Campaña de medida de la presión arterial (‘May Measurement Month’) 2019: análisis del cribado en farmacias comunitarias españolas y detección de hipertensión enmascarada / May Measurement Month 2019: Analysis of screening in Spanish community pharmacies and detection of masked hypertension

Objetivo: conocer dentro del proyecto May Measurement Month (MMM), la situación de la presión arterial (PA) en la población española, difundir la importancia de su medida periódica y estimar la prevalencia de hipertensión enmascarada (HEN). Métodos: estudio descriptivo transversal en farmacias comunitarias españolas durante mayo de 2019. Sujetos: usuarios adultos que consentían participar. Variables: presión arterial sistólica (PAS), presión arterial diastólica (PAD) en milímetros de mercurio (mmHg), frecuencia cardíaca (FC) en latidos/minuto (lat/min) A los participantes con PA ≥130/85 y <149/90 se les ofrecía realizar automedida (AMPA) para confirmar HEN. Resultados: 491 farmacéuticos recogieron 3.402 registros válidos (61,9% mujeres), edad media 56,6 años. 143 (4,2 %) nunca se habían medido la PA y 918 (27,0 %) no la habían medido en el último año. 1.047 tomaban antihipertensivos, de los que el 45,7 % tenían la PA alta. 780 (22,9 %) participantes tenían valores elevados de PA; ambos, 252 (7,4 %). La PASm fue 125,0 y la PADm 76,5 mmHg, mayor en hombres (p<0,001). La FCm fue de 72,6 lat/min. Se encontró relación directa entre PAS y PAD e IMC (p<0,0001). PADm y FCm fueron mayores en fumadores (p<0,0001). En pacientes diabéticos, PAS, PAD y FC fueron mayores. 61 participantes con sospecha de HEN aceptaron realizar AMPA. 25 (40,1 %) resultaron con PA ≥135/85 mmHg. Conclusiones: casi uno de cada cuatro participantes tenía valores de PA ≥140/90 mmHg. Los factores de riesgo relacionados más estrechamente con la PA elevada fueron sobrepeso, diabetes y edad. El 40 % de las sospechas de HEN se confirmaron mediante AMPA (AU)

A holistic assessment of the sources, prevalence, and distribution of bisphenol A and analogues in water, sediments, biota and plastic litter of the Ebro Delta (Spain).

Bisphenol A (BPA) is one of the main ubiquitous compounds released from plastics in the environment. This compound, considered an endocrine disruptor, poses a risk to aquatic wildlife and human population, being included in multiple environmental monitoring programmes. Following the regulations restricting BPA use in the last years, BPA-like chemicals have been produced and used as BPA substitutes. However, they are not commonly included in monitoring programs yet and their presence is thus misrepresented, despite showing similar endocrine disrupting potential. In this work, an analytical method for analysing bisphenol A and five of its analogues (Bisphenol S, B, F, AF and Tetrabromobisphenol A) is described, validated for water (riverine, sea and wastewater), sediment, and biota (fish and biofilm) and applied to monitor their presence in the Ebro River Delta (NE Spain). In addition, plastic litter was also collected to evaluate their role as potential source of bisphenols. All compounds except BPF were detected in the analysed samples. Wastewater treatment plants (WWTPs) were discarded as major sources of BPs into the natural aquatic environment, as no BPs were detected in treated effluents. Indeed, the high levels of BPs in the natural environment could be related with direct discharge of raw wastewater from small rural population nucleus. The analysis of riverine plastic leachates yielded 4 out of the 6 BPs analysed, strengthening the hypothesis that plastic debris are also a source of BPs in the natural environment. Whereas Bisphenol S and BPA were detected in water and, to a limited extent, in biota, less polar analogues (mainly BPAF and TBBPA) were not found in any of the water samples. Instead, these hydrophobic BPs were found in fish tissues and biofilm, pointing out plastics and microplastics as their possible vectors. Finally, biofilm demonstrated its potential as sentinel of chemical contamination in freshwater environment.

Cambios producidos en el paciente con hipertensión durante el confinamiento que podrían modificar su riesgo cardiovascular / Changes in the patient with hypertension during confinement that could modify cardiovascular risk

Introducción: la pandemia SARS-CoV-2 ha provocado importantes cambios en el sistema sanitario y como consecuencia retrasos en el control de las patologías crónicas. Además, el confinamiento impuso una serie de restricciones que modificaron las condiciones habituales, por lo que resulta de interés conocer su influencia en el paciente con hipertensión. Objetivos: determinar los cambios en los hábitos de estilos de vida saludables durante el confinamiento, en hipertensos tratados y que pudieran agravar su riesgo cardiovascular (RCV).Métodos: estudio observacional, transversal y descriptivo realizado del 10 de junio al 10 de julio de 2020 en farmacias comunitarias españolas. Los pacientes cumplimentaron un cuestionario sobre el conocimiento de su enfermedad y factores que pudieron afectarse durante el confinamiento.Resultados: participaron 215 pacientes. Un 84,7 % afirmó conocer su enfermedad, el 56,7 % conocía sus valores de presión arterial (PA). Un 9,6 % no se la controlaba antes, pasando al 46,3 % durante el confinamiento. La mayoría mantuvo sus hábitos de estilo de vida saludables, excepto en el ejercicio donde disminuyó un 68,4 %. El 34,9 % refiere haber sufrido ansiedad; 27 % tiene miedo de acudir a enfermería, 27,9 % al médico y 10,2 % a la farmacia. El 56,7 % usó telemedicina. Conclusiones: dentro de los hábitos saludables el confinamiento no ha modificado sustancialmente los hábitos alimenticios, pero ha supuesto una importante disminución del ejercicio físico y aumento de peso en la mitad de los pacientes, que, junto con la disminución en el control de los valores y seguimiento, repercute negativamente en el control de la PA y el RCV. (AU)

Thalassemia in Asia 2021 Thalassemia in Brunei Darussalam.

