Anti-interleukin-17 therapies for moderate/severe psoriasis in clinical practice: effectiveness, safety and association with clinical patient factors.

OBJECTIVES: Interleukin-17 (IL-17) contributes to the pathogenesis of psoriasis. Secukinumab, ixekizumab, and brodalumab are monoclonal antibodies anti-IL-17 antibodies, approved for the treatment of moderate/severe plaque psoriasis.The aim of the study was to describe the effectiveness and safety of anti-IL-17 agents in moderate/severe plaque psoriasis in clinical practice. We also analysed anti-IL-17 therapies' survival, dose adjustment, and clinical patients' factors associated with their effectiveness and safety. METHODS: A retrospective, longitudinal study was conducted at a tertiary hospital. We included patients with moderate/severe psoriasis treated with anti-IL-17 agents. The effectiveness was evaluated with Psoriasis Area and Severity Index (PASI) score and safety through the adverse drug reactions (ADRs) collected. RESULTS: 38 patients were studied (median age=47.4 years, 71.0% male). The mean number of biological therapies that patients received was 2.6, and anti-IL-17 therapy was the first biological therapy for 36.8% of patients. The median years in treatment were 2.5 (95% CI 1.95 to 2.98) for secukinumab, 1.2 (95% CI 0.36 to 1.47) for ixekizumab, and 0.7 (IQR 0.71) for brodalumab. The median PASI score after 6 months of treatment was 0 (IQR 0) and 85.3% of patients achieved a PASI of 90 (84.0% with secukinumab, 87.5% with ixekizumab, and 100% with brodalumab). Dose adjustment was associated with the line of treatment (p=0.034 for naïve patients), age (p=0.044 for younger patients), and concomitant pathologies (p=0.015 without more diseases).24 patients suffered from ADRs, mainly infections of the upper respiratory tract, and there were no statistically significant differences between the three therapies. CONCLUSIONS: Anti-IL-17 agents constitute an effective treatment for patients with moderate/severe plaque psoriasis and for longer. Dose reductions were associated with fewer lines of treatment, younger patients and absence of concomitant pathologies. ADR were minor and similar among the anti-IL-17.

Recomendaciones para la administración de antineoplásicos e inmunomoduladores orales por sonda enteral en oncohematología / Recommendations for using oral antineoplastic and immunomodulating agents in oncohematology by enteral tube administration

Introducción y objetivo: en los últimos años, el número de fármacos antineoplásicos e inmunomoduladores orales (ANIOS) ha crecido enormemente. Con frecuencia, estos fármacos deben administrarse por sonda enteral (SE) o a pacientes con problemas de deglución, planteando un problema respecto a su manipulación (muchos pertenecen al grupo de medicamentos peligrosos). Además, también pueden presentar interacciones cuando se administran con la nutrición enteral (NE). El objetivo ha sido analizar y actualizar las recomendaciones de administración y manipulación de los ANIOS. Métodos: se creó un Grupo de Trabajo formado por farmacéuticos del Grupo de Farmacia de la Sociedad Española de Nutrición Clínica y Metabolismo (SENPE) y del Grupo de Nutrición Clínica de la Sociedad Española de Farmacia Hospitalaria (SEFH). Se realizó una revisión bibliográfica entre 2015 y 2020 de las condiciones de manipulación y administración de los ANIOS en oncohematología, elaborando una tabla que recoge especialidades farmacéuticas, dosis, presentación, nombre comercial, instrucciones para la administración oral y por SE, interacciones con la NE, precauciones y observaciones para su manipulación y administración. Resultados: se elaboró una tabla con 77 principios activos y 84 formas farmacéuticas, recogiendo recomendaciones e instrucciones para su administración por vía oral, sonda nasogástrica y gastrostomía, para la correcta manipulación y para la administración junto a la NE. Conclusiones: la información sobre cómo administrar y manipular los ANIOS en personas con accesos enterales o problemas de deglución es escasa. Consideramos importante incluir en los estudios poscomercialización una investigación dirigida a responder a estas cuestiones para garantizar una administración segura y eficaz de los medicamentos a estos pacientes (AU)

Introduction and objective: in recent years, the number of oral antineoplastic and immunomodulating drugs in oncohematology has increased enormously. Often, these drugs must be administered to patients with enteral tube feeding or swallowing disorders, which causes safety problems when handling these drugs (many of them are classified as hazardous drugs). In addition, it is important to note that the administration of these drugs can also interact with enteral nutrition (EN). The objective of this study was to review and update the recommendations for the administration and handling of oral antineoplastic and immunomodulating drugs. Methods: a Working Group made up of pharmacists from the Pharmacy Group of The Spanish Society of Clinical Nutrition and Metabolism (SENPE) and the Clinical Nutrition Group of The Spanish Society of Hospital Pharmacy (SEFH) was created. A bibliographic review was carried out between 2015 and 2020 on the administration and handling of oral antineoplastic and immunomodulating drugs in oncohematology. The information about pharmaceutical specialties, dosage, presentation, brand names, instructions for oral or enteral tube administration, interactions with EN, precautions, and remarks for handling and administration was analyzed. Results: a total of 77 active principles and 84 pharmaceutical forms were included. Recommendations and instructions for oral, nasogastric tube, and gastrostomy administration, handling of the antineoplastic and immunomodulating drugs, and interactions with EN were described. Conclusions: the handling and administration information about the oral antineoplastic and immunomodulating drugs currently used in oncohematology for people with enteral accesses or swallowing disorders is limited. It is important to perform post-marketing studies to ensure a safe and effective administration of these drugs (AU)

