El acceso a los medicamentos, un privilegio para pocos

Fil: Lagomarsino, Eduardo. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica; ArgentinaLa ley de medicamentos genéricos es el marco legal necesario para habilitar el acceso a\nlos medicamentos, sobre todo, a los sectores sociales más vulnerables. Según el autor de\neste artículo, aún con todas las herramientas necesarias, esto sigue sin suceder. Entre las\ncausas señala una incorrecta regulación de la norma y el fuerte poder de influencia del\nmercado farmacéutico

Development of an empirical model for chlorophyll-a and Secchi Disk Depth estimation for a Pampean shallow lake (Argentina)

Shallow Pampean lakes are located in the most productive plain of Argentina. They are highly variable in salinity, turbidity and surface area. Laguna Chascomús has been monitored as a representative example of them. We developed a linear model based on satellite images validated against field measurements (2001–2011 period). A vegetation index and Landsat Surface Reflectance (Band 4) produced the best correlations with chlorophyll-a (Chl-a) and Secchi Disk Depth (SDD), respectively. In a second instance, a retrospective analysis (1986–2013) was performed. As a result, significant positive trends were observed for SDD and Chl-a. In addition, both variables displayed trends related to rainfall and site depth.Fil: Bohn, Vanesa Yael. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Bahía Blanca; Argentina. Universidad Nacional del Sur. Departamento de Geografía y Turismo; ArgentinaFil: Carmona, Facundo. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Nacional del Centro de la Provincia de Buenos Aires. Rectorado. Instituto de Hidrología de Llanuras - Sede Tandil. Provincia de Buenos Aires. Gobernación. Comisión de Investigaciones Científicas. Instituto de Hidrología de Llanuras - Sede Tandil; ArgentinaFil: Rivas, Raúl Eduardo. Universidad Nacional del Centro de la Provincia de Buenos Aires. Rectorado. Instituto de Hidrología de Llanuras - Sede Tandil. Provincia de Buenos Aires. Gobernación. Comisión de Investigaciones Científicas. Instituto de Hidrología de Llanuras - Sede Tandil; ArgentinaFil: Lagomarsino, Leonardo. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Instituto de Investigaciones Biotecnológicas. Instituto de Investigaciones Biotecnológicas "Dr. Raúl Alfonsín" (sede Chascomús). Universidad Nacional de San Martín. Instituto de Investigaciones Biotecnológicas. Instituto de Investigaciones Biotecnológicas "Dr. Raúl Alfonsín" (sede Chascomús); ArgentinaFil: Diovisalvi, Nadia Rosalia. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Instituto de Investigaciones Biotecnológicas. Instituto de Investigaciones Biotecnológicas "Dr. Raúl Alfonsín" (sede Chascomús). Universidad Nacional de San Martín. Instituto de Investigaciones Biotecnológicas. Instituto de Investigaciones Biotecnológicas "Dr. Raúl Alfonsín" (sede Chascomús); ArgentinaFil: Zagarese, Horacio Ernesto. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Instituto de Investigaciones Biotecnológicas. Instituto de Investigaciones Biotecnológicas "Dr. Raúl Alfonsín" (sede Chascomús). Universidad Nacional de San Martín. Instituto de Investigaciones Biotecnológicas. Instituto de Investigaciones Biotecnológicas "Dr. Raúl Alfonsín" (sede Chascomús); Argentin

Detección y resolución de Problemas Relacionados con Medicamentos en un servicio de Atención Farmacéutica en Argentina

Introducción: La Atención Farmacéutica consiste en un proceso asistencial sistemático para detectar, resolver y prevenir Problemas Relacionados con Medicamentos. El objetivo del presente trabajo es describir el número y perfil de problemas detectados y resueltos en un conjunto de pacientes adultos atendidos en una Unidad de Optimización de la Farmacoterapia en Argentina, durante un seguimiento farmacoterapéutico promedio de un año. Método: Se realizó un estudio cuasi-experimental, abierto y prospectivo en 40 pacientes ambulatorios. Se registraron las características clínicas y medicamentos, así como su adherencia o no al servicio. Se empleó la clasificación de Problemas Relacionados con Medicamentos de Minnesota, registrando su dimensión, categoría, causa, patología o condición clínica asociada, medicamento asociado, estado de riesgo, estado final y método de resolución. Resultados: Los grupos farmacoterapéuticos mayormente utilizados fueron beta-bloqueantes, estatinas, vitaminas y minerales, analgésicos, inhibidores de la bomba de protones y benzodiacepinas. Los problemas de indicación, especialmente por necesidad de farmacoterapia adicional, prevalecieron como los más frecuentes, incluyendo la falta de farmacoterapia preventiva con vacunas. Se logró resolver el 73,6% de los problemas detectados, de los cuales el 60,3% se hizo a través de informes a los médicos tratantes. El resto se pudo abordar mediante la educación al paciente, especialmente los de adherencia. Conclusiones: La Atención Farmacéutica permitió una descripción sistemática del perfil de problemas farmacológicos detectados y resueltos en un conjunto de pacientes adultos mayores ambulatorios, principalmente de sexo femenino, en el contexto de una Unidad de Optimización de la Farmacoterapia montada en un hospital universitario de Argentina

