Adherencia al tratamiento en paciente polimedicado con sistemas personalizados de dosificación (SPD) y su impacto en salud / Adherence to treatment in polymedicated patients using Monitored Dosage Systems (MDS) and their impact on health

Los Sistemas Personalizados de Dosificación (SPD) son una herramienta eficaz, segura y homologada para el reacondicionamiento de fármacos en farmacia comunitaria. Estos implican la revisión del uso del medicamento (RUM) y la colaboración con el médico de atención primaria (MAP). En el presente artículo se describe el caso de una paciente de 57 años intervenida de lumbociatalgia en 2021 y 2022, con dolor crónico mal controlado y aturdimiento derivado del olvido y/o duplicidad de las tomas. Durante la dispensación habitual se detectan estos problemas relacionados con el medicamento (PRM) y se deriva a la paciente al servicio SPD. Tras la implantación del mismo, la paciente mejora a nivel cognitivo, eliminando el aturdimiento y controlando el dolor, lo que supuso un aumento en su calidad de vida. En conclusión, se destaca la importancia de los diferentes servicios disponibles en la farmacia para mejorar la calidad de vida del paciente, la adherencia al tratamiento y la detección de PRM. (AU)

Monitored Dosage Systems (MDS) are an efficient, reliable and approved device for drug reconditioning in pharmacy. These systems imply a review on proper drug use and the collaboration between primary health care and pharmacists. The case study describes a female patient with a surgical intervention due to lumbosciatica in 2021 and 2022. Patient describes uncontrolled chronic pain and confusion related to improper drug use. During regular dispensing of her medication, these medicine-related problems (MRP) were detected and the patient was referred to the MDS service. After its implementation, the patient’s confusion was eliminated and pain management was achieved, increasing her quality of life. As a conclusion, the different health services provided by the pharmacy can improve a patient’s quality of life, treatment adherence and MRP detection. (AU)

Is euchromatin really open in the cell?

Genomic DNA is wrapped around a core histone octamer and forms a nucleosome. In higher eukaryotic cells, strings of nucleosomes are irregularly folded as chromatin domains that act as functional genome units. According to a typical textbook model, chromatin can be categorized into two types, euchromatin and heterochromatin, based on its degree of compaction. Euchromatin is open, while heterochromatin is closed and condensed. However, is euchromatin really open in the cell? New evidence from genomics and advanced imaging studies has revealed that euchromatin consists of condensed liquid-like domains. Condensed chromatin seems to be the default chromatin state in higher eukaryotic cells. We discuss this novel view of euchromatin in the cell and how the revealed organization is relevant to genome functions.

Condensed but liquid-like domain organization of active chromatin regions in living human cells.

In eukaryotes, higher-order chromatin organization is spatiotemporally regulated as domains, for various cellular functions. However, their physical nature in living cells remains unclear (e.g., condensed domains or extended fiber loops; liquid-like or solid-like). Using novel approaches combining genomics, single-nucleosome imaging, and computational modeling, we investigated the physical organization and behavior of early DNA replicated regions in human cells, which correspond to Hi-C contact domains with active chromatin marks. Motion correlation analysis of two neighbor nucleosomes shows that nucleosomes form physically condensed domains with ~150-nm diameters, even in active chromatin regions. The mean-square displacement analysis between two neighbor nucleosomes demonstrates that nucleosomes behave like a liquid in the condensed domain on the ~150 nm/~0.5 s spatiotemporal scale, which facilitates chromatin accessibility. Beyond the micrometers/minutes scale, chromatin seems solid-like, which may contribute to maintaining genome integrity. Our study reveals the viscoelastic principle of the chromatin polymer; chromatin is locally dynamic and reactive but globally stable.

Phosphoregulation of DSB-1 mediates control of meiotic double-strand break activity.

