Structural analysis of potato starch transformation during high-energy ball-milling: Oxygen and humidity content effects.

High Energy Ball-Milling (HEBM) modifies starchs' granule morphology, physicochemical properties, and chemical structure. However, understanding how the HEBM changes the starch chemical structure is necessary to control these modifications. Therefore, this study aimed to investigate the changes in potato starch's long- and short-range molecular order during HEBM at different environmental conditions such as oxygen (Air) and humidity content. Due to the correlation between the starch modification and the energy supplied (Esupp) by the HEBM, Burgio's equation was used to calculate this energy. The starch transformation was followed by X-ray diffraction, Fourier Transform-Infrared Spectroscopy, and Raman spectroscopy. A Principal Component Analysis (PCA) was conducted to reduce the HEBM variables. PAC analysis demonstrated that the different oxygen-humidity conditions do not affect the HEBM of potato starch. Based on the starch chemical structure transformation correlated with Esupp during HEBM, four stages were observed: orientation, modification, mechanolysis, and over-destruction. It was identified for the first time that at low milling energy (<1.5 kJ/g, orientation stage), the glycosidic rings change their orientation, and starch-water interaction increases while the starch's organization reduces. Ergo, the potato starch could be more susceptible to chemical modifications during the first two stages.

Age as a primary driver of the gut microbial composition and function in wild harbor seals.

Dietary changes are the major variation cause in the composition of the gut microbiota. The short lactation phase in phocids provides an exceptional opportunity to explore the microbiota's response to a quick transition from a milk-based to a solid diet. We investigated the effects of age and sex on the gut microbiota of harbor seals in Mexico using rectal and fecal samples from pups and adults. 16S gene sequencing revealed age explains most of the observed variations in microbial composition. Individuals with frequent contact (pups-female adults) have major microbial similarities than those with little or no contact (pups-male adults). Overall, adults and females (regardless of sex and age, respectively) have a greater microbial richness; as seals grow, the core microbiome shrinks, and microbial diversity increases. We found pathways related to milk and chitin digestion in pups' microbiomes, indicating pups were transitioning to a solid diet. An enrichment of routes related to dramatic weight loss and body mass indicated higher metabolic stress in pups in late breeding season, when they are weaned and start intermittent fasting. Our findings highlight the host-microbiome interaction in harbor seals during late breeding season in response to food shifts and metabolic stress.

Low-pressure and liquid level fiber-optic sensor based on polymeric Fabry-Perot cavity.

An experimental study of the interaction between a Mylar® polymer film and a multimode fiber-optic is presented for the simultaneous fiber-optic detection of low-pressure and liquid levels. The junction between the polymer and optical fiber produces an interference spectrum with maximal visibility and free spectral range around 9 dB and 31 nm, respectively. Water pressure, which is controlled by the liquid level, stresses the polymer. As a result, the spectrum wavelength shifts to the blue region, achieving high sensitivities around 2.49 nm/kPa and 24.5 nm/m. The polymeric membrane was analyzed using a finite element model; according to the results, the polymer shows linear stress response. Furthermore, the membrane material is operated below the yielding point. Moreover, the finite analysis provides information about the stress effect over the thickness and the birefringence changes. This sensor exhibits a quadratic polynomial fitting with an adjusted R-squared of 0.9539. The proposed sensing setup offers a cost-effective alternative for liquid level and low-pressure detection.

Planetary ball-mill as a versatile tool to controlled potato starch modification to broaden its industrial applications.

Pure potato starch has been modified by high-energy-ball-milling as a function of energy supplied, aiming to obtain products for different possibilities of industrial application. Burgios's equation has been used to calculate the energy supplied. The effect of the milling has been followed by a characterization of the starch morphology, crystallinity, solubility, swelling, retrogradation, viscosity, apparent viscosity, functional groups, and reducing sugar concentration. The high-energy-ball-milling not only changes the physical properties but also induces the mechanolysis of potato starch, breaking the glycosidic linkages of the starch molecules. A representation of the possible mechanism of starch mechanolysis is proposed. Three stages of the transformation of potato starch through high-energy ball-milling can be identified. Each of these stages generates starch with properties that can be used in different industrial applications.

Impact of an intervention for reducing waste through educational strategy: A Mexican case study, what works, and why?

