Detección de prescripciones potencialmente inapropiadas en pacientes ancianos: estudio descriptivo en dos farmacias comunitarias

Introducción: Los ancianos son un grupo de pacientes heterogéneos a los que se les prescribe un número elevado de medicamentos. Esto conlleva a prescripciones potencialmente inapropiadas.Objetivo: Analizar la farmacoterapia del paciente anciano desde la farmacia comunitaria para detectar prescripciones potencialmente inapropiadas (Beers 2012 y STOPP) y prescripciones potencialmente omitidas (START), determinando su prevalencia.Metodología: Estudio descriptivo, observacional en el que se incluyeron pacientes mayores de 65 años de atención primaria que llevaban al menos un tratamiento crónico. Se verificó la idoneidad de la medicación según los criterios Beers 2012 y STOPP & START.Resultados: Se incluyeron 223 pacientes con una edad media de 75 años. En total se prescribieron 1.558 medicamentos, con una media de 7 medicamentos por paciente. El 67 % de los pacientes eran polimedicados. Con Beers 2012 se detectaron 246 prescripciones inapropiadas y el criterio que más se repitió fue el de benzodiazepinas de acción corta, intermedia y larga (36 %). Con STOPP se detectaron 146 prescripciones inapropiadas. El criterio más frecuente fue IBP a dosis plenas durante más de 8 semanas (14 %). Con START se detectaron 103 prescripciones potencialmente omitidas, siendo antiagregantes plaquetarios en diabetes mellitus la más frecuente (11,6 %).Conclusiones: Los criterios Beers 2012 y STOPP-START, suponen una herramienta de utilidad en la detección de los posibles problemas relacionados con los medicamentos en una farmacia comunitaria. En ningún caso suponen una prohibición en la utilización de dichos medicamentos, puesto que su prescripción dependerá de las características del paciente en concreto y del juicio clínico del médico prescriptor

Herramientas para evaluar la adecuación de la prescripción en ancianos

El envejecimiento es un proceso complejo. Con la edad se van produciendo importantes cambios fisiológicos y aumenta la incidencia de múltiples patologías orgánicas y sistémicas. A los pacientes ancianos se les prescribe un elevado número de medicamentos. Además, son los que realizan un mayor número de visitas médicas e ingresos hospitalarios. Los ancianos son el grupo poblacional con mayor grado de polimedicación. La polimedicación genera un elevado coste para el Sistema Nacional de Salud (SNS) y puede además incrementar el número de reacciones adversas medicamentosas e interacciones. La prescripción inapropiada de fármacos es un problema frecuente en los mayores, que contribuye al aumento del riesgo de reacciones adversas a medicamentos (RAM). En los últimos años, se han desarrollado varias herramientas para detectar la prescripción potencialmente inadecuada en ancianos. El objetivo de esta revisión consiste en describir dos de estas herramientas: los criterios americanos de BEERS y los criterios europeos STOPP (Screening Tool of Older Person’s Prescriptions)/ START (Screening Tool to Alert doctors to Right i.e. appropriate, indicated Treatment). Los criterios STOPP aportan el valor añadido de detectar no sólo la prescripción inadecuada por determinados fármacos, sino también por falta de prescripción de medicamentos indicados. Los criterios STOPP/START pueden convertirse en una buena herramienta para mejorar la prescripción en los pacientes mayores

Detecció de compostos volàtils, clorofenols, cloroanisoles i 2,4,6-tribromoanisole, relacionats amb el "gust del suro"