In the first meiotic cell division, proper segregation of chromosomes in most organisms depends on chiasmata, exchanges of continuity between homologous chromosomes that originate from the repair of programmed double-strand breaks (DSBs) catalyzed by the Spo11 endonuclease. Since DSBs can lead to irreparable damage in germ cells, while chromosomes lacking DSBs also lack chiasmata, the number of DSBs must be carefully regulated to be neither too high nor too low. Here, we show that in Caenorhabditis elegans, meiotic DSB levels are controlled by the phosphoregulation of DSB-1, a homolog of the yeast Spo11 cofactor Rec114, by the opposing activities of PP4PPH-4.1 phosphatase and ATRATL-1 kinase. Increased DSB-1 phosphorylation in pph-4.1 mutants correlates with reduction in DSB formation, while prevention of DSB-1 phosphorylation drastically increases the number of meiotic DSBs both in pph-4.1 mutants and in the wild-type background. C. elegans and its close relatives also possess a diverged paralog of DSB-1, called DSB-2, and loss of dsb-2 is known to reduce DSB formation in oocytes with increasing age. We show that the proportion of the phosphorylated, and thus inactivated, form of DSB-1 increases with age and upon loss of DSB-2, while non-phosphorylatable DSB-1 rescues the age-dependent decrease in DSBs in dsb-2 mutants. These results suggest that DSB-2 evolved in part to compensate for the inactivation of DSB-1 through phosphorylation, to maintain levels of DSBs in older animals. Our work shows that PP4PPH-4.1, ATRATL-1, and DSB-2 act in concert with DSB-1 to promote optimal DSB levels throughout the reproductive lifespan.

Impacto de una intervención de «no hacer» en 12 determinaciones de laboratorio / Impact of a do-not-do intervention on 12 laboratory measurements

Objetivos. En los últimos años distintas sociedades científicas y organizaciones sanitarias han generado recomendaciones orientadas a disminuir las intervenciones sanitarias que no han demostrado eficacia o efectividad. El objetivo de este estudio es evaluar el impacto de una intervención acerca de 12 recomendaciones de «no hacer» referidas al laboratorio en 7 centros hospitalarios. Métodos. Estudio antes-después llevado a cabo en 7 centros hospitalarios de Córdoba y Jaén durante los años 2015 y 2016. Se consensuaron según las recomendaciones de las sociedades científicas existentes diferentes actuaciones referidas a determinaciones de laboratorio. Se analizaron el número y coste de las determinaciones de 6 marcadores tumorales [(antígeno carcinoembrionario, antígeno prostático específico, antígeno carbohidrato (CA) 15.3, CA125, CA19.9 y alfa-fetoproteína)], tirotropina, T3, T4, hemoglobina glicada, urea, ferritina y anticuerpos antigliadina, antes y después de la implantación del consenso. Resultados. Se dejaron de hacer en el año 2016 respecto al año anterior 55.902 determinaciones de laboratorio (-19%), con un ahorro global de 82.100€. La reducción en el número de determinaciones se produjo principalmente en la urea plasmática (-50,3%) y en los marcadores tumorales CA125 (-16%), CA19.9 (-11,6%) y CA15.3 (-10,5%). El ahorro más acusado se obtuvo en la determinación de urea (-21.002€), en la de hormonas tiroideas (-12.716€) y tirotropina (-7.638€). Conclusiones. La adopción y consenso de recomendaciones de «no hacer» entre niveles asistenciales conlleva una reducción significativa de las determinaciones innecesarias (AU)

