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.

La docencia del área de Toxicología de la Universidad de La Laguna / The teaching of Toxicology at the University of La Laguna

La docencia de Toxicología en la Universidad de La Laguna (ULL) se integra en diversas Licenciaturas y Grados tales como Farmacia, Ciencia y Tecnología de los Alimentos (CTA), Medicina, Náutica y Transporte Marítimo y el Máster Oficial de Seguridad y Calidad de los Alimentos. En la Licenciatura de Farmacia en la ULL, el Área de Toxicología imparte la asignatura troncal Toxicología de 7 créditos y dos asignaturas optativas, Drogodependencias y Toxicología Clínica y Laboral, de 4,5 créditos cada una. En el Grado en Farmacia, se imparte la asignatura obligatoria de Toxicología (9 ECTS) y la asignatura optativa de Drogodependencias (6 ECTS). Asimismo, se imparte un total de 11 créditos en la Licenciatura de CTA quedando ésta extinguida en el curso académico 2013/2014. En la Licenciatura de Medicina, se imparte docencia de Toxicología en las asignaturas de Medicina Legal y Toxicología (asignado 1 crédito) y Toxicología clínica (4,5 créditos) mientras que en el Grado de Medicina se integra en las asignaturas Farmacología, anestesia y tratamiento del dolor (9 ECTS) y Aspectos éticos, aspectos legales y aspectos humanísticos de la Medicina (6 ECTS). En ellas, la Toxicología tiene asignado 1 y 0,5 ECTS, respectivamente. La Licenciatura de Náutica y Transporte Marítimo, la docencia de Toxicología se engloba en una asignatura obligatoria mientras que en el Grado en Ingeniería Radioelectrónica se incluye en una asignatura optativa (3 ECTS). En la docencia de Postgrado, la Toxicología se imparte en el Máster Oficial en Seguridad y Calidad de los Alimentos desde dos módulos con 6 ECTS cada uno de ellos (AU)

The Toxicology Department at the University of La Laguna (ULL) offers courses included in the curricula of several degrees such as Pharmacy, Food Science and Technology, Medicine, Marine and Maritime Transport, and Food Safety and Quality Master program. In the Bachelor of Pharmacy at ULL that will end in 2014/2015, the Toxicology Department offers the mandatory subject "Toxicology", with 7 credits, as well as two optional subjects ("Clinical and Professional Toxicology", and "Drug Addiction"), with 4.5 credits each. In the Degree in Pharmacy, the "Toxicology" course is a compulsory subject worth 9 credits in the European Credit Transfer System (ECTS) and the optional "Drug Addiction" subject remains, and will be worth 6 ECTS. The Toxicology Department also gives a total of 11 credits in the Food Science and Technology Bachelor that will end in the academic course 2013/2014. In the Bachelor of Medicine, Toxicology is taught in two courses: "Pharmacology, anesthesia and pain management" (9 ECTS, of which 1 ECTS is for toxicology) and "Ethical, legal and humanistic aspects of medicine" (6 ECTS, of which 0.5 ECTS is for toxicology). In the Bachelor of Nautical and Maritime Transport, Toxicology is included in a mandatory subject while in the Bachelor of Radio Electronics Engineering, Toxicology is an optional subject (3 ECTS). As for postgraduate teaching, Toxicology is taught in the Master program in Food Safety and Quality, in two modules of 6 ECTS each (AU)

La ocratoxina A en alimentos de consumo humano: revisión / Ochratoxin A in foods for human consumption: review

