Comprende el medicamento/descubre al farmacéutico. Resultados preliminares 2021 y 2022. Diferencias entre cursos / Understand the medicine/discover the pharmacist. Preliminary results 2021 and 2022. Differences between courses

Introducción. En 2020 el estudio CONÓCEME: Impacto de intervenciones educativas en el uso adecuado del medicamento por farmacéuticos comunitarios (FC) en estudiantes de bachiller, concluye que las intervenciones educativas (IE) fueron efectivas y viables para mejorar el conocimiento general del uso adecuado del medicamento en estudiantes. En 2021 el proyecto CONÓCEME: comprende el medicamento/descubre al farmacéutico, va dirigido también a estudiantes de 4º o 3º Educación Secundaria Obligatoria (ESO) con el fin de llegar a todos los adolescentes.Objetivos. Evaluar la diferencia de aprendizaje de las nociones básicas del uso adecuado del medicamento entre estudiantes de 1º bachillerato, 4º y 3º ESO. _Impartir las IE como una actividad complementaria en el programa educativo para inculcar buenos hábitos desde la adolescencia con la finalidad de conseguir un uso responsable del medicamento a medio y largo plazo. _Evaluar el grado de satisfacción con la actividad de los estudiantes y personal docente.Material y métodos. Estudio observacional descriptivo, transversal, prospectivo, multicéntrico, realizado en 23 provincias de España durante 2021/2022. La actividad educativa fue impartida por uno o dos FC en dos sesiones. Después de cada IE, de forma anónima los estudiantes resolvieron cinco ejercicios en la plataforma del proyecto. En la segunda además rellenaron una encuesta de satisfacción. Para completar la actividad se envió al centro el ebook “Guía práctica para el uso adecuado de los medicamentos” para su difusión entre alumnos y profesores. Además, se envió una encuesta anónima de satisfacción al personal docente. (AU)

Chemical composition and bioactivity potential of the new Endosequence BC Sealer formulation HiFlow.

AIM: To evaluate in a laboratory setting the effects of Endosequence BC Sealer HiFlow (Brasseler USA, Savannah, GA, USA), a novel calcium silicate-based sealer developed for use in warm canal filling techniques, on human periodontal ligament stem cells (hPDLSCs). METHODOLOGY: Eluates of EndoSequence BC Sealer HiFlow (BCHiF) (Brasseler USA), EndoSequence BC Sealer (BCS) (Brasseler USA) and AH Plus (AHP) (Dentsply DeTrey GmbH, Konstanz, Germany) were placed in contact with hPDLSCs. The characterization of the chemical elements of the root canal sealers was assessed using scanning electron microscopy and energy-dispersive X-ray analysis (SEM-EDX). Inductively coupled plasma-mass spectrometry (ICP-MS) was used to determine the ion release of the sealers. MTT assay and wound healing techniques were used to determine cell viability and migration, respectively. Cell morphology and cell attachment were assessed using a direct contact technique of hPDLSCs onto the surface of the sealers and analysed by SEM. The bioactivity potential was carried out with the Alizarin Red and qPCR testing methods. The statistical differences were evaluated using one-way anova and Tukey's test (P < 0.05). RESULTS: ICP-MS and EDX revealed significantly more zirconium in BCHiF than BCS (P < 0.05), whereas BCS had slightly higher levels of Ca2+ than BCHiF (P < 0.05). The cell viability assay revealed no relevant differences between BCS and BCHiF when compared with the control group (P > 0.05). Both BCS and BCHiF had similar rates of cell migration to the control group at 24 and 48 h. Cell morphology and adhesion capacity were also similar for BCS and BCHiF groups, whilst the AHP group was associated with reduced adhesion capacity. The Alizarin Red assay revealed a significant difference between the BCS and the control group (P < 0.001), as well as for the BCHiF group (P < 0.001). Finally, BCS and BCHiF promoted overexpression of osteo/cementogenic genes. CONCLUSIONS: In general, EndoSequence BC Sealer HiFlow possesses suitable biological properties to be safely used as a root canal filling material and promote increased expression of oste/cementogenic genes by hPDLSCs.

GuttaFlow Bioseal promotes spontaneous differentiation of human periodontal ligament stem cells into cementoblast-like cells.