Objectives. In recent years, various scientific societies and healthcare organisations have created recommendations aimed at decreasing the use of healthcare interventions that have shown no efficacy or effectiveness. The aim of this study was to assess the impact of an intervention on 12 do-not-do recommendations regarding the laboratory in 7 hospital centres. Methods. Before-after study conducted in 7 hospital centres of Cordoba and Jaen during 2015 and 2016. Based on the recommendations of existing scientific societies, a consensus was reached on various actions regarding laboratory measurements. We analysed the number and cost of measuring 6 tumour markers (carcinoembryonic antigen, prostate-specific antigen, carbohydrate antigen [CA] 15.3, CA125, CA19.9 and alpha-fetoprotein), thyrotropin, T3, T4, glycated haemoglobin, urea, ferritin and antigliadin antibodies, before and after implementing the consensus. Results. Compared with the previous year, there were 55,902 fewer laboratory measurements (-19%) in 2016, with an overall savings of €82,100. The reduction in the number of measurements occurred mainly in plasma urea (-50.3%) and in the tumour markers CA125 (-16%), CA19.9 (-11.6%) and CA15.3 (-10.5%). The most pronounced savings were achieved in the measurements of urea (-€21,002), thyroid hormones (-€12,716) and thyrotropin (-€7,638). Conclusions. The adoption and consensus of do-not-do recommendations among healthcare levels resulted in a significant reduction in unnecessary measurements (AU)

Impact of a do-not-do intervention on 12 laboratory measurements. / Impacto de una intervención de «no hacer¼ en 12 determinaciones de laboratorio.

OBJECTIVES: In recent years, various scientific societies and healthcare organisations have created recommendations aimed at decreasing the use of healthcare interventions that have shown no efficacy or effectiveness. The aim of this study was to assess the impact of an intervention on 12 do-not-do recommendations regarding the laboratory in 7 hospital centres. METHODS: Before-after study conducted in 7 hospital centres of Cordoba and Jaen during 2015 and 2016. Based on the recommendations of existing scientific societies, a consensus was reached on various actions regarding laboratory measurements. We analysed the number and cost of measuring 6 tumour markers (carcinoembryonic antigen, prostate-specific antigen, carbohydrate antigen [CA] 15.3, CA125, CA19.9 and alpha-fetoprotein), thyrotropin, T3, T4, glycated haemoglobin, urea, ferritin and antigliadin antibodies, before and after implementing the consensus. RESULTS: Compared with the previous year, there were 55,902 fewer laboratory measurements (-19%) in 2016, with an overall savings of €82,100. The reduction in the number of measurements occurred mainly in plasma urea (-50.3%) and in the tumour markers CA125 (-16%), CA19.9 (-11.6%) and CA15.3 (-10.5%). The most pronounced savings were achieved in the measurements of urea (-€21,002), thyroid hormones (-€12,716) and thyrotropin (-€7,638). CONCLUSIONS: The adoption and consensus of do-not-do recommendations among healthcare levels resulted in a significant reduction in unnecessary measurements.

[Intraobserver reliability and internal consistency of the Behavioral Pain Scale in mechanically-ventilated patients]. / Fiabilidad interobservador y consistencia interna de la Behavioral Pain Scale en pacientes con ventilación mecánica.

BACKGROUND: The Behavioral Pain Scale (BPS) is a tool of pain assessment that often gives contradictory results when used by different raters. OBJECTIVE: To assess internal consistency and interrater reliability of BPS scale in the pain assessment performed by intensives care nurses. METHODS: A prospective observational study in 34 mechanically-ventilated patients, carried out in an Intensive Care Unit from April to June 2012. Variables analyzed included demographic characteristics, diagnosis of referral, clinical status, pain and sedation level. Pain was assessed by two nurses independently at rest (T1) and during a mobilization procedure (T2) using the BPS scale. Internal consistency was calculated by Cronbach's alpha, and intraobserver reliability was determined with the intraclass correlation coefficient (ICC), with a confidence interval (CI) of 95%. This study was approved by the Ethical Committee for Clinical Research. RESULTS: One-hundred and twenty-eight pain assessments were performed. The Cronbach's alpha of total BPS score at rest was 0.66 (95%CI: 0.33 to 0.83) and during mobilization of 0.73 (95%CI: 0.47 to 0.87). The CCI of total BPS score was 0.50 (95%CI: 0.19 to 0.71) at rest and 0.58 (95%CI: 0.31 to 0.77) during mobilization. CONCLUSIONS: The level of internal consistency of the scale is appropriate and moderate interrater agreement. For the BPS useful in clinical practice, it is imperative that nurses have prior experience with a regulated use of this tool.