Generation and inadequate management of solid waste constitute a global challenge. Projections for 2050 portend an annual increase of 3.40 billion tons of waste. This study assessed the impact of an environmental education intervention (EEI) aimed at reducing waste generation and fomenting pro-environmental behaviors in an academic public-health institution in Mexico. The EEI was implemented over 20 months using a model of behavior change. Using a mixed-method design (QUAN + qual), baseline and follow-up measurements were performed through electronic questionnaires (n = 754), focus groups (n = 20), and waste quantification. A double-difference model was performed to measure pro-environmental behaviors impact: overall and by sex, age, educational level and function within the institution. Waste quantification was performed using a quartering method and weekly monitoring. The qualitative data were studied through thematic analysis. As a result of the EEI, women reduced their use of multilayer packaging (-15.6 pp, p < 0.05) and frequent use of non-ecological materials (-17.6 pp, p < 0.05). Graduate-level participants reduced their regular and frequent use of these materials (-33.3 pp, p < 0.05, 27.6 pp, p < 0.01), while those with lower educational levels increased their ecological behavior at home (12.1 pp, p < 0.05). Waste generation dropped by 60.1% vis-a-vis the baseline measurement. Our qualitative findings showed a relationship between holding a position of power in the institution and recycling. They also revealed that available infrastructure for separating waste contributed substantially to the observed impact. With actions centered on physical structure, community practice and institutional policy components, the EEI improved the pro-environmental behaviors and perceptions of participants.

Medical education from the point of view of medical students: Results from four participatory Delphi panels in Quito, Ecuador.

BACKGROUND: Medical curricula have historically been designed in a top-down approach, usually excluding students. While Delphi panels have been used as a tool for medical education curricula design, none have been conducted in Ecuador. In addition, no such approach has ever included students both as panelists and researchers. MATERIAL AND METHODS: Four Delphi panels were developed and conducted using a participatory approach that allowed medical students to take part both as expert panelists and researchers: specifically, students developed the questionnaire and conducted a qualitative synthesis. Questionnaire responses were anonymized and dispatched online to panelists. The information was organized and collected to develop the qualitative syntheses and prepare the final statements. RESULTS: Thirty-two medical students participated between February and May 2018. A total of 32 questions were developed, corresponding to five different categories. For some questions, consensus was reached; for other questions, general statements were obtained.Discussion and conclusion: Developing the questionnaire, responding to it and analyzing the answers allowed students to raise significant concerns regarding medical education topics proposing relevant policy and curricula change. Participatory Delphi panels can be an efficient tool to obtain organized feedback, improve student class involvement, and promote research skills.

HLA-B*57 and IFNL4-related polymorphisms are associated with protection against HIV-1 disease progression in controllers.

Background: HIV-1-controllers maintain HIV-1 viremia at low levels (normally <2000 HIV-RNA copies/mL) without antiretroviral treatment. However, some HIV-1-controllers have evidence of immunologic progression with marked CD4+T-cell decline. We investigated host genetic factors associated with protection against CD4+T-cell loss in HIV-1-controllers. Methods: We analysed the association of interferon lambda 4 (IFNL4)-related polymorphisms and HLA-B haplotypes within Long Term Non-Progressor HIV-1-controllers ((LTNP-C), defined by maintaining CD4+T-cells counts >500 cells/mm3 for more than 7 years after HIV-1 diagnosis) versus non-LTNP-C, who developed CD4+T-cells counts <500 cells/mm3 Both a Spanish study cohort (n=140) and an international validation cohort (n=914) were examined. Additionally, in a subgroup of individuals HIV-1-specific T-cell responses and soluble cytokines were analysed RESULTS: HLA-B*57 was independently associated with the LTNP-C phenotype (OR=3.056 (1.029-9.069) p=0.044 and OR=1.924 (1.252-2.957) p=0.003) while IFNL4 genotypes represented independent factors for becoming non-LTNP-C (TT/TT, ss469415590, OR=0.401 (0.171-0.942) p=0.036 or A/A, rs12980275, OR=0.637 (0.434-0.934) p=0.021) in the Spanish and validation cohort, respectively, after adjusting for sex, age at HIV-1 diagnosis, IFNL4-related polymorphisms and different HLA-B haplotypes. LTNP-C showed lower plasma IP-10 (p=0.019) and higher IFN-γ (p=0.02) levels than the HIV-1-controllers with diminished CD4+T-cell numbers. Moreover, LTNP-C exhibited higher quantities of IL2+CD57- and IFN-γ+CD57- HIV-1-specific CD8+T-cells (p=0.002 and 0.041, respectively) than non-LTNP-C. Conclusions: We have defined genetic markers able to segregate stable HIV-1-controllers from those who experience CD4+T-cell decline. These findings allow for identification of HIV-1-controllers at risk for immunologic progression, and provide avenues for personalized therapeutic interventions and precision medicine for optimizing clinical care of these individuals.