Acknowledging and understanding the extent of thalassemia and hemoglobinopathy issues in a country is crucial for the benefit of implementing a national preventive and control program to reduce its prevalence. In order to obtain reliable prevalence data, the gene frequencies of the thalassemias and other hemoglobinopathies should be investigated. Molecular studies on thalassemia have yet to be done for Brunei's population. It was estimated that carriers of thalassemia or hemoglobinopathies in Brunei is approximately 5.0% or less of the overall population. There are about 200 current cases of thalassemia and other hemoglobinopathies including adults and children reported across all four districts of Brunei. Blood parameter analysis, microscopy, hemoglobin (Hb) electrophoresis and high performance liquid chromatography (HPLC) are the most common methods of investigation in aiding diagnosis in the hospital laboratory. Genotyping analysis conducted in an overseas laboratory has been employed to confirm some diagnosis. Compiled data from 2009-2017 at the Hematology Laboratory of the Raja Isteri Pengiran Anak Saleha Hospital, Jalan Putera Al-Muhtadee Billah, Bandar Seri Begawan, Brunei Darussalam, showed that the most reported diagnoses are α-thalassemia (α-thal) trait, ß-thalassemia (ß-thal) trait, heterozygous Hb E (HBB: c.79G>A)/ß-thal, ß-thal major (ß-TM) and ß-thal intermedia (ß-TI). The data reported indicate the importance of establishing a thalassemia registry with relevant data on patients and patient outcomes as a tool for monitoring and improving patient care.

Posicionamiento de la Sociedad Española de Farmacia Clínica, Familiar y Comunitaria sobre telefarmacia: teleatención farmacéutica (TAF) / Position of the Spanish Society of Clinical, Family and Community Pharmacy on telepharmacy: telepharmaceutical telecare (TAF)

Las nuevas tecnologías de la información y comunicación (TIC) están desarrollándose desde hace bastantes años, pero la pandemia de COVID-19 ha acelerado la transformación digital de la sociedad. En el campo de la salud han surgido nuevas actividades y de esta forma términos como telemedicina, teleasistencia o teleconsulta empiezan a ser habituales. Indudablemente suponen un avance, pero tienen el riesgo de deshumanizar el contacto de sanitarios y pacientes.En el campo de la farmacia ha surgido la telefarma cia con unas innegables connotaciones logísticas y comerciales. Desde la Sociedad Española de Farmacia Clínica, Familiar y Comunitaria se prefiere utilizar el término teleatención farmacéutica (TAF), definiéndolo como la práctica farmacéutica asistencial a distancia que utiliza las TIC para complementar la atención farmacéutica presencial que precise el paciente. La TAF incluye la prestación a distancia de algunos servicios profesionales farmacéuticos asistenciales (SPFA). La TAF debe ayudar al farmacéutico comunitario a prestar algunos SPFA, mejorando así la practica farmacéutica clínica sin caer en la deshumanización que la aplicación indiscriminada de las TIC puede producir. (AU)

Low serum 25-hydroxyvitamin D (vitamin D) level among children with ventricular septal defect: how big is the risk for pulmonary hypertension?

INTRODUCTION: Ventricular septal defect is the most common CHD, leading to pulmonary hypertension. Significantly lower 25-hydroxyvitamin D level was reported in children with CHD compared with healthy controls. The current study aimed to investigate the correlation between 25-hydroxyvitamin D level and pulmonary hypertension in children with ventricular septal defect. METHODS: A cross-sectional study was conducted on ventricular septal defect paediatric patients from January to June, 2019. Serum 25-hydroxyvitamin D was measured using electrochemiluminescence. Pulmonary hypertension was defined as mean pulmonary artery systolic pressure > 20 mmHg for children >3 months of age at sea level, measured by Doppler echocardiography. RESULTS: From forty-four subjects, the majority of the subjects were female (56.8%) with normal nutritional status and perimembranous ventricular septal defect. Bivariate analysis showed that 25-hydroxyvitamin D level was associated with pulmonary hypertension (p < 0.01), type and size of ventricular septal defect (p = 0.02), and heart failure (p < 0.01). Higher 25-hydroxyvitamin D level was correlated with better nutritional status (p = 0.04, r = 0.26), and lower 25-hydroxyvitamin D level was correlated with the occurence of perimembranous ventricular septal defect (p = 0.01, r = -0.39), larger defect size (p < 0.01, r = -0.70), history of pneumonia (p = 0.02, r = -0.31), and heart failure (p < 0.01, r = -0.64). Subjects with 25-hydroxyvitamin D deficiency had prevalence ratio of 24.0 times for pulmonary hypertension. Higher pulmonary artery pressure was correlated to the occurence perimembranous ventricular septal defect (p = 0.01, r = 0.47), larger defect size (p < 0.01, r = 0.78), history of pneumonia (p = 0.01, r = 0.38), and heart failure (p < 0.01, r = 0.75). CONCLUSION: Children with ventricular septal defect who had low 25-hydroxyvitamin D level posed a higher risk of having pulmonary hypertension.