Apoptotic activities of thymoquinone, an active ingredient of black seed (Nigella sativa), in cervical cancer cell lines.

Thymoquinone (TQ) is the main constituent of black seed (Nigella sativa, spp) essential oil which shows promising in vitro and in vivo anti-neoplastic activities in different tumor cell lines. However, to date there are only a few reports regarding the apoptotic effects of TQ on cervical cancer cells. Here, we report that TQ stimulated distinct apoptotic pathways in two human cervical cell lines, Siha and C33A. TQ markedly induced apoptosis as demonstrated by cell cycle analysis in both cell lines. Moreover, quantitative PCR revealed that TQ induced apoptosis in Siha cells through p53-dependent pathway as shown by elevated level of p53-mediated apoptosis target genes, whereas apoptosis in C33A cells was mainly associated with the activation of caspase-3. These results support previous findings on TQ as a potential therapeutic agent for human cervical cancer.

Volatile composition and sensory properties of Vitis vinifera red cultivars from north west Spain: correlation between sensory and instrumental analysis.

The aroma and volatile composition of wines from five red cultivars from NW Spain (Brancellao, Mencía, Merenzao, Mouratón and Sousón) have been studied by gas chromatography-mass spectrometry (GC-MS) and sensory descriptive analysis (SDA) during three consecutive vintages (2007-2009) in order to characterize these wines. In addition, relationships between the instrumental (volatile) and sensory variables were analyzed through the application of partial least squares regression (PLSR). Results revealed that the effect of "cultivar" was very important as a third of compounds (16 in total) varied significantly (P≤0.05) among varieties. Mencía wines presented the highest concentrations of γ-nonalactone, whereas Sousón wines were the richest in monoterpene compounds. On the contrary, no significant difference was observed with respect to the esters content, probably as a consequence of using the same yeast for all vinifications. Twenty out of 51 quantified volatile compounds were present in some samples at concentrations higher than their corresponding odor thresholds (OAV>1), thus contributing to the final wine aroma. Partial least square (PLS) regression was applied to volatile compounds with OAV>0.2 and aroma descriptors with %GM>10. PLSR yielded a satisfactory model for the prediction of four important aroma descriptors in this set of wines--aroma quality, aroma intensity, herbaceous and red fruit--from instrumental analysis data. This work contributes to gaining knowledge about the sensory profiles and its relation to the volatile composition of minority Galician red grape cultivars.

Varietal differences among the flavonoid profiles of white grape cultivars studied by high-performance liquid chromatography.

In order to develop a method that allows to distinguish between white grape cultivars, the flavonoid profiles of 10 white accessions from the "Misión Biológica de Galicia" germplasm collection were studied during years 2003, 2004 and 2005 by high-performance liquid chromatography (HPLC). Twenty-four flavonoids (15 flavonols and 9 dihydroflavonols) were totally or partly identified, and significant differences between the studied flavonoid markers were found. With this method all the cultivars examined could be easily distinguished from each other, and we may conclude that this has been proved to be of great value for white grape cultivar recognition.

Reduction in urea distribution volume over time in clinically stable dialysis patients.