OBJECTIVES: To evaluate in vitro the cementogenic potential and the biological effects of GuttaFlow Bioseal, GuttaFlow 2, MTA Fillapex and AH Plus on human periodontal ligament stem cells (hPDLSCs). METHODS: Cell viability, cell migration and cell morphology assays were performed using eluates of each material. To evaluate cell attachment, hPDLSCs were directly seeded onto the material surfaces and analyzed by scanning electron microscopy (SEM). The effects of endodontic sealers on cementum protein 1 (CEMP1), cementum-derived attachment protein (CAP), bone sialoprotein (BSP), ameloblastin (AMBN), amelogenin (AMELX) and alkaline phosphatase (ALP) gene expression on hPDLSCs were investigated by qPCR and immunofluorescence (IF). Statistical analysis was performed with analysis of variance and Bonferroni or Tukey post-test (α<0.05). RESULTS: More than 90% of viable cells were obtained using extracts of GuttaFlow Bioseal and GuttaFlow2 after 72h of culture. By contrast, AH Plus and MTA Fillapex induced significantly lower levels of cell viability. GuttaFlow2 and GuttaFlow Bioseal promoted wound closure in a concentration-dependent manner, comparable to that observed with control extracts (*p<0.05). However, with AH Plus and MTA Fillapex, cell migration was significantly lower than in the control (***p<0.0001). SEM analysis pointed to an organized stress fiber assembly and high degree of cell adhesion on GuttaFlow Bioseal disks but low rates on GuttaFlow2, MTA Fillapex and AH Plus. When hPDLSCs were cultured with GuttaFlow Bioseal-conditioned media, qPCR assays and IF showed a higher level of AMELX, AMBN, CEMP1 and CAP expression than the control (*p<0.05)), whereas no such expression was observed in the other sealers. SIGNIFICANCE: Our results showed that GuttaFlow sealers were more cytocompatible than AH Plus and MTA Fillapex, while GuttaFlow Bioseal favored cementoblast differentiation of hPDLSCs in the absence of any growth factors.

Comparative analysis of the biological effects of the endodontic bioactive cements MTA-Angelus, MTA Repair HP and NeoMTA Plus on human dental pulp stem cells.

AIM: To evaluate the biological effects in vitro of MTA-Angelus (MTA-Ang; Angelus, Londrina, PR, Brazil), MTA Repair HP (MTA-HP; Angelus) and NeoMTA Plus (NeoMTA-P; Avalon Biomed Inc, Bradenton, FL, USA) on human dental pulp stem cells (hDPSCs). METHODOLOGY: Cell viability and cell migration assays were performed using eluates of each material. To evaluate cell morphology and cell attachment to the different materials, hDPSCs were directly seeded onto the material surfaces and analysed by immunocytofluorescence and scanning electron microscopy, respectively. The chemical composition of the materials was determined by energy-dispersive X-ray (EDX), and eluates were analysed by inductively coupled plasma-mass spectrometry (ICP-MS). Statistical analysis was performed with the analysis of variance and Bonferroni or Tukey post-test (α < 0.05). RESULTS: Undiluted MTA-Ang, MTA-HP and NeoMTA-P displayed a significant increase in cell viability greater than that obtained using complete medium alone (control) (*P < 0.05; **P < 0.01; ***P < 0.001). Moreover, a cell migration assay revealed cell migration rates after incubation with extracts of MTA-Ang, MTA-HP and NeoMTA-P that were similar to levels obtained in the control group. In addition, stretched cytoskeletal F-actin fibres were detected in the cells treated with the three material extracts. SEM studies revealed a high degree of cell proliferation and attachment on all three materials. EDX analysis demonstrated similar weight percentages of C, O and Ca in all three materials, whilst other elements such as Al, Si and S were also found. CONCLUSIONS: MTA-Ang, MTA-HP and NeoMTA-P were associated with biological effects on hDPSCs in terms of cell proliferation, morphology, migration and attachment.