D'entre els defectes organolèptics associats al vi, en destaca l'anomenat "gust de suro" habitualment vinculat a la presència de cloroanisoles, els quals són productes de l'activitat microbiana formats a partir dels corresponents clorofenols. La present tesi doctoral recull, en primer lloc, metodologies analítiques adreçades principalment a la determinació dels compostos clorofenòlics (2,4,6-triclorofenol, 2,3,4,6-tetraclorofenol i pentaclorofenol) en el control de qualitat dels taps suro, emprant dissolucions hidroalcohòliques com a medi de maceració o d'extracció i utilitzant les tècniques d'extracció en fase sòlida (SPE) i microextracció en fase sòlida (SPME) acoblades a la cromatografia de gasos (GC).En segon lloc, per tal de dur a terme l'anàlisi de cloroanisoles juntament amb els seus precursors en matrius de suro s'ha avaluat un mètode basat en l'extracció amb dissolvent orgànic, el qual ha estat aplicat per a l'estudi de diferents sistemes d'eliminació d'aquests anàlits en la matriu citada. En darrer lloc, s'han proposat metodologies per l'anàlisi de mostres de vi, en les quals d'una banda s'han determinat els compostos clorofenòlics utilitzant la SPME i de l'altra el 2,4,6-tricloroanisole i el 2,4,6-tribromoanisole mitjançant l'acoblament de la SPE i la injecció de grans volums (LVI) en el sistema cromatogràfic.The organoleptic defect known as cork taint is associated with a musty or mouldy aroma in wine. Chloroanisoles, which are produced through a process of detoxification by fungal methylation of chlorophenolic compounds, are considered to be the main contributory substances. In the present work, analytical methods for the determination of chlorophenols (2,4,6-trichlorophenol, 2,3,4,6-tetrachloropheol and pentachlorophenol) in cork matrices using the solid-phase extraction (SPE) and the solid-phase microextraction (SPME) as preconcentration techniques were evaluated. Therefore, hydroalcoholic solutions have been proposed as extractant solvent in order to test the quality of cork stoppers.Furthermore, a methodology based on extraction with an organic solvent for the simultaneous determination of chloroanisoles and chlorophenols in cork matrices was proposed. This methodology was applied with the aim of checking the efficiency of several washing treatments to remove the target analytes in naturally contaminated cork samples.Finally, different procedures have been developed for the analysis of wine samples. On one hand, chlorophenols were quantified by employing a SPME method. On the other hand, a reliable SPE method coupled to large volume injection was proposed for the determination of both 2,4,6-trichloroanisole and 2,4,6-tribromoanisole

Analysis of microplastics in the environment: Identification and quantification of trace levels of common types of plastic polymers using pyrolysis-GC/MS

This work describes the development of analytical workflows based on pyrolysis coupled with gas chromatography-mass spectrometry (Pyr-GC/MS) for the qualitative and quantitative analysis of 12 of the most common plastic polymers in environmental samples. The most suitable characteristic pyrolyzate compounds and respective indicator ions were selected for each polymer in order to obtain the most appropriate response for analytical purposes. Additionally, commercial pyrolyzates and polymers libraries were used to confirm the identity of the detected microplastics. The method was validated, showing a good linearity for all the plastic polymers (R2 > 0.97) and limits of detection between 0.1 (polyurethane) to 9.1 µg (polyethylene). The developed methodology was successfully applied for the analysis of plastic polymers in environmental microplastic samples collected in three Mediterranean beaches (NE Spain). • Fast and reproducible Pyr-GC/MS method for the analysis of the 12 most common plastic polymers in a single GC/MS run • Straightforward analytical workflows using pyrolyzates and polymers libraries enable a fast identification and quantification of microplastics in environmental sample

Composition of Total and Cell-Proliferating Bacterioplankton Community in Early Summer in the North Sea – Roseobacters Are the Most Active Component