Mortalidad en pacientes con hemorragia intracerebral asociada a anticoagulación oral. Eficacia de un protocolo de reversión y seguimiento clínico (proyecto HIC-ACO) / Mortality in patients with intracerebral haemorrhage associated with oral anticoagulation. Efficacy of a reversal protocol and clinical follow-up (ICH-OAC project)

Introducción: La hemorragia intracerebral espontánea asociada a anticoagulantes orales (HIC-ACO) presenta una elevada mortalidad. La aparición de nuevos fármacos anticoagulantes y protocolos de reversión aumenta el interés por esta entidad. Objetivos: El objetivo principal es determinar la tasa de mortalidad en pacientes con HIC-ACO (precoz, hospitalaria, global) en nuestra área sanitaria y analizar las principales variables relacionadas. El objetivo secundario es determinar la eficacia de las terapias de reversión de la anticoagulación (TRA), reflejada por la expansión radiológica del hematoma y el pronóstico funcional. Pacientes y métodos: Estudio prospectivo observacional que introdujo un protocolo dirigido al manejo de pacientes con HIC-ACO. Incluyó medidas generales y neuromonitorización, administración individualizada de TRA, tomografía craneal y seguimiento durante seis meses. Se recogieron los fármacos prescritos en el área durante este período, mortalidad y pronóstico funcional. Se diseñó un estudio bivariante y regresión logística para investigar variables relacionadas con la mortalidad. Resultados: Se incluyó a 49 pacientes durante tres años; de ellos, un 71,4% recibió TRA. La mortalidad fue del 16,3% (primeras 24 horas), el 53,1% (ingreso) y el 61,2% (180 días). Se observó una menor supervivencia entre pacientes con puntuaciones basales mayores en la National Institutes of Healt Stroke Scale (NIHSS) (p < 0,0001), valor de creatinina (p = 0,02), índice internacional normalizado (p = 0,048), volumen hemorrágico (p = 0,008), hidrocefalia (p = 0,015) y toma de acenocumarol (p = 0,030). Los pacientes que no recibieron TRA tuvieron una mayor mortalidad precoz (p = 0,003). La única variable relacionada con la mortalidad global de forma independiente fue la puntuación en la NIHSS basal (odds ratio = 1,282; intervalo de confianza al 95%: 1,023-1,608; p = 0,031)...(AU)

Introduction: Spontaneous intracerebral haemorrhage associated with oral anticoagulants (ICH-OAC) has a high mortality rate. The emergence of new anticoagulant drugs and reversal protocols increases interest in this entity. Objectives: The main objective is to determine the mortality rate in patients with ICH-OAC (early, in-hospital, global) in our health area and to analyse the main variables related to it. The secondary objective is to determine the efficacy of anticoagulation reversal therapies (ART) as reflected by radiological expansion of the haematoma and the functional prognosis. Patients and methods: A prospective observational study that introduced a protocol aimed at the management of patients with ICH-OAC. It included general measures and neuromonitoring, individualised administration of ART, cranial tomography and a six-month follow-up. Data on the drugs prescribed in the area during this period, mortality and functional prognosis were collected. A bivariate and logistic regression study was designed to investigate mortality-related variables. Results: Forty-nine patients were included over three years; of these, 71.4% received ART. Mortality was 16.3% (first 24 hours), 53.1% (admission) and 61.2% (180 days). Lower survival was observed among patients with higher baseline scores on the National Institutes of Health Stroke Scale (NIHSS) (p < 0.0001), creatinine value (p = 0.02), International Normalised Index (p = 0.048), bleeding volume (p = 0.008), hydrocephalus (p = 0.015) and acenocoumarol intake (p = 0.030). Patients who did not receive ART had a greater rate of early mortality (p = 0.003). The only variable independently related to overall mortality was the baseline NIHSS score (odds ratio = 1.282; 95% confidence interval: 1.023-1.608; p = 0.031)...(AU)

[Mortality in patients with intracerebral haemorrhage associated with oral anticoagulation. Efficacy of a reversal protocol and clinical follow-up (ICH-OAC project)]. / Mortalidad en pacientes con hemorragia intracerebral asociada a anticoagulación oral. Eficacia de un protocolo de reversión y seguimiento clínico (proyecto HIC-ACO).

