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A wastewater treatment system consists of a series of physical, chemical, and biological processes that aim to eliminate the contaminants present in the water. The objective of the research is to evaluate the wastewater treatment systems of the Punta Carnero sector, Ancón and Anconcito parish, through an experimental descriptive investigation to know the impact generated by the contamination parameters due to the incorrect treatment of these with respect to the analysis. of its efficiency and final discharge from the urban-rural area of ​​the Province of Santa Elena. The removal efficiency of pollutant loads was evaluated in percentage and the final discharge by the mean and standard deviation from 2015 to 2020. It was determined that the Ancón and Anconcito systems have better removal efficiency than Punta Carnero., however, the percentage is not optimal. The discharge of fecal coliforms, chemical oxygen demand, total suspended solids, and surfactants in none of the systems complies with the maximum permissible limits of Ecuadorian regulations. It was known that these systems generate negative impacts on health and the environment of the sector under study.

Water is an irreplaceable element that requires sanitary processes and measures. The growing demand has promoted of designs to recover and reuse it, one of the innovation systems is bioremediation that allows the application of microbial agents capable of degrading contaminants. This research consists of the review of primary source literature to obtain criteria in the application of bacteria for wastewater treatment and reuse. Bioremediation has proven to be one of the most efficient and cost-effective alternatives for the elimination of bodies that pollute the ecosystem, compared to conventional physical – chemical systems. However, the results of this remediation strategy will depend on the place and environmental conditions, which is why it is the importance of finding new biotechnologies and implementing cost-effective techniques applied to the well-being of the environment and safety of society. For future studies associated to the application of some type of bioremediation, a previous analysis of the ecological and economic feasibility must be carried out according to the conditions of the damaged ecosystem.

Petroleum is a crucial resource that has globally influenced the scientific community and socio-economic development. However, its industrial processes negatively affect the natural environment. This research aims to analyse the intellectual structure of the petroleum and environment relationship in South American countries' contributions through bibliometric methods. The study presents a methodology: i) establishing search criteria; ii) initial search results; iii) refinement of results; iv) data analysis. Bibliometric methods were incorporated to analyse the performance of scientific production, and its mapping, allowing to reveal its structure. The results show a growth of this field of study (538 articles) through the contribution of countries, institutions and authors. Most of the studies related to oil and environment carried out by Brazil (399 articles) have a strong collaboration with Argentina, Colombia and Uruguay and partnerships with countries outside the region such as the United States, United Kingdom, and Spain. In addition, seven research themes were found (Biomarkers-petroleum derivatives, bioremediation, bioproductive processes, hydrocarbon-environmental, pollution effects, mangrove pollution, oil spill-simulation). This study provided relevant information on environmental pollution reflected in diverse sectors of South America (coastal and Amazonian areas). It showed several environmental remediation methods focused on microorganisms, biosurfactants, microbial residues, ionic processes and phytoremediation. Therefore, this research allows us to obtain meaningful and current information on the art state in this field of study.

20 páginas, 5 figuras, 5 tablas, The increase in life expectancy has also been accompanied by an increase in the use of medication to treat chronic diseases. Polypharmacy is associated with medication-related problems such as the increase in the anticholinergic burden. Older people are more susceptible to anticholinergic effects on the central nervous system and this, in turn, may be related to cognitive impairment. In this paper, we develop an updated anticholinergic burden scale, the CRIDECO Anticholinergic Load Scale (CALS) via a systematic review of the literature and compare it with the currently most used Anticholinergic Burden Scale (ACB). Our new scale includes 217 different drugs with anticholinergic properties, 129 more than the ACB. Given the effect that anticholinergic medications have on cognitive performance, we then used both scales to investigate the relationship between anticholinergic burden and cognitive impairment in adult Spanish subjects with subjective memory complaint. In our population, we observed an association between cognitive impairment and the anticholinergic burden when measured by the new CALS, but not when the ACB was applied. The use of a more comprehensive and upgraded scale will allow better discrimination of the risk associated with the use of anticholinergic medications on cognitive impairment. CALS can help raise awareness among clinicians of the problems associated with the use of medications, or combinations of them, with large anticholinergic effect, and promote a better personalized pharmacological approach for each patient., This work was supported by SANTANDER-CEU FUSP-BS-PPC26/2018

Este artículo se encuentra disponible en la siguiente URL: https://www.mdpi.com/1660-4601/18/19/9934 Este artículo pertenece a la sección "Mental Health". Dementia is a neurodegenerative disease with no cure that can begin up to 20 years before its diagnosis. A key priority in patients with dementia is the identification of early modifiable factors that can slow the progression of the disease. Community pharmacies are suitable points for cognitiveimpairment screening because of their proximity to patients. Therefore, the continuous training of professionals working in pharmacies directly impacts the public health of the population. The main purpose of this study was to assess community pharmacists’ knowledge of dementia-related factors. Thus, we conducted a cross-sectional study of 361 pharmacists via an online questionnaire that quizzed their knowledge of a list of dementia-related factors, which we later arranged into the A-to-Z Dementia Knowledge List. We found that younger participants had a better knowledge of risk factors associated with dementia. The risk factors most often identified were a family history of dementia followed by social isolation. More than 40% of the respondents did not identify herpes labialis, sleep more than 9 h per day, and poor hearing as risk factors. A higher percentage of respondents were better able to identify protective factors than risk factors. The least known protective factors were internet use, avoidance of pollution, and the use of anti-inflammatory drugs. Pharmacists’ knowledge of dementia-related factors should be renewed with the aim of enhancing their unique placement to easily implement cognitive-impairment screening.