Síndrome de Guillain-Barré durante la pandemia de COVID-19: experiencia de un centro de referencia en México / Guillain-Barré syndrome during COVID-19 pandemic: experience from a referral healthcare center in Mexico

Introducción: Se trata de describir las características clínicas y variantes electrofisiológicas de los casos de síndrome de Guillain-Barré (SGB) durante la pandemia. Llevamos a cabo un análisis comparativo entre pacientes con SGB relacionado con el SARS-CoV-2 y sin antecedente del virus, y posteriormente realizamos una comparación con los casos de 2019. Pacientes y métodos: Se llevó a cabo un estudio transversal de los pacientes con diagnóstico de SGB según los criterios de Asbury y Cornblath. Se recolectaron información clínica y variables paraclínicas. Definimos el SGB relacionado con el SARS-CoV-2 conforme a la descripción de Ellul et al. Se utilizaron los criterios de Hadden para la clasificación de las variantes electrofisiológicas. Por último, realizamos un análisis comparativo entre grupos. Resultados: Se diagnosticó a 42 pacientes con SGB en 2020, un 64,2% hombres, con una edad de 46 ± 17,4 años, un 42,8% con obesidad/sobrepeso, un 31% con historia de diarrea previa y un 14,2% con infección respiratoria previa. El 71,4% tuvo una puntuación en la Guillain-Barré Disability Score igual o mayor que 3 puntos y el 69% tenía afectados los nervios del cráneo. La variante electrofisiológica más común fue la polirradiculoneuropatía desmielinizante inflamatoria aguda (PDIA; 53,5%). Siete (16,6%) casos tuvieron relación con el SARS-CoV-2, cuatro hombres, con edad de 43,4 ± 13,4 años. Al realizar la comparación entre pacientes con SGB de 2020 frente a los de 2019, observamos un decremento en el antecedente de infección previa en 2020 (45,2 frente a 73,3%; p = 0,005) y un decremento específico en la historia de infección respiratoria (14,2 frente a 33,3%; p = 0,045), así como una mayor frecuencia de afectación de los nervios del cráneo y de disociación albuminocitológica. Conclusiones: Las maniobras preventivas para la infección por el SARS-CoV-2 impactan directamente en la presentación de enfermedades postinfecciosas como el SGB...(AU)

Introduction: To describe clinical characteristics and electrophysiological variants of GBS cases during the pandemic, we carried out a comparative analysis between SARS-CoV2 related GBS and non-SARS-CoV2 patients and then compared to the 2019 cases. Patients and methods: We carried out a cross-sectional study of GBS patients diagnosed according to Asbury and Cornblath criteria. We collected information on clinical and paraclinical variables. We defined a SARS-CoV-2 related GBS case according to the description of Ellul et al. We used Hadden criteria to classify the electrophysiological variants. We performed a comparative analysis between groups. Results: Fourty-two patients were diagnosed with GBS in 2020, men 64.2%, age 46 ± 17.4 years, patients with obesity/overweight 42.8%, previous diarrhea 31%, history of respiratory tract infection 14.2%. Guillain Barre Disability Scale ≥ 3 points 71.4% and, cranial nerve involvement 69%. The most frequent electrophysiological variant was acute inflammatory demyelinating polyradiculoneuropathy (AIDP) 53.5%. Seven (16.6%) cases were SARS-CoV2 related, four men, age 43.4 ± 13.4 years. When comparing patients with GBS in 2020 vs patients in 2019, we observed a decrease in the previous infection history during 2020 (45.2% vs 73.3%, p-value = 0.005) and a decrease in previous respiratory infection (14.2% vs 33.3%, p = 0.045), as well as a higher frequency of cranial nerve involvement, and albuminocytologic dissociation. Conclusions: SARS-CoV2 virus infection preventive measures may be impacting the presentation of post-infectious diseases such as GBS. We did not observe an increase in GBS cases during 2020. Also, the AIDP variant were more frequent in our population in the COVID-19 pandemic.(AU)

Guillain-Barre syndrome during COVID-19 pandemic: experience from a referral healthcare center in Mexico. / Síndrome de Guillain-Barré durante la pandemia de COVID-19: experiencia de un centro de referencia en México.

INTRODUCTION: To describe clinical characteristics and electrophysiological variants of GBS cases during the pandemic, we carried out a comparative analysis between SARS-CoV2 related GBS and non-SARS-CoV2 patients and then compared to the 2019 cases. PATIENTS AND METHODS: We carried out a cross-sectional study of GBS patients diagnosed according to Asbury and Cornblath criteria. We collected information on clinical and paraclinical variables. We defined a SARS-CoV-2 related GBS case according to the description of Ellul et al. We used Hadden criteria to classify the electrophysiological variants. We performed a comparative analysis between groups. RESULTS: Fourty-two patients were diagnosed with GBS in 2020, men 64.2%, age 46 ± 17.4 years, patients with obesity/overweight 42.8%, previous diarrhea 31%, history of respiratory tract infection 14.2%. Guillain Barre Disability Scale = 3 points 71.4% and, cranial nerve involvement 69%. The most frequent electrophysiological variant was acute inflammatory demyelinating polyradiculoneuropathy (AIDP) 53.5%. Seven (16.6%) cases were SARS-CoV2 related, four men, age 43.4 ± 13.4 years. When comparing patients with GBS in 2020 vs patients in 2019, we observed a decrease in the previous infection history during 2020 (45.2% vs 73.3%, p-value = 0.005) and a decrease in previous respiratory infection (14.2% vs 33.3%, p = 0.045), as well as a higher frequency of cranial nerve involvement, and albuminocytologic dissociation. CONCLUSIONS: SARS-CoV2 virus infection preventive measures may be impacting the presentation of post-infectious diseases such as GBS. We did not observe an increase in GBS cases during 2020. Also, the AIDP variant were more frequent in our population in the COVID-19 pandemic.