INTRODUCTION: Spontaneous intracerebral haemorrhage associated with oral anticoagulants (ICH-OAC) has a high mortality rate. The emergence of new anticoagulant drugs and reversal protocols increases interest in this entity. OBJECTIVES: The main objective is to determine the mortality rate in patients with ICH-OAC (early, in-hospital, global) in our health area and to analyse the main variables related to it. The secondary objective is to determine the efficacy of anticoagulation reversal therapies (ART) as reflected by radiological expansion of the haematoma and the functional prognosis. PATIENTS AND METHODS: A prospective observational study that introduced a protocol aimed at the management of patients with ICH-OAC. It included general measures and neuromonitoring, individualised administration of ART, cranial tomography and a six-month follow-up. Data on the drugs prescribed in the area during this period, mortality and functional prognosis were collected. A bivariate and logistic regression study was designed to investigate mortality-related variables. RESULTS: Forty-nine patients were included over three years; of these, 71.4% received ART. Mortality was 16.3% (first 24 hours), 53.1% (admission) and 61.2% (180 days). Lower survival was observed among patients with higher baseline scores on the National Institutes of Health Stroke Scale (NIHSS) (p < 0.0001), creatinine value (p = 0.02), International Normalised Index (p = 0.048), bleeding volume (p = 0.008), hydrocephalus (p = 0.015) and acenocoumarol intake (p = 0.030). Patients who did not receive ART had a greater rate of early mortality (p = 0.003). The only variable independently related to overall mortality was the baseline NIHSS score (odds ratio = 1.282; 95% confidence interval: 1.023-1.608; p = 0.031). CONCLUSIONS: ICH-OAC has a high mortality rate, related to the use of acenocoumarol and regardless of the initial clinical situation. A lower rate of early mortality was found among patients who received ART.

TITLE: Mortalidad en pacientes con hemorragia intracerebral asociada a anticoagulación oral. Eficacia de un protocolo de reversión y seguimiento clínico (proyecto HIC-ACO).Introducción. La hemorragia intracerebral espontánea asociada a anticoagulantes orales (HIC-ACO) presenta una elevada mortalidad. La aparición de nuevos fármacos anticoagulantes y protocolos de reversión aumenta el interés por esta entidad. Objetivos. El objetivo principal es determinar la tasa de mortalidad en pacientes con HIC-ACO (precoz, hospitalaria, global) en nuestra área sanitaria y analizar las principales variables relacionadas. El objetivo secundario es determinar la eficacia de las terapias de reversión de la anticoagulación (TRA), reflejada por la expansión radiológica del hematoma y el pronóstico funcional. Pacientes y métodos. Estudio prospectivo observacional que introdujo un protocolo dirigido al manejo de pacientes con HIC-ACO. Incluyó medidas generales y neuromonitorización, administración individualizada de TRA, tomografía craneal y seguimiento durante seis meses. Se recogieron los fármacos prescritos en el área durante este período, mortalidad y pronóstico funcional. Se diseñó un estudio bivariante y regresión logística para investigar variables relacionadas con la mortalidad. Resultados. Se incluyó a 49 pacientes durante tres años; de ellos, un 71,4% recibió TRA. La mortalidad fue del 16,3% (primeras 24 horas), el 53,1% (ingreso) y el 61,2% (180 días). Se observó una menor supervivencia entre pacientes con puntuaciones basales mayores en la National Institutes of Healt Stroke Scale (NIHSS) (p lower than 0,0001), valor de creatinina (p = 0,02), índice internacional normalizado (p = 0,048), volumen hemorrágico (p = 0,008), hidrocefalia (p = 0,015) y toma de acenocumarol (p = 0,030). Los pacientes que no recibieron TRA tuvieron una mayor mortalidad precoz (p = 0,003). La única variable relacionada con la mortalidad global de forma independiente fue la puntuación en la NIHSS basal (odds ratio = 1,282; intervalo de confianza al 95%: 1,023-1,608; p = 0,031). Conclusiones. La HIC-ACO presenta una elevada mortalidad, relacionada con la toma de acenocumarol y de forma independiente con la situación clínica inicial. Se comprobó una menor tasa de mortalidad precoz entre pacientes que recibieron TRA.

Anxiety levels among social work students during the COVID-19 lockdown in Spain.

The COVID-19 pandemic has compelled university students to adapt to remote learning modalities resulting in increased of anxiety symptoms. This study explores levels of anxiety, and risk and protection factors among Social Work students at two universities in southern Spain. Thirty four percent were experiencing severe anxiety, and 28.5% mild to moderate, revealing that anxiety levels had increased significantly. Greater concern about academic situation and future economic scenario, living in an urban area and leave the habitual residence increased anxiety symptoms. By contrast, family income stability and higher social support from relatives reduced anxiety symptoms. These results support the planning of emotional support services for college students, as well as the incorporation in the study plans the acquisition of skills to live better in these conditions.

The use of autologous serum eye drops for the treatment of ocular surface disorders.