Este artículo se encuentra disponible en la siguiente URL: https://www.mdpi.com/1660-4601/19/19/12911 Cognitive impairment (CI), an intermediate phase between the decline in physiological cognition and dementia, is known to be mediated by a variety of risk and protective factors, with age being the most influential of these. The multifactorial nature of CI and the worldwide phenomenon of an aging population makes decoupling old age from disease through the concept of healthy aging (HA) a matter of major interest. Focusing on psychosocial variables and psychological constructs, here we designed and piloted a data collection booklet (DeCo-B) to assess CI and HA from a holistic perspective. The DeCo-B comprises six sections: sociodemographic factors, CI, meaning in life, psychosocial factors, health problems, and lifestyle. The estimated prevalence of CI and HA in our cohort were 24.4% and 6.6%, respectively. Spearman correlations mainly identified pairwise associations between the meaning in life domains and psychosocial variables. Moreover, age, marital status, purpose in life, resilience, chronic pain, cognitive reserve, and obstructive sleep apnea were significantly associated with an increased risk of CI. Our results showed that DeCo-B is a suitable tool for researching how modifiable risk and protective factors influence cognitive status. The complex interrelationships between variables should be further investigated and, for practical reasons, the questionnaire should be optimized in future work.

Los suelos que conforman el perfil costero entre las parroquias de Ancón y Anconcito de la Provincia de Santa Elena, tienen rasgos geomorfológicos de acantilados de aproximadamente 40 metros de altura junto al mar. En esta zona se mantiene una explotación petrolera marginal, y desde la última década se han producido asentamientos humanos no consolidados sin servicios básicos como de agua potable, alcantarillado sanitario y pluvial, que han ocasionado problemas de estabilidad de los suelos en la zona descrita. Esta inestabilidad también tiene su génesis con la formación de grietas en los suelos de fundación relacionadas con los cambios volumétricos, erosión y dispersión que dependen de la mineralogía de los suelos. Debido a la falta de estudios Geotécnicos en el sector, se realizaron actividades como: recopilación de datos de la estructura geológica, recorridos en la zona de estudio y exploración del subsuelo con el método de calicatas a cielo abierto para extraer muestras con la que se efectuaron los ensayos de laboratorio para caracterizar el suelo desde sus propiedades mecánicas y de su mineralogía. Obteniendo así los parámetros de resistencia al cortante indispensables para el análisis de estabilidad de Talud y con estos valores se modeló el deslizamiento ocurrido en el año 2010 en el barrio 2 de febrero ubicado en el cantón Salinas, en el programa de GEOSLOPE argumentando la veracidad de los parámetros de resistencia al cortante obtenidos.

Este artículo se encuentra disponible en la siguiente URL: https://www.mdpi.com/2075-4426/11/12/1366 Este artículo pertenece a la sección "Epidemiology". Subjective memory complaints (SMCs) may be important markers in the prediction of cognitive deterioration. The aim of this study was to find associations between individual lifestyle factors, which may contribute to cognitive impairment (CI) in people with SMCs and to conduct a literature review on the relationship between internet use and CI in subjects over 50 years old, as a related factor. This was a case-controlled study that included 497 subjects aged over 50 years with SMCs who were recruited from 19 community pharmacies. Three screening tests were used to detect possible CIs, and individuals with at least one test result compatible with a CI were referred to primary care for evaluation. Having self-referred SMC increased the odds of obtaining scores compatible with CI and this factor was significantly related to having feelings of depression (OR = 2.24, 95% CI [1.34, 3.90]), taking anxiolytics or antidepressants (OR = 1.93, 95% CI [1.23, 3.05]), and being female (OR = 1.83, 95% CI [1.15, 2.88]). Thirty percent of our sample obtained scores compatible with CI. Age over 70 years increased the odds of obtaining scores compatible with CI. A high-level education, reading, and daily internet use were factors associated with a reduced risk of positive scores compatible with CI (37–91%, 7–18%, and 67–86%, respectively), while one extra hour television per day increased the risk by 8–30%. Among others, modifiable lifestyle factors such as reading, and daily internet usage may slow down cognitive decline in patients over 50 with SMCs. Four longitudinal studies and one quasi-experimental study found internet use to be beneficial against CI in patients over 50 years of age.

Subjective cognitive decline (SCD) would correspond to a preclinical phase of Alzheimer's disease. The aim of this study was to find associations between lifestyle individual factors compatible scores with cognitive impairment (CI) in SCD people. Methods: This is a case-control study to detect SCD, CI and potential associated factors in 497 patients over 50 years in Community Pharmacies. Three screening tests detected possible CI and patients with at least one test compatible with CI were referred to Primary Care to be evaluated. Results: In self-complaint patients statistically significant with depressive feelings were found (86.8%) with benzodiazepines consumers (83.9%) and female patients (81.2%). Thirty percent of our sample obtained scores compatible with CI. Being older than 70 years old increased the odds of obtaining scores compatible with CI. High level education, reading and internet use were able to reduce the odds of positive scores compatible with CI (37%-91%, 7%-18% and 67%-86%), whereas, one extra hour television/day increased the risk in 8%-30%. Reading was able to nullify the effect of both internet and TV consumption. Conclusion: Not just the age but also modifiable lifestyle factors are acting in favour of a cognitive decline.

