 199) was 4.4 (95% CI 3.6-5.3) months and 10.5 (95% CI 8.5-13.8) months. Our results reinforce that real-world patients with relapsed MM, particularly those with TCR disease, have dismal outcomes. There remains an urgent unmet need for the development of and access to effective therapeutics for these patients.

[Evaluation of the application of hyaluronic acid in postoperative arthroscopy patients with grade II-III gonarthrosis using the WOMAC scale]. / Evaluación en la aplicación de ácido hialurónico en pacientes postoperados de artroscopía con gonartrosis grado II-III mediante la escala de womac.

INTRODUCTION: gonarthrosis is a degenerative disease, whose loss of cartilage causes changes in the adjacent bone and its response produces deformations and attempts at regeneration. In 1934 Meyer and Palmer isolated bovine vitreous humor, a polysaccharide called hyaluronic acid, which has the property of visco-elasticity. Today, multiple procedures performed in orthopedics are known, in order to limit the degenerative process that this entails. OBJECTIVE: to know the use and efficacy of hyaluronic acid in the patient requiring knee arthroscopy, evaluating the evolution of the patient using the WOMAC scale; as well as the ideal time of application of hyaluronic acid in this study group. MATERIAL AND METHODS: clinical, non-randomized, prospective, analytical trial. 48 patients from 45 to 60 years of age, divided into 3 groups with a diagnosis of gonarthrosis grade II-III, who underwent arthroscopy with subsequent hyaluronic acid application, were evaluated; in the postoperative period (group 1), one month after the postoperative period (group 2) and without application (group 3) in a period from September 2015 to June 2016 at the ISSSTE Hospital "Dr. Darío Fernández Fierro". RESULTS: the treatment showed differences in patients regarding reduction of pain and stiffness; and improvement in functional capacity. CONCLUSION: despite, there are no conclusive results if the treatment is better than the other, certain data suggests that using hyaluronic acid in the postoperative improves rigidity and function, however, it was not statistically significant.

INTRODUCCIÓN: la gonartrosis es una enfermedad degenerativa, cuya pérdida de cartílago origina cambios en el hueso adyacente y su respuesta produce deformaciones e intentos de regeneración. En 1934 Meyer y Palmer aislaron el humor vítreo bovino, polisacárido denominado ácido hialurónico, que tiene la propiedad de visco elasticidad. Hoy en día se conocen múltiples procedimientos realizados en ortopedia, con la finalidad de limitar el proceso degenerativo que este conlleva. OBJETIVO: conocer el uso y la eficacia del ácido hialurónico, en el paciente que requiere artroscopía de rodilla, valorando la evolución del paciente mediante escala de WOMAC; así como el tiempo ideal de aplicación del ácido hialurónico en este grupo de estudio. MATERIAL Y MÉTODOS: ensayo clínico, no aleatorizado longitudinal, prospectivo, analítico. Se valoraron 48 pacientes de 45 a 60 años de edad, divididos en tres grupos con diagnóstico de gonartrosis grado II-III, en quienes se realizaron artroscopía con posterior aplicación ácido hialurónico; en el transquirúrgico (grupo 1), al mes del postquirúrgico (grupo 2) y sin aplicación (grupo 3) en un período de Septiembre de 2015 a Junio de 2016 en el Hospital del ISSSTE "Dr. Darío Fernández Fierro". RESULTADOS: el tratamiento mostró diferencias en los pacientes en cuanto a reducción de dolor y rigidez; y mejoría en capacidad funcional. CONCLUSIÓN: a pesar de que no es concluyente si algún tratamiento es mejor que otro, ciertos datos sugieren que el utilizar ácido hialurónico en el transquirúrgico mejora la rigidez y la función, sin embargo, no logró ser estadísticamente significativo.

Momentum-independent magnetic excitation continuum in the honeycomb iridate H3LiIr2O6.