EL AÑO DE LA PANDEMIA: LA SALUD PUESTA EN LA MIRA Y JUZGADA POR LA SOCIEDAD

En el contexto de pandemia, la demanda sanitaria fue sustancialmente diferente y el rol de los profesionales de la salud cambió ante las nuevas exigencias de un marco desconocido. En esta nota el doctor Eduardo Lagomarsino describe las experiencias y vivencias que han experimentado en el ejercicio de la Farmacia Clínica. En especial, qué cambios debieron implementarse en las rutinas de trabajo y qué impactos han tenido

Anxiety, anger, salivary cortisol and cardiac autonomic activity in palliative care professionals with and without mind-body training experience : results from a pilot study

Abstract: Palliative care practitioners suffer a considerable burden of stress. Although it is not possible to eliminate stress entirely, people can learn to manage it. Mind/Body intervention help individuals turn maladaptive responses to stress into more adaptive ones. The aim of the study was to assess the impact of mind body techniques in a group of Palliative Care professionals. Methods: We investigated anxiety, anger, baseline salivary cortisol levels immediately after awakening and autonomic nervous system activity in a group of health care professionals from a Palliative Care Unit (n = 22). In addition, we assessed the autonomic response to relax instructions. The participants were divided into two groups according to their regular practice of mind-body techniques.Results: No significant differences between groups were found for anxiety and anger. Baseline salivary cortisol levels were significantly greater in the untrained group (5.23 ± 5.16 μg/dl) when compared with the trained one (0.57 ± 0.19 μg/dl) (Mann-Whitney U Test = 0; p < 0.001). When comparing heart rate variability (HRV) values during relaxation with HRV values at rest within each group, trained subjects showed a significant increase in LF% (z = -2.073, p = 0.038), while untrained subjects showed a significant increase in HF% (z = -2.100, p = 0.036). Conclusions: Subjects who regularly practice mind-body techniques evidenced lower baseline morning cortisol levels and achieved a differential autonomic response to relax instructions

Symptomatic bone langerhans cell histiocytosis treated at diagnosis or after reactivation with indomethacin alone

This study evaluated the outcome of patients with symptomatic bone Langerhans cell histiocytosis (LCH) treated with indomethacin alone, either at diagnosis or after reactivation (after recurrence with previous therapies). We evaluated the nonrandomized use of oral indomethacin (2 mg/kg/d) in patients with symptomatic single-system bone LCH. From 1997 to 2012, 38 sequential patients were treated for a median of 4 months. Criteria of nonactive disease (NAD) after initial treatment (8 wk) were: no pain, no soft tissue involvement, no increase of size, or no new bone lesions. Twentytwo patients were treated at diagnosis: 18 showed NAD after initial treatment (2 patients who had bone reactivations were retreated with indomethacin and remain with NAD). Three patients improved and they are with NAD after treatment with indomethacin, steroids, or radiotherapy. One patient developed progressive bone disease and he is with NAD after treatment with steroids and chemotherapy. Sixteen patients were treated after reactivation, and all were with NAD after initial treatment: 5 reactivated and 4 remain with NAD after retreatment with indomethacin. Toxicity was not significant. We conclude that indomethacin is a well tolerated and active drug in patients with symptomatic bone disease. The results support the concept that chemotherapy may not be necessary for limited bone disease.Fil: Braier, Jorge. Gobierno de la Ciudad de Buenos Aires. Hospital de Pediatría "Juan P. Garrahan"; ArgentinaFil: Rosso, Diego. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Pollono, Daniel. No especifica;Fil: Rey, Guadalupe. No especifica;Fil: Lagomarsino, Eduardo. No especifica;Fil: Latella, Antonio. No especifica;Fil: Zubizarreta, Pedro. No especifica