OBJECTIVES: To investigate the use of autologous serum (AS) eye drops in patients with ocular surface disorders who were refractory to conventional treatments. METHODS: A retrospective cohort study was conducted at a tertiary care centre. We included patients with a prescription of AS eye drops from December 2006 to January 2016. Electronic prescriptions (Prescriplant) and clinical histories were reviewed. A database with sociodemographic and pharmacotherapheutic variables was created. The efficacy was evaluated subjectively and adverse effects was a measurement of safety. AS eye drops were elaborated, in a laminar flow hood, with the blood samples for a final concentration of 20%. RESULTS: One hundred and seventy-three patients were considered for the study, 78.03% of them female. Their mean age was 63.87 years (SD 16.69). The use of AS eye drops was indicated for several diseases: corneal diseases (corneal ulcer or corneal persistent epithelial defects) (34.32%); Sjögren syndrome (17.16%); dry eye resulting from autoimmune disease (15.38%); and blepharitis/blepharospasm (12.43%). The regular dosage was every 3 or 4 hours (40.46%). 21.97% patients used the AS in one eye only. The mean length of treatment was 2.71 years. All patients, except one, improved their symptoms with the treatment and no one suffered harmful effects. CONCLUSIONS: Numerous national and international guidelines on dry eye treatment have been published, but they differ in dosing, concentration and indication of AS eye drops. Consequently, there is no consensus about the best therapy with AS. In this article we describe the clinical practice of AS eye drops. In the study, indications for AS therapy were mostly: corneal diseases; Sjögren syndrome; and dry eye resulting from autoimmune disease; and blepharitis or blepharospasm. Patients went to the hospital pharmacy to pick up AS eye drops before 90 days, it ensures the stability of eye drops. AS is an effective, safe and well tolerated treatment.

[Paradoxical arterial gas embolism following a direct incisive injury to the skull]. / Embolismo arterial gaseoso paradojico tras una herida incisa craneal directa.

INTRODUCTION: An arterial gas embolism is defined as the presence of air in the arterial circulation. This is an extremely rare cause of stroke that has been described in a multitude of clinical scenarios, generally related to iatrogenic processes. A clinical case is reported in which the arterial gas embolism occurred after a traumatic brain injury, and the most relevant aspects of diagnosis and aetiopathogenesis are reviewed. CASE REPORT: We report the case of a 52-year-old woman with an open craniofacial wound resulting from an attack with an axe. The initial CT scan found fractures in the left zygomatic, sphenoidal and maxillary arches, as well as pneumocephalus in the cavernous sinuses and the right carotid canal. One hour later, the patient showed a neurological deficit in the right hemisphere, and so a new cranial computed tomography scan with multimodal vascular study was urgently requested, which revealed the mobilisation of the pneumocephalus and ruled out a large vessel arterial occlusion. A shunt study using transcranial Doppler and echocardiography showed the presence of a patent foramen ovale to be the cause of arteriovenous communication that justified an arterial gas embolism. The follow-up CT scan at 48 hours confirmed the appearance of a right parietal ischaemic lesion. CONCLUSION: This case reflects the simultaneous presence of air in the arterial and venous circulation of the brain, as well as the peripheral communication through a patent foramen ovale. This production mechanism is poorly documented in the literature.

TITLE: Embolismo arterial gaseoso paradojico tras una herida incisa craneal directa.Introduccion. El embolismo arterial gaseoso se define como la presencia de aire en la circulacion arterial. Se trata de una causa extremadamente rara de ictus que se ha descrito en multitud de escenarios clinicos, generalmente relacionados con procesos yatrogenos. Se aporta un caso clinico en el que el embolismo arterial gaseoso sucedio tras un traumatismo craneoencefalico, y se revisan los aspectos mas relevantes del diagnostico y la etiopatogenia. Caso clinico. Mujer de 52 años que presentaba herida incisa craneofacial tras una agresion con un hacha. La tomografia computarizada inicial objetivo fractura en los arcos cigomatico, esfenoidal y maxilar izquierdos, asi como neumoencefalo en los senos cavernosos y el canal carotideo derecho. Una hora mas tarde, la paciente mostro un deficit neurologico hemisferico derecho, por lo que se solicito de forma urgente una nueva tomografia computarizada craneal con estudio vascular multimodal, que objetivo la movilizacion del neumoencefalo y descarto una oclusion arterial de gran vaso. Un estudio de shunt mediante Doppler transcraneal y ecocardiografia comprobo la presencia de un foramen oval permeable como causa de comunicacion arteriovenosa que justificaba un embolismo arterial gaseoso. La tomografia computarizada de control a las 48 horas confirmo la aparicion de una lesion isquemica parietal derecha. Conclusion. En este caso queda reflejada la presencia simultanea de aire en la circulacion cerebral arterial y venosa y la comunicacion periferica a traves de un foramen oval permeable. Este mecanismo de produccion esta escasamente documentado en la bibliografia.

Pharmacotherapy follow-up of key points in the safety of oral antineoplastic agents.

We assessed the impact of a pharmacotherapy follow-up programme on key safety points [adverse events (AE) and drug administration] in outpatients treated with oral antineoplastic agents (OAA). We performed a comparative, interventional, quasi-experimental study of outpatients treated with OAA in a Spanish hospital to compare pre-intervention group patients (not monitored by pharmacists during 2011) with intervention group patients (prospectively monitored by pharmacists during 2013). AE data were collected from medical records. Follow-up was 6 months, and 249 patients were included (pre-intervention, 115; intervention, 134). After the first month, AE were detected in 86.5% of patients in the pre-intervention group and 80.6% of patients in the intervention group, P = 0.096. During the remaining months, 79.0% patients had at least one AE in the pre-intervention group compared with 78.0% in the intervention group, P = 0.431. AE were more prevalent with sorafenib and sunitinib. In total, 173 drug interactions were recorded (pre-intervention, 80; intervention, 93; P = 0.045). Drug interactions were more frequent with erlotinib and gefitinib; food interactions were more common with sorafenib and pazopanib. Our follow-up of cancer outpatients revealed a reduction in severe AE and major drug interactions, thus helping health professionals to monitor the safety of OAA.