Understanding the interplay between the inherent disorder and the correlated fluctuating-spin ground state is a key element in the search for quantum spin liquids. H3LiIr2O6 is considered to be a spin liquid that is proximate to the Kitaev-limit quantum spin liquid. Its ground state shows no magnetic order or spin freezing as expected for the spin liquid state. However, hydrogen zero-point motion and stacking faults are known to be present. The resulting bond disorder has been invoked to explain the existence of unexpected low-energy spin excitations, although data interpretation remains challenging. Here, we use resonant X-ray spectroscopies to map the collective excitations in H3LiIr2O6 and characterize its magnetic state. In the low-temperature correlated state, we reveal a broad bandwidth of magnetic excitations. The central energy and the high-energy tail of the continuum are consistent with expectations for dominant ferromagnetic Kitaev interactions between dynamically fluctuating spins. Furthermore, the absence of a momentum dependence to these excitations are consistent with disorder-induced broken translational invariance. Our low-energy data and the energy and width of the crystal field excitations support an interpretation of H3LiIr2O6 as a disordered topological spin liquid in close proximity to bond-disordered versions of the Kitaev quantum spin liquid.

Improvement of the optical, photocatalytic and antibacterial properties of ZnO semiconductor nanoparticles using different pepper aqueous extracts.

Peppers are fruits that grow on plants of the genus Capsicum and are popular for their use in gastronomy as a condiment and for their anti-inflammatory and anti-cancer properties due to their phytocompounds such as flavonoids, polyphenols, or alkaloids. Semiconductor zinc oxide (ZnO) nanoparticles (NPs) were synthesized using a green approach employing natural aqueous extracts of several varieties of peppers (jalapeño, morita, and ghost). The obtained NPs were characterized by different techniques, and their photocatalytic and antibacterial activity was studied. The signal at 620 cm-1 in the FTIR spectra belonging to the Zn-O bond, the appearance of the main peaks of a hexagonal wurtzite structure in the XRD pattern, and the characteristic signals in the UV-Vis spectra confirm the correct formation of ZnO NPs. The photocatalytic activity was analyzed against Methylene Blue (MB), Rhodamine B (RB), and Methyl Orange (MO) under UV and sunlight. All syntheses were able to degrade more than 93% of the pollutants under UV light. Antibacterial assays were performed against gram-positive and gram-negative bacteria. All syntheses exhibited antibacterial activity against all bacteria and maximum growth inhibition against Bacillus subtilis. The prominent results demonstrate that natural aqueous extracts obtained from peppers can be used to synthesize ZnO NPs with photocatalytic and biomedical applications.

Management of women with abnormal uterine bleeding: Clinical practice guidelines of the French National College of Gynaecologists and Obstetricians (CNGOF).

OBJECTIVE: To provide French guidelines for the management of women with abnormal uterine bleeding (AUB). DESIGN: A consensus committee of 26 experts was formed. A formal conflict-of-interest policy was developed at the beginning of the process and enforced throughout. The entire guidelines process was conducted independently of any industry funding (i.e. pharmaceutical or medical device companies). The authors were advised to follow the rules of the Grading of Recommendations Assessment, Development and Evaluation (GRADE®) system to guide assessment of quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasized. METHODS: The last guidelines from the Collège National des Gynécologues et Obstétriciens Français on the management of women with AUB were published in 2008. The literature seems now sufficient for an update. The committee studied questions within 7 fields (diagnosis; adolescents; idiopathic AUB; endometrial hyperplasia and polyps; type 0-2 fibroids; type 3 or higher fibroids; and adenomyosis). Each question was formulated in a PICO (Patients, Intervention, Comparison, Outcome) format and evidence profiles were compiled. The GRADE® methodology was applied to the literature review and the formulation of recommendations. RESULTS: The experts' synthesis work and the application of the GRADE method resulted in 36 recommendations. Among the formalized recommendations, 19 are strong and 17 weak. No response was found in the literature for 14 questions. We chose to abstain from recommendations rather than providing advice based solely on expert clinical experience. CONCLUSIONS: The 36 recommendations make it possible to specify the diagnostic and therapeutic strategies for various clinical situations practitioners encounter, from the simplest to the most complex.