TITLE: Síndrome de Guillain-Barré durante la pandemia de COVID-19: experiencia de un centro de referencia en México.Introducción. Se trata de describir las características clínicas y variantes electrofisiológicas de los casos de síndrome de Guillain-Barré (SGB) durante la pandemia. Llevamos a cabo un análisis comparativo entre pacientes con SGB relacionado con el SARS-CoV-2 y sin antecedente del virus, y posteriormente realizamos una comparación con los casos de 2019. Pacientes y métodos. Se llevó a cabo un estudio transversal de los pacientes con diagnóstico de SGB según los criterios de Asbury y Cornblath. Se recolectaron información clínica y variables paraclínicas. Definimos el SGB relacionado con el SARS-CoV-2 conforme a la descripción de Ellul et al. Se utilizaron los criterios de Hadden para la clasificación de las variantes electrofisiológicas. Por último, realizamos un análisis comparativo entre grupos. Resultados. Se diagnosticó a 42 pacientes con SGB en 2020, un 64,2% hombres, con una edad de 46 ± 17,4 años, un 42,8% con obesidad/sobrepeso, un 31% con historia de diarrea previa y un 14,2% con infección respiratoria previa. El 71,4% tuvo una puntuación en la Guillain-Barré Disability Score igual o mayor que 3 puntos y el 69% tenía afectados los nervios del cráneo. La variante electrofisiológica más común fue la polirradiculoneuropatía desmielinizante inflamatoria aguda (PDIA; 53,5%). Siete (16,6%) casos tuvieron relación con el SARS-CoV-2, cuatro hombres, con edad de 43,4 ± 13,4 años. Al realizar la comparación entre pacientes con SGB de 2020 frente a los de 2019, observamos un decremento en el antecedente de infección previa en 2020 (45,2 frente a 73,3%; p = 0,005) y un decremento específico en la historia de infección respiratoria (14,2 frente a 33,3%; p = 0,045), así como una mayor frecuencia de afectación de los nervios del cráneo y de disociación albuminocitológica. Conclusiones. Las maniobras preventivas para la infección por el SARS-CoV-2 impactan directamente en la presentación de enfermedades postinfecciosas como el SGB. No observamos un incremento en los casos de SGB durante 2020. Asimismo, la variante de PDIA fue la más frecuente en nuestra población durante la pandemia de COVID-19.

Campaña de medida de la presión arterial (May Measurement Month) desde las farmacias comunitarias en el 2018: análisis del cribado en España / Blood pressure measurement campaign (May Measurement Month) from community pharmacies in 2018: analysis of screening in Spain

Introducción: Dentro del proyecto internacional May Measurement Month (MMM) en España, la farmacia comunitaria es el establecimiento sanitario en el que se llevan a cabo el mayor número de mediciones y donde se puede sensibilizar a la población sobre la importancia de la medida periódica de la presión arterial (PA). Objetivo: Conocer la situación de la PA de la población española y la difusión de la importancia de su medida periódica, a través de las farmacias comunitarias. Material y métodos: Estudio descriptivo transversal realizado en las farmacias comunitarias españolas durante el mes de mayo de 2018, entre los usuarios de las mismas, mayores de edad. Como variables principales se midieron la presión arterial sistólica (PAS), presión arterial diastólica (PAD) y frecuencia cardíaca. Resultados: Se llevaron a cabo 5.785 determinaciones por 891 farmacéuticos. 1.755 (34,8%) personas no se habían medido la PA en el último año. El 31,2% de los participantes tenía cifras elevadas de PA. PAS media (PASm) fue de 127,1 ± 20,1 y PAD media (PADm) de 77,5 ± 12,5, mayor en hombres (p < 0,001). Los pacientes con valores de PA de normalidad fueron 3.981 (68,8%); elevadas una 1.226 (21,2%) y dos 578 (10%). Los pacientes con PAS ≥ 140 fueron 912 (15,76%) y con PAD ≥ 90 fueron 314 (5,4%). Se detectaron cuatro (0,07%) emergencias hipertensivas. Conclusiones: Tres de cada diez personas participantes tenían algún valor alto de PA. Por lo que, las determinaciones de PA protocolizadas realizadas en un establecimiento sanitario como la farmacia comunitaria, ha permitido identificar un número significativo de sujetos con PA elevada y no tratada. (AU)

