Easy Medication Reconciliation at Hospital Admission: The EzMedRec Decision Support System.

Medication reconciliation (MR) aims at preventing medication errors at care transitions. It is a complex, time-consuming, cognitively demanding pharmacological task. We have developed a decision support system, EzMedRec, to assist retroactive MR at hospital admission. EzMedRec compares the best possible medication history (BPMH), i.e., all medications taken by the patient before hospitalization, to the list of admission medication orders (AMO). The process includes (i) the decomposition of BPMH and AMO drugs into their active ingredients (AIs), (ii) the detection of medication discontinuations and additions, and (iii) the identification of modified medication orders. The ATC classification is used to semantically enrich MR by comparing discontinued AIs and added AIs and suggesting a potential intentional drug substitution serving the same therapeutic objective. EzMedRec has been evaluated on a sample of 52 actual MRs involving 822 medication order lines, 406 in BPMHs, and 416 in AMOs with a global accuracy of 98,3%.

Skin expression of mammalian target of rapamycin and forkhead box transcription factor O1, and serum insulin-like growth factor-1 in patients with acne vulgaris and their relationship with diet.

BACKGROUND: Acne vulgaris is a multifactorial disorder of the pilosebaceous units. Several studies have reported that insulin-like growth factor (IGF)-1, forkhead box transcription factor (Fox)O1 and mammalian target of rapamycin (mTOR) interactions may be the key to understanding the links between genetic and environmental factors in acne vulgaris. OBJECTIVES: To evaluate the immunohistochemical detection of mTOR and FoxO1 in the skin, and the serum level of IGF-1 in patients with acne vulgaris. METHODS: This study was carried out on 60 participants, including 40 patients with acne and 20 controls. A diet questionnaire was administered to the patients and controls. Serum levels of IGF-1 were measured using enzyme-linked immunosorbent assay, and skin biopsies were taken from lesions on the backs of the patients and controls. FoxO1 and mTOR expression was detected using immunohistochemistry. RESULTS: A significantly higher serum IGF-1 level was found in the patients with acne than in the controls. The cytoplasmic expression of FoxO1 was found to be significantly greater in the acne group, whereas in the control subjects this expression was likely to be nuclear. Both the cytoplasmic expression and the nuclear expression of mTOR were significantly more intense in the patients with acne than in the controls. Excess consumption of a high-glycaemic-load diet was significantly associated with higher serum levels of IGF-1 and cytoplasmic expression of FoxO1 and mTOR. CONCLUSIONS: These results suggest that FoxO1, mTOR, serum IGF-1 and a high-glycaemic-load diet may play a role in acne pathogenesis.

Clinical, electrophysiological, and immunopathological study of peripheral nerves in Hansen's disease.

Hansen's disease is a disease of peripheral nerves. Some patients develop peripheral neuropathy before the diagnosis of the disease, and others develop these complications after starting therapy. Electrophysiological (EP) studies were carried out in Hansen's disease patients. This work studied the neural deficits, electromyography (EMG) and motor nerve conduction (MNC) variables in different types of leprosy and the immunopathology of sural nerve tissue in patients with severe neural deficits. Forty leprosy patients had neurological examinations and EP study. Histopathological and immunopathological study of sural nerve biopsy specimens was performed for 10 patients with severe neural deficits. The results of the neurological study showed that there was involvement of cranial nerves, muscular system, motor reflexes and sensory system and trophic and vasomotor changes. EP study showed significant changes in EMG of abductor digiti minimi in patients as compared to controls. MNC variables of common peroneal nerve were abnormal in 80% of all patients, MNC of median nerve was abnormal in 72.5%, while MNC of ulnar nerve was abnormal in 70% and SNC of ulnar nerve was abnormal in 77.5% of the total. In conclusion, electrophysiological investigations have an important role in the detection of muscle denervation and neuropathic changes in leprosy patients. These investigations are safe, rapid and non-invasive techniques. On the other hand immunopathological study revealed that the degree of immune positivity correlated with the degree of nerve fibrosis.

[Acute fatty liver of pregnancy. Three case reports]. / La stéatose hépatique aiguë gravidique. A propos de 3 cas.

The acute fatty liver of pregnancy is a specific disease of pregnancy. Its incidence is rare but prognosis is poor in complicated entities, and can compromise the foetal and maternal life. An early diagnosis of the illness and a multidisciplinary management based on uterine evacuation and an intensive medical care can improve the prognosis of the acute fatty liver of pregnancy (A.F.L.P). In hope to contribute at a better approach of this affection, the authors report their experience about 3 cases of A.F.L.P., collected in 1997.

Aspectos inmunoseróligos de la leishmaniasis / Immune and serological aspects of leishmaniasis

Con el propósito de actualizar conocimientos sobre el comportamiento inmunológico del hospedador frente a la infección por Leishmania spp., se realiza la presente revisión bibliográfica dirigida a abordar aspectos claves en la inmunoserología de la Leishmaniasis. La respuesta inmunológica está regulada por mecanismos celulares y humorales; ambos modulados entre sí por vías aún no del todo conocidas. El parásito lleva consigo antígenos de superficie que evaden mecanismos de defensa del hospedador. El lipofosglicano y la proteína gp63 facilitan la entrada de promastigotas metacíclicos. La inmunidad celular mediada por subpoblaciones de células T CD4+(Th1 y Th2) produce citocinas funcionalmente diferentes entre ellas, asociadas a resistencia y suceptibilidad a infección respectivamente. Macrófagos activados utilizan dos mecanismos para eliminar al parásito: acumulando derivados del oxígeno y a través del óxido nítrico. La inmunidad humoral incide sobre la respuesta celular durante la infección. Diferentes citocinas como el factor de necrosis tumoral-alfa e interferón-gamma se asocian con la curación en Leishmaniasis al estimular la actividad leishmanicida del macrófago; citocinas como: interleucina-1 e interleucuna-10 regulan antagónicamente. Bases genéticas son estudiadas para esplicar el comportamiento inmunológico frente a las especies de Leishmania

Oil of bitter orange: new topical antifungal agent.

BACKGROUND: Superficial dermatophyte infection is one of the most common dermatologic diseases. Some of these infections are extremely resistant to therapy. METHODS AND PATIENTS: Sixty patients participated in this study; they were classified into three groups (20 patients in each). All groups had comparable numbers of patients with tinea corporis, cruris, and pedis. Group 1 was treated with a 25% emulsion of oil of bitter orange (OBO) three times daily; group 2 was treated with 20% OBO in alcohol three times daily and group 3 was treated with pure OBO, once daily. Clinical and mycologic examinations were performed before therapy and every week until a complete cure had occurred. RESULTS: In group 1, 80% of patients were cured in 1 to 2 weeks and 20% in 2 to 3 weeks. In group 2, 50% were cured in 1 to 2 weeks, 30% in 2 to 3 weeks and 20% in 3 to 4 weeks. In group 3, 25% of patients did not continue the trial. Of the remaining patients, 33.3% were cured in one week, 60% in 1 to 2 weeks, and 6.7% in 2 to 3 weeks. Oil of bitter orange produced no side effects except mild irritation seen with the use of the pure form. CONCLUSIONS: An in vitro study showed that OBO (natural product) exerts fungistatic and fungicidal activity against a variety of pathogenic dermatophyte species. It is a promising, cheap, and available topical antifungal therapeutic agent.