Current vision on diagnosis and comprehensive care in hepatic encephalopathy.

The first clinical guidelines on hepatic encephalopathy were published in 2009. Almost 14 years since that first publication, numerous advances in the field of diagnosis, treatment, and special condition care have been made. Therefore, as an initiative of the Asociación Mexicana de Gastroenterología A.C., we present a current view of those aspects. The manuscript described herein was formulated by 24 experts that participated in six working groups, analyzing, discussing, and summarizing the following topics: Definition of hepatic encephalopathy; recommended classifications; epidemiologic panorama, worldwide and in Mexico; diagnostic tools; conditions that merit a differential diagnosis; treatment; and primary and secondary prophylaxis. Likewise, these guidelines emphasize the management of certain special conditions, such as hepatic encephalopathy in acute liver failure and acute-on-chronic liver failure, as well as specific care in patients with hepatic encephalopathy, such as the use of medications and types of sedation, describing those that are permitted or recommended, and those that are not.

Las reacciones adversas a fármacos son la primera causa de eritrodermia. Estudio retrospectivo de 70 pacientes en un hospital universitario de Argentina / Adverse Drug Reactions Are the Main Causes of Erythroderma in an Argentinian Teaching Hospital: A Retrospective Study of 70 Patients

Antecedentes La eritrodermia es un cuadro caracterizado por un eritema y descamación que compromete al menos el 90% de la superficie corporal. Su etiología puede ser variable. La mayor parte de sus características clínicas y alteraciones del laboratorio son inespecíficas, lo que hace que el diagnóstico sea un desafío. Materiales y métodos Se realizó un estudio retrospectivo en el periodo comprendido entre el 1 de enero de 2010 y el 1 de junio de 2020. Se revisaron los antecedentes, las características clínicas, los hallazgos de laboratorio e histopatológicos, así como la evolución de todos los pacientes con una eritrodermia hospitalizados en el Hospital Italiano de Buenos Aires, con un seguimiento mínimo de 6 meses. Resultados Se incluyeron 70 pacientes. La edad media de aparición fue de 63 años con una relación hombre:mujer de 1,2:1. La principal causa de eritrodermia fueron las reacciones adversas a fármacos (48%), siendo la vancomicina el principal medicamento involucrado (30%), mientras que la segunda causa fueron las dermatosis preexistentes, dentro de las cuales la psoriasis fue la más común (42%). En el 40% de los pacientes se observó una adecuada correlación clínico-patológica con la primera biopsia, mientras que el rédito diagnóstico aumentó a un 76% con la segunda. El número máximo de biopsias requerido para efectuar el diagnóstico etiológico fue de 8 (2 pacientes). La evolución fue favorable en el 92% de los casos. Conclusión Las reacciones adversas a fármacos fueron la primera causa de eritrodermia y la vancomicina el fármaco responsable más frecuente. No se encontraron asociaciones estadísticamente significativas entre las variables estudiadas, ni se identificaron predictores de una determinada etiología, marcadores de mala evolución o factores de riesgo asociados a mortalidad (AU)

Background Erythroderma, characterized by erythema and scaling that affects at least 90% of the body, has diverse causes. Most of the clinical manifestations and laboratory findings are nonspecific, making diagnosis challenging. Material and methods Retrospective study of patients treated between January 1, 2010, and June 1, 2020. We reviewed the records to identify all patients with erythroderma who were hospitalized in Hospital Italiano de Buenos Aires and followed for at least 6 months. We extracted information on clinical histories, the characteristics of the episodes, laboratory and histopathologic findings, and clinical course. Results Seventy patients were studied. The mean age at onset was 63 years, and the ratio of men to women was 1.2:1. Adverse drug reactions caused the largest proportion of the rashes (48%), and vancomycin was the most common culprit (involved in 30% of the cases). The next most frequent cause was a preexisting skin disease, psoriasis being the most common (in 42%). The clinicopathologic correlation was adequate for diagnosis after the first biopsy in 40% of patients, but the diagnostic yield increased to 76% with the second biopsy. The largest number of biopsies required was 8, in 2 patients. The outcome was favorable in 92% of the cases. Conclusion Adverse reactions to medications accounted for the largest proportion of erythroderma cases in this series, and vancomycin was the main culprit. We found no statistically significant associations among the variables studied. Nor did we identify potential predictors of causes, poor outcomes, or mortality (AU)