Paclitaxel: What has been done and the challenges remain ahead

In recent years, the nanotechnology has offered researchers the opportunity to solve the problems caused by the vehicle of the standard and first formulation of paclitaxel (Taxol), while maximizing the provenantineoplastic activity of the drug against many solid tumors. Hence, different types of nanocarriers have been employed to improve the efficacy, safety, physicochemical properties and pharmacokinetic/pharmacodynamic profile of this drug. To date, paclitaxel is the unique drug that is marketed in three different nanoplatforms for its parenteral delivery: polymeric nanoparticles (Abraxane), liposomes (Lipusu), and polymeric micelles (Genexol, Nanoxel and Paclical). Indeed, a fourth nanocarrier might be available soon, because phase III studies of OpaxioTM, a polymeric-conjugated, are near completion. Furthermore, other several nanoformulations are currently in various stages of clinical trials. Therefore, it is only through the critical analysis of clinical evidence from these studies that we can get a more concrete idea of what has been achieved with pharmaceutical nanotechnology so far. This review attempts to summarize current information available regarding the clinical status and the physicochemical characteristic of different nanocarriers for paclitaxel delivery in cancer therapy. We present an overview of the preclinical and clinical data of these systems including their pharmacokinetics, dose and administration, adverse events and clinical efficacy.Fil: Bernabeu, Ezequiel Adrian. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica; ArgentinaFil: Cagel, Carlos Maximiliano. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica; ArgentinaFil: Lagomarsino, Eduardo. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica; ArgentinaFil: Moretton, Marcela Analía. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica; ArgentinaFil: Chiappetta, Diego Andrés. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica; Argentin

Advances in therapy for the prevention of HIV transmission from mother to child

Introduction: Actually, ~17.8 million women and 1.8 million children (90%) resulted from ‘HIV mother-to-child transmission’ (MTCT), both in pregnancy, labour, delivery and later by breastfeeding. Due to its high pediatric incidence, MTCT represents a public health concern. 15 Areas covered: In this review, we focus on available treatments and antiretroviral drugs recommended by the World Health Organization, and the main clinical investigations in antiretroviral pharmacotherapy to prevent the MTCT. Expert opinion: The MTCT has been improved dramatically in the last few years mainly due to prophylactic perinatal antiretroviral therapy for pregnant women living with HIV. However, there is 20 still a milestone to reach since HIV MTCT remains as a public health challenge associated with MTCT though breastfeeding (post-natal transmission). In this context, different strategies could be employed as an attempt to reduce pediatric HIV infections. One of them involves the improvement of patient adherence to the HIV therapy. One possible solution is the development of novel long-acting formulations for prophylaxis of mothers and children, and a second possible solution is increase the inclusion of 25 mothers and infants in care programs to more effectively prevent the vertical transmission.Fil: Moretton, Marcela Analía. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica; ArgentinaFil: Bertera, Facundo Martin. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica; ArgentinaFil: Lagomarsino, Eduardo. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica; ArgentinaFil: Riedel, Jennifer Denise. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica; ArgentinaFil: Chiappetta, Diego Andrés. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica; ArgentinaFil: Höcht, Christian. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica; Argentin

Mixed micelles for encapsulation of doxorubicin with enhanced in vitro cytotoxicity on breast and ovarian cancer cell lines versus Doxil®

Doxorubicin (DOX) is used as a “first-line” antineoplastic drug in ovarian and metastatic breast cancer. However, serious side effects, such as cardiotoxicity have been reported after DOX intravenous administration. Hence, we investigated different micelle-former biomaterials, as Soluplus®, Pluronic F127, Tetronic T1107 and d-α-tocopheryl polyethylene glycol 1000 succinate (TPGS) to develop a potential mixed micellar nanocarrier for DOX delivery. Since DOX hydrochloride is a poor candidate to be encapsulated inside the hydrophobic core of the mixed micelles, we assayed a hydrophobic complex between DOX and sodium deoxycholate (NaDC) as an excellent candidate to be encapsulated within polymeric micelles. The combination of T1107:TPGS (1:3, weight ratio) demonstrated the best physicochemical properties together with a high DL capacity (6.43% w/v). Particularly, DOX in vitro release was higher at acidic tumour microenvironment pH value (5.5) than at physiological counterpart (7.4). The hydrodynamic diameter of the DOX/NaDC-loaded mixed micellar system was 10.7 nm (PDI = 0.239). The in vitro cytotoxicity of the mixed micellar formulation resulted significantly (p < 0.05) higher than Doxil® against ovarian (SKOV-3) and triple-negative breast cancer cells (MDA-MB- 231). Further, the in vitro cellular uptake assays demonstrated a significant increment (p < 0.05) of the DOX intracellular content for the mixed micelles versus Doxil® for both, SKOV-3 (at 2, 4 and 6 h of incubation) and MDA-MB-231 (at 4 h of incubation) cells. These findings suggest that T1107:TPGS (1:3) mixed micelles could be employed as a potential nanotechnological platform for drug delivery of DOX.Fil: Cagel, Carlos Maximiliano. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica; ArgentinaFil: Bernabeu, Ezequiel Adrian. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica; ArgentinaFil: Gonzalez, Lorena. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Departamento de Química Biológica. Cátedra de Química Biológica Vegetal; ArgentinaFil: Lagomarsino, Eduardo. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica; ArgentinaFil: Zubillaga, Marcela Beatriz. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Departamento de Fisicomatemática. Cátedra de Física; ArgentinaFil: Moretton, Marcela Analía. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica; ArgentinaFil: Chiappetta, Diego Andrés. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica; Argentin

