Resultados de serviços farmacêuticos centrados no doente implementados em Portugal

The current high overload of the National Health System results in a tendency for the decline in length of stay of individuals in hospitals and transfer of care settings, many of which was previously considered as hospital care, both for services to support the community or to the families themselves. The Primary Health Care network is the first level of contact of individuals, family and community with the National Health System. This contact allows access to essential care and solving their problems, in a specialized and personalized manner.The pharmacist's role in improving the health of patients, hospitalized or outpatient, both institutionalized or community dwelling, has been a reality over time. However, they need to take the space of excellence of the community pharmacy to demonstrate to the society and other professionals their skills as partner in Primary Health Care. The need for pharmacists in the future will be dependent on the provision of pharmaceutical services patient centered, beyond dispensing medication service.Evidence of pharmacist’s intervention presented in this paper shows that it is possible to articulate the services of drug information, health status monitoring, screening for various diseases, medication review and pharmacotherapy follow-up with other health care structures providers. The results point to the added value of integrating pharmacists and pharmacies in the Primary Health Care network.A elevada sobrecarga atual do Sistema Nacional de Saúde tem como consequência uma tendência para a diminuição acentuada do tempo de permanência dos indivíduos nos hospitais e a transferência de muitos dos cuidados, que antes eram considerados como hospitalares, quer para os serviços de apoio à comunidade quer para as próprias famílias. Os Cuidados de Saúde Primários são o primeiro nível de contacto dos indivíduos, da família e da comunidade com o Sistema Nacional de Saúde. Este contacto permite o acesso a cuidados essenciais e à resolução dos seus problemas, de forma especializada e personalizada.O papel do farmacêutico na melhoria da saúde dos doentes, hospitalizados ou em ambulatório, tanto institucionalizados como residentes na comunidade, tem sido uma realidade ao longo do tempo. Contudo, precisa de aproveitar o espaço de excelência da farmácia comunitária para evidenciar, junto da sociedade civil e das restantes classes profissionais, as suas competências como interlocutor nos Cuidados de Saúde Primários. A necessidade de farmacêuticos, no futuro, estará dependente da prestação dos serviços farmacêuticos centrados no doente, para além do serviço de dispensa de medicamentos.A evidência da intervenção do farmacêutico apresentada neste artigo mostra que é possível articular os serviços de informação sobre medicamentos, monitorização do estado de saúde, rastreio de diversas doenças, revisão da medicação e acompanhamento farmacoterapêutico com as outras estruturas prestadoras de cuidados de saúde. Os resultados obtidos apontam para a mais valia da integração dos farmacêuticos e farmácias comunitárias na rede de Cuidados de Saúde Primários

A Step Forward in Breast Cancer Research: Gold Nanoparticles as Photothermal Therapy Enhancers

Gold nanoparticles (AuNPs) have been widely used and characterized for multiple biomedical applications, including the enhancement of photothermal therapy (PTT). AuNPs present a particular plasmon resonance band and are able to convert the absorbed optical radiation into heat, which validates their use in PTT. Several production methods have already been proposed for the synthesis of AuNPs, allowing to optimize the particles' morphology, size and optical properties. However, the production methods commonly used are frequently associated with the use of toxic reagents such as Cetyltrimethylammonium bromide, which presents some concerns for clinical applications. Herein, it is proposed a novel AuNPs' core synthesis method using tetrachloroauric acid and a mixture of reducing agents, later on coated with a combination of hyaluronic and oleic acids. The coating here represents a potential improvement of AuNPs biocompatibility, biodegradability and lifetime, while simultaneously potentiating the attachment towards specific ligands, such as the CD44 receptor, to develop more localized and highly selective tools. The produced functionalized nanoparticles were characterized by Dynamic Light Scattering, Microscopy Techniques and Spectroscopy, showing diameter sizes under 350 nm, polydispersity index smaller than 0.4 and enhanced absorbance in the Near Infrared (NIR, 650 to 900 nm) range. Moreover, the AuNPs safety and efficacy were preliminarily assessed in vitro using breast cancer cell lines. No toxicity was observed by MTT assay, both in breast cancer cell lines, and red blood cells. The irradiation process was proved to be safe; however, when combined with the AuNPs administration, it resulted in a significant reduction of cell viability for some of the breast cell lines tested. Thus, the results highlight the potential of the proposed system for some type of tumors, even though further tests are required to better understand the mechanisms behind the obtained results

Gold nanoparticles as a part of a photothermal therapy system.