[Translated article] Adverse Drug Reactions Are the Main Causes of Erythroderma in an Argentinian Teaching Hospital: A Retrospective Study of 70 Patients / Las reacciones adversas a fármacos son la primera causa de eritrodermia. Estudio retrospectivo de 70 pacientes en un hospital universitario de Argentina

Background Erythroderma, characterized by erythema and scaling that affects at least 90% of the body, has diverse causes. Most of the clinical manifestations and laboratory findings are nonspecific, making diagnosis challenging. Material and methods Retrospective study of patients treated between January 1, 2010, and June 1, 2020. We reviewed the records to identify all patients with erythroderma who were hospitalized in Hospital Italiano de Buenos Aires and followed for at least 6 months. We extracted information on clinical histories, the characteristics of the episodes, laboratory and histopathologic findings, and clinical course. Results Seventy patients were studied. The mean age at onset was 63 years, and the ratio of men to women was 1.2:1. Adverse drug reactions caused the largest proportion of the rashes (48%), and vancomycin was the most common culprit (involved in 30% of the cases). The next most frequent cause was a preexisting skin disease, psoriasis being the most common (in 42%). The clinicopathologic correlation was adequate for diagnosis after the first biopsy in 40% of patients, but the diagnostic yield increased to 76% with the second biopsy. The largest number of biopsies required was 8, in 2 patients. The outcome was favorable in 92% of the cases. Conclusion Adverse reactions to medications accounted for the largest proportion of erythroderma cases in this series, and vancomycin was the main culprit. We found no statistically significant associations among the variables studied. Nor did we identify potential predictors of causes, poor outcomes, or mortality (AU)

Antecedentes La eritrodermia es un cuadro caracterizado por un eritema y descamación que compromete al menos el 90% de la superficie corporal. Su etiología puede ser variable. La mayor parte de sus características clínicas y alteraciones del laboratorio son inespecíficas, lo que hace que el diagnóstico sea un desafío. Materiales y métodos Se realizó un estudio retrospectivo en el periodo comprendido entre el 1 de enero de 2010 y el 1 de junio de 2020. Se revisaron los antecedentes, las características clínicas, los hallazgos de laboratorio e histopatológicos, así como la evolución de todos los pacientes con una eritrodermia hospitalizados en el Hospital Italiano de Buenos Aires, con un seguimiento mínimo de 6 meses. Resultados Se incluyeron 70 pacientes. La edad media de aparición fue de 63 años con una relación hombre:mujer de 1,2:1. La principal causa de eritrodermia fueron las reacciones adversas a fármacos (48%), siendo la vancomicina el principal medicamento involucrado (30%), mientras que la segunda causa fueron las dermatosis preexistentes, dentro de las cuales la psoriasis fue la más común (42%). En el 40% de los pacientes se observó una adecuada correlación clínico-patológica con la primera biopsia, mientras que el rédito diagnóstico aumentó a un 76% con la segunda. El número máximo de biopsias requerido para efectuar el diagnóstico etiológico fue de 8 (2 pacientes). La evolución fue favorable en el 92% de los casos. Conclusión Las reacciones adversas a fármacos fueron la primera causa de eritrodermia y la vancomicina el fármaco responsable más frecuente. No se encontraron asociaciones estadísticamente significativas entre las variables estudiadas, ni se identificaron predictores de una determinada etiología, marcadores de mala evolución o factores de riesgo asociados a mortalidad (AU)