Este artículo se encuentra disponible en la siguiente URL: https://www.jove.com/es/t/59649/a-machine-learning-approach-to-design-an-efficient-selective Mild cognitive impairment (MCI) is the first sign of dementia among elderly populations and its early detection is crucial in our aging societies. Common MCI tests are time-consuming such that indiscriminate massive screening would not be cost-effective. Here, we describe a protocol that uses machine learning techniques to rapidly select candidates for further screening via a question-based MCI test. This minimizes the number of resources required for screening because only patients who are potentially MCI positive are tested further. This methodology was applied in an initial MCI research study that formed the starting point for the design of a selective screening decision tree. The initial study collected many demographic and lifestyle variables as well as details about patient medications. The Short Portable Mental Status Questionnaire (SPMSQ) and the Mini-Mental State Examination (MMSE) were used to detect possible cases of MCI. Finally, we used this method to design an efficient process for classifying individuals at risk of MCI. This work also provides insights into lifestyle-related factors associated with MCI that could be leveraged in the prevention and early detection of MCI among elderly populations.

Este artículo se encuentra disponible en la página web de la revista en la siguiente URL: https://www.farmaceuticoscomunitarios.org/en/system/files/journals/1821/articles/fc2020-12-1-06-ecoe.pdf La enseñanza universitaria evoluciona hacia la formación basada en problemas. La prueba ECOE (Evaluación Clínica Objetiva Estructurada) permite evaluar la capacidad del alumno en tres de los cuatro escalones de la pirámide de Miller; saber, saber cómo y demostrar cómo (conocimientos, habilidades y actitudes). Esta es la prueba de evaluación de las practicas tuteladas y en la Universidad Cardenal Herrera CEU se ha impartido en los dos últimos cursos a un total de 79 alumnos con resultados satisfactorios. El alumno debe pasar por 5 estaciones donde en 5 minutos en cada una debe resolver el problema práctico que se le plantea. Un profesor entrenado hace de paciente y otro profesor evalúa las habilidades del alumno. Luego se pasó una encuesta de satisfacción anónima a los alumnos siendo el resultado de 4,12/6. Es necesario ir modificando los problemas planteados a los alumnos para que cada vez más se adapten a la realidad que se encontraran al obtener el grado como profesionales farmacéuticos. / Higher education evolves towards Problem Based Learning. The Objective Structured Clinical Examination (OSCE) assesses students’ competencies in three of the four levels of Miller’s pyramid; Knows, Knows How, and Shows How (knowledge, competence, and performance). In the last two years, a total of 79 students at Cardenal Herrera University CEU were assessed with this examination, with good results. Student are asked to go through 5 stations, in which they have 5 minutes to resolve a practical problem. A trained teacher acts as the patient, while another evaluates the student’s abilities. Next, an anonymous satisfaction survey is given to the students, with the result 4,12/6. The problems presented to the students must be changed constantly so that each time they increasingly adapt to the situations they will find in their real-life practice once the graduate as professional pharmacists.

Este es el artículo que se ha publicado de forma definitiva en: https://www.frontiersin.org/articles/10.3389/fphar.2019.00860/full Community pharmacists and general practitioners have daily contact with patients with Alzheimer’s disease (AD) but the number of positive cases constantly increases every day. Thus, the aim of this research is to describe the level of AD knowledge among community pharmacists and general practitioners in Spain, in order to see where the biggest gaps in the knowledge are. Therefore, a cross-sectional study has been carried out, using the Alzheimer’s disease knowledge survey (ADKS), among members of the Spanish Society of Primary Care Physicians and the Spanish Society of Family and Community Pharmacy to report the differences in AD knowledge in both professional collectives. The ADKS has been responded by 578 community pharmacists and 104 general practitioners and consists of a battery of 30 questions, whose possible answers are true or false. It assesses the AD knowledge in seven areas (impact on the disease, risk factors, course of the disease, diagnosis, care, treatment and symptoms). Results indicate that Spanish pharmacists and general practitioners have a high personal knowledge of AD, nevertheless, it is not associated with greater awareness. Both scored above 80% at the categories: diagnostic, treatment and symptoms. However, lower knowledge level (60% of correct answers) was found in those related to risk factors, such as the ignorance about hypercholesterolemia or hypertension as risk factors for the disease. Community pharmacists are already acting to control cardiovascular risk factors, but a wider knowledge of the relationship of these factors to AD is needed to act against these silent risk factors. Thus, pharmacists may also be involved in the management of AD that includes recognizing early symptoms for early detection of cognitive impairment. Hence, knowledge about risk factors is very important in developing this expanding role.