Introducción: La Ocratoxina A (OTA) es una micotoxina neurotóxica, inmunosupresora, genotóxica, carcinógena y teratogénica de gran actualidad que contamina alimentos de consumo humano, principalmente cereales y derivados, bebidas alcohólicas y productos de molienda(café, cacao). Los niveles de Ocratoxina A en los alimentos están estrechamente relacionados con las condiciones de producción y conservación. Objetivo: Esta revisión tiene como objetivo evaluar la presencia de OTA en diferentes grupos de alimentos, así como actualizar el conocimiento sobre su toxicidad, mecanismo de acción, métodos de análisis utilizados para su detección y cuantificación, y diferentes aspectos sobre su legislación. Método: Se buscaron y seleccionaron, en base a unos criterios de inclusión, artículos y publicaciones relacionados con los mecanismos de acción, toxicidad, análisis y legislación de la OTA en alimentos, publicados en las bases de datos de MEDLINE/PubMed, Scielo, Science Direct, Ebscohost. Resultados: La presencia de OTA sigue observándose en diferentes grupos de alimentos. Los niveles detectados son inferiores a los permitidos por la legislación vigente. Sin embargo, se observa como prácticas agrotecnológicas de producción poco adecuadas y la incorrecta conservación de algunos alimentos siguen constituyendo puntos de control crítico para evitar los riesgos tóxicos derivados de la exposición humana a esta toxina. Conclusiones: Se recomienda fomentar el uso correcto de prácticas agrotecnológicas sobre las materias primas y productos transformados, con el objetivo de reducir la concentración de OTA presente en los alimentos y evitarla toxicidad consecuente al consumo de alimentos contaminados por OTA (AU)

Introduction: Ochratoxin A is a neurotoxic, immunosuppressive, genotoxic, carcinogenic and teratogenic mycotoxins present in human food, mainly cereals and cereals products, alcoholic beverages and mill products(coffee, cocoa). The levels of Ochratox in A in food are closely related with the production and conservation conditions. Objetive: This review aims to assess the presence of OTA in different food groups, and to update the knowledge about its toxicity, mechanism of action, methods of analysis used for detection and quantification, and different aspects about regulations. Methods: References and publications related to the mechanism of action, toxicity, analysis and regulations about OTA in foods were searched and selected based on inclusion criteria. MEDLINE/PubMed, Scielo, Science Direct, Ebscohost were used as databases. Results: The presence of OTA keeps on being observed in different food groups. The detected OTA levels are below those permitted by limits set by the regulations However, inadequate agrotechnological production practices and improper storage of foods remain as critical control points to avoid the toxic hazards resulting from human exposure to this toxin. Conclusions: It’s recommended to promote the correct use of agrotechnological practices for raw materials and processed products to reduce the concentration of OTA in foods and to avoid the toxicity resulting from the consumption of OTA contaminated foods (AU)

Trihalometanos en aguas de consumo humano / Trihalomethanes in water supply

Los trihalometanos (THMs) son subproductos de desinfección que resultan de la cloración de las aguas. Los THMs engloban a sustancias como el cloroformo (CHCl ), el 3 bromodiclorometano (CHBrCl ), el clorodibromometano (CHBr Cl) 2 2 y el tribromometano (CHBr ). La Agencia Internacional para la 3 Investigación del Cáncer ha clasificado al cloroformo y al bromodiclorometano en el grupo 2B que incluye a las sustancias posiblemente carcinogénicas en humanos. Debido a su toxicidad y a que el agua de consumo humano constituye la principal vía de exposición del hombre a estos compuestos, su presencia en las aguas de consumo humano está limitada por la Directiva Europea 98/83/CE a 100 ìg/L. En esta revisión se destacan los aspectos más relevantes sobre su toxicidad, reglamentación, determinación, concentración en aguas, variaciones estacionales y eliminación (AU)

Trihalomethanes (THMs) are disinfection byproducts resulting from chlorination of water. THMs comprise substances such as chloroform (CHCl ), 3 bromodichloromethane (CHBrCl ), chlorodibromomethane 2 (CHBr Cl) and tribromomethane (CHBr ). The International Agency 2 3 for Research on Cancer has classified chloroform and bromodichloromethane in Group 2B, which includes potentially carcinogenic substances in humans. Because of its toxicity and that drinking water is the main human exposure to these compounds, their presence in drinking water is limited by the European Directive 98/83/EC to 100 mg/L. This review highlights the most relevant aspects of its toxicity, regulation, determination, concentration in water, and removing seasonal variations (AU)

[Ochratoxin A in foods for human consumption: review]. / La ocratoxina A en alimentos de consumo humano: revisión.