Heterotrophic bacterioplankton communities play an important role in organic matter processing in the oceans worldwide. In order to investigate the significance of distinct phylogenetic bacterial groups it is not only important to assess their quantitative abundance but also their growth dynamics in relation to the entire bacterioplankton. Therefore bacterial abundance, biomass production and the composition of the entire and cell-proliferating bacterioplankton community were assessed in North Sea surface waters between the German Bight and 58°N in early summer by applying catalyzed reporter deposition (CARD-FISH) and bromodeoxyuridine fluorescence in situ hybridization (BrdU-FISH). Bacteroidetes and the Roseobacter group dominated the cell-proliferating fraction with 10–55 and 8–31% of total BrdU-positive cells, respectively. While Bacteroidetes also showed high abundances in the total bacterial fraction, roseobacters constituted only 1–9% of all cells. Despite abundances of up to 55% of total bacterial cells, the SAR11 clade constituted <6% of BrdU-positive cells. Gammaproteobacteria accounted for 2–16% of the total and 2–13% of the cell-proliferating cells. Within the two most active groups, BrdU-positive cells made up 28% of Bacteroidetes as an overall mean and 36% of roseobacters. Estimated mean growth rates of Bacteroidetes and the Roseobacter group were 1.2 and 1.5 day-1, respectively, and much higher than bulk growth rates of the bacterioplankton whereas those of the SAR11 clade and Gammaproteobacteria were 0.04 and 0.21 day-1, respectively, and much lower than bulk growth rates. Only numbers of total and cell-proliferating roseobacters but not those of Bacteroidetes and the other groups were significantly correlated to chlorophyll fluorescence and bacterioplankton biomass production. The Roseobacter group, besides Bacteroidetes, appeared to be a major player in processing phytoplankton derived organic matter despite its low partitioning in the total bacterioplankton community

Impact of fullerenes in the bioaccumulation and biotransformation of venlafaxine, diuron and triclosan in river biofilms

A huge variety of organic microcontaminants are presently detected in freshwater ecosystems, but there is still a lack of knowledge about their interactions, either with living organisms or with other contaminants. Actually, carbon nanomaterials like fullerenes (C60) can act as carriers of organic microcontaminants, but their relevance in processes like bioaccumulation and biotransformation of organic microcontaminants by organisms is unknown. In this study, mesocosm experiments were used to assess the bioaccumulation and biotransformation of three organic microcontaminants (venlafaxine, diuron and triclosan) in river biofilms, and to understand how much the concomitant presence of C60 at environmental relevant concentrations could impact these processes. Results indicated that venlafaxine exhibited the highest bioaccumulation (13% of the initial concentration of venlafaxine in water), while biotransformation was more evident for triclosan (5% of the initial concentration of triclosan in water). Furthermore, biotransformation products such as methyl-triclosan were also present in the biofilm, with levels up to 42% of the concentration of accumulated triclosan. The presence of C60 did not involve relevant changes in the bioaccumulation and biotransformation of microcontaminants in biofilms, which showed similar patterns. Nevertheless, the study shows that a detailed evaluation of the partition of the organic microcontaminants and their transformation products in freshwater systems are important to better understand the impact of the co-existence of others microcontaminants, like carbon nanomaterials, in their possible routes of bioaccumulation and biotransformation. © 2018 Elsevier Inc.This work has been funded by the Spanish Ministry of Economy and Competitiveness (project NANOTRANSFER; ERA SIINN PCIN-2015-182-C02-02 and project PLAS-MED; CTM2017-89701-C3-2-R). Authors also acknowledge the support from the Economy and Knowledge Department of the Catalan Government through Consolidated Research Group (ICRA-ENV 2017 SGR 1124 & 2017 SGR 1404). Lúcia H.M.L.M. Santos acknowledges the Juan de la Cierva Program (FJCI-2014-22377) and Sara Rodríguez-Mozaz acknowledges the Ramon y Cajal Program (RYC-2014-16707). Funding sources This work has been funded by the Spanish Ministry of Economy and Competitiveness (project NANOTRANSFER; ERA SIINN PCIN-2015-182-C02-02 and project PLAS-MED; CTM2017-89701-C3-2-R). Authors also acknowledge the support from the Economy and Knowledge Department of the Catalan Government through Consolidated Research Group (ICRA-ENV 2017 SGR 1124 & 2017 SGR 1404). Lúcia H.M.L.M. Santos acknowledges the Juan de la Cierva program (FJCI-2014-22377) and Sara Rodríguez-Mozaz acknowledges the Ramon y Cajal program (RYC-2014-16707).Peer reviewe

Fate of priority pharmaceuticals and their main metabolites and transformation products in microalgae-based wastewater treatment systems

