Analysis of drugs returned by inpatient services after unit dose distribution in a portuguese public hospital

Unit-dose has been considered the most effective dispensing system in hospital pharmacy, however not all drugs are administered, are then returned to the pharmacy. The analysis of non-administered drugs might provide important data regarding pharmacotherapeutic follow-up, but also regarding pharmacy management decisions. The present study aims at depicting the drugs returned to the pharmacy following their previous unit-dose dispensing. Methods: During a period of 45 days, the unused returned drugs of five different inpatient clinical services were analyzed regarding the state of conservation, justification for return, inpatient clinical service provenance, and dosage regimen. Of a total of 65280 unit-dose dispensed drugs, 25.2% were returned (n=16431) and 74.9% of SOS (i.e. medications prescribed as needed) drugs (n=6583) were unused. Excluding SOS drugs, more than a half of the returned drugs (52.4%, n=4967), were probably returned due to unintended omission of administration, after excluding patients that were not physically on the unit and patients whose treatments were modified. The large majority of returned drugs (98.6%, n=16201) were suitable for reintroduction in the medication circuit. In order to accomplish the basic principles of unit-dose dispensing genesis, the returned drugs must be kept to a minimum. Therefore, the suspension of dispensing SOS drugs by unit-dose should be considered. Additionally, the careful analysis of returned drugs should be promoted, in order to avoid, as much as possible, the omission of administration.info:eu-repo/semantics/publishedVersio

Potentially irritant preservatives in newborn baby cosmetics – analysis of labels of products sold in Portugal

The use of cosmetics containing preservatives might pose a risk to the skin health of newborns, despite improving their adaptation to the external environment. The present work aimed at depicting the potentially hazardous preservatives in cosmetics sold in the district of Porto, Portugal. A total of 281 labels from newborn cosmetics were analyzed. From 729 different ingredients found in the analyzed labels, 15 were preservatives with previously recorded irritant activity, being sodium benzoate the most mentioned (n = 118). There was a significant difference between the means of number of preservatives with an irritant potential present in the products sold in pharmacies and in the products sold in supermarkets. Most analyzed products contained at least one preservative. Still, the choice of cosmetics for newborns should consider those with a minimum number of preservatives, being more probable to choose a less sensitizing product in pharmacies than in supermarkets.info:eu-repo/semantics/publishedVersio

FROM SCIENCE AND TECHNOLOGY TO INNOVATION DIPLOMACY: THEIR FUTURE AND THE RELATIONSHIP WITH INTERNATIONAL SECURITY

This article consists of a theoretical essay, essentially supported by bibliographical research strongly complemented with our own experience in most subjects and it has a qualitative and exploratory bias. It consists of an introduction to the research object where we make a broad approach in a world undergoing constant changes specially related to scientific and technical aspects of science, technology, and innovation diplomacy (ST&I) during the last two decades. Among many others, to address the issue we have chosen some relevant areas like Artificial Intelligence (AI), Internet of Things (IoT), Cyber Diplomacy, and Quantum Technology. We also make the linkages between the ST&I aspects and diplomacy, and its relationship with some aspects of military technologies. In this aspect, we reinforce the relevance – a point of concern – of the proliferation of military technologies by scientific collaboration, commercial trade, or other mechanisms. Despite the traditional scientific collaborations between thousands of groups all around the world, we show the importance of considering that both enemies and potential enemies, should be avoided of having access to certain critical and sensitive technologies. In this way, we show its relevance and importance as a strategic planning in national defense essential for the sovereignty of any country and international security. technologies by scientific collaboration, commercial trade, or other mechanisms. Despite the traditional scientific collaborations between thousands of groups all around the world, we show the importance of considering that both enemies and potential enemies, should be avoided of having access to certain critical and sensitive technologies. In this way, we show its relevance and importance as a strategic planning in national defense essential for the sovereignty of any country

Molecular characterization of EGFR, PDGFRA and VEGFR2 in cervical adenosquamous carcinoma