We have previously shown that, assuming urea distribution volume (V) remains constant for 1 month, ionic dialysance (ID) allows the dialysis dose to be calculated without the need for blood sampling. The aim of this multicenter study was to verify whether the assumption of a constant V can be extended to 1 year. In clinically stable patients receiving thrice-weekly hemodialysis at 13 dialysis centers, V and Kt/V were assessed during three dialysis sessions at baseline and 1 year later using ID as dialyzer urea clearance and the single-pool urea kinetic model. Baseline albumin, hemoglobin, and C reactive protein were prespecified covariates for predicting the change in V over time. Of the 52 enrolled patients, 40 (25 males; age 63.0+/-13.5 years) completed the study. Baseline end-dialysis body weight (62.4+/-13.7 kg) showed a non-significant 1% reduction during follow-up (-0.6+/-2.8 kg; P=0.175), whereas V significantly decreased from 29.0+/-6.8 to 27.4+/-6.0 l (-1.6+/-3.0 l or 4.5%; P=0.002). The reduction in V was greater when baseline albumin was lower (P=0.001) and baseline V was higher (P=0.005). The single-pool K(t)/V calculated using baseline V underestimated the actual value by 0.07+/-0.16 (P=0.008). The slight underestimate of Kt/V during follow-up suggests that annual V evaluations may be sufficient for dialysis dose quantification as the only risk is underestimating the actually delivered dialysis dose. However, the relationship between baseline albumin and the reduction in V over time may have nutritional value, and suggests more frequent V evaluations.

Varietal differences among the anthocyanin profiles of 50 red table grape cultivars studied by high performance liquid chromatography.

In order to develop a method that allows to distinguish between grape cultivars, the anthocyanin profiles of 50 accessions from the "Misión Biológica de Galicia" germplasm collection were studied by high performance liquid chromatography (HPLC). Nineteen anthocyanins were totally or partly identified and significant quantitative differences between the studied anthocyanin markers were found. With this method all 50 cultivars examinated could be easily distinguished from each other. In addition, the HPLC fingerprints and the relative-area anthocyanins plot for every cultivar has been elaborated and stored in a database. To test the validity of this method, several unknown samples have been analysed comparing their anthocyanin profile with the fingerprint database, and we may conclude that this has been proved to be of great value for grape cultivar recognition.

Rate dependence of acute PTH release and association between basal plasma calcium and set point of calcium-PTH curve in dialysis patients.

BACKGROUND: In vivo, the control of calcium-mediated acute PTH release during induced hypo- or hypercalcaemia is linked not only to plasma calcium concentration per se but also to the rate and direction of calcium change. In fact, during induced hypocalcaemia, the predominant mechanism that causes PTH to be released is the reduction of plasma Ca(2+) irrespective of the absolute starting concentration of ionized calcium. This mechanism, which is rate-dependent and even activated in conditions of hypercalcaemia, may be involved in the association, reported in several papers, between the basal Ca(2+) and the set point of the calcium-PTH curve. METHODS: The calcium-PTH relationship was studied in 12 dialysis patients under conditions of induced low and high predialysis plasma Ca(2+). At each level of basal Ca(2+), dynamic tests were conducted using two methodological approaches. In method A patients underwent low (0.5 mmol/l) calcium dialysis in the stimulation test and high (2 mmol/l) calcium dialysis in the inhibition test, while the dialysate calcium (CaD) was kept constant during each test. In this way a higher but variable rate of change in plasma Ca(2+) was achieved. In method B, CaD was progressively decreased (stimulation test) and increased (inhibition test) during the tests in order to obtain a lower but more constant rate of change in plasma Ca(2+). Consequently, for each patient, four calcium-PTH curves were produced: low basal Ca(2+) with methods A and B, and high basal Ca(2+) with methods A and B. RESULTS: Basal plasma Ca(2+) was similar in A and B at low (1.16+/-0.02 vs 1.15+/-0.02 mmol/l) and high (1.25+/-0.02 vs 1.26+/-0.02 mmol/l) basal plasma Ca(2+). The set point was higher in A than in B both at low (1.12+/-0.02 vs 1.10+/-0.02 mmol/l, P=0.01) and high (1.20+/-0.02 vs 1.16+/-0.02 mmol/l, P=0.03) basal Ca(2+) as was the slope (542+/-41 vs 426+/-44%/mmol, P=0.02; 615+/-73 vs 389+/-25%/mmol, P=0.01). No significant difference was found between A and B as regards minimal PTH and plasma Ca(2+) at minimal PTH (Camin) in both calcaemic states. Maximal PTH was slightly higher in B at low (510+/-97 vs 548+/-107 pg/ml, P=NS) and high basal plasma Ca(2+) (410+/-97 vs 464+/-108 pg/ml, P=0.02). Plasma calcium at maximal PTH (Camax) was significantly higher in A (1.1+/-0.03 vs 0.99+/-0.02 mmol/l, P=0.001) at high basal plasma Ca(2+). The set point was strictly related to basal plasma Ca(2+) in both methods, but the slope of the linear regression was significantly steeper with method A. The set point was predicted to increase by 0.881 (CI 0.772-0.990) mmol/l for each mmol/l of increase in basal plasma Ca(2+) with method A and by 0.641 (CI 0.546-0.737) mmol/l for each mmol/l of increase in basal plasma Ca(2+) with method B. CONCLUSIONS: (i) Higher and variable rates of change in plasma Ca(2+) produce a higher set point value and a steeper slope of the calcium-PTH curve when compared to lower and more constant rates of calcium change. (ii) The different slope of the linear correlations between basal plasma Ca(2+) and set point in the two methods suggests that the rate-dependent mechanism of acute PTH release plays a significant role in the association between set point and basal plasma Ca(2+). (iii) The significance of the set point is questionable when the calcium-PTH curve is carried out in vivo.

