Impact on the work of clinical pharmacist at the pharmacotherapy management of critically ill patient: Local experience in a clinical hospital

Context: The complexity in critical patient management and polypharmacy, raise the need for support from a clinical pharmacist to optimize drug therapies. Aims: To evaluate the clinical pharmacist participation in an Adult Intensive Care Unit in a local context where the practice is not well established. Methods: The study was conducted in a teaching hospital. Consisted of two stages a retrospective in which were collected of pharmacotherapy follow-up during a period of two years and a prospective phase of observational and cross-sectional character, which picked up the clinical history of patients and pharmaceutical interventions. These pharmaceutical interventions were evaluated by two intensive care physicians and two external pharmacist, using a default score to each one of these, the degree of concordance was obtained using the kappa coefficient. Results: In the retrospective phase were collected 182 patients, who were performed a total of 750 interventions, of which 99.7% was accepted by physician. In the prospective phase, were analyzed 53 patients that involved 263 pharmaceutical interventions with 96.6% of acceptance on the part of the medical staff. The degree of correlation of the interventions was κ = 0.61 between two physicians of the unit, and κ = 0.71 between two external pharmacists. Conclusions: The contribution that a clinical pharmacist can provide in an adult intensive care has a positive impact on the treatment of patients with a high percentage of acceptances on the part of the medical team

Efecto de la adición de restos de poda y biochar en las propiedades de una turba parda como sustrato de cultivo

Las turberas realizan la función de sumidero de carbono en los ecosistemas terrestres pero debido a su excesivo uso como combustible o como medio de cultivo se está produciendo la sobreexplotación de este recurso no renovable. En los últimos años se han llevado a cabo diversas investigaciones con el objetivo de encontrar sustratos procedentes de diferentes residuos orgánicos que sean de alta calidad y bajo coste con el fin de disminuir el consumo de turba

MODELO BASADO EN SERVICIOS WEB PARA LA COMPARACIóN INTELIGENTE DE PROCESOS DE NEGOCIO

El objetivo principal del artículo es proponer un modelo inteligente de comparación de procesos de negocio, para la propagación de cambios en variantes de procesos. El sistema fue desarrollado teniendo en cuenta dos componentes: una plataforma tecnológica basada en servicios web soportada por un sistema multiagente y un mecanismo de inferencia sensible al contexto. La validación del sistema se realizó sobre un caso de estudio relacionado con el proceso de admisiones a programas de educación superior en la Universidad Nacional de Colombia. Se puede concluir que la comparación de variantes puede verse afectada por información del contexto y que un enfoque distribuido soportado por servicios web y agentes inteligentes, facilita el uso del mecanismo de inferencia.PALABRAS CLAVES: Procesos de negocio, variantes, Comparación inteligente, Arquitectura orientada a servicios web, Servicios Web

Fertilization and connectivity in the Garrucha Canyon (SE-Spain) Implications for Marine Spatial Planning

Postprin

CO2 Capture by Absorption with Potassium Carbonate

The objective of this work is to improve the process for CO{sub 2} capture by alkanolamine absorption/stripping by developing an alternative solvent, aqueous K{sub 2}CO{sub 3} promoted by piperazine. The best K{sup +}/PZ solvent, 4.5 m K{sup +}/4.5 m PZ, requires equivalent work of 31.8 kJ/mole CO{sub 2} when used with a double matrix stripper and an intercooled absorber. The oxidative degradation of piperazine or organic acids is reduced significantly by inhibitor A, but the production of ethylenediamine is unaffected. The oxidative degradation of piperazine in 7 m MEA/2 m PZ is catalyzed by Cu{sup ++}. The thermal degradation of MEA becomes significant at 120 C. The solubility of potassium sulfate in MEA/PZ solvents is increased at greater CO{sub 2} loading. The best solvent and process configuration, matrix with MDEA/PZ, offers 22% and 15% energy savings over the baseline and improved baseline, respectively, with stripping and compression to 10 MPa. The energy requirement for stripping and compression to 10 MPa is about 20% of the power output from a 500 MW power plant with 90% CO{sub 2} removal. The stripper rate model shows that a ''short and fat'' stripper requires 7 to 15% less equivalent work than a ''tall and skinny'' one. The stripper model was validated with data obtained from pilot plant experiments at the University of Texas with 5m K{sup +}/2.5m PZ and 6.4m K{sup +}/1.6m PZ under normal pressure and vacuum conditions using Flexipac AQ Style 20 structured packing. Experiments with oxidative degradation at low gas rates confirm the effects of Cu{sup +2} catalysis; in MEA/PZ solutions more formate and acetate is produced in the presence of Cu{sup +2}. At 150 C, the half life of 30% MEA with 0.4 moles CO{sub 2}/mole amine is about 2 weeks. At 100 C, less than 3% degradation occurred in two weeks. The solubility of potassium sulfate in MEA solution increases significantly with CO{sub 2} loading and decreases with MEA concentration. The base case corrosion rate in 5 M MEA/1.2M PZ is 22 mpy. With 1 wt% heat stable salt, the corrosion rate increases by 50% to 160% in the order: thiosulfate< oxalate<acetate<formate. Cupric carbonate is ineffective in the absence of oxygen, but 50 to 250 ppm reduces corrosion to less than 2 mpy in the presence of oxygen