<p>Abstract</p> <p>Background</p> <p>Adenosquamous carcinoma of the uterine cervix is an infrequent but aggressive subtype of cervical cancer. A better understanding of its biological behaviour is warranted to define more accurate prognosis and therapeutic targets. Currently, the blockage of receptor tyrosine kinase (RTKs) activity is an efficient therapeutic strategy for many different cancers. The objective of this study was to investigate EGFR, PDGFRA and VEGFR2 RTKs overexpression and activating gene mutations in a cohort of 30 adenosquamous carcinomas of the uterine cervix.</p> <p>Methods</p> <p>EGFR, PDGFRA and VEGFR2 immunohistochemistry was performed in all samples, followed by DNA isolation from the gross macroscopically dissection of the neoplastic area. Screening for <it>EGFR </it>(exons 18–21) and <it>PDGFRA </it>(exons 12, 14 and 18) mutations was done by PCR – single-strand conformational polymorphism (PCR-SSCP).</p> <p>Results</p> <p>Despite the presence of EGFR immunohistochemical positive reactions in 43% (13/30) of the samples, no <it>EGFR </it>activating mutations in the hotspot region (exons 18–21) were identified. A silent base substitution (CAG>CAA) in <it>EGFR </it>exon 20 at codon 787 (Q787Q) was found in 17 cases (56%). All PDGFRA immunohistochemical reactions were positive and consistently observed in the stromal component, staining fibroblasts and endothelial cells, as well as in the cytoplasm of malignant cells. No activating <it>PDGFRA </it>mutations were found, yet, several silent mutations were observed, such as a base substitution in exon 12 (CCA>CCG) at codon 567 (P567P) in 9 cases and in exon 18 (GTC>GTT) at codon 824 (V824V) in 4 cases. We also observed the presence of base substitutions in intron 14 (IVS14+3G>A and IVS14+49G>A) in two different cases, and in intron 18 (IVS18-50insA) in 4 cases. VEGFR2 positivity was observed in 22 of 30 cases (73.3%), and was significantly associated with lack of metastasis (<it>p </it>= 0.038).</p> <p>Conclusion</p> <p>This is the most extensive analysis of EGFR, PDGFRA and VEGFR2 in cervical adenosquamous carcinomas. Despite the absence of <it>EGFR </it>and <it>PDGFRA </it>activating mutations, the presence of overexpression of these three important therapeutic targets in a subset of cases may be important in predicting the sensitivity of adenosquamous carcinoma to specific anti-RTKs drugs.</p

Geoeconomic variations in epidemiology, ventilation management, and outcomes in invasively ventilated intensive care unit patients without acute respiratory distress syndrome: a pooled analysis of four observational studies

Background: Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. Methods: In this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middle-income countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Findings: Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42\ub74% vs 44\ub72%; absolute difference \u20131\ub769 [\u20139\ub758 to 6\ub711] p=0\ub767; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5\u20138] vs 6 [5\u20138] cm H2O; p=0\ub70011). ICU mortality was higher in MICs than in HICs (30\ub75% vs 19\ub79%; p=0\ub70004; adjusted effect 16\ub741% [95% CI 9\ub752\u201323\ub752]; p&lt;0\ub70001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0\ub780 [95% CI 0\ub775\u20130\ub786]; p&lt;0\ub70001). Interpretation: Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status. Funding: No funding

Effects of alirocumab on types of myocardial infarction: insights from the ODYSSEY OUTCOMES trial

Aims  The third Universal Definition of Myocardial Infarction (MI) Task Force classified MIs into five types: Type 1, spontaneous; Type 2, related to oxygen supply/demand imbalance; Type 3, fatal without ascertainment of cardiac biomarkers; Type 4, related to percutaneous coronary intervention; and Type 5, related to coronary artery bypass surgery. Low-density lipoprotein cholesterol (LDL-C) reduction with statins and proprotein convertase subtilisin–kexin Type 9 (PCSK9) inhibitors reduces risk of MI, but less is known about effects on types of MI. ODYSSEY OUTCOMES compared the PCSK9 inhibitor alirocumab with placebo in 18 924 patients with recent acute coronary syndrome (ACS) and elevated LDL-C (≥1.8 mmol/L) despite intensive statin therapy. In a pre-specified analysis, we assessed the effects of alirocumab on types of MI. Methods and results  Median follow-up was 2.8 years. Myocardial infarction types were prospectively adjudicated and classified. Of 1860 total MIs, 1223 (65.8%) were adjudicated as Type 1, 386 (20.8%) as Type 2, and 244 (13.1%) as Type 4. Few events were Type 3 (n = 2) or Type 5 (n = 5). Alirocumab reduced first MIs [hazard ratio (HR) 0.85, 95% confidence interval (CI) 0.77–0.95; P = 0.003], with reductions in both Type 1 (HR 0.87, 95% CI 0.77–0.99; P = 0.032) and Type 2 (0.77, 0.61–0.97; P = 0.025), but not Type 4 MI. Conclusion  After ACS, alirocumab added to intensive statin therapy favourably impacted on Type 1 and 2 MIs. The data indicate for the first time that a lipid-lowering therapy can attenuate the risk of Type 2 MI. Low-density lipoprotein cholesterol reduction below levels achievable with statins is an effective preventive strategy for both MI types.For complete list of authors see http://dx.doi.org/10.1093/eurheartj/ehz299</p

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

90-річчя члена-кореспондента НАН України Г.К. Степанковської

The p(T)-differential production cross section of electrons from semileptonic decays of heavy-flavor hadrons has been measured at midrapidity in proton-proton collisions at root s = 2.76 TeV in the transverse momentum range 0.5 < p(T) < 12 GeV/c with the ALICE detector at the LHC. The analysis was performed using minimum bias events and events triggered by the electromagnetic calorimeter. Predictions from perturbative QCD calculations agree with the data within the theoretical and experimental uncertainties