The role of the pharmacist in humanitarian aid in Bosnia-Herzegovina: the experience of Pharmaciens Sans Frontières

BACKGROUND: Founded in 1985, Pharmaciens Sans Frontières (PSF) is a nongovemmental organization of pharmacists involved in humanitarian aid. PSF relied on approximately 100 expatriates in 1998, which included 50 pharmacists distributed throughout 24 missions (i.e., 14 emergency, 7 development, 3 assessment). It is necessary to add 200-250 local staff to this group. OBJECTIVE: To describe PSF's mission in Bosnia-Herzegovina from 1992 to 1999 and to define the pharmacist's impact in the supply of medicines and the development of pharmaceutical care and services. RESULTS: In April 1992, at the beginning of Sarajevo's siege, PSF sent a small team of three volunteer pharmacists to Bosnia-Herzegovina. The objective of the emergency phase (1992-1995) was to set up a massive supply program of essential medicines and medical and biologic materials and to implement a distribution system based on existing health centers. The signing of the Dayton peace agreement and a progressive return to peace and stability marked the beginning of the postemergency phase (1995-1997). This phase pursued previous objectives of establishing a distribution network and added the implementation of logistic centers. PSF widened its involvement to medical laboratory analysis, production of medicines, disposal of expired medications sent during the conflict, and the implementation of a national center for quality control. Currently, the development phase's (1998-1999) objective is to provide adequate support for the reorganization of pharmaceutical care and services by establishing pharmacy work groups and developing and maintaining good relationships with the international community and Bosnia-Herzegovina pharmacists. CONCLUSIONS: Humanitarian aid is essential in major conflicts, as seen in the case of Bosnia-Herzegovina. Although it is difficult to evaluate the impact of the distribution network implemented by PSF, it allowed for a better provisioning of medications to the general population. PSF played an important role in such cases. In fact, PSF provides its pharmaceutical expertise to these embattled areas not only by offering financial support to the logistics or supplying of medications, but by offering professional support to the organization/reorganization of the pharmaceutical practice.     

Variations in the human soluble epoxide hydrolase gene and recurrence of atrial fibrillation after catheter ablation

Background

Single nucleotide polymorphisms (SNPs) of EPHX2 alter sEH activity and are associated with increased [rs41507953 (K55R)] or reduced [rs751141 (R287Q)] cardiovascular risk via modulation of fibrosis, inflammation or cardiac ion channels. This indicates an effect on development and therapy response of AF. This study tested the hypothesis that variations in the EPHX2 gene encoding human soluble epoxide hydrolase (sEH) are associated with atrial fibrillation (AF) and recurrence of atrial fibrillation after catheter ablation.

Methods and results

A total of 218 consecutive patients who underwent catheter ablation for drug refractory AF and 268 controls were included. Two SNPs, rs41507953 and rs751141, were genotyped by direct sequencing. In the ablation group, holter recordings 3, 12 and 24 months after ablation were used to detect AF recurrence. No significant association of the SNPs and AF at baseline was detected. In the ablation group, recurrence of AF occurred in 20% of the patients 12 months after ablation and in 35% 24 months after ablation. The presence of the rs751141 polymorphism significantly increased the risk of AF recurrence 12 months (odds ratio [OR]: 3.2, 95% confidence interval [CI]: 1.237 to 8.276, p = 0.016) and 24 months (OR: 6.076, 95% CI: 2.244 to 16.451, p < 0.0001) after catheter ablation.

Conclusions

The presence of rs751141 polymorphism is associated with a significantly increased risk of AF recurrence after catheter ablation. These results point to stratification of catheter ablation by genotype and differential use of sEH-inhibitory drugs in the future.     

Endoskopische Resektion der Bursa trochanterica

In surgical treatment of chronic trochanteric bursitis many open approaches are described for resection the bursa. After the good experience in endoscopic shoulder surgery with the treatment of bursitis subacromialis, a minimal invasive endoscopic procedure may be an alternative. Purpose of the study is to develop a standard procedure and to present the first experiences with this new method. In our series 19 cases with refractory chronic bursitis were treated exclusively endoscopically. The mean postoperative follow-up was 10 months. In the clinical scores excellent and good clinical results were achieved in 16 cases after endoscopic excision of the bursa trochanterica. In 8 cases with calcification of the bursa a permanent remission of the calcific deposits was observed. In 3 cases a poor result was seen, due to a secondary After a short learning curve, endoscopic bursectomy can be regarded as an effective and comfortable method for treatment of chronic trochanteric bursitis in comparison to the open procedure including all the general advantages of a minimal invasive surgical procedure.     