Introduction: Within the international project May Measurement Month, in Spain, the community pharmacy is where the greatest number of measurements are carried out and where the population can be made aware of the importance of regular blood pressure measurement. Objectiv: To ascertain the situation of the Spanish population's blood pressure and dissemination of the importance of its regular measurement through the community pharmacies. Methods: Cross-sectional descriptive study carried out in Spanish community pharmacies during the month of May 2018, among pharmacy users of legal age. Systolic blood pressure, diastolic blood pressure and heart rate were measured as main variables. Results: Five thousand, seven hundred and eighty-five readings were made by 891 pharmacists. One thousand, seven hundred and fifty-five (34.8%) people had not had their blood pressure measured in the last year. Of the participants, 31.2% had high blood pressure readings. Mean systolic blood pressure was 127.1±20.1 and mean diastolic blood pressure 77.5±12.5, higher in men (p<.001). There were normal blood pressure values in 3,981 (68.8%) patients; one high reading in 1,226 (21.2%); and two in 578 (10%). There were 912 (15.76%) patients with SBP≥140 and 314 (5.4%) with DBP≥90. Four (0.07%) hypertensive emergencies were detected. Conclusions: Three out of ten participants had a high blood pressure reading. Therefore, protocolized blood pressure readings carried out in a health care facility such as the community pharmacy, allowed the identification of a significant number of subjects with high and untreated blood pressure. (AU)

[Blood pressure measurement campaign (May Measurement Month) from community pharmacies in 2018: analysis of screening in Spain]. / Campaña de medida de la presión arterial (May Measurement Month) desde las farmacias comunitarias en el 2018: análisis del cribado en España.

INTRODUCTION: Within the international project May Measurement Month, in Spain, the community pharmacy is where the greatest number of measurements are carried out and where the population can be made aware of the importance of regular blood pressure measurement. OBJECTIV: To ascertain the situation of the Spanish population's blood pressure and dissemination of the importance of its regular measurement through the community pharmacies. METHODS: Cross-sectional descriptive study carried out in Spanish community pharmacies during the month of May 2018, among pharmacy users of legal age. Systolic blood pressure, diastolic blood pressure and heart rate were measured as main variables. RESULTS: Five thousand, seven hundred and eighty-five readings were made by 891 pharmacists. One thousand, seven hundred and fifty-five (34.8%) people had not had their blood pressure measured in the last year. Of the participants, 31.2% had high blood pressure readings. Mean systolic blood pressure was 127.1±20.1 and mean diastolic blood pressure 77.5±12.5, higher in men (p<.001). There were normal blood pressure values in 3,981 (68.8%) patients; one high reading in 1,226 (21.2%); and two in 578 (10%). There were 912 (15.76%) patients with SBP≥140 and 314 (5.4%) with DBP≥90. Four (0.07%) hypertensive emergencies were detected. CONCLUSIONS: Three out of ten participants had a high blood pressure reading. Therefore, protocolized blood pressure readings carried out in a health care facility such as the community pharmacy, allowed the identification of a significant number of subjects with high and untreated blood pressure.

Cobertura de la vacunación antigripal en los farmacéuticos comunitarios: razones aportadas y absentismo relacionado. Predisposición a vacunar a la población / Influenza vaccination coverage in the community pharmacy: reasons given and related absenteeism. Willingness to vaccinate the population

INTRODUCCIÓN: la vacuna antigripal está indicada entre el personal sanitario, aunque la cobertura antigripal en farmacéuticos comunitarios españoles actualmente se desconoce. Este trabajo pretende averiguar esta cobertura, las causas de los farmacéuticos para vacunarse o no de la gripe, el absentismo laboral que les ocasiona, si recomiendan la vacunación antigripal entre los grupos de riesgo y su disposición a administrarla en la farmacia. MÉTODOS: estudio descriptivo transversal mediante un cuestionario online destinado a farmacéuticos comunitarios de toda España. Se realizó un análisis descriptivo de las variables estudiadas y de la asociación entre la vacunación y las variables cualitativas (test Chi-cuadrado y Fisher) y cuantitativas (ANOVA). RESULTADOS: se obtuvo una tasa de respuesta del 9,4 % (n = 1.436). Los farmacéuticos refirieron vacunarse en torno al 30 % en las tres temporadas estudiadas (2016-2019), siendo del 31-35,8 % (IC95 %) en la temporada 2018-2019. Ser titular/cotitular de la farmacia, la experiencia profesional, la edad, vacunarse para evitar la gripe y/o por responsabilidad, y vacunarse en temporadas anteriores son factores asociados a vacunarse (p < 0,05). Ser socio de SEFAC también lo es. El absentismo por gripe en la temporada 2018-2019 fue del 9,5 %. Los farmacéuticos que más dijeron vacunarse recomiendan más la vacuna que los que no, y tendrían mayor predisposición a administrarla (p < 0,05). CONCLUSIONES: la cobertura vacunal antigripal entre los farmacéuticos comunitarios es baja a pesar del absentismo que les causa. Facilitar la vacunación a los farmacéuticos podría incrementar su cobertura. Los farmacéuticos recomiendan la vacunación contra la gripe a los pacientes de riesgo y estarían dispuestos a vacunar en farmacias autorizadas

INTRODUCTION: while the influenza vaccine is indicated for healthcare personnel, its coverage among Spanish community pharmacists is currently unknown. This study aims to quantify this coverage as well as evaluate the causes leading pharmacists to be inoculated or not, their flu-related absenteeism, whether they recommend the vaccine to risk groups, and their willingness to administer it in the pharmacy. METHODS: descriptive cross-sectional study using an online questionnaire aimed at community pharmacists throughout Spain. A descriptive analysis of the variables ­studied and of the association between vaccination and qualitative (Chi-square and Fisher test) and quantitative (ANOVA) variables was performed. RESULTS: a response rate of 9.4% (n = 1,436). Pharmacists reported vaccinating around 30% in the three seasons under study (2016-2019), being 31-35.8% (IC95%) in the 2018-2019 season. Being a pharmacy owner/co-owner, professional experience, age, being vaccinated to avoid influenza and/or for responsibility, and being vaccinated in previous seasons are factors associated with being vaccinated (p < 0.05). Being a member of SEFAC is also a factor. Flu-related absenteeism in the 2018-2019 season was 9.5%. Pharmacists who reported being vaccinated themselves were more likely to recommended the vaccine and more likely to administer it (p < 0.05). CONCLUSIONS: flu vaccination coverage among community pharmacists is low despite the absenteeism this causes. Making vaccination easier for pharmacists could increase coverage. Pharmacists recommend flu vaccination for at-risk patients and would be willing to vaccinate in licensed pharmacies

Correlation between Serum Fatty Acid Binding Protein 4 (FABP4) Levels and Cardiac Function in Patients with Thalassemia Major.