Impact of medication adherence on the effectiveness of deferasirox for the treatment of transfusional iron overload in myelodysplastic syndrome.

WHAT IS KNOWN AND OBJECTIVE: Regular blood transfusions in the management of myelodysplastic syndrome (MDS) often lead to iron overload. The main objective of this study was to evaluate the impact of medication adherence on the effectiveness of deferasirox for the treatment of transfusional iron overload in patients with MDS. Secondary objectives were to describe treatment effectiveness and safety in daily clinical practice. METHODS: A longitudinal, retrospective, observational study was carried out in a university hospital. The inclusion criteria were age over 18 years, MDS diagnosis and treatment with deferasirox for transfusion-dependent iron overload during the period of study (from January 2011 to April 2015). Treatment effectiveness was estimated by serum ferritin (SF), and adherence was measured by medication possession ratio (MPR). Clinically relevant analytical alterations during the treatment and reasons for treatment discontinuation were also assessed. RESULTS: Thirty-five patients were included in the study. Median SF at baseline was 1636 µg/L, and it decreased to 1399 µg/L during follow-up. The median adherence rate was 92%, although only 54·8% of the patients maintained deferasirox adherence ≥90% during the whole duration of treatment. Adherence rate was inversely correlated to SF (r = -0·288, P = 0·004). The median (p25, p75) duration of treatment was 11 (3·0, 37·8) months. The most common reasons for treatment discontinuation were renal toxicity (35%) and patient's death (25%). WHAT IS NEW AND CONCLUSION: Deferasirox's effectiveness, measured by the decrease in SF, was significantly better in adherent patients. The most frequent reason for treatment discontinuation was renal toxicity. Developing strategies to improve deferasirox treatment adherence and monitoring renal function in those patients should be key points in pharmaceutical care.

Dose Modification in Biologic Therapy for Moderate to Severe Psoriasis: A Descriptive Analysis in a Clinical Practice Setting.

INTRODUCTION: In biologic therapy, dose modification in carefully selected patients when psoriasis is in remission could reduce treatment costs and the risks associated with drug exposure. MATERIAL AND METHODS: Observational, descriptive, crosssectional study, performed in January 2014, of 112 patients with moderate to severe psoriasis who had been on biologic therapy for at least 6 months. The therapeutic objective in all cases was to achieve and maintain a 75% reduction in Psoriasis Area and Severity Index (PASI 75). All the patients had started treatment with the standard regimen. During treatment, the dose had been reduced in patients who achieved the therapeutic objective and escalated in those who failed to respond adequately to standard doses. RESULTS: At the time of the study, 42.9% of the patients were receiving the standard dose, 50% were on a reduced dose, and 7.1% were on an escalated regimen. The agent with which the dose was most often reduced was adalimumab (57.7%), and the agents with which therapy was most often escalated were ustekinumab (17.9%) and infliximab (12.5%). Patients who received reduced doses had significantly longer-standing disease (P=.049) and longer treatment duration with the same biologic agent (P=.009). In the group that did not fulfill the criteria for dose reduction, the proportion of patients with psoriatic arthritis was significantly higher (P=.023). Cost savings were as follows: 21.5% with adalimumab, 13.8% with etanercept, .9% with ustekinumab, and .55% with infliximab. CONCLUSIONS: Patients with longer-standing disease and longer treatment duration with the same biologic agent were significantly more likely to be candidates for dose reduction. The proportion of patients with psoriatic arthritis was greater in the group of patients who did not fulfill the conditions for dose reduction. The overall cost saving achieved using the dose modification algorithm described in this study was 13%. Controlled studies are needed to define the profile of the patients best suited for dose reduction strategies without loss of treatment efficacy.

Características produtivas da consorciação de trevo-persa e azevém submetidos a pastejo / Productive characteristics of intercropping persian clover and ryegrass submitted to grazing

Este estudo teve como objetivo avaliar o efeito de diferentes intervalos entre pastejos sobre as características produtivas de trevo-persa e azevém, consorciados e manejados sob lotação rotacionada, nos anos de 2009 e 2010. Os tratamentos consistiram em quatro intervalos entre pastejos (tempo para o surgimento de 2,5; 3,5; 4,5 e 5,5 folhas em plantas de trevo-persa), em delineamento de blocos completos ao acaso, com seis repetições. As variáveis analisadas foram: índice de área foliar, área foliar, altura do pasto e de plantas, comprimento de perfilhos/ramificações, taxa de acúmulo de matéria seca e produção de matéria seca. O índice de área foliar do dossel e do trevo-persa foi maior no intervalo de 5,5 folhas nos anos de 2009 e 2010. No ano de 2009, maiores valores de área foliar foram obtidos nos intervalos de 3,5 e 4,5 folhas e não se observou efeito dos intervalos entre pastejos sobre essa variável em 2010. Maiores intervalos entre pastejos proporcionaram maior altura do pasto e de plantas e também maior comprimento de perfilhos e ramificações. A produção de matéria seca do trevo-persa foi maior em 2010, ao passo que, para azevém, maior produção foi encontrada em 2009. A produção de matéria seca total foi maior no intervalo de 5,5 folhas. A taxa de acúmulo de matéria seca foi maior no intervalo de 5,5 folhas em 2009 e no intervalo de 2,5 folhas em 2010. As características produtivas da consorciação trevo-persa e azevém anual são modificadas pelos intervalos entre pastejos. Recomendam-se intervalos de até 3,5 folhas surgidas, em consorciação de trevo-persa e azevém anual, os quais proporcionam menor alongamento de caules associado à menor presença de material morto, o que, provavelmente, melhora a qualidade da forragem colhida.