Mortality and cardiovascular disease burden of uncontrolled diabetes in a registry-based cohort: the ESCARVAL-risk study

BACKGROUND: Despite the epidemiological evidence about the relationship between diabetes, mortality and cardiovascular disease, information about the population impact of uncontrolled diabetes is scarce. We aimed to estimate the attributable risk associated with HbA1c levels for all-cause mortality and cardiovascular hospitalization. METHODS: Prospective study of subjects with diabetes mellitus using electronic health records from the universal public health system in the Valencian Community, Spain 2008-2012. We included 19,140 men and women aged 30 years or older with diabetes who underwent routine health examinations in primary care. RESULTS: A total of 11,003 (57%) patients had uncontrolled diabetes defined as HbA1c ≥6.5%, and, among those, 5325 participants had HbA1c ≥7.5%. During an average follow-up time of 3.3 years, 499 deaths, 912 hospitalizations for coronary heart disease (CHD) and 786 hospitalizations for stroke were recorded. We observed a linear and increasingly positive dose-response of HbA1c levels and CHD hospitalization. The relative risk for all-cause mortality and CHD and stroke hospitalization comparing patients with and without uncontrolled diabetes was 1.29 (95 CI 1.08,1.55), 1.38 (95 CI 1.20,1.59) and 1.05 (95 CI 0.91, 1.21), respectively. The population attributable risk (PAR) associated with uncontrolled diabetes was 13.6% (95% CI; 4.0-23.9) for all-cause mortality, 17.9% (95% CI; 10.5-25.2) for CHD and 2.7% (95% CI; - 5.5-10.8) for stroke hospitalization. CONCLUSIONS: In a large general-practice cohort of patients with diabetes, uncontrolled glucose levels were associated with a substantial mortality and cardiovascular disease burden

CO2 Capture by Absorption with Potassium Carbonate

The objective of this work is to improve the process for CO{sub 2} capture by alkanolamine absorption/stripping by developing an alternative solvent, aqueous K{sub 2}CO{sub 3} promoted by piperazine. The best solvent and process configuration, matrix with MDEA/PZ, offers 22% and 15% energy savings over the baseline and improved baseline, respectively, with stripping and compression to 10 MPa. The energy requirement for stripping and compression to 10 MPa is about 20% of the power output from a 500 MW power plant with 90% CO{sub 2} removal. The stripper rate model shows that a ''short and fat'' stripper requires 7 to 15% less equivalent work than a ''tall and skinny'' one. The stripper model was validated with data obtained from pilot plant experiments at the University of Texas with 5m K{sup +}/2.5m PZ and 6.4m K{sup +}/1.6m PZ under normal pressure and vacuum conditions using Flexipac AQ Style 20 structured packing. Experiments with oxidative degradation at low gas rates confirm the effects of Cu{sup +2} catalysis; in MEA/PZ solutions more formate and acetate is produced in the presence of Cu{sup +2}. At 150 C, the half life of 30% MEA with 0.4 moles CO{sub 2}/mole amine is about 2 weeks. At 100 C, less than 3% degradation occurred in two weeks. The solubility of potassium sulfate in MEA solution increases significantly with CO{sub 2} loading and decreases with MEA concentration. The base case corrosion rate in 5 M MEA/1,2M PZ is 22 mpy. With 1 wt% heat stable salt, the corrosion rate increases by 50% to 160% in the order: thiosulfate< oxalate<acetate<formate. Cupric carbonate is ineffective in the absence of oxygen, but 50 to 250 ppm reduces corrosion to less than 2 mpy in the presence of oxygen

Increased glycolipid storage produced by the inheritance of a complex intronic haplotype in the α-galactosidase A (GLA) gene

BACKGROUND: Accumulation of galactosphingolipids is a general characteristic of Fabry disease, a lysosomal storage disorder caused by the deficient activity of α-galactosidase A encoded by the GLA gene. Although many polymorphic GLA haplotypes have been described, it is still unclear whether some of these variants are causative of disease symptoms. We report the study of an inheritance of a complex intronic haplotype (CIH) (c.-10C > T, c.369 + 990C > A, c.370-81_370-77delCAGCC, c.640-16A > G, c.1000-22C > T) within the GLA gene associated with Fabry-like symptoms and galactosphingolipid accumulation. We analysed α-Gal A activity in plasma, leukocytes and skin fibroblasts in patients, and measured accumulation of galactosphingolipids by enzymatic methods and immunofluorescence techniques. Additionally, we evaluated GLA expression using quantitative PCR, EMSA, and cDNA cloning. RESULTS: CIH carriers had an altered GLA expression pattern, although most of the carriers had high residual enzyme activity in plasma, leukocytes and in skin fibroblasts. Nonetheless, CIH carriers had significant galactosphingolipid accumulation in fibroblasts in comparison with controls, and also glycolipid deposits in renal tubules and glomeruli. EMSA assays indicated that the c.-10C > T variant in the promoter affected a nuclear protein binding site. CONCLUSIONS: Thus, inheritance of the CIH caused an mRNA deregulation altering the GLA expression pattern, producing a tissue glycolipid storage