Este artículo se encuentra disponible en la página web de la revista en la siguiente URL: https://www.farmaceuticoscomunitarios.org/en/system/files/journals/1745/articles/fc2019-11-1-03deteriorio-cognitivo.pdf Introducción: El deterioro cognitivo (DC) es una enfermedad que aumenta con la edad. Es importante conocer los factores protectores y de riesgo de esta enfermedad. Metodología: Estudio observacional realizado a 729 personas mayores de 65 años en 13 farmacias comunitarias durante dos años. Se recogieron datos demográficos (sexo, edad, nivel de estudios) y de estilos de vida (afición a la lectura, realización de pasatiempos, horas de televisión) y para el cribaje de los pacientes se realizaron los test SPMSQ (Short-Portable Mental State Questionaire) de Pfeiffer y Mini-Mental State Examination (MMSE) versión NORMADERM. También se realizó una revisión bibliográfica del tema. Resultados: Se detectó un 17,6% de DC. Se encontró una asociación estadísticamente significativa como protección frente al DC con la afición a la lectura y el nivel de estudios. No se encontró asociación con las horas de televisión (TV) ni con la realización de pasatiempos. La revisión bibliográfica aportó más factores protectores y de riesgo. Discusión: Con nuestros datos podemos afirmar que tanto la reserva cognitiva (años de estudio) como la estimulación cognitiva (horas de lectura) protegen del DC. Sobre los demás datos obtenidos no se han encontrado coincidencias, por lo que sería necesario aumentar el tamaño muestral para poder realizar una comparación más eficaz. Conclusiones: El nivel educativo bajo es un factor de riesgo de DC, mientras que estudios superiores serían un factor preventivo. La lectura es un factor protector de DC. / Introduction: Cognitive Dysfunction (CD) is a disease that increases with age. It is important to know the protective and risk factors for this disease. Methodology: Observational study carried out on 729 people over 65 years of age in community 13 pharmacies for two years. Demographic data were collected (sex, age, level of studies) and lifestyles (love of reading, hobbies such as crossword puzzles or sudokus etc, TV hours), and the SPMSQ (Short-Portable Mental State Questionaire) test of Pfeiffer and Mini- Mental State Examination (MMSE) were carried out to check the patient’s CD. A bibliographic review of the subject was also conducted. Results: 17.6% of CD was detected. A statistically significant association was found as a protection against CD with a love of reading and the level of studies. No association was found with TV hours or hobbies. The literature review provided more protective and risk factors. Discussion: With our data we can affirm that both cognitive reserve (years of study) and cognitive stimulation (hours of reading) protect from CD. No coincidences were found on the other data obtained, so it would be necessary to increase the sample size in order to make a more effective comparison. Conclusions: Low educational level is a risk factor for CD while higher education would be a preventive factor. Reading is a protective factor of CD.

ObjectiveTo evaluate the efficiency and toxicity of carboplatin using actual body weight in obese/overweight patients using the Calvert formula with Cockcroft–Gault for CrCl estimation.MethodsWe evaluated the association of BMI in regards to efficiency and toxicity in a retrospective cohort study of patients who started treatment with carboplatin between 2012 and 2013. Cohorts included obese/overweight patients and normal-weight patients. Efficiency was measured by overall survival, progression-free survival and response rate. Toxicity was measured by the proportion of dose reductions and delays of chemotherapy cycles. We utilized a bivariate and multivariate analysis.ResultsEighty-six patients were included in the study (50% obese/overweight). There was not a statistically significant difference in effectiveness and toxicity between the two groups in BMI. In the multivariate analysis, BMI not was associated with overall survival (hazard ratio: 0.95, 95% CI: 0.54–1.66, p = 0.849), progression-free survival (hazard ratio: 0.91; 95% CI: 0.54–1.54; p = 0.732), cycle delays (odds ratio (OR): 1.47, 95% CI: 0.80–2.69, p = 0.218) or carboplatin dose reductions (OR: 0.87, 95% CI: 0.35–2.15, p = 0.760). Response rate was 53.5% in both groups.ConclusionsIn our study, obese and overweight cancer patients did not show a statistically significant difference in terms of effectiveness and toxicity compared to normal-weight cancer patients who were treated with carboplatin using their actual body weight with the Calvert formula and Cockcroft–Gault for CrCl estimation. Therefore, it was appropriate to use the actual body weight for our patients.