Indicadores de calidad mínimos para la mejora de la gestión de la hipertensión arterial en Atención Primaria / Minimun quality indicators for improving the management of hypertension in Primary Care

Propósito. La hipertensión arterial (HTA) sigue siendo un problema sanitario de primer orden por su alta prevalencia, morbimortalidad y alto coste económico, lo que hace necesario un método que permita una mejor gestión de la misma. Desde esta perspectiva hemos planteado un trabajo para la selección de los indicadores de calidad mínimos (ICM) para evaluar, controlar y seguir adecuadamente al paciente hipertenso y cuya supervisión permita evaluar la calidad asistencial que recibe la población hipertensa. Material y métodos. Tras definir el problema, revisar la bibliografía y consultar a expertos en hipertensión, la selección de indicadores se realizó a partir de las principales guías nacionales e internacionales de hipertensión. Para la selección de los ICM utilizamos tres criterios: cumplir requisitos que definen un indicador de calidad, concordancia entre guías y evidencia científica y actualización en función del año de aparición en guía. Resultados. Inicialmente obtuvimos 113 indicadores potenciales; de entre ellos seleccionamos 32 ICM que incluían elementos de anamnesis, exploración física, exploraciones complementarias y tratamiento (de primera visita y visita anual). Conclusiones. La intervención mediante la definición de ICM en HTA y la medición de la cumplimentación de los mismos debe ser el primer paso para el control del paciente hipertenso en Atención Primaria (AU)

[Clinical manifestations of the mouth revealing Vitamin B12 deficiency before the onset of anemia]. / Signes buccaux révélateurs d'une carence en vitamine B12 avant l'apparition d'une anémie.

INTRODUCTION: The association of manifestations in the mouth and Vitamin B12 deficiency is already known. The signs are not specific to Vitamin B12 deficiency, however they may reveal the deficiency and this is often ignored and leads to delays in diagnosis. We report two cases of Vitamin B12 deficiency revealed by stomatodynia, glossitis and erosions in the mouth. OBSERVATIONS: Two women aged 51 and 76 years consulted, one for atrophic glossitis and the other for stomatodynia that had progressed over the past few months. No other symptoms were present. The biological examinations revealed isolated macrocytosis without anemia. Vitamin B12 could not be measured in the serum. The symptoms regressed in less than one month following replacement therapy. DISCUSSION: As with our two patients, the majority of cases of Vitamin B12 deficiency reported in the literature were only discovered several months or years after their onset, or were treated for other causes. Vitamin B12 deficiency leads to severe neuropathies. The neurological damage is reversible when replacement therapy is initiated early. Since the oral signs appear before the modification in the systemic markers of deficiency, it is crucial that these signs be recognized and diagnosed before the occurrence of severe after effects.

[Predictive variables of adherence to treatment in alcoholics]. / Variables predictoras de adherencia al tratamiento en pacientes alcohólicos.

OBJECTIVE: This paper aims to study the predictive potential of the stage of change, type of treatment followed and other variables regarding adherence to therapy. METHODOLOGY: A longitudinal and multicentre study has been carried out in three drug-addiction treatment centres within the Valencia Region, Spain. The sample included 172 alcohol-addicted clients (152 men and 20 women). Adherence to treatment was measured at one, 3, 6, 9, 12, 18, and 24 months. RESULTS: The most successful variable predicting treatment adherence is the type of program followed associated to all the time cutoffs. The fact of attending the centre with some relative or friend is a sign of potential adherence to treatment at the 3 and 6 months. The longer the withdrawal period previous to treatment, the greater the chances of adherence at the 6, 9 and 12 months of treatment. CONCLUSIONS: Those variables directly associated with treatment are potentially better predictors of adherence than the stage of change. We have found it necessary to assess it throughout the therapeutic process.

Variables predictoras de adherencia al tratamiento en pacientes alcohólicos / Predictive variables of adherence to treatment in alcoholics

ObObjetivo. Estudiar el potencial predictivo del estadio de cambio, tipo de tratamiento y otras variables sobre la adherencia al tratamiento. Material y método. Estudio longitudinal multicéntrico realizado en tres unidades de conductas adictivas de la Comunidad Valenciana. La muestra está formada por 172 alcoholdependientes (152 varones y 20 mujeres). La adherencia al tratamiento ha sido medida al mes, 3, 6, 9, 12, 18 y 24 meses. Resultados. La variable predictora de adherencia al tratamiento más potente es el tipo de programa, asociándose a todos los cortes temporales. Acudir acompañado predice adherencia a los 3 y 6 meses, y mayor tiempo de abstinencia previa predice mayor probabilidad de adherencia a los 6, 9 y 12 meses. Conclusiones. El estadio de cambio es menos potente para predecir adherencia que las variables relativas al tratamiento. Sería conveniente evaluarlo a lo largo de todo el proceso terapéutico. (AU)

[Bone evaluation in ten adults with cutaneous mastocytosis]. / Evaluation de l'état osseux chez dix adultes atteints de mastocytose cutanée.