Association between -174G/C and -572G/C interleukin 6 gene polymorphisms and severe radiographic damage to the hands of Mexican patients with rheumatoid arthritis: a preliminary report.

Several interleukin 6 gene (IL6) polymorphisms are implicated in susceptibility to rheumatoid arthritis (RA). It has not yet been established with certainty if these polymorphisms are associated with the severe radiographic damage observed in some RA patients, particularly those with the development of joint bone ankylosis (JBA). The objective of the present study was to evaluate the association between severe radiographic damage in hands and the -174G/C and -572G/C IL6 polymorphisms in Mexican Mestizo people with RA. Mestizo adults with RA and long disease duration (>5 years) were classified into two groups according to the radiographic damage in their hands: a) severe radiographic damage (JBA and/or joint bone subluxations) and b) mild or moderate radiographic damage. We compared the differences in genotype and allele frequencies of -174G/C and -572G/C IL6 polymorphisms (genotyped using polymerase chain reaction-restriction fragment length polymorphism) between these two groups. Our findings indicated that the -174G/C polymorphism of IL6 is associated with severe joint radiographic damage [maximum likelihood odds ratios (MLE_OR): 8.03; 95%CI 1.22-187.06; P = 0.03], whereas the -572G/C polymorphism of IL6 exhibited no such association (MLE_OR: 1.5; 95%CI 0.52-4.5; P = 0.44). Higher anti-cyclic citrullinated peptide antibody levels were associated with more severe joint radiographic damage (P = 0.04). We conclude that there is a relevant association between the -174G/C IL6 polymorphism and severe radiographic damage. Future studies in other populations are required to confirm our findings.

The impact of transrectal prostate biopsy on erectile function. / Impacto de la biopsia transrectal de próstata en la función eréctil.

OBJECTIVE: To assess erectile function at different periods of time in patients who undergo transrectal prostate biopsy (TRPB). MATERIAL AND METHODS: A total of 364 patients underwent TRPB. All of the patients were assessed using the International Index of Erectile Function-5 (IIEF-5). All patients with a positive result for cancer or with previous erectile dysfunction in the initial assessment were excluded. Ninety-three patients were included and were assessed before the biopsy and at 4, 12 and 24 weeks after the TRPB, using the IIEF-5 and assessing erectile function across these time periods. RESULTS: We assessed 93 patients. During the first prebiopsy assessment, 100% of the patients scored ≥22 points. In the first postbiopsy evaluation at 4 weeks, 66.6% scored ≥ 22 points, and 33.3% had erectile dysfunction, thereby indicating a statistically significant reduction in the IIEF-5 score (P=.001). In the second postbiopsy evaluation, only 9.1% patients still had mild to moderate erectile dysfunction (P=.04). By the end, 92.48% of the patients scored ≥ 22 points, and 7.52% still had mild erectile dysfunction, without presenting a significant difference (P=.1). CONCLUSIONS: After a TRPB, the drop in IIEF-5 scores and the presence of erectile dysfunction are temporary and transient, with greater impairment during the first month following the procedure and improvement starting after the first month, with almost total recovery at 6 months.

Reacciones Adversas a Medicamentos reportadas como resultado de la implementación de Atención Farmacéutica en la Farmacia Institucional DIGEMID - Ministerio de Salud de Perú / Adverse drug reactions reported as a result of the implementation of pharma- ceutical care in the Institutional Pharmacy DIGEMID - Ministry of Health

Objetivos: Determinar el resultado de la implementación de la Atención Farmacéutica en las notificaciones de sospechas de reacciones adversas de medicamentos (RAM) en los pacientes ambulatorios de la Farmacia Institucional de la DIGEMID. Material y métodos: Se realizó un estudio retrospectivo, descriptivo, observacional y transversal del año 2013. Se emplearon las fichas farmacoterapéuticas de los pacientes atendidos en el año 2013. Se seleccionaron las fichas de los pacientes que tuvieron notificación de sospecha de RAM. Resultados: Se recolectó las notificaciones de sospecha de RAM de 44 pacientes ambulatorios de la Farmacia Institucional de DIGEMID y se procedió a analizar las notificaciones de la RAM. Se notificaron 77 sospecha de RAM y el mayor porcentaje fueron los de trastorno gastrointestinal (26,0%). El medicamento causante del mayor porcentaje de RAM fue carbamazepina (6,7%), siendo los medicamentos relacionados con el sistema nervioso los que presentaron más RAM (28,9%), Según la gravedad la RAM más frecuente fueron las serias (61%) y en cuanto a la categoría de la causalidad el más frecuente fue "probable" (43,1%). Conclusión: La implementación de la atención farmacéutica tuvo un resultado positivo en las notificaciones de las sospechas de RAM en la Farmacia Institucional de DIGEMID