Este artículo se encuentra disponible en la página web de la revista en la siguiente URL: https://www.farmaceuticoscomunitarios.org/en/node/1615/full Introducción: Las prescripciones potencialmente inadecuadas son causas de aparición de problemas relacionados con los medicamentos y de resultados negativos de la medicación, principalmente en ancianos. Los estudios en farmacia comunitaria son escasos. Objetivos: Mejorar la farmacoterapia de pacientes mayores de 65 años polimedicados mediante entrevista con el paciente. Realizar un perfil farmacoterapéutico, de hábitos en salud y adherencia. Medir la intervención del farmacéutico, derivación y satisfacción del paciente. Hacer una evaluación económica. Metodología: Se diseñó un estudio piloto descriptivo en pacientes de una farmacia comunitaria en Valencia. Se recogieron datos en una base Microsoft Acces®. Se midió la prevalencia de las prescripciones potencialmente inadecuadas mediante los criterios STOPP-START (2014) utilizando el software informático Checkthemeds®. Resultados: Se realizó sobre 88 pacientes, 77 (87,5%) finalizaron. La prevalencia de prescripciones potencialmente inadecuadas fue de un 33,0% (26,0% STOPP y 7,0% START), siendo la sección A de los criterios STOPP la mayoritaria (duplicidades terapéuticas y fármacos sin indicación basada en la evidencia). El estreñimiento fue la condición clínica más prevalente. También destacó la falta de adherencia (52,0%), así como un 77,0% de pacientes sin los requerimientos hídricos necesarios. Se intervino en un 36,0% de las prescripciones potencialmente inadecuadas encontradas con un grado de aceptación del 14,0%. Se estimó que en un 9,0% de las ocasiones se evitó derivación con un ahorro medio de 6,57 €/paciente. Conclusiones: La prevalencia de los criterios STOPP fue similar a otros estudios. La de los criterios START menor. La entrevista permite descartar falsas prescripciones potencialmente inadecuadas. La revisión sistemática y protocolizada mejora la farmacoterapia mediante la detección en intervención en las prescripciones potencialmente inadecuadas. / Background: Potentially inappropriate prescriptions are related with Medication Related Problems and Negative Medication Results, especially in the elderly. Few studies in community pharmacy are available. Objectives: To improve pharmacotherapy in patients over 65 years receiving more than five medicines. We investigated pharmacotherapy, healthy style, treatment adherence by conducting an open interview with the community pharmacist. Pharmacists´ interventions, patients´ satisfaction and costs were reported. Patients and methods: A descriptive study in a community pharmacy in Valencia (Spain) was designed. Data were collected in a Microsoft Acces® database and prevalence of potentially inappropriate prescriptions STOPP/START criteria 2014 was evaluated with the Checkthemeds® software. Results: 88 patients were enroled and 77 patients completed the study (87.5%). Prevalence of potentially inappropriate prescriptions was 33.0% (27.0% STOPP, 7.0% START criteria). A section (duplicities and low evidence treatments) was the most representative. Constipation was very common between the patients. Non-compliant patients (52.0%) and low hydration (77.0%) were important too. 36.0% of potentially inappropriate prescriptions required pharmacist intervention with 14.0% of agreement. 9.0% of potentially inappropriate prescriptions avoided medical intervention with a save of 6,57 € per patient. Conclusions: The prevalence of STOPP criteria was similar to that other studies. That of minor START criteria. The interview allows to eliminate false, potentially inadequate prescriptions. The systematic and protocolized review improves pharmacotherapy by identifying and intervening in potentially inadequate prescriptions.

Este artículo se encuentra disponible en la página web de la revista en la siguiente URL: http://farmaceuticoscomunitarios.org/en/node/1632 En ancianos es frecuente la polimedicación. Esto incrementa el riesgo de sufrir reacciones adversas a los medicamentos, y también el riesgo de sufrir interacciones que pueden ser relevantes. Las interacciones más frecuentes son las que afectan a la farmacocinética de los medicamentos y, especialmente, al metabolismo de estos. Aquí el citocromo P450 tiene mucha relevancia, pero desde hace poco más de una década se conoce otro mecanismo implicado, las proteínas transportadoras de membrana. Dentro de estas tienen especial relevancia las OATP (Organic anion transporting polypeptide) de las que existen diferentes tipos y ubicaciones. La competición de diferentes substratos por estas proteínas puede generar interacciones que acaban repercutiendo en el tratamiento farmacoterapeutico del paciente. / In the elderly, polymedication is frequent. This increases the risk of adverse reactions to medications, and also the risk of interactions that may be relevant. The most frequent interactions are those that affect the pharmacokinetics of drugs and, especially, their metabolism. Here the cytochrome P450 has a lot of relevance, but for a little more than a decade we know another mechanism involved, the membrane transporter proteins. Within these are the OATP (Organic anion transporting polypeptide) of which there are different types and locations. The competition of different substrates for these proteins can generate interactions that end up having an impact on the pharmacotherapeutic treatment of the patient.

Este artículo se encuentra disponible en la página web de la revista en la siguiente URL: http://farmaceuticoscomunitarios.org/en/node/1629 Objetivo: desarrollar un programa de cribado de deterioro cognitivo (DC) en mayores de 50 años. Con la finalidad de que el servicio profesional farmacéutico sea más costo-efectivo utilizaremos un árbol de decisión para la selección del paciente. Además, se pretende valorar la importancia de la dieta mediterránea y el consumo de antioxidantes en la prevención del deterioro cognitivo y estudiar marcadores genéticos de riesgo de enfermedad de Alzheimer. Método: para ello se diseña un estudio observacional transversal mediante entrevista personal estructurada en pacientes que muestren indicios de pérdida de memoria. El estudio de captación se realizará en farmacias desde septiembre 2018 hasta septiembre de 2019. Los pacientes con puntuación en los test con posible DC se remitirán a atención primaria, previa presentación del proyecto a coordinación médica. Se perseguirá el resultado del diagnóstico obtenido en atención primaria y/o especializada. Se utilizarán como test de cribado el Memory Impairment Screening (MIS), Short Portable Mental State Questionnaire (SPMSQ) de Pfeiffer, el Fluidez Verbal Semántica (FVS) y siempre que sea posible el Test del Informador (TIN). Se define deterioro cognitivo por MIS ≤4; SPMSQ ≥ 3 (para analfabetos ≥ 4); FVS ≤10 palabras y el valor del TIN >57. A su vez se recogen una muestra de saliva del paciente, para estudio genético, y datos de nutrición para valorar la importancia de la dieta mediterránea y de los alimentos antioxidantes en la prevención del DC. / The aim of this study is to develop a screening program for cognitive impairment (CI) in people older than 50 year old. In order to make the pharmaceutical professional service more cost-effective, we will use a decision tree for patient’s selection. In addition, to assess the importance of the Mediterranean diet and the consumption of antioxidants in the prevention of cognitive deterioration and study genetic markers of risk of Alzheimer’s disease. A cross-sectional observational study is designed by a structured personal interview in patients showing signs of cognitive impairment. The recruitment study will be conducted in pharmacies from September 2018 to September 2019. Patients with a score on the tests with possible CI will be referred to primary care previous presentation of the project to the medical coordination. The result of the diagnosis obtained in primary and / or specialized care will be pursued. The Memory Impairment Test (MIS), the Short Portable Mental State Questionnaire (SPMSQ) of Pfeiffer, the Semantic Verbal Fluency (FVS) and, whenever possible, the Informer Test (TIN) will be used as screening tests. Cognitive impairment is defined by MIS ≤4; SPMSQ ≥ 3 (for illiterates ≥ 4); FVS ≤10 words. The value of TIN> 57. In turn, a sample of the patient’s saliva, for genetic study, and nutrition data are collected through a survey to assess the importance of the Mediterranean diet and antioxidant foods in CI prevention.