INTRODUCTION: Ochratoxin A is a neurotoxic, immunosuppressive, genotoxic, carcinogenic and teratogenic mycotoxins present in human food, mainly cereals and cereals products, alcoholic beverages and mill products (coffee, cocoa). The levels of Ochratoxin A in food are closely related with the production and conservation conditions. OBJECTIVE: This review aims to assess the presence of OTA in different food groups, and to update the knowledge about its toxicity, mechanism of action, methods of analysis used for detection and quantification, and different aspects about regulations. METHODS: References and publications related to the mechanism of action, toxicity, analysis and regulations about OTA in foods were searched and selected based on inclusion criteria. MEDLINE/PubMed, Scielo, Science Direct, Ebscohost were used as databases. RESULTS: The presence of OTA keeps on being observed in different food groups. The detected OTA levels are below those permitted by limits set by the regulations However, inadequate agrotechnological production practices and improper storage of foods remain as critical control points to avoid the toxic hazards resulting from human exposure to this toxin. CONCLUSIONS: It's recommended to promote the correct use of agrotechnological practices for raw materials and processed products to reduce the concentration of OTA in foods and to avoid the toxicity resulting from the consumption of OTA contaminated foods.

[Incidence rate of adverse drug effects in a hospital emergency unit and its associated factors]. / Incidencia de resultados negativos de medicación en un servicio de urgencias hospitalario y factores asociados.

INTRODUCTION: Adverse drug effects (ADEs) are the reason for 0.86% to 38.2% of hospital emergency admissions, and a large percentage of them are avoidable. Rational prescription and pharmacotherapy monitoring decrease the appearance of such health problems. METHOD: Study performed in a tertiary hospital emergency unit with patients selected using a two-phase random sample. The information was obtained from a validated questionnaire and from the clinical history. The data were grouped according to the following cause-effect schema: 1-Potential risk factors for an ADE. 2-Effects likely to be caused by drugs. 3-Consequences of ADEs. 4-Potential confounding factors. The information obtained was evaluated by four independent evaluators using the Dader method. RESULTS: 840 patients were included in the study, and 33% of them came to the emergency unit due to an ADE. ADEs were more frequently observed in female patients, those with higher drug consumption, older patients, those with an underlying illness and in those from underprivileged backgrounds. The factors determining risk of an ADE are the quantity of drugs consumed, sex and the health practices index. DISCUSSION: One third of hospital emergency admissions were due to ADEs, and these were associated with the same factors found in other studies (number of drugs consumed, female sex, age and social background). In addition, we observed that ADEs are predominant in patients with low values on the health practices index, and in those with underlying illnesses.

La acrilamida, contaminante químico de procesado: revisión / Acrylamide formation in foods: a review Acrylamide

La acrilamida, 'probable carcinógeno para los humanos',mutágeno de categoría 2 y tóxico para la reproducción de categoría 3según la UE, se comporta como neurotóxico tras exposiciones agudas. A pesar de que se recomienda disminuir los niveles de exposición, el tabaquismo, la exposición ocupacional y la exposición dietética son fuentes de acrilamida para el hombre. De entre todos los alimentos, son los ricos en carbohidratos y los elaborados a altas temperaturas, los que mayores niveles de este tóxico presentan. En la presente revisión se explica la formación de acrilamida en los alimentos, se describen sus efectos tóxicos, se citan los métodos analíticos usados en su determinación, se recopilan datos sobre los niveles detectados en distintos alimentos y se enumeran los datos más recientes sobre la ingesta en distintas poblaciones (AU)