Calcium-PTH relationship in dialysis patients: the pitfalls of using a constant dialysate calcium concentration during the dynamic tests.

The calcium-PTH relationship in uremic patients has been often studied during dialysis sessions with high or low dialysate calcium concentration (CaD). This method has been used because it is less complex and invasive than i.v. infusion of calcium salts and calcium chelating agents. However, the constancy of CaD during the tests does not allow for the control of the serum calcium profile and, given that the blood calcium concentration is only one factor of a more complex calcium-related mechanism of the PTH release, the calcium-PTH curve may become dependent on the unpredictable rate at which the ionized calcium changes. Dynamic testing of the parathyroid gland was performed in 9 dialysis patients comparing constant CaD of 1.0 and 2.0 mmol/l (A) with a linear change in CaD (B). The rate of serum calcium change remained constant over time only in experiment B. The total decrease in calcemia (0-0.38 +/- 0.03 vs -0.14 +/- 0.1 mmol/l) and PTHmax (748.25 +/- 124.76 vs 374.89 +/- 53.03 pg/ml) were significantly higher in B, whereas the total increase in calcemia (+0.26 +/- 0.03 vs +0.28 +/- 0.02 mmol/l) and the minimum value of PTH (59.15 +/- 9.53 vs 55.64 +/- 9.08 pg/ml) were similar in both experiments. The calcium-PTH curves were clearly different in A and B. The setpoint and the slope were significantly higher in A (1.196 +/- 0.01 vs 1.142 +/- 0.02 mmol/l; 840.54 +/- 96.85 vs 542.43 +/- 112.26%/mmol). For similar serum calcium values (1.084 +/- 0.01 vs 1.059 +/- 0.02 in the stimulation test and 1.325 +/- 0.02 vs 1.336 +/- 0.02 mmol/l in the inhibition test) the PTH secretion was significantly different (335.86 +/- 44.36 vs 647.65 +/- 104.09 in the stimulation test and 76.35 +/- 12.57 vs 105.03 +/- 20.59 pg/ml in the inhibition test). In conclusion, the way of inducing serum calcium change affected the calcium-PTH curve and the value of the set point and the slope was a function of the way in which the blood calcium changes were achieved. The modulated CaD dialysis was shown to be a more correct method of studying the calcium-PTH relationship in dialysis patients, as well as an alternative to the more complex and invasive infusional methodology.

[Cardiopathy in uremic dialyzed patients: transthoracic and transesophageal echocardiography]. / Cardiopatia degli uremici dializzati: valutazione ecocardiografica transtoracica e transesofagea.