Objetivo: Determinar factores de riesgo, relacionados con el estilo de vida, asociados con la presencia de deterioro cognitivo en personas mayores de 65 anos. Metodo: Para ello se diseno un estudio observacional transversal con personas mayores de 65 anos no institucionalizadas mediante entrevista personal estructurada. El estudio se realizo en 14 farmacias de la Comunidad Valenciana desde marzo 2011 hasta marzo de 2013. Se utilizan como test de cribado el Short Portable Mental State Questionnaire (SPMSQ) de Pfeiffer y el Mini-Mental State Examination (MMSE) version NORMACODERM de Blesa. Se definio deterioro cognitivo por SPMSQ ≥ 3 (para analfabetos ≥ 4) y/o MMSE ≤ 24. Resultados: Participaron en el estudio 729 personas. Se encontro que el 17,6% de los participantes (n = 128) presentaban resultados compatibles con deterioro cognitivo. Se determino que dormir 9 o mas horas diarias es causa o consecuencia y, por tanto, un factor de riesgo y/o de alarma en el desarrollo de deterioro cognitivo en personas mayores de 65 anos. El ejercicio fisico y pocas horas de sueno no obtuvo relacion con el deterioro cognitivo. Conclusion: El cambio de habitos de sueno en el anciano (pasar a dormir mas horas) es una senal de alerta para estudiar la presencia de un posible deterioro cognitivo.

ResumenObjetivosMejorar el uso de benzodiazepinas (BZD) en ancianos desde una colaboración farmacéutico-médica.DiseñoSe realizó un estudio controlado simple ciego durante un año en farmacias con la finalidad de conseguir que las BZD sean eficaces, seguras y se utilicen el tiempo necesario.EmplazamientoOnce farmacias comunitarias de la Comunidad Valenciana.ParticipantesPacientes mayores de 65años tratados con BZD que acudieron a las farmacias participantes durante el periodo del estudio.IntervencionesEntrevistas y seguimiento farmacoterapéutico durante un año.Medidas principalesDetección de duplicidades, reacciones adversas al medicamento, interaccciones farmacológicas y medida de la efectividad del tratamiento.ResultadosSe estudiaron 314 pacientes, distribuidos de forma aleatoria al grupo control o intervención, que utilizaban 346 BZD. El 67% utilizaban BZD durante más de 1 año. Solo el 5% de los pacientes con insomnio conocía que la duración del tratamiento debía ser inferior al mes. El 20% utilizaban BZD de vida larga, 76% de vida media y el 4% de vida corta. Se detectaron 132 interacciones farmacológicas y 278 RAM: 32% pérdida de memoria, 21% somnolencia, 12% incoordinación motora, 8,3% mareo y confusión, 8,3% desorientación y 10% otras. Se realizaron 426 intervenciones farmacéuticas, 30 aceptadas por el médico, y se resolvieron 78 al finalizar el año. El 30% de los casos del grupo intervención fueron satisfactorios, y solo 11% del control.ConclusionesLas benzodiazepinas se utilizan en los pacientes ancianos de la Comunidad Valenciana con mayor frecuencia y por periodos más prolongados de lo recomendado por la Agencia Española del Medicamento.AbstractAimsTo improve the use of benzodiazepines (BZD) in the elderly by a pharmacist-physician collaboration, and to insure that BZD are effective, safe, and used as long as necessary.DesignA single blind controlled study was conducted on 11 pharmacies in the Community of Valencia.SettingEleven pharmacies in the Community of Valencia.ParticipantsPatients older than 65years treated with BZD attending the participating pharmacies.InterventionsInterviews and pharmaceutical care for a year.Main measurementdetection of duplications, adverse drug reactions, drug interactions and measuring the effectiveness of the treatment.ResultsWe studied 314 patients, randomised to control or intervention and who used 346 BZD. The majority (67%) of patients used BZD for more than 1 year. Only 5% patients with anxiety knew the duration of treatment should be one month. Long-acting BZD were used by 20% of the patients, 76% used medium-acting (39% lorazepam and 37% other BZD) and 4% short-acting BZD. A total of 132 drug interactions were detected and 278 adverse drug reactions: 32% memory loss, 21% drowsiness, 12% lack of coordination, 8.3% dizziness and confusion, 8,3% disorientation and 10% others. A total of 426 pharmacist interventions were performed, 30 accepted by the doctor and 78 were resolved at the end of the year of study. Eleven per cent of cases were considered satisfactory in the control group and 30% in the intervention group.ConclusionThe use of benzodiazepines in the Community of Valencia exceeds the recommendations of the Spanish Medicines Agency.