Acrylamide formation in foods: A review Acrylamide,'probable carcinogenic for humans', mutagenic type 2 and toxic for reproduction type 3 for the European Union, produces neurotoxicity after acute expositions. Although recommendations are given to minimize the exposition levels to this compound, smoking and occupational and dietary exposures are important acrylamide sources. Among foods, those rich in carbohydrates and those cooked at high temperatures present the highest acrylamide concentrations. The present revision points out the acrylamide formation in foods, its toxic effects and the analytical methods used in its determination. Moreover, data are given about acrylamide levels in foods and dietary intakes in different populations (AU)

[Implementation and evaluation of critical hazards and check points analysis (CHCPA) in gofio-producing industries from Tenerife]. / Implantación y evaluación del análisis de peligros y puntos de control críticos (APPCC) en las industrias tinerfeñas productoras de Gofio.

OBJECTIVE: To satisfactorily implement the critical hazards and check points analysis. SETTING: Tenerife Island Subjects: 15 industries INTERVENTION: visits to gofio-manufacturing industries were done with the aim of giving advice to employers and workers, and thereafter, the intervention was assessed verifying the hygiene and sanitary conditions of the industry and the correct application of the established auto-control system. RESULTS: After the advising intervention, we observed that certain parameters taken into account from the hygiene and sanitary perspective have been corrected, such as modifying the facilities to adapt them to in force regulations, or asking the suppliers to certify raw materials. With regards to food production process, the intervention was effective in such a way that more than have of the industries reduced the time of those phases with higher contamination susceptibility and to carry out the control registries that were established. CONCLUSIONS: All industries implemented the auto-control system by means of registration charts of each one of the elaboration phases. 86% of the industries have introduced more hygienic materials. 60% implemented a reduction in intermediate times of production phases. 26% perfmored some obsolete machinery replacement modernaizing the facilities.

Bases científicas para el desarrollo de productos cárnicos funcionales con actividad biológica combinada / Scientific bases for the development of functional meat products with combined biological activity

Las evidencias científicas sobre la relación entre la alimentación y la salud han dado lugar a la aparición de un nuevo mercado alimentario de rápido crecimiento desde hace algunos años: el mercado de los alimentos funcionales. Aunque el interés de mantener o mejorar el estado de salud mediante el consumo de alimentos tradicionales a los que se han incorporado ingredientes bioactivos es indudablemente alto, la población española, cada vez más formada e informada, es reticente a consumir alimentos funcionales, a menos que éstos posean una base científica rigurosa. En este artículo se presenta una revisión de las bases científicas sobre las que se ha sustentado el desarrollo de alimentos funcionales cárnicos con relación omega-6/omega-3 equilibrada y una combinación de antioxidantes sinérgicos, entre ellos un extracto de romero obtenido mediante extracción con CO2 supercrítico (AU)

The scientific evidences on the relationship between food and health have given place to a new food market of rapid growth in the last years: the market of the functional food. Though the interest of maintaining or improving the state of health by means of the consumption of traditional food with bioactive ingredients added is undoubtedly high, the Spanish population, increasingly formed and informed, is unwilling to consume functional food, until these possess a scientific rigorous base. This article presents a review of the scientific bases that support the development of functional meat products with balanced ratio omega-6/omega-3 and a combination of synergic antioxidants, among them an extract of rosemary obtained by means of extraction with supercritical CO2 (AU)

Hidrocarburos Aromáticos Policíclicos (HAPs) en productos de la pesca: revisión / Polycyclic Aromatic Hydrocarbons (PAHs) in fishery products: a review

El interés de los hidrocarburos aromáticos policíclicos (HAPs) como contaminantes alimentarios se debe a que, algunos de ellos, son conocidos cancerígenos humanos, clasificados en el grupo 2 de la Agencia Internacional de Investigación sobre el Cáncer (IARC), además de producir efectos teratógenos y otros efectos agudos (alteraciones digestivas, cefaleas, malestar general, agitación y confusión, irritación de piel y mucosas, etc.). La determinación de los niveles de estas sustancias en los alimentos, especialmente en productos de la pesca y en alimentos ahumados, se ha incrementado en los últimos años por diversas causas. Esta revisión reúne los datos más relevantes sobre las concentraciones de estos compuestos en los productos de la pesca así como los valores de ingesta alimentaria estimados para algunas poblaciones