Objectives: To determine the result of the implementation of Pharmaceutical Care in the notifications of suspected adverse drug reactions (ADRs) in the outpatients of the institutional pharmacy DIGEMID. Methods: A retrospective, descriptive, observational and cross-sectional study was conducted in 2013. The pharmacotherapeutic records of the patients that have been seen in 2013 were taken to carry out this study. Particularly, the patients who were reporting suspected ADRs were selected. Results: 44 Notifications of suspected ADR of outpatients from the Institutional Pharmacy of DIGEMID were collected and analyzed. PRM was the most common adverse reaction detected (PRM 5) with 35%. 77 suspected ADRs were related to gastrointestinal disorders (26.0%); this represented the highest percentage. The drug which caused the biggest percentage of the ADRs was nervous system one (28.9%). Regarding the gravity, the serious ADR’s were the most common ones (61%) and taking into account the category of the most frequent ones, causality was "likely" (43.1%). Conclusion: The implementation of pharmaceutical care had a positive result in the notifications of suspected ADR in the institutional pharmacy DIGEMID

Expresión diferencial de reactantes de fase aguda en distintos tipos celulares de pacientes con enfermedad pulmonar obstructiva crónica / Differential expression of acute phase reactants for various cell types in patients with chronic obstructive pulmonary disease

INTRODUCCIÓN: la presencia de valores aumentados de marcadores inflamatorios plasmáticos se ha asociado a la presencia de muchos de los procesos extrapulmonares relacionados con la enfermedad pulmonar obstructiva crónica (EPOC). El tejido pulmonar es capaz de sintetizar reactantes de fase aguda (RFA), cuya secreción puede estar relacionada con variables clínicas de la enfermedad. En el presente estudio nos planteamos el análisis de diversos grupos celulares con objeto de evaluar qué células están implicadas en esta síntesis pulmonar de RFA. MÉTODO: estudio analítico observacional de caso-control, en el que se compararon los niveles de distintos RFA en células epiteliales, macrófagos y fibroblastos pulmonares humanos de muestras quirúrgicas de tejido pulmonar de pacientes fumadores o exfumadores con EPOC en fase estable frente a pacientes sin EPOC. RESULTADOS: la muestra estaba compuesta por 74 sujetos, divididos en 39 pacientes EPOC y 35 fumadores sin la enfermedad. Tanto fibroblastos, células epiteliales y macrófagos pulmonares son capaces de sintetizar estos reactantes de fase aguda. A pesar de que las diferencias entre casos y controles no son llamativas, en sujetos control parece que la producción de PCR estaría más elevada en células epiteliales, mientras que los diversos genes de amiloide A sérico (AAS) estarían elevados en las células epiteliales y macrófagos. CONCLUSIONES: los hallazgos del presente estudio señalan la capacidad de las células del aparato respiratorio en sintetizar reactantes de fase aguda en los pacientes con EPOC. Nuestros resultados nos permiten valorar esta producción y sugerir que es probable que no sean los únicos tipos celulares implicados

INTRODUCTION: the presence of increased values for plasma inflammatory markers has been associated with the presence of extra-pulmonary processes linked to Chronic Obstructive Pulmonary Disease (COPD). Lung tissue is able to synthesize Acute Phase Reactants (APR), and this secretion could be linked to clinical variables of the disease. In this study, we contemplate analyzing a number of cell groups to assess which cells are involved in this pulmonary synthesis of APR. METHOD: control case, analytical, observational study that compares the levels of various APR in human lung epithelial, macrophage and fibroblast cells of surgical lung tissue samples from patients with a stable phase of COPD who were either smokers or ex-smokers, and compare these with patients without COPD. RESULTS: the sample was composed of 74 subjects, divided into groups with 39 COPD patients, and 35 smokers without the disease. Both the lung fibroblast, epithelial and macrophage cells are able to synthesize these acute phase reactants. Although the differences between the cases and the control group are not significant, in the control subjects it seems that the production of PCR would be higher in the epithelial cells, while several serum Amyloid A genes would be overexpressed in the epithelial and macrophage cells. CONCLUSIONS: the findings of this study point out the ability of respiratory system cells to synthesize acute phase reactants in patients with COPD. Our results allow us to assess this production and suggest that these are not the only cells involved