Introduction An inverse relationship has been reported between decreased postoperative Antithrombin (AT) plasmatic levels and the incidence of complications. We hypothesized that Nuclear Hormone Receptors could modulate the expression of SERPINC1 , encoding AT, through a Hormone Regulatory Element present in its promoter, and thus hormone analogs could be a pharmacological complement in surgical procedures to activate endogenous AT synthesis. Materials and Methods The expression of SERPINC1 was analyzed in HepG2 cells by quantitative RT-PCR and Western Blot. Two studies were conducted with (a) patients submitted to cardiac surgery with cardiopulmonary bypass receiving (n =17) or not (n=321) glucocorticoids (GCs) as part of their pharmacological treatment, and (b) patients who received (n =20) or not (n=16) GCs as part of their surgery (exodontia or knee arthroscopic, respectively). AT activity in plasma was determined by Innovance Antithrombin Test on a BCS XP System hemostasis analyzer. Results 13 nuclear hormone receptor ligands were assayed, being GW4064 (FXR ligand) the most potent activator. Retinoids, activating RXR, and GCs (Dexamethasone, cortisone and methylprednisolone) also resulted in increased AT expression. Chronic GC treatment mitigates the decreased AT activity observed after cardiac surgery. In patients who received two acute GC doses, pre-operative and post-operative AT activity was similar, whereas a significant decrease was observed after surgery in untreated patients. Conclusions Whereas retinoids and FXR ligands are investigational compounds, regulation of AT by GCS could have a higher potential for translation to clinical practice, pre-conditioning the patient against complications related to reduced AT levels. Larger prospective studies are needed to define the exact role of GCs and their potential clinical utility in cardiac surgery.

Frequency of cognitive impairment among people over 65 years old in community pharmacy. Study of asssociated factors, referral of cases to the specialist and inclusion in a program of health education.Cross-sectional study of prevalence, frequency, conducted in four pharmacies (two urban and two rural pharmacies) in the Autonomous Community of Valencia.people over 65 years old who come to the pharmacy and who agree to participate in the study after signing an informed consent. It is used as the initial screening test, the Short Portable Mental State Questionnaire of Pfeiffer. Pfeiffer positive cases undergo a second test (Mini-Mental State Examination, NORMACODEM version). A questionnaire designed specifically for the study has been used to collect information. It includes questions to gain demographic data, questions on lifestyle and chronic diseases. We used analysis logistic regression multilevel.245 patients have participated (76% of respondents). 12.65% were detected to have cognitive impairment. In the Logistic regression analysis multivariate there is a relation between cognitive impairment and some variables: age, lack of reading habit, unusual reading habit, sleeping less than 6 or more than 8 hours a day. Only 12.9% wanted to be referred for clinical evaluation and 42% were included in a cognitive training program.There are asssociation between lifestyle habits that are modifiable and cognitive impairment.

OBJETIVO: Determinar si la duración de los tratamientos con benzodiacepinas, sus análogos y antidepresivos se ajusta a las recomendaciones farmacológicas, así como evaluar la efectividad de estos tratamientos. DISEÑO: Estudio descriptivo, transversal, basado en encuestas directas. EMPLAZAMIENTO: Farmacias comunitarias de Baleares. PARTICIPANTES: Pacientes mayores de 65 años a los que se les prescribió mediante el Sistema Nacional de Salud alguna benzodiacepina y/o sus análogos y/o antidepresivos. MEDICIONES PRINCIPALES: Principio activo, indicación, duración de los tratamientos, efectividad. RESULTADOS: Los siguientes tratamientos tuvieron una duración mayor que 1 año: el 55,07% de los utilizados para tratar la ansiedad, el 56,52% para el insomnio crónico y el 87,5% de los tratamientos con alprazolam para tratar la ansiedad con depresión. En cambio, el 52% de los tratamientos de depresión tuvieron una duración menor que 1 año. Según los pacientes, el 6,2% de los tratamientos no fueron efectivos y el 13,9% lo fueron sólo al principio. DISCUSIÓN Y CONCLUSIONES: El hecho de que más del 50% de los tratamientos de la ansiedad (55,07%) y el insomnio crónico (56,52%) duren más de 1 año evidencia que no se cumplen en muchos casos las recomendaciones farmacológicas sobre el uso de benzodiacepinas y análogos. Estos resultados coinciden con los de otros estudios realizados en otras comunidades autónomas y con otro diseño experimental(1,2). La falta de efectividad de benzodiacepinas y análogos puede deberse, en algunos casos, a los tratamientos prolongados en los que aparece tolerancia, como se detecta también en este estudio (el 18,60% de los tratamientos de más de 1 año con benzodiacepinas que fueron efectivos sólo al principio). En cambio, la falta de efectividad en los tratamientos antidepresivos quizá podría explicarse por el incumplimiento terapéutico(3). Sin embargo, en más de la mitad (52%) de los casos los tratamientos de la depresión resultaron ser más cortos de lo que indican las recomendaciones farmacológicas. Esta diferencia en la duración de los tratamientos entre antidepresivos y benzodiacepinas podría deberse a la aparición retardada del efecto terapéutico y ausencia de desarrollo de dependencia en los antidepresivos frente a la aparición inmediata de los efectos y posible desarrollo de dependencia de las benzodiacepinas. Por todo ello, creemos que aplicar la atención fármacéutica a los pacientes en tratamiento con psicofármacos, así como la colaboración multidisciplinaria en atención primaria, ayudaría a la resolución de los problemas hallados.