BACKGROUND: Patients with thalassemia major may suffer from complications due to iron overload. It has been suggested that several adipokines may play a potential role in the development of complications in thalassemia. Fatty acid-binding protein 4 (FABP4) is one of the adipokines, bridging several aspects of metabolic and inflammatory pathways. Little is known about the relationship between this adipokine and cardiac and liver function, especially in patients with thalassemia major. AIMS: This study is aimed at determining serum FABP4 levels in patients with thalassemia major and whether its concentration correlated with serum ferritin levels, as well as cardiac and liver function. METHODS: Thalassemia major outpatients (n = 48) completed laboratory examination, echocardiography, and electrocardiography. RESULTS: The mean age was 21.9 ± 8.0 years. A negative and weak correlation between serum ferritin and FABP4 was observed (r = -0.291, p < 0.05). In addition, there was moderate and positive correlation between left atrial volume index (LAVI) and FABP4 (r = 0.316, p < 0.05). CONCLUSIONS: Serum FABP4 correlated with serum ferritin and cardiac function in patients with thalassemia major. FABP4 may be a potential clinical biomarker for cardiac dysfunction via metabolic and inflammatory pathways due to iron accumulation and toxicity in patients with thalassemia major.

Deleterious effect of short-term gavage of an ethanol extract of cogon grass (Imperata cylindrica L.) roots on testis and epididymal sperm quality.

BACKGROUND AND AIM: Cogon grass (Imperata cylindrica L.) (CGG) is a herbal medicine that could be developed into a male antifertility agent. The present study aims to determine the effect of an ethanol extract of CGG roots on mice testicular activity, reproductive hormone levels, and epididymal sperm quality. MATERIALS AND METHODS: This study was designed as completely randomized with three different doses, such as an ethanol extract of CGG roots at 0 (control), 90, and 115 mg/kg body weight. In total, 21 male DDY mice strain were treated with the CGG extract (by gavage) for 14 days, followed by an evaluation of reproductive organs, epididymal sperm quality, testis histology, histomorphometry, and reproductive hormone assays. All quantitative data were analyzed by analysis of variance, followed by Tukey's post hoc test at α=0.05. RESULTS: The results showed that the administration of the CGG root ethanol extract disrupted the testis interstitial area and seminiferous tubules, resulting in decreased epididymal sperm quality as well as serum testosterone levels in a dose-dependent pattern. CONCLUSION: Oral administration of a CGG root ethanol extract induced testicular damage, decreased epididymal sperm quality, and impaired testosterone secretion.

Fish community responses to antecedent hydrological conditions based on long-term data in Mediterranean river basins (Iberian Peninsula).

In recent decades many studies have proven the paramount impact of flow regimes on the structure of lotic ecosystems, both through extreme events (i.e. floods and droughts) but also during intermediate flows, which temporarily and spatially regulate the habitat availability. Human demand for water is steadily increasing and scientists are challenged to define ecosystem needs clearly enough to guide policies and management strategies. However, field studies demonstrated that a variety of interacting factors, such as, presence of barriers (e.g. dams) and temporal changes in habitat structure affect the abundance, composition and distribution of fish assemblages. This work based on quantile regression tested hypotheses to elucidate the effect of antecedent hydrological conditions on fish communities. A large monitoring database collecting and homogenizing the existing information on fish fauna in the Júcar River Basin District (Eastern Iberian Peninsula) was gathered and used to evaluate biological metrics (species richness, Capture Per Unit Effort-CPUE, and CPUE ratio over the total CPUE) related to life history strategies (i.e. periodic, opportunistic or equilibrium) and species origin (i.e. native, translocated or alien). The resulting dataset was complemented with diverse indicators of the measured daily discharge at the nearest gauging site. Most of the significant relationships confirmed the role of antecedent hydrological conditions as limiting factors, although other environmental factors likely play additional roles. In general, richness and abundance of alien species showed the higher proportion of significant associations, particularly spring flows and annual minima and maxima. These flow-ecology relationships shall be particularly useful to manage ecological responses to hydrological alteration. They also provide with clear ecological foundations for developing environmental flows assessments in Mediterranean river basins worldwide, using holistic approaches which can harmonise eco-hydrological approaches with smaller-scale and habitat-based ecohydraulics methods, especially under the current climate trends.

Curcumin Downregulates GSK3 and Cdk5 in Scopolamine-Induced Alzheimer's Disease Rats Abrogating Aß40/42 and Tau Hyperphosphorylation.