Evaluación del efecto de la administración endobronquial de ácido tranexámico (ATx) en el sangrado de vía aérea / Assessment of the effect of endobronchial administration of tranexamic acid (ATx) in airway bleeding

INTRODUCCIÓN: la hemoptisis puede ser espontánea o iatrogénica, durante la broncofibroscopia y toma de muestras. Falta por determinar la efectividad del tratamiento antifibrinolítico con ácido tranexámico (ATx) a nivel endobronquial. OBJETIVOS: valorar la efectividad del ATx por vía endobronquial en la hemoptisis y estudiar las repercusiones del ATx sobre los parámetros de coagulación-fibrinolisis. PACIENTES Y MÉTODOS: se incluyeron 69 pacientes y se establecieron tres grupos: grupo-1 de pacientes con hemoptisis, tratados con ATx (n = 29), grupo-2 de pacientes con neoplasia de pulmón, sin tratamiento local con ATx (n = 20) y grupo-3 de pacientes sin patología neoplásica y sin tratamiento local con ATx (n = 20). Se determinaron niveles séricos basales de TAT (complejo trombina-antitrombina) y DD (dímero-D) 1 hora tras la técnica. Los grupos 2-3 no tratados con ATx, son grupos referencia para valorar la significación de datos obtenidos en los pacientes tratados con ATx. RESULTADOS: el ATx fue efectivo en el 90% de los casos. No se observaron complicaciones inmediatas. La repercusión del ATx sobre el equilibrio coagulación-fibrinólisis es evidente. Los niveles basales séricos de TAT y DD están incrementados en todos los grupos, aunque sin diferencia significativa entre estos. La diferencia en los niveles de TAT entre la determinación basal y la obtenida tras una hora, fue significativa en los tres grupos, más evidente en el grupo-1 (11x superior) tratado con ATx. CONCLUSIONES: el ATx por vía endobronquial es efectivo en la hemoptisis. Este fármaco parece influir en los parámetros de coagulación-fibrinólisis aunque de forma subclínica, dada la ausencia de complicaciones tromboembólicas clínicamente significativas

INTRODUCTION: hemoptysis could be spontaneous or iatroge nic during bronchofiberscopy and when harvesting samples. The effectiveness of anti-fibrinolytic treatment using tranexa mic acid at the endobronchial level has yet to be determined. OBJECTIVES: to assess the effectiveness of endobronchial application of ATx in hemoptysis and study the repercussions of ATx on systemic coagulation- fibrinolysis parameters. PATIENTS AND METHODS: 69 patients were included in the study and three groups were established: Group-1 included patients with hemoptysis treated with ATx (n=29), Group-2 included patients with lung neoplasia without ATx local treatment (n=20) while Group-3 included patients without neoplastic pathology and without ATx local treatment (n=20). Basal levels for TAT (thrombin-anti-thrombin complex) and DD (dimer-D) were determined and one hour after the technique was applied. Groups 2 and 3 were not treated with ATx; they were reference groups to assess the signification of data obtained in patients treated with ATx. RESULTS: ATx was effective in 90% of the cases. No immediate complications were observed. The repercussion of ATx on the coagulation-fibrinolysis is evident. Basal levels for TAT and DD in peripheral venous blood were increased in all groups, although without significant differences among them. The differences in TAT levels between the basal determination and that obtained after one hour was significant in all three groups; it was more evident in Group-1 (11 times greater) which was treated with ATx. CONCLUSIONS: endobronchial application of ATx is effective in hemoptysis. This drug could influence the coagulation-fibrinolysis parameters although sub-clinically, given the absence of clinically significant, thromboembolic complications

Outcomes of modified Dega acetabuloplasty in acetabular dysplasia related to developmental dislocation of the hip.