Introduction Photothermal therapy (PTT) is attracting increased attention for the treatment of superficial localized tumors, relying on the induction of local hyperthermia of tumor cells upon their irradiation with light beams1. PTT efficacy depends, however, on the heat generated and, on the depth reached by the light. Some strategies to improve PTT efficacy includes the use of the near infrared (NIR, 650 to 900 nm) radiation to enhance the penetration depth of the light, combined with gold nanoparticles (AuNPs) to enhance the photothermal effect2. Experimental Methods Core AuNPs were synthesized by a novel method using tetrachloroauric acid and a mixture of reducing agents, and subsequently coated with a combination of hyaluronic and oleic acids, for improving the NPs biocompatibility, biodegradability, and lifetime. This coating also promotes the binding of specific cell receptors of the tumor cells. The particles were physico-chemically characterized, and in vitro and in vivo tests were carried out in breast cancer models to assess their safety and efficacy, when applied alone or combined with NIR irradiation3. Results and Discussion AuNPs presented a predominant spherical morphology with sizes under 350 nm, polydispersity index lower than 0.4 and enhanced absorbance in the NIR. The particles showed no toxicity in vitro and promising efficacy in vivo when administering the NPs in situ and later irradiating them externally. Histopathological analysis of tumors treated with both AuNPs and laser irradiation showed the presence of necrosis in most of the tumors and no effect or practically absence in healthy surrounding cells, which are very encouraging outcomes. Conclusion The results are promising, however, there is still room for improving the system, namely by reducing even more the invasiveness of the treatment through the combined use of aerogels structures. Aerogel’s unique properties4 make them ideal candidates to minimize the exposure of healthy tissues to laser radiation, acting as light and thermal insulators, as well as to incorporate the nanoparticles into their skeletal structure and thus potentiating a topical application of the particles. For these reasons, some exploratory methods were carried to produce and design aerogels structures for PTT applications