The aim of this trial was to study the effect of different grazing intervals on productive characteristics of persian clover and ryegrass, in consortium and managed under rotational stocking during the years 2009 and 2010. Treatments were composed of four grazing intervals (time to onset of 2.5; 3.5; 4.5 and 5.5 leaves in persian clover plants) allocated in completely randomized blocks, with six replications. Leaf area index (LAI), leaf area, pasture and plants height, length of tillers/branches, rate of dry matter accumulation and dry matter yield were evaluated. The leaf area index of the canopy and the persian clover was higher in the interval of 5.5 leaves in years 2009 and 2010. In 2009, higher values of leaf area were obtained in intervals of 3.5 and 4.5 leaves and there no was effect of grazing intervals on this variable in 2010. Higher grazing intervals provided greater pasture height and plant height and also greater tiller and branch length. The dry matter production of persian clover was higher in 2010, while for ryegrass highest yields were found in 2009. Total dry matter yield was higher in the interval of 5.5 leaves. The rate of dry matter accumulation was higher in the interval of 5.5 leaves in 2009 and in the interval of 2.5 leaves in 2010. The productive characteristics of a of mixture persian clover and ryegrass are modified by the grazing intervals. It is recommended intervals up to 3.5 of appeared leaves with a mixture of persian clover and ryegrass, which provides lower elongation of stems associated with a lower presence of dead material, which probably improves the quality of the harvested forage.

[Evaluation of drug administration through enteral feeding tubes in hospitalized patients]. / Evaluación de las prácticas de administración de fármacos por sonda nasoentérica y enterostomía en pacientes hospitalizados.

OBJECTIVE: To describe the administration of drugs through nasogastric tubes by the nursing staff of a tertiary hospital and to identify the most common administration errors. METHODS: An observational study was carried out between November of 2010 and March of 2011. The study population was the nursing staff of the hospital. A questionnaire was created asking about the daily practice of drugs administration through the nasogastric tube; a score was assigned to each question. A document on correct administration techniques of drugs through the nasogastric tube was elaborated, which served for the comparison of the answers obtained. RESULTS: A total of 162 surveys were answered. Most of the staff (44.5%) had a deficient knowledge on the proper administration techniques. 69.7% of the staff stated to have grinded some time a tablet with enteric coverage, and 66.2% a tablet with modified release. A significant lower number of perceived obstructions per month was obtained in those nurses with higher degree of knowledge, in those consulting the Pharmacy Department when they had doubts, and in those never having grinded a tablet with enteric coverage of modified release. CONCLUSIONS: It is observed that the knowledge on proper administration of drugs through the nasogastric tube by the nursing staff is deficient; therefore, it would be convenient to carry out specific training courses as well as a closer collaboration between the Pharmacy department and the Nursing units.

[Kt calculation as a quality indicator of haemodialysis adequacy]. / Cálculo del Kt como indicador de calidad en el área de adecuación en hemodiálisis.

The haemodialysis dose is a good marker of dialysis adequacy, and we usually monitor it with Kt/V measure. The dialysis dose monitored with Kt allows a better discrimination, detecting a percentage of the patients that perhaps do not get an adequate dose for their gender or body surface area after treatment with a minimum recommended dose of Kt/V. The objective of this study was to evaluate Kt as a clinical indicator referred to dialysis adequacy in the haemodialysis population. The aim was that more than 85% of the patients would achieve the recommended Kt target for their gender (at least 50 litres in men and 45 litres in women), or their body surface area. In each of the patients (mean 129) the Kt mean value was determined for three consecutive dialysis sessions, one every two months, during the follow-up period (14 months). At the beginning, the Kt/V value was on target (> 1.3) in 93.2% of the patients, but only in 58% according to Kt measure for their gender. After 4 months, we observed that 85% of patients' Kt target increased for their gender, but only 68% did if we used the Kt individualised for their body surface area. From month 6 to the end of the follow-up period, more than 85% of patients obtained an adequate Kt for their body surface area (p < 0.001). A significant increase of Kt mean (5.4 litres) was observed at the end of the study (p < 0.001). The usual dialysis prescription parameters were modified increasing blood flow rate (34.14 ml/min, p < 0.001), session effective duration (8.04 minutes, p < 0.001), dialyser surface area (24.1% of patients changed from helixone 1.3 to 1.6 m2, p < 0.001) and haemodialysis modality (56.8% of patients changed from conventional haemodialysis to on-line haemodiafiltration, p < 0.001). We conclude that monitoring dialysis dose with Kt is a good clinical measure of adequacy, and using it as a quality indicator can be done in line with the more demanding quality standards.