UNLABELLED: Developmental dislocation of the hip (DDH) is frequently, even after reduction, associated with residual acetabular dysplasia. Various surgical techniques are used to correct this, one of which is Dega acetabuloplasty. This osteotomy technique has, however, rarely been assessed in this particular indication. The present study therefore sought to describe the technical details, report clinical and radiological results, and present limitations. HYPOTHESIS: Unlike reorientation osteotomy in children, Dega acetabuloplasty does not lead to a high rate of acetabular retroversion at the end of growth. PATIENTS AND METHODS: Sixteen Dega acetabuloplasties in 15 patients were assessed on joint range of motion, limp, lower limb length discrepancy and impaired everyday activity, pre-operatively and at end of follow-up. Hips were classified following Wicart et al. (2003). Radiologic assessment comprised Wiberg angle and acetabular index, pre- and post-operatively and at follow-up. Acetabular retroversion was analyzed by crossover sign, and hips were classified following Severin. RESULTS: Median age at surgery was 3 years (range, 1.1-12.2 years) and 10 years (6.4-17.8) at end of follow-up. At end of follow-up, all hips were pain-free and classified as Wicart A, and all activities were allowed. Radiologically, hips were classified as Severin I, II or IV, in 11 (68.5%), 4 (25%) and 1 (6.5%) cases respectively. Wiberg angle rose from a mean 3.3° (-30° to 30°) to 23° (10° to 38°) and acetabular index fell from a mean 31° (25° to 45°) to 20° (5° to 30°) with surgery, and both continued to improve over follow-up: 26° (12-45°) and 13° (3-24°) respectively (P<0.05). Acetabular retroversion was found in 2 of the 10 hips with Y cartilage fusion. DISCUSSION: Modified Dega acetabuloplasty was effective in correcting acetabular dysplasia in DDH. Functional and radiological results were good, with a low rate of acetabular retroversion (2/10), unlike with other techniques. LEVEL OF EVIDENCE: Level IV. Therapeutic study.

Campaña de atención farmacéutica como estrategia de implementación de los servicios farmacéuticos: experiencia Perú / Pharmaceutical care campaign as a strategy for implementation of pharmaceutical services: experience Peru

Introducción: Se necesita mostrar las actividades farmacéuticas enfocadas en el cuidado de los pacientes, logrando un uso efectivo y seguro del medicamento y, finalmente, alcanzar las metas terapéuticas de los pacientes. Objetivo: Describir las actividades realizadas en una campaña de atención farmacéutica como estrategia para la implementación de servicios farmacéuticos. Material y métodos: Estudio observacional, descriptivo, transversal, que incluyó a pacientes que asistieron a la farmacia institucional el día de la campaña, quienes recibieron al menos uno de los 3 servicios siguientes: 1. Información sobre medicamentos usando un atril con láminas; 2. Medición de la presión arterial; 3. Seguimiento farmacoterapéutico. Resultados: Se desarrollaron las tres actividades programadas. Un total de 815 personas estuvieron interesadas en la información brindada con el atril con láminas. Un total de 96 personas acudieron para que se les midiera la presión arterial (un 62,5% varones y el resto mujeres). El promedio de edad fue de 67,83 años (desviación estándar [DE]: 13,624). El 25% de los pacientes presentó valores de presión arterial por encima del objetivo terapéutico. El servicio de SFT fue solicitado por 39 pacientes (un 66,66% mujeres y el resto varones). El promedio de edad fue de 64,7 años (DE: 19,7). En 33 se detectaron problemas reales relacionados con los medicamentos, y en 7 problemas potenciales habiéndose tomado el Segundo Consenso de Granada como referencia para la clasifi cación. Se notificaron 12 reacciones adversas a medicamentos, el 50% graves. Conclusión: El desarrollo de la campaña farmacéutica ha permitido obtener datos sobre el uso de medicamentos en enfermedades crónicas y las reacciones adversas, así como valorar en qué medida los pacientes alcanzan sus objetivos terapéuticos. En definitiva, se muestra la urgente necesidad de que los pacientes ambulatorios reciban de modo sistemático servicios farmacéuticos que logren optimizar sus tratamientos farmacológicos(AU)

Introduction: It needs to show pharmaceutical activities focused on patient care, achieving safe and effective use of medication and finally achieve the therapeutic goals of patients. Objective: To describe the activities carry out in a pharmaceutical care campaign as strategy for pharmaceutical service implementation. Material and methods: An observational, descriptive, transversal, which included patients who attended institutional pharmacy day of the campaign, who received at least one of the three following services: 1) drug information using a music stand with sheet; 2) pressure measurement blood, and 3) pharmaceutical care. Results: We developed the 3 programmed activities. 815 people were interested in the information provided with the flip chart. A total of 96 people came for blood pressure measured, 62.5% being male and the other women. The mean (standard deviation) age was 67.83 (13,624). 25% of patients had values greater than 140/90 mmHg. Pharmacotherapy follow up service was requested by 39 patients, 66.66% women and other men. The mean (SD) age was 64.7 (19.7). 33 real DRP and 7 potential DRP were detected. It was notifi ed 12 reports of adverse drug reactions, with 50% of serious gravity. Conclusion: The development of pharmaceutical campaign has yielded data on medication use in chronic diseases, adverse reactions and to what extent patients reach their therapeutic goals, which shows the urgent need for patients to receive services in a systematic achieve optimized pharmaceutical drug treatments for outpatients(AU)