The present study evaluates the removal capacity of two high rate algae ponds (HRAPs) to eliminate 12 pharmaceuticals (PhACs) and 26 of their corresponding main metabolites and transformation products. The efficiency of these ponds, operating with and without primary treatment, was compared in order to study their capacity under the best performance conditions (highest solar irradiance). Concentrations of all the target compounds were determined in both water and biomass samples. Removal rates ranged from moderate (40–60 %) to high (>60 %) for most of them, with the exception of the psychiatric drugs carbamazepine, the β-blocking agent metoprolol and its metabolite, metoprolol acid. O-desmethylvenlafaxine, despite its very low biodegradability in conventional wastewater treatment plants, was removed to certain extent (13–39 %). Biomass concentrations suggested that bioadsorption/bioaccumulation to microalgae biomass was decisive regarding the elimination of non-biodegradable compounds such as venlafaxine and its main metabolites. HRAP treatment with and without primary treatment did not yield significant differences in terms of PhACs removal efficiency. The implementation of HRAPs as secondary treatment is a feasible alternative to CAS in terms of overall wastewater treatment, including organic micropollutants, with generally higher removal performances and implying a green, low-cost and more sustainable technology.This research was funded by the Spanish Ministry of Economy and Competitiveness (FOTOBIOGAS Project CTQ2014-57293-C3-3-R) and the European Union’s Horizon 2020 research and innovation program under the Marie Skłodowska-Curie grant agreement No 676070 (SuPER-W). This communication reflects only the author’s view and the Research Executive Agency of the EU is not responsible for any use that may be made of the information it contains. M.J. García-Galán and L.H.M.L.M. Santos acknowledges their Juan de la Cierva research grants (FJCI-2014-22767 and IJCI-2017-34601, and IJCI-2017-32747, respectively), and M. Garfí and S. Rodríguez-Mozaz thanks the Ramon y Cajal program (RYC-2016-20059 and RYC-2014-16707, respectively), all from the Spanish Ministry of Economy and Competitiveness

Comparació dels resultats obtinguts en la incorporació de l'ACME, en dues assignatures de química de primer curs de dos estudis: Química i Ciències Ambientals, a la Universitat de Girona

En aquest treball es volen avaluar els resultats obtinguts en la implantació de l’avaluació continuada i particularment de l’eina informàtica ACME (Avaluació Continuada i Millora de l’Ensenyament) en dues assignatures de química de primer curs corresponents als estudis de Química i Ciències Ambientals de la UdG. A nivell d’impacte en les qualificacions obtingudes pels estudiants, s’observa un augment de la nota final entre 0,6 i 1 punt respecte a la qualificació obtinguda en l’examen final, per les dues assignatures. L’ACME permet treballar algunes competències, principalment la capacitat de resolució de problemes, competència que apareix en el disseny de les dues assignatures de Química. També permet desenvolupar altres competències com ara la capacitat de planificació i organització. Addicionalment, l’ACME és un bon sistema per l’autoavaluació del propi aprenentatge, que en definitiva és el que es persegueix amb el sistema d’avaluació continuad

Fate of priority pharmaceuticals and their main metabolites and transformation products in microalgae-based wastewater treatment systems

The present study evaluates the removal capacity of two high rate algae ponds (HRAPs) to eliminate 12 pharmaceuticals (PhACs) and 26 of their corresponding main metabolites and transformation products. The efficiency of these ponds, operating with and without primary treatment, was compared in order to study their capacity under the best performance conditions (highest solar irradiance). Concentrations of all the target compounds were determined in both water and biomass samples. Removal rates ranged from moderate (40–60 %) to high (>60 %) for most of them, with the exception of the psychiatric drugs carbamazepine, the ß-blocking agent metoprolol and its metabolite, metoprolol acid. O-desmethylvenlafaxine, despite its very low biodegradability in conventional wastewater treatment plants, was removed to certain extent (13–39 %). Biomass concentrations suggested that bioadsorption/bioaccumulation to microalgae biomass was decisive regarding the elimination of non-biodegradable compounds such as venlafaxine and its main metabolites. HRAP treatment with and without primary treatment did not yield significant differences in terms of PhACs removal efficiency. The implementation of HRAPs as secondary treatment is a feasible alternative to CAS in terms of overall wastewater treatment, including organic micropollutants, with generally higher removal performances and implying a green, low-cost and more sustainable technologyPeer Reviewe