Preliminary assessment of antivenom availability and management in the public health system of Costa Rica: An analysis based on a survey to pharmacists in public health facilities.

Availability and accessibility of safe and effective antivenoms are key elements for the successful treatment of snakebite envenoming (SBE). This study provides a preliminary analysis on the way antivenoms are managed by the public health system in Costa Rica and on the role played by pharmacists in the overall management of antivenoms. This was an observational, cross-sectional study based on an online survey sent to pharmacists working at Caja Costarricense de Seguro Social (Costa Rican Social Security System; CCSS) in different locations in Costa Rica. Characteristics and location of health facilities, as well as antivenom availability and management details, were analyzed. Responses from a total of 96 pharmacists, corresponding to 55 different healthcare facilities, were included in this study. Most respondents worked at pharmacies located in urban communities (69.0%) and in the secondary level of care, which includes clinics, and regional and peripheral hospitals (55.2%). Overall, participants reported antivenom availability at all levels of care and in centers having various operating schedules, although they were not available in some facilities in regions where SBE is uncommon or do not attend SBE cases because of the proximity of more complex health centers. On average, the stocks of anticoral and polyvalent antivenoms per health facility were compatible with the dose of antivenom required for treating a SBE case. More than half of participants reported knowing the availability of protocols for the management of SBE and the correct use of antivenom at their healthcare facilities. Of the total respondents, 49% agreed on possessing all the resources needed for the correct management of these medicines at their facilities, and 65.6% indicated that they know the procedures for antivenom storage and management. Our findings provide a first description of the availability of antivenoms in the public health system of Costa Rica, including the primary care level. Results also underscore the perceived role of participating pharmacists in the management of these life-saving drugs and the need to improve their knowledge on this topic.

Evaluación de contaminantes microbianos en muestras de cannabis incautadas en Costa Rica / Evaluation of microbial contamination in samples of cannabis seized in Costa Rica

Diferentes literaturas sugieren que el consumo de cannabis es un importante problema para la salud pública. El cannabis, por su naturaleza ilegal, llega a sus usuarios sin cumplimiento de normas adecuadas de cultivo, almacenamiento, procesamiento y tráfico; lo que puede generar diversos contaminantes, que pueden ser químicos, físicos o microbianos. La presencia de contaminantes microbianos es un riesgo para la salud de los usuarios, sobre todo en pacientes con el sistema inmune comprometido. Costa Rica no cuenta con estudios sobre la presencia de contaminantes microbianos en el cannabis comercializado, por lo que este estudio pretendía establecer si los hay en las muestras incautadas en seis regiones del territorio costarricense y relacionar este hecho con riesgos para la salud de sus consumidores. En dichas muestras se realizaron pruebas de conteo total de bacterias aeróbicas, levaduras y hongos según los procedimientos establecidos por la Farmacopea de los Estados Unidos de América (USP). Para la identificación de microorganismos potencialmente patógenos, se realizaron los procedimientos descritos por la USP, el uso del sistema API y metodología de identificación morfológica de hongos. Los conteos totales de bacterias, de levaduras y hongos superan los límites establecidos por USP en la mayoría de las muestras. Se hallaron cuatro tipos de hongos: Aspergillus sp., Scopulariopsis sp, Fusarium sp y Penicillum sp y cinco especies bacterianas: Staphylococcus aureus, S. xylosus, S. lentus, Enterobacter cloacae y E. sakazakki. La contaminación hallada requiere de un debate para el establecimiento de una verdadera política de regulación, tanto para fin terapéutico como para fines recreativos

Different literature suggests that cannabis use is a major problem for public health. Cannabis, through its illegal nature, reaches its users without complying with any suitable standards of growth, storage, processing and transport, which may generate diverse pollutants, which can be chemical, physical or microbial. The presence of microbial pollutants is a risk for the user’s health, especially in patients whose immune system is compromised. In Costa Rica there are no studies on the presence of microbial pollutants in commercialized cannabis, which is why the aim of this study was to establish the presence of the aforementioned pollutants in cannabis samples seized in six regions of Costa Rican territory and to relate this fact to risks for the health of its consumers. These samples were tested for their total count in aerobic bacteria, yeast and fungi according to procedures established by the Pharmacopoeia of the United States (USP). Identification of potentially pathogenic microorganisms was performed using methods described by USP; using the API system and methodology for morphological identification of fungi. The total counts of bacteria, yeast and fungus exceed limits set by USP on most of the seized samples. Four types of fungus were found: Aspergillus sp, Scopulariopsis sp, Fusarium sp and Penicillium sp, and five bacterial species: Staphylococcus aureus, S. xylosus, S. lentus, Enterobacter cloacae and E. sakazakki. The contamination found requires a debate for establishing a genuine policy of cannabis regulation, both for therapeutic or recreational purposes