No causal effect of unemployment on smoking? A German panel study

Objectives

This study analyses the effects of different unemployment durations on smoking behaviour in Germany by investigating smoking take-up, relapse, quitting and smoking intensity.

Methods

Longitudinal data from the German Socio-Economic Panel from the years 1998, 2001, 2002, 2004, 2006, and 2008 were used to examine the effect of unemployment (52,940 observations from 17,028 respondents, aged 17–65?years). Unemployment duration was measured at 1–6, 7–12, 13–24, and 24+ months. Effects were estimated using zero-inflated negative binomial regressions and fixed effects logistic panel regressions.

Results

The zero-inflated negative binomial regression models suggest that the likelihood of smoking increases with unemployment, while smoking intensity is not affected. However, fixed effects logistic regression models demonstrate that unemployment is neither a significant predictor for taking up smoking, relapsing, nor quitting.

Conclusions

The results indicate that in Germany, there is no direct causal effect of unemployment on smoking behaviour. The observed relationship between smoking and unemployment appears to be driven by stable, unobserved differences between employed and unemployed respondents.     

Levobunolol and metipranolol: comparative ocular hypotensive efficacy, safety, and comfort.

Topical levobunolol 0.5% was compared with topical metipranolol 0.6% for efficacy, safety, and comfort in 46 patients with open angle glaucoma or ocular hypertension. The study was of parallel design, randomised, double-masked, and of three months' duration. After a washout interval the study medications were instilled twice daily in both eyes. The overall mean decrease in intraocular pressure (IOP) was approximately 7 mmHg in both groups. More than 90% of patients in both groups successfully completed the study. Both agents caused slight decreases in heart rate and blood pressure. More complaints of burning and stinging were reported in the metipranolol group than in the levobunolol group. This three-month, 46-patient study showed levobunolol 0.5% and metipranolol 0.6% to be similarly effective ocular hypotensive agents.     

Diagnosis of prospective malignancy in koilocytic dysplasias of the cervix with DNA cytometry

DNA cytometric measurements were performed with a TV image analysis system on 90 routine cytologic cervical smears from 18 women after automatic restaining of the smears with the Feulgen method. In the cytologic follow-up all the patients revealed borderline lesions (mild to moderate dysplasia) of the epithelium with koilocytosis. Since DNA aneuploidy is widely accepted as a marker for malignancy, an attempt was made to obtain a DNA diagnosis of prospective malignancy in these cases on the basis of the detection of single aneuploid cells. Because koilocytosis strongly suggests human papillomavirus infection, euploid polyploidy might result in up to 8c (c = haploid amount of DNA). Therefore, the aneuploidy detection threshold was set to 9c, excluding values around 16c and 32c (+/- 12.5%) to avoid false-positive diagnoses in cases of higher polyploidy values. The DNA diagnosis of malignancy was made in 13 patients. In 12 of them, carcinoma in situ was diagnosed in the histologic follow-up, resulting in 100% sensitivity of the DNA diagnosis. In five patients no cells greater than 9c were measured, leading to a benign DNA diagnosis. In the histologic follow-up, six patients revealed normal epithelium or moderate dysplasia. Thus, the specificity of the DNA diagnosis was 83.3%.     

The induction of cytochrome P-450 in Lodderomyces elongisporus

In the alkane-utilizing yeast strain Lodderomyces elongisporus cytochrome P-450 is induced by aliphatic hydrocarbons and to a lesser degree also by some of their derivatives. Cycloheximide and glucose inhibit the induction process, the former by inhibition of cytoplasmic translation, the latter presumably by catabolite repression. Among the nearly 40 checked compounds tetradecane and 1-tetradecene are the most effective inducers. The branching of the alkyl chain as well as the terminal introduction of electrophilic atoms decrease the induction effect.