Alzheimer's disease (AD) is the most common form of dementia. Extracellular amyloid-ß (Aß) aggregation and tau hyperphosphorylation are the key drivers of AD. Glycogen synthase kinase 3 (GSK3) and cyclin dependent kinase 5 (Cdk5) have been known as leading applicants arbitrating abnormal tau hyperphosphorylation. Thus, we evaluated the efficacy and underlying mechanism of action of curcumin in scopolamine-induced AD rats in our study. We found that curcumin-treated AD rats markedly reduced the levels of Aß40 and Aß42 in the brain and in the plasma in comparison to untreated AD rats. Moreover, the levels of phosphorylated tau at Ser396 (PHF13), Ser202/Thr205 (AT8), and Aß40/42 (MOAB2) were decreased significantly in AD rats treated with curcumin. Phospho-GSK3ß (Tyr216), the active form of GSK3ß, and total GSK3ß were significantly decreased in AD rats treated with curcumin. Furthermore, Cdk5 and its activators p35 and p25 were significantly decreased in curcumin-treated AD rats. The reduced levels of Cdk5, p35, p25, and GSK3ß in curcumin-treated AD rats may result decreased Aß aggregation and tau hyperphosphorylation, thus ameliorating AD. Impaired spatial memory and locomotor activity in AD rats were partially reversed by curcumin. Therefore, curcumin, as a natural compound present in turmeric, may be a more effective therapeutic agent in the treatment of AD in humans.

Curcumin Ameliorates the Impaired Insulin Signaling Involved in the Pathogenesis of Alzheimer's Disease in Rats.

To date, dysregulation of the insulin signaling pathway in the brain has not been demonstrated unequivocally in Alzheimer's disease (AD). The purpose of the study was to examine the possible dysregulation of insulin signaling pathway in an AD rat model. Furthermore, the present study investigated the effect of Donepezil and Curcumin on insulin signaling, insulin, and glucose levels in AD rat brain. The rats were induced to develop AD by intraperitoneal administration of Scopolamine. We found that glucose levels in plasma and brain were decreased in AD rats, whereas the insulin levels was increased in plasma but decreased in brain in AD rats. In addition, insulin signaling proteins IR-ß, IGF-1, IRS-1, IRS-2 p-Akt (Ser473), and Akt were markedly reduced in the AD rats. Furthermore, GLUT3 and GLUT4 levels in the brain were markedly reduced in AD rats. All these data were compared to Saline-treated control rats. Curcumin significantly increased glucose levels in plasma and in brain. However, insulin levels was decreased in plasma and was increased in AD rats' brain. Moreover, GLUT3 and GLUT4 levels were significantly increased in Curcumin-treated AD rats. All these data were compared to Scopolamine- induced AD rats. Thus amelioration of impaired insulin signaling and improved glucose regulation in AD rats by Curcumin may be beneficial in the management of AD.

Determination of environmental flows in rivers using an integrated hydrological-hydrodynamic-habitat modelling approach.

We propose the novel integrated modelling procedure 3H-EMC for the determination of the environmental flow in rivers and streams; 3H-EMC combines Hydrological, Hydrodynamic and Habitat modelling with the use of the Environmental Management Classes (EMCs) that are defined by the Global Environmental Flow Calculator. We apply 3H-EMC in the Sperchios River in Central Greece, in which water abstractions for irrigation cause significant environmental impacts. Calculations of the hydrodynamic-habitat model, in which the large and the small chub are the main fish species, suggest discharge values that range from 1.0 m3/s to 4.0 m3/s. However, hydrological modelling indicates that it is practically difficult to achieve discharges that are higher than approximately 1.0-1.5 m3/s. Furthermore, legislation suggests significantly lower values (0.4-0.5 m3/s) that are unacceptable from the ecological point of view. This behaviour shows that a non-integrated approach, which is based only on hydrodynamic-habitat modelling does not necessarily result in realistic environmental flows, and thus an integrated approach is required. We propose the value of 1.0 m3/s as the "optimum" environmental flow for Sperchios River, because (a) it satisfies the habitat requirements, as expressed by the values of weighted useable area that are equal to 2180 and 1964 m2 for the large and small chub, respectively, and correspond to 82 and 95% of their respective maximum values, (b) it is consistent with the requirements of Environmental Classes A and B, whose percentiles are higher than 75% for discharge (77.2%) and for habitat availability (>83.5% for the large chub and >85.0% for the small chub), (c) it is practically achievable from the hydrological point of view, and (d) it is higher than the value proposed by the Greek legislation. The proposed modelling approach can be applied to any river or stream using the same or similar modelling tools, which should be linked via suitable coupling algorithms.

Programa "I-Valor": la indicación farmacéutica protocolizada, consensuada y registrada en la farmacia comunitaria / The "I-VALOR" program: standardized, protocolized, and registered drug indications for community pharmacy

La indicación farmacéutica (IF) es el servicio prestado ante la demanda de un paciente o usuario que llega a la farmacia sin saber qué medicamento debe adquirir y solicita al farmacéutico el remedio más adecuado para un problema de salud concreto. Es un servicio demandado frecuentemente en la farmacia y necesita ser protocolizado para garantizar la seguridad del paciente. Se pretende diseñar un programa de actuación (I-VALOR: el valor de la indicación farmacéutica) que facilite su implantación en la farmacia comunitaria. Material y métodos: Desarrollo de un programa informático en formato web que incluye un programa de formación, un listado de criterios de derivación consensuados entre sociedades científicas médicas y farmacéuticas, un sistema de registro y otro de información a los pacientes. El programa permite emitir informes elaborados de manera semiautomática dirigidos bien a los pacientes bien al médico al que se deriva el paciente. Además el programa pretende conseguir su implantación y generalización en la farmacia comunitaria. Resultados: Participaron 1.022 farmacéuticos, 520 titulares y 502 adjuntos, en 846 farmacias de todas las provincias de España. El 50,4% de las farmacias se declaraban como "de barrio" y el 34,4% rurales. Se recogieron 37.701 registros de 5 problemas de salud: erosiones cutáneas, resfriado, pirosis, sequedad ocular y alergias. No se apreciaron diferencias en cuanto a tipo de farmacia ni de comunidad autónoma. Conclusiones: El programa I-VALOR incorpora una herramienta informática que facilita el ejercicio profesional en el servicio de IF. Por la elevada participación de farmacéuticos se puede afirmar que es útil y aplicable a la práctica de la farmacia comunitaria (AU)