BACKGROUND: Despite progress and improvement in the dialysis modalities, cardiovascular disease remains the leading cause of death in patients receiving chronic hemodialysis therapy. METHODS: To determine the prevalence of myocardial abnormalities among these patients, thirty-nine patients (22 males and 17 females, ranging in age from 20 to 87; mean age 61.38 +/- 15.04) underwent echocardiographic study. Twenty-seven were also examined by transesophageal echocardiogram. The morphology and function of the left ventricle as well as the presence of pericardial effusion, valvular disease and calcification were examined. The data obtained from transthoracic and transesophageal echocardiography were then compared. RESULTS: The patients on chronic hemodialysis treatment showed a high prevalence of valvular disease (observed in 90% of the cases, but rarely hemodynamically relevant), calcifications (74%) and left ventricular hypertrophy (74%). Impaired cardiac function (diastolic dysfunction in 74% of the patients; systolic dysfunction in 36%) and left atrial enlargement (50%) were frequently observed. The incidence rates of pericardial effusion (7%) left atrial thrombi (7%) and atherosclerotic plaques of coronary arteries (10%) were uncommon. CONCLUSIONS: Transesophageal echocardiography is more accurate than transthoracic echocardiography in evaluating the presence of cardiac calcification (particularly of mitral apparatus), valvular leaflet mobility minor valvular regurgitation, left atrial and auricolar thrombi and spontaneous echocontrast, aortic and interatrial septum abnormalities and coronary artery atherosclerotic plaque.

Electronic dental anesthesia versus topical anesthesia for the control of pain caused by nasopalatine block injections.

Topical anesthetics are routinely used to reduce the pain and discomfort that patients may experience during dental injections. Just recently, however, an anesthesia (Electronic Dental Anesthesia or EDA) which works by transcutaneous electrical nerve stimulation (TENS) was introduced to the dental profession. The purpose of this study was to determine whether an electrical signal as provided by an EDA is more effective than topical anesthesia in reducing pain and discomfort caused by local anesthetic injections. Two nasopalatine block injections, one using and EDA as the adjunct, and the other using a topical anesthetic ointment of Xylocaine 5% were performed on thirty-four patients. The volunteers were asked on the spot to report the level of the pain they felt during the penetration of the needle to the mucosa, during the deposition of local anesthetic solution, and their overall evaluation of the injections. The results of this investigation showed that the EDA is the more effective adjunct for local anesthetic injections compared to the traditional topical anesthetics.

[A preliminary study of variation in Tarebia granifera (Lamarck), Río Hatibonico, Camagüey]. / Estudio preliminar de la variación de Tarebia granifera (Lamarck), Río Hatibonico, Camagüey.

A study was carried out on Tarebia granifera in Camagüey which allowed to gather ecological evidence in order to know this freshwater mollusk species likely to act as a biological control agent of intermediate hosts for tropical diseases. Highest density was observed in November, coinciding with the highest temperatures of a running water habitat. Also, there was an influence of density variations according to variations of ions NH4+, NO2- and NO3- concentrations in the medium. These data are useful to know the right time for extracting Tarebia granifera from the habitat and using it as competitor without considerable alterations in the population stability.

[Serologic study for determining the circulation of respiratory viruses in Havana City]. / Estudio serológico para determinar la circulación de virus respiratorios en Ciudad de La Habana.

During 1991, 2,400 serum samples from subjects under 15 years, and 2,400 serum samples from subjects with the same age or over 15 years were assessed against antigens of 7 respiratory viruses by the complement fixation test or by the haemagglutination inhibition technique. The results from these investigations allowed to determine the little circulation of the respiratory syncytial virus which may result in an increase of a susceptible population and the occurrence of outbreaks. The endemic state of Adenoviruses was determined and the subtype H1N1 of influenza viruses was found to have a little circulation with a raise in the population under 1 year old age during November. The subtype H3N2 of influenza A was the most important agent within the population studied, followed by Influenza B virus during September and November. All viral agents were found to have circulated in the different age groups of the population assessed.