We studied the influence of the inflammatory state of the gallbladder with gallstones on its response to cholecystokinin (CCK). Responses to CCK were evaluated in isolated human gallbladder strips incubated with pharmacological antagonists. Gallbladders from patients with gallstones were classified as having mild and severe chronic cholecystitis. Healthy gallbladders were collected from liver donors. In donor gallbladders, the CCK contraction was abolished with the CCK-A receptor antagonist, L-364718, and significantly reduced by indomethacin. In gallbladders with gallstones, only mild cholecystitis showed a decreased contraction to CCK. In gallbladders with gallstones, no involvement of prostaglandins in the CCK response was observed. In severe cholecystitis, CCK contractile effect was reduced by the serotonin receptor antagonist methysergide. In healthy gallbladder, the contraction provoked by CCK is mediated by CCK-A receptors and modulated by prostaglandins. The presence of gallstones in the gallbladder is correlated with a loss of prostaglandins-modulated CCK contraction. However, the excessive release of serotonin in advanced cholecystitis normalizes the contraction to CCK, suggesting that the state of cholecystitis affects the pool of inflammatory mediators responsible for gallbladder CCK-altered motility.

The present study analyses in in vitro models the pharmacological activity of methanol and dichloromethane extracts (1, 10 and 100 microg/mL) obtained from the leaves and stems of Globularia alypum L. Preincubation of the guinea-pig ileum and rat uterus with both extracts produced a dose dependent abolition of the contractile effects of histamine and serotonin, respectively. At the same doses, neither methanol nor dichloromethane extract reduced the contractile effects of acetylcholine on rat duodenum or noradrenaline on rat vas deferens.

Objetivo Determinar si la duracion de los tratamientos con benzodiacepinas, sus analogos y antidepresivos se ajusta a las recomendaciones farmacologicas, asi como evaluar la efectividad de estos tratamientos. Diseno Estudio descriptivo, transversal, basado en encuestas directas. Emplazamiento Farmacias comunitarias de Baleares. Participantes Pacientes mayores de 65 anos a los que se les prescribio mediante el Sistema Nacional de Salud alguna benzodiacepina y/o sus analogos y/o antidepresivos. Mediciones principales Principio activo, indicacion, duracion de los tratamientos, efectividad. Resultados Los siguientes tratamientos tuvieron una duracion mayor que 1 ano: el 55,07% de los utilizados para tratar la ansiedad, el 56,52% para el insomnio cronico y el 87,5% de los tratamientos con alprazolam para tratar la ansiedad con depresion. En cambio, el 52% de los tratamientos de depresion tuvieron una duracion menor que 1 ano. Segun los pacientes, el 6,2% de los tratamientos no fueron efectivos y el 13,9% lo fueron solo al principio. Discusion y conclusiones El hecho de que mas del 50% de los tratamientos de la ansiedad (55,07%) y el insomnio cronico (56,52%) duren mas de 1 ano evidencia que no se cumplen en muchos casos las recomendaciones farmacologicas sobre el uso de benzodiacepinas y analogos. Estos resultados coinciden con los de otros estudios realizados en otras comunidades autonomas y con otro diseno experimental1,2. La falta de efectividad de benzodiacepinas y analogos puede deberse, en algunos casos, a los tratamientos prolongados en los que aparece tolerancia, como se detecta tambien en este estudio (el 18,60% de los tratamientos de mas de 1 ano con benzodiacepinas que fueron efectivos solo al principio). En cambio, la falta de efectividad en los tratamientos antidepresivos quiza podria explicarse por el incumplimiento terapeutico3. Sin embargo, en mas de la mitad (52%) de los casos los tratamientos de la depresion resultaron ser mas cortos de lo que indican las recomendaciones farmacologicas. Esta diferencia en la duracion de los tratamientos entre antidepresivos y benzodiacepinas podria deberse a la aparicion retardada del efecto terapeutico y ausencia de desarrollo de dependencia en los antidepresivos frente a la aparicion inmediata de los efectos y posible desarrollo de dependencia de las benzodiacepinas. Por todo ello, creemos que aplicar la atencion farmaceutica a los pacientes en tratamiento con psicofarmacos, asi como la colaboracion multidisciplinaria en atencion primaria, ayudaria a la resolucion de los problemas hallados.