Biocontrol bacteria selected by a direct plant protection strategy against avocado white root rot show antagonism as a prevalent trait.

AIM: This study was undertaken to study bacterial strains obtained directly for their efficient direct control of the avocado white root rot, thus avoiding prescreening by any other possible mechanism of biocontrol which could bias the selection. METHODS AND RESULTS: A collection of 330 bacterial isolates was obtained from the roots and soil of healthy avocado trees. One hundred and forty-three representative bacterial isolates were tested in an avocado/Rosellinia test system, resulting in 22 presumptive protective strains, all of them identified mainly as Pseudomonas and Bacillus species. These 22 candidate strains were screened in a more accurate biocontrol trial, confirming protection of some strains (4 out of the 22). Analyses of the potential bacterial traits involved in the biocontrol activity suggest that different traits could act jointly in the final biocontrol response, but any of these traits were neither sufficient nor generalized for all the active bacteria. All the protective strains selected were antagonistic against some fungal root pathogens. CONCLUSIONS: Diverse bacteria with biocontrol activity could be obtained by a direct plant protection strategy of selection. All the biocontrol strains finally selected in this work were antagonistic, showing that antagonism is a prevalent trait in the biocontrol bacteria selected by a direct plant protection strategy. SIGNIFICANCE AND IMPACT OF THE STUDY: This is the first report on the isolation of biocontrol bacterial strains using direct plant protection strategy in the system avocado/Rosellinia. Characterization of selected biocontrol bacterial strains obtained by a direct plant protection strategy showed that antagonism is a prevalent trait in the selected strains in this experimental system. This suggests that antagonism could be used as useful strategy to select biocontrol strains.

Micellar electrokinetic chromatography method for the determination of several natural red dyestuff and lake pigments used in art work.

The identification of organic colorants used in artistic paintings is an important information source for reconstructing the working techniques found in a particular work and for defining a programme for the restoration and conservation of the painting. In this work, sodium dodecyl sulfate (SDS) was used as a surfactant in micellar electrokinetic chromatography (MEKC) for separating a broad range of red organic pigments, based on their colouring matters: madder (colouring matters: alizarin, quinizarin and purpurin), cochineal (colouring matter: carminic acid), red sandalwood (colouring matter: santalin), brazilwood (colouring matter: brazilin), lac dye (colouring matter: laccaic acid) and dragon's blood (colouring matter: dracorhodin). The running electrolyte used was 20 mM borax (pH 9), containing 20 mM SDS and 10% acetonitrile as organic modifier. Separation was carried out by applying a +20 kV voltage at the injection end, 25 degrees C and 214 nm/254 nm as detection wavelengths. All colorants were separated within less than 13 min with a good baseline resolution. The method was applied to the analysis of paint samples obtained from the Diocesan Museum of Holy Art of Bilbao.

Development of a solid phase extraction procedure for HPLC-DAD determination of several angiotensin II receptor antagonists in human urine using mixture design.

The optimisation of a solid phase extraction procedure involves several variables whose influence has been widely studied. However, in most cases, only process variables are taken into account. In this work, the influence of those process variables together with the fact of using mixtures of solvents during the elution step of the solid phase extraction of four angiotensin II receptor antagonist drugs has been studied. Since the influence on the extraction efficiency of several process variables were simultaneously tested, a D-optimal design was constructed. The composition of the elution solvent (a mixture of methanol, acetonitrile, ethanol and acetone at different proportions from 0 to 100% each solvent), the percentage and pH of the buffer solution added to the urine samples at the beginning of the extraction procedure; the percentage of the organic component and the volume of the washing solution, the drying time and the volume of the elution solvent were the studied variables. The chromatographic separation was carried out by gradient elution mode with 0.026% trifluoroacetic acid (TFA) in the organic phase and 0.031% TFA in the aqueous phase using an Atlantis dC18, 100mmx3.9mm I.D. chromatographic column at a flow rate of 1mL/min and a column temperature of 35+/-0.2 degrees C. For detection a diode array detector set at 232nm was used. The extraction procedure for spiked human urine samples was developed using C8 cartridges, phosphate buffer pH 6.8 as conditioning agent, a drying step of 10min, a washing step with methanol-phosphate buffer (20:80, v/v) and methanol as eluent. Recovery percentages obtained: 84% for eprosartan, 74% for telmisartan, 74% for irbesartan and 89% for valsartan allow the determination of these drugs concentration levels in urine.

Avocado Dieback Caused by Neofusicoccum parvum in the Andalucia Region, Spain.