The great interest of the polycyclic aromatic hydrocarbons (PAHs) as food contaminants is due to their well known human carcinogenic properties. Moreover, they are classified in the second group of the International Agency for Research on Cancer (IARC). These compounds also present teratogenic and acute toxic effects (digestive alterations, cephalea, malaise, cluttering, skin and mucosa irritation, etc.). The determination of the levels of these compounds in foods, especially in fishery products and smoked foods, has increased in the last years. This review gathers the most relevant data about the PAHs concentrations in fishery products at the same time that gives information about the estimated dietary intakes of PAHs for certain populations

Análisis, diagnóstico y tratamiento de las intoxicaciones arsenicales / Analysis, diagnosis and treatment of arsenic poisoning

El arsénico (As) fue aislado por primera vez como elemento químico por Jabir-Ibn-Haiyanb en el año 776 y su nombre procede etimológicamente del griego arsenicon (masculino). Es de color gris y apariencia metálica y brillante, posee escasas propiedades metálicas, se encuentra ampliamente distribuido en el universo y su toxicidad depende de las distintas formas químicas y estados de oxidación que posee: -3, 0, +3 y +5. La evolución histórica de la Toxicología está íntimamente unida al uso de este metaloide. Actualmente, las sustancias arsenicales se utilizan en la industria, en la agricultura y ganadería y en medicina. Por ello, las fuentes de exposición del hombre a este metal son diversas destacando la laboral, la alimentaria y la medicamentosa. En este trabajo se hace una revisión de la etiología, medidas preventivas, análisis, diagnóstico y tratamiento de las intoxicaciones por As (AU)

Arsenic (As) was isolated for the first time as a chemical element by Jabir-Ibn-Haiyanb in the year 776, and its name comes etymologically from the Greek arsenicon (masculine). It is gray in color and of a shining metallic appearance, has little metallic properties, is distributed widely in the universe and its toxicity depends on the different chemical forms and states of oxidation that it has: -3, 0, +3 and +5. The historical evolution of the toxicology is intimately united to the use of this nonmetal. At present, arsenical substances are used in industry, agriculture, cattle ranching, and medicine. For that reason, the sources of exposure of man to this metal are diverse; out standing are labor, food and medicaments. In this work a revision is made of the etiology, preventive measures, analysis, diagnosis and treatment of the poisoning by As (AU)

Análisis, diagnóstico y tratamiento de las intoxicaciones arsenicales / Analysis, diagnosis and treatment of arsenic poisoning

El arsénico (As) fue aislado por primera vez como elemento químico por Jabir-Ibn-Haiyanb en el año 776 y su nombre procede etimológicamente del griego arsenicon (masculino). Es de color gris y apariencia metálica y brillante, posee escasas propiedades metálicas, se encuentra ampliamente distribuido en el universo y su toxicidad depende de las distintas formas químicas y estados de oxidación que posee: -3, 0, +3 y +5. La evolución histórica de la Toxicología está íntimamente unida al uso de este metaloide. Actualmente, las sustancias arsenicales se utilizan en la industria, en la agricultura y ganadería y en medicina. Por ello, las fuentes de exposición del hombre a este metal son diversas destacando la laboral, la alimentaria y la medicamentosa. En este trabajo se hace una revisión de la etiología, medidas preventivas, análisis, diagnóstico y tratamiento de las intoxicaciones por As. (AU)

Nitrate intake from drinking water on Tenerife island (Spain).

