[Drug related problems in Belgian community pharmacies]. / Les problèmes liés aux médicaments dans les officines belges.

INTRODUCTION: The identification, the management and if possible the prevention of drug related problems (DRP), are the main responsibilities of pharmacists. AIM: The aims of the study were 1/to investigate the frequency and nature of drug related problems detected by community pharmacists, 2/to inventories the frequency and nature of the interventions by community pharmacists on prescribed medicines, and 3/to evaluate whether there is a difference between DRP detection at the moment of dispensing versus in a quiet setting (a posteriori detection). METHOD: All trainees of the participating universities of Belgian were asked to contribute to a observational study. Participating pharmacists quantified DRP's and their interventions on prescribed medicines for 5 days. Registrations were made by using a web tool based on an adapted version of the classification list of PCNE. The registration took place in two phases, at the time of delivery as well as in an a posteriori verification of the prescriptions with the pharmaceutical record file of the patients. RESULTS: The study was conducted from November 2012 to April 2013 in 534 community-pharmacies with internship. During this period 9.869 prescriptions (15%) with at least one DRP were detected on a total of 64.962 prescriptions treated by tutor pharmacists. Since there could be more than one problem on a prescription, 15.952 DRP's were registered. 2.597 of the DRP's were detected by a posteriori verification. 75% of all problems had a technical cause and 37% were clinical in nature. Under the technical causes an incomplete prescription was the most common. The most frequently registered clinical causes were a drug interaction, an inopportune time of intake, a too high or too low dose and an unsuitable drug. Participating pharmacists solved almost 3 of the 4 detected DRP's. In more than half of the DRP's, the patient was verbally and/or written informed. In 44% of the a posteriori discovered problems, the pharmacist intervened. CONCLUSION: Pharmacist detected one or more DRP's with 15% of the prescriptions. Analysis of a prescription prior to dispensing the medicines therefore appears necessary. The active intervention of the pharmacist in 83% of the problems indicates that he contributes to the optimization of drug therapy with a potential increase in the quality of life of the patient and a reduction in the cost of healthcare. The a posteriori discovered DRP's demonstrate the need for pharmacist lead meditation reviews possibly together with the physician and/or patient.

Risk factors for the herd-level bacteriologic prevalence of Salmonella in Belgian slaughter pigs.

Herd-level risk factors for salmonellosis in pigs were investigated in a cross-sectional study on 62 Belgian farrow-to-finish pig herds belonging to one slaughterhouse cooperative. Data concerning housing and ventilation, management, hygiene, biosecurity, production parameters, feeding, disease control and transport to the slaughterhouse were collected during a herd visit by means of a questionnaire. The percentage of positive animals in a slaughterhouse delivery, as determined by qualitative Salmonella isolation in the mesenteric lymph nodes taken from 30 slaughter pigs, was the outcome variable. All samples were taken in 4 different slaughterhouses. Variables first were submitted to a univariable analysis using a logistic mixed regression model, with herd as random effect. Variables which were related to the Salmonella prevalence (P < 0.05) were analysed further in a multivariable model. The clustering of Salmonella infection within a pen also was studied in a generalised mixed model with pen as random effect. Salmonella isolates were identified by serotype. In 57 (92%) of the herds, at least one sample was found positive for Salmonella. The median percentage of positive Salmonella samples per delivery was 64% (range: 0-100%). In the multivariable model, only type of floor was related significantly to the prevalence: 100% (95% CI 88-100) for herds with <50% slatted floors to 54% (36-70) for herds with fully slatted floors. The results from the analysis should be interpreted with care because only 62 herds were included in the study. Clustering between pigs from the same pen could not be demonstrated (variance +/- S.D.: 0.11 +/- 0.16). S. typhimurium (30%) and S. derby (20%) were most common among the 23 different serotypes that were found.

Hypertension and accelerated atherosclerosis in endstage renal disease.

In patients with chronic renal failure cardiovascular morbidity and mortality are higher than in non-uremic controls. Chronic renal failure influences a number of factors that promote atherogenesis: blood pressure, nitric oxide activity, advanced glycosylation, lipid metabolism, oxidant stress, homocysteine levels, glucose metabolism and PTH. How these factors are influenced by chronic renal failure, how they interrelate and how they promote atherogenesis is still debated. Published data are for and against accelerated atherogenesis. The use of only clinical endpoints may be partially responsible for these conflicting data. Measurement of atherosclerosis itself by computerized ultrasound imaging of the common carotid arteries can be used as an outcome variable. We conclude that there is still a need for prospective, controlled, epidemiologic studies to answer the question whether or not atherogenesis is accelerated in chronic renal failure and to clarify the role of hypertension and other risk factors.

Evolution of trimethylarsine by a Penicillium sp. isolated from agricultural evaporation pond water.

Arsenicals are used in agriculture as pesticides and defoliants. In the Central Valley of California, arsenic is present in soil at naturally high concentrations, being derived from marine sedimentary parent material of the Coastal Range. Due to intense agricultural irrigation, soluble arsenic is leached from the soil and accumulates in evaporation ponds where it may pose an environmental threat to the waterfowl and wildlife. A Penicillium sp. isolated from evaporation pond water was found to be capable of methylating and subsequently volatilizing organic arsenic. The major focus of this study was to characterize the environmental conditions, including culture media, arsenic substrates, pH, temperature, and the presence of phosphates, carbohydrates and amino acids on the methylation of arsenic. Trimethylarsine was monitored by gas chromatography (GC)-flame ionization detection and identified by GC-mass spectrometry. The conditions or additions for optimum trimethylarsine production were: a minimal medium in which 100 mgl-1 methylarsonic acid served as the arsenic source, pH 5-6, temperature of incubation 20 degrees C, and phosphate concentration of 0.1-50 mM (KH2PO4). The addition of carbohydrates and sugar acids to the minimal medium suppressed trimethylarsine production. The amino acids phenylalanine, isoleucine, and glutamine promoted trimethylarsine production with an enhancement ranging from 10.2- to 11.6-fold over the control without amino acid supplementation. The information obtained from this study may be useful in developing a bioremediation approach in trapping the arsenic gas evolved from soil or water as a mitigation alternative in the cleanup of arsenic contamination.

Determination of oxygen and silicon in rocks by 14-MeV neutron-activation analysis and its precision.

Oxygen and silicon have been determined in the six new U.S. Geological Survey standard rocks and two standard refractory materials by 14-MeV neutron-activation analysis, followed by both single and multichannel analyser counting of the induced (16)N (4.5-8 MeV gamma radiation) and (28)Al activities (1.78 MeV photopeak). Owing to the long analysing time per pulse, dead-time corrections are necessary in multichannel analyser counting. Four methods were investigated in this work: counting in the live-time mode without additional correction, short counting corrected by an external live-time scaler, the method of Bartoseck, and the method of Schonfeld. Each measurement was controlled by a simultaneous measurement with a single-channel analyser. Silica ignited at 1000 degrees was used as a reference. Correction was made for the interfering elements, F, P, Al, Fe and Mg, using literature data. Attention was paid to neutron, gamma and beta attenuation. For oxygen the mean coefficient of variation for a single determination with a single-channel analyser was 1.7 % for silicon 1.1 %. The mean results for single-channel counting were compared with literature values.