Feasibility and results of an intraarterial chemotherapy program for the conservative treatment of retinoblastoma in Argentina

Background: The feasibility and results of intraarterial chemotherapy, also termed ophthalmic artery chemosurgery (OAC), for retinoblastoma in less developed countries have seldom been reported. Procedure: A retrospective evaluation of a program of OAC in Argentina from 2010 to 2015. Results: Ninety-seven eyes from 81 patients (61 bilateral) were analyzed. In 35 eyes, OAC was given as primary therapy and in 62 it was used for the treatment of tumors with partial response or those relapsing after systemic chemoreduction with focal therapy or external-beam radiotherapy. Twenty-two primarily treated eyes had group D and 13 groups B/C. A total of 400 procedures were carried out. Chemotherapy used included combinations of melphalan, carboplatin, and topotecan. There was no mortality associated with OAC. Toxicity included fever and neutropenia in five (1.25%), hypotension and bradycardia during anesthesia in two and femoral thrombosis in one, eyelid edema in nine, and neutropenia or thrombocytopenia in 28 cycles. With a median follow-up of 48.7 months (range 12–79), the 3-year probability of event-free survival (pEFS) (enucleation and/or radiotherapy were considered events) was comparable for patients who received first-line therapy and those treated at relapse (0.65 vs. 0.63, P = 0.5). In the former, the pEFS was 0.91 and 0.43 for groups B/C and D, respectively (P = 0.01). Two patients died of extraocular dissemination after refusal of enucleation. Conclusions: OAC was feasible with low toxicity. pEFS improved in all groups compared to the previous experience with systemic chemotherapy reducing the use of radiotherapy. The overall mortality associated with OAC is comparable to our previous experience with systemic chemoreduction.Fil: Funes, Santiago. Hospital Universitario Austral; ArgentinaFil: Sampor, Claudia. Gobierno de la Ciudad de Buenos Aires. Hospital de Pediatría "Juan P. Garrahan"; ArgentinaFil: Villasante, Francisco Eduardo. Hospital Universitario Austral; ArgentinaFil: Fandiño, Adriana Cristina. Gobierno de la Ciudad de Buenos Aires. Hospital de Pediatría "Juan P. Garrahan"; ArgentinaFil: Manzitti, Julio. Gobierno de la Ciudad de Buenos Aires. Hospital de Pediatría "Juan P. Garrahan"; ArgentinaFil: Sgroi, Mariana. Gobierno de la Ciudad de Buenos Aires. Hospital de Pediatría "Juan P. Garrahan"; ArgentinaFil: Neira, Pablo. Clinica y Maternidad Suizo Argentina; ArgentinaFil: Peralta, Laura. Gobierno de la Ciudad de Buenos Aires. Hospital de Pediatría "Juan P. Garrahan"; ArgentinaFil: Lagomarsino, Eduardo. Gobierno de la Ciudad de Buenos Aires. Hospital de Pediatría "Juan P. Garrahan"; ArgentinaFil: Schaiquevich, Paula Susana. Gobierno de la Ciudad de Buenos Aires. Hospital de Pediatría "Juan P. Garrahan"; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Ceciliano, Alejandro. Hospital Universitario Austral; ArgentinaFil: Chantada, Guillermo Luis. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Gobierno de la Ciudad de Buenos Aires. Hospital de Pediatría "Juan P. Garrahan"; Argentina. Hospital Universitario Austral; Argentin