Although meat and vegetable products contain higher concentrations of nitrate, drinking water is the fastest and most direct form of nitrate consumption by the population. It becomes contaminated with nitrates when sea water infiltrates fresh water aquifers and when rain and irrigation water wash through soils that have been excessively treated with nitrated fertilizers. Nitrates are of great toxicological interest as they are involved in the origin of nitrites and nitrosamines and the development of metahaemoglobinaemia in infants. The objective of this study was to determine the quantities of NO(3)(-) in the water supply of each of the Island's municipalities and in the leading brands of bottled waters consumed by the population of Tenerife. This parameter is necessary for the determination of Acceptable Daily Intake (A.D.I.) of nitrates from drinking water. With one unremarkable exception, the nitrate levels found in the water analyzed were optimum for human consumption and amply complied with current European Legislation.

Bacteriocinogenic activity from starter cultures used in Spanish meat industry.

Thirty-nine bacterial strains, obtained from commercial starter cultures and commonly used by the meat industry in Spain, have been examined for their ability to produce bacteriocins. Fourteen (35%) of them showed antagonism against at least one of the indicator strains, by the agar spot test. The strains showing an inhibitory action against pathogenic indicator strains were identified as Pediococcus acidilactici, Lactobacillus curvatus, Lactobacillus pentosus and Lactobacillus plantarum, which showed an inhibitory action against a wide range of Gram-positive bacteria. The only strain which showed reliable inhibitory activity against pathogenic indicator strains, by the well diffusion assay, was P. acidilactici. This strain produces an inhibitory compound, which reaches its maximum activity at the beginning of the stationary phase of growth. This antimicrobial substance (bacteriocin) has a proteinaceous nature, is stable over a broad range of pH, resistant to heat and shows a bactericidal action.

The capturing of pollens in the atmosphere of La Laguna City, Tenerife, Canary Islands 1990-1995.

This paper forms part of a Doctorate Thesis, carried out in the Allergy and Immunology Department of the Nuestra Señora de la Candelaria Hospital, Tenerife, entitled "Epidemiology of Pollens on the Island of Tenerife. Allergy to Pollen". This paper deals with the capturing of pollen in the atmosphere of the city of La Laguna, Tenerife, during the period 1990-1995, and demonstrates that the Occidental Islands of the Canarian Archipelago are similar to a miniature continent with a special microclimate and a large amount of vegetation, where all classes of pollen can be found given the large variety of plants and trees including native species. High concentrations of more than 50 grains of pollen per m3 can be found in the air of the Occidental Islands, above all wild grasses, cultivated grasses, weeds, Artemisa vulgaris, Parietaria officinalis and Plantago lanceolata, and in a lowe proportion, Cupressaceae, Pinaceas, Mercurialis and Rumex. We have pollen concentrations very similar to other parts of the continent.

Quantity of K, Ca, Na, Mg, Fe, Cu, Pb, Zn and ashes in DOC Tacoronte-Acentejo (Canary Islands, Spain) musts and wines.

This study determines ash, K, Ca, Na, Mg, Fe, Cu, Pb, and Zn content in musts and wines of the DOC Tacoronte-Acentejo (Tenerife, Canary Islands) from two consecutive harvests. Samples were treated with HNO3 and H2O2. Na and K were determined by flame photometry and the remaining metals by air/acetilene flame atomic absorption spectrophotometry. Significant differences were observed in Na, Ca and Mg contents between both harvests, possibly due to climate conditions.

Historical background of aeropalynology in the Canary Islands.

This paper forms part of a Doctorate Thesis, currently being completed at the Allergy and Immunology Section of the Ntra. Sra. de la Candelaria Hospital, Tenerife, regarding the Epidemiology of pollens We would like to illustrate that this island and its provinces are similar to a miniature continent, where pollens from the most important allergenic families present in the National Territory of the Iberian Peninsula can be found. We have a very high incidence of patients allergic to grass pollens (gramineas), Mugwort (Artemisia), Pellitory (Parietaria) and plantain (Plantago) pollens, with respect to the number of inhabitants and allergic subjects living on our island. In a further paper, we shall expose the graphs corresponding to an Aerobiological Study during the last five years, where we obtained more than 100 gr of pollen per m3 of air.