BACKGROUND: To systematically evaluate the bone status, searching for osteoporosis in patients with cutaneous mastocytosis. PATIENTS AND METHODS: In a prospective study from March 1997 to June 2000, we included all new patients examined for cutaneous signs of mastocytosis. Past history, physical examination, skin biopsy, laboratory tests, bone densitometry, cytology and histopathology of bone marrow and other complementary investigations were performed in all these patients. RESULTS: Ten patients were included. Two patients had osteoporosis. Five others had osteopenia. Four patients had bone marrow involvement due to mastocytosis. One of these four patients had myelodysplasia. DISCUSSION: This study suggests better investigation of bone density and bone marrow in patients who have cutaneous mastocytosis. Systematic histopathology of bone marrow and osteodensitometry help to detect patients with systemic involvement. Bone densitometry is particularly effective for early detection of patients at risk for fracture and is of practical interest since patients with osteoporosis can now be treated with Pamidronate.

Estudio del estadio de cambio y estado emocional en jugadores patológicos / A study of the stage of change and the emotional state applied to pathological gamblers

Objetivo: estudiar el estadio de cambio y el estado emocional de los jugadores patológicos al inicio de tratamiento en cinco Unidades de Conductas Adictivas de la Comunidad Valenciana. Material y Método: estudio multicéntrico de carácter descriptivo. Instrumentos utilizados: SOGS, BDI, STAI y CBA. Muestra constituida por 133 sujetos (14 mujeres y 119 hombres) adictos al juego. El análisis de los datos realizado con el paquete stadístico SPSS. Resultados: Todos los sujetos de la muestra cumplían criterios de probable jugador patológico (SOGS). La mitad de la muestra se ubica en el estadio de contemplación. Percentil medio 68.38 para ansiedad/estado y 76.17 para ansiedad/rasgo. El BDI refleja estado emocional disfórico. Las puntaciones del CBA indican consumo moderado de alcohol. El 63.2 por ciento no precisa tratamiento farmacológico. Conclusiones: El alto porcentaje de sujetos que presenta consumo de alcohol concominante con la conducta de juego, exige una intervención específica para estos sujetos. Los altos niveles de ansiedad y disforia que presentan los sujetos al inicio de tratamiento, parecen relacionados con los estresores propios de la conducta de juego (AU)

Objective: The purpose of this article is to study the stage of change and the emotional state of pathological gamblers at treatment intake within five drug addiction treatment centres (Unidades de Conductas Adictivas) in the Valencia region, Spain. Material and Method: A descriptive, multi-centre study. Material used: SOGS, BDI, STAI y CBA. Our sample consists of 133 subjects, 14 females and 119 males –all being addicted to gambling. Data was analysed using the Statistical Package for the Social Sciences (SPSS). Results: All subjects in our sample meet the SOGS criteria for potential pathological gamblers. Half of the subjects are in a stage of contemplation. The anxiety/state mean percentile is 68.38 and it is 76.17 for anxiety/traits. BDI shows a dysphoric emotional estate. CBA scores show moderate alcohol consumption. 63.2% of them do not need any pharmacological treatments. Conclusions: The high percentage of subjects who drink alcohol while gambling requires a specific intervention. High levels of anxiety and dysphoria shown by the subjects at treatment intake seem to be related to stress factors common to gambling behaviours (AU)

Characterization of a tomato xyloglucan endotransglycosylase gene that is down-regulated by auxin in etiolated hypocotyls.