Expresión local de reactantes de fase aguda en la enfermedad pulmonar obstructiva crónica / Local expression of acute-phase reactants in chronic obstructive pulmonary disease

Objetivo: Determinar la expresión de ARN, de proteína-C-reactiva (PCR) y amiloide-A-sérico (AAS) en parénquima pulmonar y tejido bronquial de pacientes EPOC en fase estable. Comparar dicha expresión de ARNm con la de sujetos fumadores sin la enfermedad. (..) (AU)

Objective: To determine the mRNA expression of C-reactive protein (CPR) and serum amyloid-A (SAA) in pulmonary parenchyma and (..) (AU)

Experiencia con un formato simplificado de la herramienta de ayuda en la toma de decisiones Adjuvant Online en pacientes con cáncer de mama / Experience with a simplified format of decision making tool adjuvant Online in breast cancer patients

Fundamento. Adjuvant. Online calcula el riesgo de recidiva y muerte a 10 años y proporciona estimaciones del beneficio del tratamiento adyuvante en pacientes con cáncer de mama. Testamos su aplicabilidad y analizamos únicamente estimaciones de mortalidad. Método. Presentamos las estimaciones de 66 pacientes intervenidas de cáncer de mama unilateral y unicéntrico, sin enfermedad residual ni metástasis. Las variables analizadas fueron edad, comorbilidad, receptores de estrógenos, grado histológico, tamaño tumoral, ganglios metastásicos, tipo de tratamiento hormonal y de quimioterapia. Resultados. La estimación de la mediana de supervivencia fue del 77%, de mortalidad por cáncer fue del 18% y por otras causas fue del 5%. La media de reducción absoluta del riesgo (RAR) de mortalidad con tratamiento hormonal fue del 4%, con quimioterapia fue del 4,5% y con tratamiento combinado fue del 7%. Resultados. Todas las pacientes con algún beneficio decidieron recibir tratamiento hormonal. Cuarenta y tres pacientes (65%) decidieron recibir quimioterapia y 23 pacientes (35%) decidieron no recibirla. La media de reducción del riesgo con quimioterapia fue del 2% en quien decidió no recibir quimioterapia y fue del 8% en quien decidió recibirla. Existe asociación entre la decisión de quimioterapia y la estimación del riesgo de mortalidad por cáncer (p=0,0001), del riesgo de mortalidad por otras causas (p=0,038) y de la RAR (p=0,0001). El 6% de las pacientes con RAR del 1%, el 50% de las que tenían RAR entre el 2–5%, y el 61,8% con RAR entre el 6–10% eligieron la quimioterapia. Conclusiones. Todas las mujeres optan por el tratamiento hormonal independientemente del beneficio. Las razones para elegir la quimioterapia fueron el propio pronóstico vital y la magnitud del beneficio. Algunas pacientes deciden elegir quimioterapia con beneficios mínimos(AU)

Background. Adjuvant. Online estimates 10-year recurrence and mortality outcomes for breast cancer patients and predicts the effect of each type of treatment. Our purpose was to test the applicability by only analysing mortality estimations. Method. We present estimations of 66 women with definitive surgery and axillary staging for unilateral, unicentric, invasive adenocarcinoma, without metastatic or residual disease. Age, co-morbidity, estrogen receptor status, histological grade, tumor size, number of positive nodes, and hormone therapy or chemotherapy option, were the variables required. Results. Median of survival estimations was 77%, cancer mortality 18% and mortality for other reasons 5%. The average of absolute risk reduction (ARR) with hormone therapy was 4%, with chemotherapy 4.5% and with combined treatment 7%. Results. All the patients with some benefit decided to receive hormone therapy. Forty-three patients (65%) decided to receive chemotherapy and 23 (35%) did not. The average risk reduction with chemotherapy was 2% in those who decided not to receive chemotherapy and 8% in those who decided to receive it. There was an association between a chemotherapy decision and the estimation of the risk of breast cancer mortality (P=0.0001), risk of mortality for other reasons (P=0.038), and the ARR (P=0.0001). There were 6% of the patients with an ARR of 1%, 50% between 2–5% and 61.8% between 6–10%, who chose chemotherapy. Conclusions. All women opted for hormone therapy regardless of benefit. The reasons for choosing chemotherapy were the prognosis itself and the magnitude of benefit. Some patients decided to choose chemotherapy even when the benefit was minimal(AU)

[Experience with a simplified format of decision making tool adjuvant! Online in breast cancer patients]. / Experiencia con un formato simplificado de la herramienta de ayuda en la toma de decisiones Adjuvant! Online en pacientes con cáncer de mama.