The minor ailment service (MAS) is the professional service offered upon demand from a patient or user who visits the community pharmacy without knowing which medicine to acquire, and wishes the pharmacist to provide the best remedy for his or her specific health problem. It is a service frequently demanded in the pharmacy and needs to have an action protocol developed to guarantee the safety of the patient. The aim is to develop an action plan (I-VALOR: "the value of drug indications") to help embed the program into community pharmacy. Material and methods: A software program in a web format which includes an educational program, a list of referral to the physician criteria after a consensus agreed within medical and pharmaceutical scientific societies, a record system and a patient information system, has been developed. The program allows issuing pre-elaborates documents oriented both to the patients and physicians in a semiautomatic way. Also, the program is intended to be fully implemented thorough Spanish community pharmacies. Results: 1,022 pharmacists, 520 owners and 502 assistant pharmacists, participated in 846 pharmacies distributed in all Spanish provinces. 50.4% of the pharmacies were situated in a "neighborhood" and 34.4% in "rural" areas. 37,701 records on 5 health problems; skin erosions, colds, heartburn, ocular dryness and allergies were registered. There were no differences in relation to the type of pharmacy or geographical region. Conclusions: The I-VALOR program includes a software tool which helps the community pharmacist to provide the minor ailment service in a more professional way. Due to the high rate of participants it can be said that the tool is useful and suitable to be used in community pharmacy practice (AU)

[Long-term effect of policosanol on the functional recovery of non-cardioembolic ischemic stroke patients: a one year study]. / Efecto a largo plazo del policosanol en la recuperacion funcional de pacientes con ictus isquemico no cardioembolico: estudio de un año.

INTRODUCTION: Stroke is a leading cause of mortality and disability. Policosanol has been effective in brain ischemia models. The aim of this study is to investigate whether policosanol, added to aspirin therapy within 30 days of stroke onset, is better than placebo + aspirine for the long-term recovery of non-cardioembolic ischemic stroke subjects. PATIENTS AND METHODS: Randomized, double-blind, placebo-controlled study. Eighty patients (mean age: 69 years) within 30 days of onset, with a modified Rankin Scale score (mRS) 2 to 4, were included. They were randomized in two groups (policosanol + aspirine or placebo + aspirine) for 12 months. RESULTS: Policosanol + aspirine decreased significantly mean mRS from the first interim check-up (1.5 months). The treatment even improved after long-term therapy. More policosanol + aspirin (87.5%) than placebo + aspirine (0%) patients achieved mRSs <= 1. Policosanol + aspirine increased significantly Barthel Index, lowered LDL-cholesterol and increased HDL-cholesterol versus placebo + aspirin. CONCLUSIONS: Long-term (12 months) administration of policosanol + aspirin given after suffering non-cardioembolic ischemic stroke was shown to be better than placebo + aspirin in improving functional outcomes when used among patients with non-cardioembolic ischemic stroke of moderate severity.

TITLE: Efecto a largo plazo del policosanol en la recuperacion funcional de pacientes con ictus isquemico no cardioembolico: estudio de un año.Introduccion. El ictus es una causa principal de mortalidad y discapacidad. El policosanol ha sido eficaz en modelos de isquemia cerebral. Este estudio investiga si el tratamiento a largo plazo con policosanol, añadido a la terapia con acido acetilsalicilico (AAS), dentro de los 30 dias posteriores a un ictus, es mejor que el placebo + AAS en la recuperacion de los pacientes. Pacientes y metodos. Estudio aleatorizado, doble ciego, controlado con placebo. Se incluyeron 80 pacientes (edad media: 69 años) que sufrieron un ictus en los 30 dias previos y con una puntuacion de 2-4 en la escala de Rankin modificada (mRS). Se distribuyeron aleatoriamente en dos grupos y recibieron policosanol + AAS o placebo + AAS durante 12 meses. Resultados. El tratamiento con policosanol + AAS disminuyo significativamente la puntuacion en la mRS desde el primer control intermedio (1,5 meses). El efecto del tratamiento incluso mejoro con la terapia a largo plazo. El numero de pacientes que alcanzaron valores de mRS menores o iguales a 1 fue superior en el grupo de policosanol + AAS (87,5%) que en el de placebo + AAS (0%). El tratamiento con policosanol + AAS aumento significativamente el indice de Barthel, disminuyo el colesterol LDL y aumento el colesterol HDL frente a placebo + AAS. Conclusiones. El tratamiento a largo plazo (12 meses) con policosanol + AAS fue mas efectivo que el tratamiento con placebo + AAS en la recuperacion funcional de los pacientes despues de sufrir un ictus isquemico no cardioembolico de moderada gravedad.