The reorganization of the cellulose-xyloglucan matrix is proposed to serve as an important mechanism in the control of strength and extensibility of the plant primary cell wall. One of the key enzymes associated with xyloglucan metabolism is xyloglucan endotransglycosylase (XET), which catalyzes the endocleavage and religation of xyloglucan molecules. As with other plant species, XETs are encoded by a gene family in tomato (Lycopersicon esculentum cv T5). In a previous study, we demonstrated that the tomato XET gene LeEXT was abundantly expressed in the rapidly expanding region of the etiolated hypocotyl and was induced to higher levels by auxin. Here, we report the identification of a new tomato XET gene, LeXET2, that shows a different spatial expression and diametrically opposite pattern of auxin regulation from LeEXT. LeXET2 was expressed more abundantly in the mature nonelongating regions of the hypocotyl, and its mRNA abundance decreased dramatically following auxin treatment of etiolated hypocotyl segments. Analysis of the effect of several plant hormones on LeXET2 expression revealed that the inhibition of LeXET2 mRNA accumulation also occurred with cytokinin treatment. LeXET2 mRNA levels increased significantly in hypocotyl segments treated with gibberellin, but this increase could be prevented by adding auxin or cytokinin to the incubation media. Recombinant LeXET2 protein obtained by heterologous expression in Pichia pastoris exhibited greater XET activity against xyloglucan from tomato than that from three other species. The opposite patterns of expression and differential auxin regulation of LeXET2 and LeEXT suggest that they encode XETs with distinct roles during plant growth and development.

Adherencia en heroinómanos: la potencia predictiva de los estadios de cambio evaluados durante la admisión al tratamiento / Adherence to treatment in heroin addicts: the predictive power of stages of change evaluated during treatment admission

Tomando como marco de referencia el modelo transteórico de cambio de Prochaska y DiClemente, el objetivo del presente estudio es evaluar el estadio de cambio en el que se ubican 317 heroinómanos (250 varones y 67 mujeres), utilizando una entrevista semiestructurada. Además, se estudia el poder predictivo del estadio de cambio, las variables sociodemográficas, toxicológicas y los tipos de tratamiento relacionados con la adherencia al mes, tres, seis, nueve y doce meses. Los resultados obtenidos indican que el estadio de cambio no es una potente variable predictora de la adherencia al tratamiento, ya que solamente se muestra estadísticamente significativa al mes y a los 3 meses; otras variables estudiadas, sin embargo, sí predicen adherencia durante todos los cortes temporales medidos: edad y tipo de tratamiento que inicia. Por otra parte, y en menor medida, los tratamientos anteriores, el tiempo máximo de abstinencia previa y el tipo de acompañamiento, tienden a predecir adherencia en los últimos cortes temporales (AU)

Auxin-regulated genes encoding cell wall-modifying proteins are expressed during early tomato fruit growth.

An expansin gene, LeExp2, was isolated from auxin-treated, etiolated tomato (Lycopersicon esculentum cv T5) hypocotyls. LeExp2 mRNA expression was restricted to the growing regions of the tomato hypocotyl and was up-regulated during incubation of hypocotyl segments with auxin. The pattern of expression of LeExp2 was also studied during tomato fruit growth, a developmental process involving rapid cell enlargement. The expression of genes encoding a xyloglucan endotransglycosylase (LeEXT1) and an endo-1, 4-beta-glucanase (Cel7), which, like LeExp2, are auxin-regulated in etiolated hypocotyls (C. Catalá, J.K.C. Rose, A.B. Bennett [1997] Plant J 12: 417-426), was also studied to examine the potential for synergistic action with expansins. LeExp2 and LeEXT1 genes were coordinately regulated, with their mRNA accumulation peaking during the stages of highest growth, while Cel7 mRNA abundance increased and remained constant during later stages of fruit growth. The expression of LeExp2, LeEXT1, and Cel7 was undetectable or negligible at the onset of and during fruit ripening, which is consistent with a specific role of these genes in regulating cell wall loosening during fruit growth, not in ripening-associated cell wall disassembly.

Auxin regulation and spatial localization of an endo-1,4-beta-D-glucanase and a xyloglucan endotransglycosylase in expanding tomato hypocotyls.