From 2002 to 2006, adult avocado trees, Persea americana Miller cv. Hass, located in the subtropical-fruit-producing area of Andalucia (southern Spain) developed symptoms of dieback characterized by death of twigs and branches in the tree canopy. Sections of surface-disinfested, necrotic branch tissues were plated on Difco potato dextrose agar (PDA) (Sparks, NV) and a Neofusicoccum-like fungus was isolated. On PDA, the isolates had white, appressed mycelium that turned dull gray as the colony aged, although conidia were not formed. Abundant pycnidia and conidia developed when isolates were cultured on 2% water agar with sterilized pine needles as substratum at 25°C under near-UV light for 2 weeks. Conidia were hyaline, unicellular, ellipsoid with an obtuse apex and subtruncate base, averaged 16.2 µm long by 5.8 µm wide and ranged from 12.0 to 20.0 by 4.0 to 8.0 µm, and becoming brown with one or two septa with age. Sequenced rDNA fragments (ITS1, 5.8S rDNA, and ITS2, amplified with ITS1 and ITS4 primers) of two avocado isolates were 100% homologous with Neofusicoccum parvum (Pennycook & Samuels) Crous, Slippers, & A.J.L. Phillips (1) (GenBank Accession Nos. AM410965 and AM410966). Morphological and molecular results confirmed this species as N. parvum, reported as the anamorph of Botryosphaeria parva (1). A pathogenicity test was conducted using two isolates on sets of five 2-year-old avocado plants produced from seeds of cv. Topa-Topa growing in 5-liter pots with soil. Unwounded and wounded plants were used for inoculations. Plants were wounded 2 to 3 cm below the apical tip with a lance (4 mm long and 1 mm deep). For inoculation, 4-mm 2-week-old PDA culture plugs were placed in contact with wounded tissues and covered with Parafilm. Five noninoculated plants treated similarly served as controls. Plants were maintained in the greenhouse with a temperature range of 18 to 26°C, and 1 month later, brown stem lesions, as much as 5 cm, originating from the inoculation site followed by dieback of branches were observed. Reisolations from necrotic branches were successful, and both isolates with identical morphology to those used for inoculations were recovered. Pathogenicity tests of seedlings using the same methods also caused stem lesions on unwounded plants and the pathogen was reisolated. To our knowledge, this is the first report of N. parvum causing dieback of avocado trees in Spain. Previously, B. parva has been reported causing stem-end rot of avocado fruit in New Zealand (2). In Spain, since diseased orchards are increasing rapidly, this pathogen could be efficiently distributed by pruning activities (tools and vegetal debris) as observed with other diseases (3). The presence of N. parvum in this subtropical area presents a serious disease problem not only to avocado but also to mango (Mangifera indica L.), which is another susceptible host (4). References: (1) P. W. Crous et al. Stud. Mycol. 55:235, 2006. (2) W. F. T. Hartill et al. N. Z. J. Crop Hortic. Sci. 30:249. 2002. (3) A. J. L. Phillips. Phytopathol. Mediterr. 41:3, 2002. (4) B. Slippers et al. Mycologia 97:99, 2005.

Validation of a solid phase extraction-high performance liquid chromatographic method for the determination of eprosartan in human plasma.

In this work, a solid phase extraction-reversed phase high performance liquid chromatographic (SPE-RP-HPLC) method with photometric detection for monitoring the antihypertensive drug eprosartan has been validated in order to assure good quantitation of eprosartan in plasma samples obtained from patients under cardiovascular treatment. This analytical method was developed by using experimental design and quantitation was accomplished with the internal standard method. No interferences were observed from endogenous compounds of plasma and other drugs which are commonly co-administered in elderly patients. The recoveries of eprosartan from plasma samples, measured at three levels of the linear concentration range (150-4000 ng/mL) were found to be between 93.4 and 102.8%. The intraday and interday precision and accuracy (measured by relative standard deviation, RSD, and relative error, RE, respectively) were always lower than 13% (RSD) and 4% (RE). Stability studies showed that eprosartan stock solutions are stable for at least 3 months when stored at 8 degrees C and plasma samples containing the drug were stable at least during the whole analytical method.

MultiSimplex and experimental design as chemometric tools to optimize a SPE-HPLC-UV method for the determination of eprosartan in human plasma samples.

A chemometric approach was applied for the optimization of the extraction and separation of the antihypertensive drug eprosartan from human plasma samples. MultiSimplex program was used to optimize the HPLC-UV method due to the number of experimental and response variables to be studied. The measured responses were the corrected area, the separation of eprosartan chromatographic peak from plasma interferences peaks and the retention time of the analyte. The use of an Atlantis dC18, 100mmx3.9mm i.d. chromatographic column with a 0.026% trifluoroacetic acid (TFA) in the organic phase and 0.031% TFA in the aqueous phase, an initial composition of 80% aqueous phase in the mobile phase, a stepness of acetonitrile of 3% during the gradient elution mode with a flow rate of 1.25mL/min and a column temperature of 35+/-0.2 degrees C allowed the separation of eprosartan and irbesartan used as internal standard from plasma endogenous compounds. In the solid phase extraction procedure, experimental design was used in order to achieve a maximum recovery percentage. Firstly, the significant variables were chosen by way of fractional factorial design; then, a central composite design was run to obtain the more adequate values of the significant variables. Thus, the extraction procedure for spiked human plasma samples was carried out using C8 cartridges, phosphate buffer pH 2 as conditioning agent, a drying step of 10min, a washing step with methanol-phosphate buffer (20:80, v/v) and methanol as eluent liquid. The SPE-HPLC-UV developed method allowed the separation and quantitation of eprosartan from human plasma samples with an adequate resolution and a total analysis time of 1h.