BACKGROUND: Adjuvant! Online estimates 10-year recurrence and mortality outcomes for breast cancer patients and predicts the effect of each type of treatment. Our purpose was to test the applicability by only analysing mortality estimations. METHOD: We present estimations of 66 women with definitive surgery and axillary staging for unilateral, unicentric, invasive adenocarcinoma, without metastatic or residual disease. Age, co-morbidity, estrogen receptor status, histological grade, tumor size, number of positive nodes, and hormone therapy or chemotherapy option, were the variables required. RESULTS: Median of survival estimations was 77%, cancer mortality 18% and mortality for other reasons 5%. The average of absolute risk reduction (ARR) with hormone therapy was 4%, with chemotherapy 4.5% and with combined treatment 7%. All the patients with some benefit decided to receive hormone therapy. Forty-three patients (65%) decided to receive chemotherapy and 23 (35%) did not. The average risk reduction with chemotherapy was 2% in those who decided not to receive chemotherapy and 8% in those who decided to receive it. There was an association between a chemotherapy decision and the estimation of the risk of breast cancer mortality (P=0.0001), risk of mortality for other reasons (P=0.038), and the ARR (P=0.0001). There were 6% of the patients with an ARR of 1%, 50% between 2-5% and 61.8% between 6-10%, who chose chemotherapy. CONCLUSIONS: All women opted for hormone therapy regardless of benefit. The reasons for choosing chemotherapy were the prognosis itself and the magnitude of benefit. Some patients decided to choose chemotherapy even when the benefit was minimal.

Sirolimus monotherapy as maintenance immunosuppression: single-center experience in 50 kidney transplant patients.

INTRODUCTION: Chronic allograft nephropathy, cardiovascular mortality, and posttransplant malignancy are complications of conventional immunosuppression after kidney transplantation. We reported the feasibility of maintenance monotherapy with sirolimus (SRL) in a pilot experience. The aim was to study safety and feasibility of SRL maintenance monotherapy in 50 kidney transplant patients. METHODS: All patients from our center with at least 6 months follow-up on SRL monotherapy were included. During the first month after start of SRL monotherapy, follow-up visits were performed weekly, then each month for the following 2 months. Each follow-up visit included a physical exam and laboratory screening. RESULTS: Mean follow-up on SRL monotherapy was 34.7 +/- 14.9 months. The time between transplantation until start of monotherapy was 7.7 +/- 3.3 years. No rejections occurred. During follow-up, two patients died of cardiovascular disease (already diagnosed before monotherapy); one, of previously diagnosed posttransplant malignancy and one, of hepatitis C-related liver failure. Glomerular filtration rate (GFR) was 53 mL/min x 1.73 m2 at start of monotherapy and 50 mL/min x 1.73 m2 after 4 years. Proteinuria was 632 +/- 562 mg/24 hours at 4 years. During the follow-up, no significant changes in the lipid profile, glycemia, or hemoglobin occurred. CONCLUSIONS: Sirolimus monotherapy is safe in a selected group of immunological low-risk patients without increasing the risk of rejection.

Sexually transmitted Chlamydia trachomatis, Neisseria gonorrhoeae, and HIV-1 infections in two at-risk populations in Barcelona: female street prostitutes and STI clinic attendees.

OBJECTIVE: To determine the prevalence of Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and HIV-1 infections in female street prostitutes and STI clinic attendees in Barcelona. DESIGN: This was a prospective study carried out in two four-month periods over two years. Urine specimens were tested for CT and NG using a PCR pooling algorithm. Among street prostitutes HIV-1 testing in urine was also carried out. RESULTS: The prevalences of CT, NG, and HIV-1 in female street prostitutes (n=301) were 4.7%, 3.7%, and 1.0%, respectively. Women from Eastern Europe had the highest prevalence of CT (p=0.01). Prevalences of CT, NG, and HIV-1 among all clinic attendees (n=536) were 4.3%, 4.5%, and 4.4%, respectively. Prevalence of HIV-1 infection among homosexual men was higher compared with heterosexual men and women (p<0.001). CONCLUSIONS: Overall CT prevalence is currently lower than in other European countries, although it could increase as a result of immigration. Rates of HIV-1 and of NG are higher among homosexual than among heterosexual men.