As bases farmacológicas dos cuidados farmacêuticos: o caso dos AINEs

Polypharmacy – a frequent situation found among the elderly, related to their physiological changes and multiple morbidities – increases the risk of adverse reactions, interactions, drugs misuse and drug-related problems. Knowing that non-steroidal anti-inflammatory drugs (NSAIDs) are widely used among the elderly, the aims of the present study were to assess the potential interactions that may occur between prescribed NSAIDs and other drugs and to create a list of recommendations for monitoring elderly patients taking NSAIDs, in order to prevent or minimize those negative outcomes. With this purpose, a retrospective study was performed at Centro de Saúde de Eiras (Coimbra, Portugal). The study involved the systematic analyses of the medication regimens of a sample of elderly patients selected from the elderly population of this primary health care unit. Eligible subjects were patients aging 65 or more years and at least with one NSAID included in their therapeutic schemes in the last three months. A total of 37 prescribed NSAIDs were found in the 29 patients of the sample. 125 potential NSAID-drug interactions were found: 2 minor and 123 moderate. Most interactions occurred between NSAIDs and anti- hypertensive drugs, such as diuretics (17.6%), angiotensin receptor blockers (14.4%), calcium channel block- ers (12.0%) and angiotensin converting enzyme inhibitors (8.8%). The prevalence of interactions between NSAIDs was 12.8%. These interactions can cause adverse effects with particular manifestations in the elderly, such as renal impairment and increased blood pressure. The pharmacist can develop a relevant role in services such as medication review, to identify these potential interactions, or pharmacotherapy follow-up, in the management of these situations when properly identified. Stresses the importance of positive interaction with General and Family Practice for the safe and efficiency of therapies. A polimedicação aumenta o risco de reações adversas, interações e uso incorreto dos medicamentos. Nos idosos é bastante prevalente, potenciando ainda mais os problemas relacionados com os medicamentos, uma vez que estes também resultam das alterações fisiológicas e multimorbilidades do envelhecimento. Sabendo que os anti-inflamatórios não esteroides (AINEs) são fármacos muito usados pelos idosos, foram objetivos deste trabalho caracterizar potenciais interações entre AINEs prescritos e a restante medicação em idosos e criar uma lista de recomendações relacionadas com a monitorização destes doentes, de modo a evitar ou detetar precocemente tais interações. Análise retrospetiva dos dados referentes à medicação prescrita de uma amostra de idosos de uma Unidade de Cuidados de Saúde Primários (Centro de Saúde de Eiras, Coimbra, Portugal) presentes numa consulta médica entre 2 e 16 de janeiro de 2012. Foram revistos os regimes farmacoterapêuticos de 29 doentes a tomar pelo menos 1 AINE, cerca de 3 meses antes da recolha de dados, num total de 37 AINEs prescritos. Foram encontradas 123 interações moderadas e 2 minor. As principais interações ocorreram entre AINEs e diuréticos (17,6%), antagonistas dos recetores da angiotensina (14,4%), bloqueadores da entrada do cálcio (12,0%) e inibidores da enzima de conversão da angiotensina (8,8%). A prevalência de interações entre AINEs foi de 12,8%. Elaborou-se uma lista de recomendações para monitorização dos doentes quando não se podem evitar as ditas interações. Estas interações devem ser tidas em conta no momento da prescrição e cedência de AINEs, pois podem desencadear efeitos negativos tais como alterações renais e aumento da pressão arterial. O farmacêutico pode desenvolver um papel relevante em serviços como a revisão da medicação, para identificar estas interações potenciais, ou no acompanhamento farmacoterapêutico, na gestão destas situações quando devidamente identificadas. Salienta-se a importância da interação positiva com a Medicina Geral e Familiar para a segurança e a eficiência das terapêuticas.

Cell membrane damage induced by phenolic acids on wine lactic acid bacteria

The aim of this work was to investigate the effect of phenolic acids on cell membrane permeability of lactic acid bacteria from wine. Several phenolic acids were tested for their effects on the cell membrane of Oenococcus oeni and Lactobacillus hilgardii by measuring potassium and phosphate efflux, proton influx and by assessing culture viability employing a fluorescence technique based on membrane integrity. The experimental results indicate that hydroxycinnamic acids (p-coumaric, caffeic and ferulic acids) induce greater ion leakages and higher proton influx than hydroxybenzoic acids (p-hydroxibenzoic, protocatechuic, gallic, vanillic, and syringic acids). Among the hydroxycinnamic acids, p-coumaric acid showed the strongest effect. Moreover, the exposure of cells to phenolic acids caused a significant decrease in cell culture viability, as measured by the fluorescence assay, in both tested strains. The results agree with previous results obtained in growth experiments with the same strains. Generally, phenolic acids increased the cell membrane permeability in lactic acid bacteria from wine. The different effects of phenolic acids on membrane permeability could be related to differences in their structure and lipophilic character

Search for a W' boson decaying to a bottom quark and a top quark in pp collisions at sqrt(s) = 7 TeV

Results are presented from a search for a W' boson using a dataset corresponding to 5.0 inverse femtobarns of integrated luminosity collected during 2011 by the CMS experiment at the LHC in pp collisions at sqrt(s)=7 TeV. The W' boson is modeled as a heavy W boson, but different scenarios for the couplings to fermions are considered, involving both left-handed and right-handed chiral projections of the fermions, as well as an arbitrary mixture of the two. The search is performed in the decay channel W' to t b, leading to a final state signature with a single lepton (e, mu), missing transverse energy, and jets, at least one of which is tagged as a b-jet. A W' boson that couples to fermions with the same coupling constant as the W, but to the right-handed rather than left-handed chiral projections, is excluded for masses below 1.85 TeV at the 95% confidence level. For the first time using LHC data, constraints on the W' gauge coupling for a set of left- and right-handed coupling combinations have been placed. These results represent a significant improvement over previously published limits.Comment: Submitted to Physics Letters B. Replaced with version publishe

Search for the standard model Higgs boson decaying into two photons in pp collisions at sqrt(s)=7 TeV