Xyloglucan, the primary hemicellulosic cell wall polysaccharide in dicotyledons, undergoes substantial modification during auxin-stimulated cell expansion. To identify candidates for mediating xyloglucan turnover, the expression and auxin regulation of tomato Cel7 and LeEXT, genes encoding an endo-1,4-beta-glucanase (EGase) and a xyloglucan endotransglycosylase (XET), respectively, were examined. LeEXT mRNA was present primarily in elongating regions of the hypocotyl and was induced to higher levels by hormone treatments that elicited elongation of hypocotyl segments. Cel7 mRNA abundance was very low in both elongating and mature regions of the hypocotyl but was induced to accumulate to high levels in both hypocotyl regions by auxin application. Analysis of the time dependence of expression of Cel7 and LeEXT during auxin treatment suggested that induction of these genes is not required for rapid growth responses but may participate in the cell wall changes involved in sustained cell elongation. Localization of Cel7 and LeEXT mRNA by in situ hybridization revealed that both genes are expressed in outer cell layers of the hypocotyl. In untreated etiolated seedlings, LeEXT mRNA was detected in epidermal cells of the elongating region, a tissue considered to play a key role in auxin-induced elongation. After auxin treatment, Cel7 and LeEXT mRNA showed an overlapping spatial distribution in the epidermis and outer cortical cell layers. We conclude that LeEXT and Cel7 exhibit both unique and overlapping patterns of expression and have the potential to act cooperatively in mediating cell wall disassembly associated with expansive growth.

Toward quality improvement in a French hospital: structures and culture.

This paper describes the evolution of quality improvement efforts over the past decade in a 600-bed French teaching hospital, after reviewing some characteristics of the French hospital system. The sequential attempts to improve drug dispensation illustrate the evolution of quality improvement efforts. Initial studies conducted in voluntary medical wards led to the modification of traditional prescription forms. Resulting improvements were presented in Evaluation Committee meetings, inducing other wards, to undertake similar changes on their own. A more systemic program currently is underway. The success of initial efforts can be credited to the willingness of physicians and nurses to engage in changes when the need for change was evident in their daily work experience, in spite of the questionable validity of some of the original findings. Focusing on systemic processes rather than on individual faults allowed this involvement. Reassessing the validity of so-called medication errors also highlighted the importance of careful process analysis, which should be stressed during the development of quality assurance procedures. The variability inherent in clinical conditions calls for a flexible, outcome-oriented approach, as used in quality improvement methods. Quality improvement efforts are spreading throughout the hospital. However, diffusion of change from motivated work groups to the larger community remains a challenge. To obtain a consistent performance level across all parts of the organization, and to avoid losing impetus due to uncoordinated efforts, innovation must become a consistent feature of the hospital structure.

A membrane-anchored E-type endo-1,4-beta-glucanase is localized on Golgi and plasma membranes of higher plants.

Endo-1,4-beta-D-glucanases (EGases, EC 3.2.1.4) are enzymes produced in bacteria, fungi, and plants that hydrolyze polysaccharides possessing a 1,4-beta-D-glucan backbone. All previously identified plant EGases are E-type endoglucanases that possess signal sequences for endoplasmic reticulum entry and are secreted to the cell wall. Here we report the characterization of a novel E-type plant EGase (tomato Cel3) with a hydrophobic transmembrane domain and structure typical of type II integral membrane proteins. The predicted protein is composed of 617 amino acids and possesses seven potential sites for N-glycosylation. Cel3 mRNA accumulates in young vegetative tissues with highest abundance during periods of rapid cell expansion, but is not hormonally regulated. Antibodies raised to a recombinant Cel3 protein specifically recognized three proteins, with apparent molecular masses of 93, 88, and 53 kDa, in tomato root microsomal membranes separated by sucrose density centrifugation. The 53-kDa protein comigrated in the gradient with plasma membrane markers, the 88-kDa protein with Golgi membrane markers, and the 93-kDa protein with markers for both Golgi and plasma membranes. EGase enzyme activity was also found in regions of the density gradient corresponding to both Golgi and plasma membranes, suggesting that Cel3 EGase resides in both membrane systems, the sites of cell wall polymer biosynthesis. The in vivo function of Cel3 is not known, but the only other known membrane-anchored EGase is present in Agrobacterium tumefaciens where it is required for cellulose biosynthesis.