Beneficial effects of essential oils from the mediterranean diet on gut microbiota and their metabolites in ischemic heart disease and type-2 diabetes mellitus

[Abstract] Ischemic heart disease (IHD) and type-2 diabetes mellitus (T2DM) remain major health problems worldwide and commonly coexist in individuals. Gut microbial metabolites, such as trimethylamine N-oxide (TMAO) and short-chain fatty acids (SCFAs), have been linked to cardiovascular and metabolic diseases. Previous studies have reported dysbiosis in the gut microbiota of these patients and the prebiotic effects of some components of the Mediterranean diet. Essential oil emulsions of savory (Satureja hortensis), parsley (Petroselinum crispum) and rosemary (Rosmarinus officinalis) were assessed as nutraceuticals and prebiotics in IHD and T2DM. Humanized mice harboring gut microbiota derived from that of patients with IHD and T2DM were supplemented with L-carnitine and orally treated with essential oil emulsions for 40 days. We assessed the effects on gut microbiota composition and abundance, microbial metabolites and plasma markers of cardiovascular disease, inflammation and oxidative stress. Our results showed that essential oil emulsions in mice supplemented with L-carnitine have prebiotic effects on beneficial commensal bacteria, mainly Lactobacillus genus. There was a decrease in plasma TMAO and an increase in fecal SCFAs levels in mice treated with parsley and rosemary essential oils. Thrombomodulin levels were increased in mice treated with savory and parsley essential oils. While mice treated with parsley and rosemary essential oils showed a decrease in plasma cytokines (INFɣ, TNFα, IL-12p70 and IL-22); savory essential oil was associated with increased levels of chemokines (CXCL1, CCL2 and CCL11). Finally, there was a decrease in protein carbonyls and pentosidine according to the essential oil emulsion. These results suggest that changes in the gut microbiota induced by essential oils of parsley, savory and rosemary as prebiotics could differentially regulate cardiovascular and metabolic factors, which highlights the potential of these nutraceuticals for reducing IHD risk in patients affected by T2DM.Junta de Andalucía; PI-0170-2018Instituto de Salud Carlos III; PT20/00101Junta de Andalucía; RH-0078-2021Instituto de Salud Carlos III; CPII19/00022Instituto de Salud Carlos III; FI20/0022

Mortality and other adverse outcomes in patients with type 2 diabetes mellitus admitted for COVID-19 in association with glucose-lowering drugs: a nationwide cohort study

Background: Limited evidence exists on the role of glucose-lowering drugs in patients with COVID-19. Our main objective was to examine the association between in-hospital death and each routine at-home glucose-lowering drug both individually and in combination with metformin in patients with type 2 diabetes mellitus admitted for COVID-19. We also evaluated their association with the composite outcome of the need for ICU admission, invasive and non-invasive mechanical ventilation, or in-hospital death as well as on the development of in-hospital complications and a long-time hospital stay. Methods: We selected all patients with type 2 diabetes mellitus in the Spanish Society of Internal Medicine's registry of COVID-19 patients (SEMI-COVID-19 Registry). It is an ongoing, observational, multicenter, nationwide cohort of patients admitted for COVID-19 in Spain from March 1, 2020. Each glucose-lowering drug user was matched with a user of other glucose-lowering drugs in a 1:1 manner by propensity scores. In order to assess the adequacy of propensity score matching, we used the standardized mean difference found in patient characteristics after matching. There was considered to be a significant imbalance in the group if a standardized mean difference > 10% was found. To evaluate the association between treatment and study outcomes, both conditional logit and mixed effect logistic regressions were used when the sample size was ≥ 100. Results: A total of 2666 patients were found in the SEMI-COVID-19 Registry, 1297 on glucose-lowering drugs in monotherapy and 465 in combination with metformin. After propensity matching, 249 patients on metformin, 105 on dipeptidyl peptidase-4 inhibitors, 129 on insulin, 127 on metformin/dipeptidyl peptidase-4 inhibitors, 34 on metformin/sodium-glucose cotransporter 2 inhibitor, and 67 on metformin/insulin were selected. No at-home glucose-lowering drugs showed a significant association with in-hospital death; the composite outcome of the need of intensive care unit admission, mechanical ventilation, or in-hospital death; in-hospital complications; or long-time hospital stays. Conclusions: In patients with type 2 diabetes mellitus admitted for COVID-19, at-home glucose-lowering drugs showed no significant association with mortality and adverse outcomes. Given the close relationship between diabetes and COVID-19 and the limited evidence on the role of glucose-lowering drugs, prospective studies are needed