A search for a Higgs boson decaying into two photons is described. The analysis is performed using a dataset recorded by the CMS experiment at the LHC from pp collisions at a centre-of-mass energy of 7 TeV, which corresponds to an integrated luminosity of 4.8 inverse femtobarns. Limits are set on the cross section of the standard model Higgs boson decaying to two photons. The expected exclusion limit at 95% confidence level is between 1.4 and 2.4 times the standard model cross section in the mass range between 110 and 150 GeV. The analysis of the data excludes, at 95% confidence level, the standard model Higgs boson decaying into two photons in the mass range 128 to 132 GeV. The largest excess of events above the expected standard model background is observed for a Higgs boson mass hypothesis of 124 GeV with a local significance of 3.1 sigma. The global significance of observing an excess with a local significance greater than 3.1 sigma anywhere in the search range 110-150 GeV is estimated to be 1.8 sigma. More data are required to ascertain the origin of this excess.Comment: Submitted to Physics Letters

Measurement of the Lambda(b) cross section and the anti-Lambda(b) to Lambda(b) ratio with Lambda(b) to J/Psi Lambda decays in pp collisions at sqrt(s) = 7 TeV

The Lambda(b) differential production cross section and the cross section ratio anti-Lambda(b)/Lambda(b) are measured as functions of transverse momentum pt(Lambda(b)) and rapidity abs(y(Lambda(b))) in pp collisions at sqrt(s) = 7 TeV using data collected by the CMS experiment at the LHC. The measurements are based on Lambda(b) decays reconstructed in the exclusive final state J/Psi Lambda, with the subsequent decays J/Psi to an opposite-sign muon pair and Lambda to proton pion, using a data sample corresponding to an integrated luminosity of 1.9 inverse femtobarns. The product of the cross section times the branching ratio for Lambda(b) to J/Psi Lambda versus pt(Lambda(b)) falls faster than that of b mesons. The measured value of the cross section times the branching ratio for pt(Lambda(b)) > 10 GeV and abs(y(Lambda(b))) < 2.0 is 1.06 +/- 0.06 +/- 0.12 nb, and the integrated cross section ratio for anti-Lambda(b)/Lambda(b) is 1.02 +/- 0.07 +/- 0.09, where the uncertainties are statistical and systematic, respectively.Comment: Submitted to Physics Letters

Search for new physics in events with opposite-sign leptons, jets, and missing transverse energy in pp collisions at sqrt(s) = 7 TeV

A search is presented for physics beyond the standard model (BSM) in final states with a pair of opposite-sign isolated leptons accompanied by jets and missing transverse energy. The search uses LHC data recorded at a center-of-mass energy sqrt(s) = 7 TeV with the CMS detector, corresponding to an integrated luminosity of approximately 5 inverse femtobarns. Two complementary search strategies are employed. The first probes models with a specific dilepton production mechanism that leads to a characteristic kinematic edge in the dilepton mass distribution. The second strategy probes models of dilepton production with heavy, colored objects that decay to final states including invisible particles, leading to very large hadronic activity and missing transverse energy. No evidence for an event yield in excess of the standard model expectations is found. Upper limits on the BSM contributions to the signal regions are deduced from the results, which are used to exclude a region of the parameter space of the constrained minimal supersymmetric extension of the standard model. Additional information related to detector efficiencies and response is provided to allow testing specific models of BSM physics not considered in this paper.Comment: Replaced with published version. Added journal reference and DO

Measurement of isolated photon production in pp and PbPb collisions at sqrt(sNN) = 2.76 TeV

Isolated photon production is measured in proton-proton and lead-lead collisions at nucleon-nucleon centre-of-mass energies of 2.76 TeV in the pseudorapidity range |eta|<1.44 and transverse energies ET between 20 and 80 GeV with the CMS detector at the LHC. The measured ET spectra are found to be in good agreement with next-to-leading-order perturbative QCD predictions. The ratio of PbPb to pp isolated photon ET-differential yields, scaled by the number of incoherent nucleon-nucleon collisions, is consistent with unity for all PbPb reaction centralities.Comment: Submitted to Physics Letters