Pharmacy in transition: A work sampling study of community pharmacists using smartphone technology

Introduction

The nature of community pharmacy is changing, shifting from the preparation and distribution of medicines to the provision of cognitive pharmaceutical services (CPS); however, often the provision of traditional services leaves little time for innovative services. This study investigated the time community pharmacists spend on the tasks and activities of daily practice and to what extent they are able to implement CPS-related services in daily practice.

Protective effect of interferon-α on the DNA- and RNA-degrading pathway in anti-Fas-antibody induced apoptosis

Aim: Fas membrane-associated polypeptide antigen is a receptor molecule responsible for apoptosis-mediated signals. In animal models of acute viral hepatitis, apoptosis of hepatocytes is mediated by Fas-death receptors; therefore, the aim of this study was to evaluate the effect of interferon (IFN)-alpha on apoptotic markers and nuclease activity against different coding and non-coding single and double stranded RNAs during Fas-induced liver apoptosis. Methods: An in vivo experiment was performed with simultaneous administration of anti-Fas (CD95) antibodies and IFN-alpha, and an in vitro experiment was performed in hepatocyte cultures treated with anti-Fas antibodies and IFN-alpha. Results: Detection of apoptosis using Annexin V-FITC/propidium iodide, Bcl-2 and Bax expression in hepatocyte cultures confirmed the appearance of early apoptotic events and progression toward late apoptosis after anti-Fas antibody treatment. IFN-alpha had a tendency to retard the apoptosis process in Fas-induced apoptosis by increasing the number of viable cells and decreasing the number of cells in late apoptosis, by increasing the percentage of Bcl-2 positive cells, by decreasing the percentage of Bax positive cells, and by decreasing the nuclease activity compared to the anti-Fas antibody treated group. Total DNA and RNA concentration was much reduced in the Fas group and DNA fragmentation assay provided evidence for increased DNA degradation. Enhanced nuclease activity against DNA, rRNA, poly(A), poly(C), poly(U), poly(I:C), and poly(A:U) was manifested in the anti-Fas antibody treated group, except for the inhibitory-bound alkaline RNase. Conclusions: The results demonstrate that the RNA-degrading pathway in Fas-induced apoptosis can accelerate the liberation of the latent enzyme from the inhibitor complex. IFN-alpha prevented enormous, Fas-ligand induced degradation of all the substrates used in this experimental study, most probably due to similarities in the signal transduction pathways. Investigations of death receptor-induced apoptosis may lead to novel treatment combinations for patients with acute or chronic liver diseases.     

An Inbred Epilepsy-Prone Substrain of BALB/c Mice Shows Absence of the Corpus Callosum, an Abnormal Projection to the Basal Forebrain, and Bilateral Projections to the Thalamus

BALB/c mice lack a corpus callosum in about 11% of the population.Two inbred substrains of BALB/c mice, epilepsy-prone (EP) andepilepsy-resistant (ER), have been examined to determine whetherthese substrains differ in regard to corpus callosum morphology.Further, this study addressed the issue of whether misroutedcortical axons form an aberrant pathway instead of the corpuscallosum. Initial studies that examined fresh brain tissue ofadult animals revealed normal corpora callosa in all ER micebut deficient or absent corpora callosa in all EP mice. Subsequently,Dil crystals were placed in the motor cortices of aldehyde-fixedbrains of 2-week-old animals to investigate cortical projectionsin both inbred substrains of mice. Fluorescent microscopy revealedthat all of the ER animals had normal corpora callosa, whereasall EP animals exhibited either reduced corpora callosa (partiallycallosal) or an absence (acallosal) of this structure. Bothacallosal and partially callosal EP mice displayed an extensive,aberrant projection to the basal forebrain as well as bilateralprojections to midline and intralaminar thalamic nuclei. Thefibers projecting to the basal forebrain arose from the cortex,coursed toward the midline before turning ventrally along themidline, and appeared to terminate in the medial septal nucleusand the nucleus of the diagonal band. ER animals lacked thisaberrant cortical projection to the basal forebrain. Electronmicroscopic results obtained from EP mice indicated that labeledaxons in this aberrant pathway formed axosomatic, axodendritic,and axospinous synapses with the neurons in the medial septal/diagonalband complex. The function of the aberrant projection to thebasal forebrain remains unknown but it may provide an abnormalexcitatory input to a region that provides cholinergic and GABAergicinput to the cerebral cortex and hippocampus. The additionalprojections to midline and contralateral intralaminar thalamicnuclei in EP mice may function to intensify the synchronizationof bilateral discharges.     

Strecker stent in stenotic hemodialysis Brescia-Cimino arteriovenous fistulas

Flexible tantalum stents (Strecker) were used as an adjunct to percutaneous transluminal angioplasty (PTA) in the treatment of stenotic arterial or venous limbs of Brescia-Cimino hemodialysis fistulas. The diagnostic procedure was performed using retrograde fistulography. After PTA with unsatisfactory results, stents were placed in 5 patients with significant residual stenoses and poor fistula function. Within the mean follow-up period of 6.4 months (range 3–10 months) all fistulas were functioning. We conclude that Strecker stent is useful in the treatment of stenotic hemodialysis arteriovenous fistulas as an adjunct to PTA.     

Deficiency of P-selectin in a patient with grey platelet syndrome

Abstract: Patient B.G. is a 29-yr-old female with a lifelong bleeding disorder characterized clinically by a highly increased bleeding time, menorrhagias, long-lasting bleeding after cuts and tooth extractions and large post-traumatic haematomas. Her coagulation tests were within normal range, platelet count was 140,000–160,000 per μl, but platelet function was impaired as demonstrated by the absence of collagen-induced aggregation, although no abnormalities were detected in aggregation response to ADP and ristocetin. Morphologically her platelets were characterized by gigantic size – average profile area was about 2.5 times higher than that of control donors, and severe deficiency of α-granules – only 16% of their number in control donors. These features taken together indicated the diagnosis of grey platelet syndrome. As has been shown by quantitative immunoblotting, patient's platelets contained small amounts of α-granule membrane protein P-selectin – about 15% of that in control donors. The content of plasma membrane glycoproteins IIb–IIIa and Ib was not reduced, suggesting the specific deficiency of α-granule membrane protein. Thus, B.G. is the second patient described in the literature (see also Lages et al, J Clin Invest 1991: 87: 919–929) with combined deficiency of α-granules and P-selectin.     

Proven and nonproven facts in knee arthroplasty

Summary The great number of knee-replacement systems makes a comparative study difficult. Even more confusing are the different criteria used for the evaluation of the results. After a critical review of what can be taken as proven facts, our own experience with the semiconstrained GSB-III knee prosthesis is critically analyzed. The survivorship method is used, presenting the cumulative success rate and analyzing the reasons for the failure rates. We feel that all authors presenting results of knee arthroplasty should adopt this method, using the same or at least comparable evaluation sheets (for instance, that of ERASS). Moreover, more attention should be given to bone dynamics in a prospective study using modern technology (CT densitometry). This will help to detect possible factors responsible for the failure of knee arthroplasty and possibly to prevent failure with medication.

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Zusammenfassung Die große Zahl verschiedener Kniegelenks-Systeme im prothetischen Ersatz erschwert vergleichendes Studium. Zusätzliche Schwierigkeiten erwachsen aus der Verwendung verschiedener Kriterien bei der Auswertung der Ergebnisse. Wir selbst haben zur Erfahrung mit der GSB-III Knie-Endoprothese kritisch analysiert, nachdem wir versucht haben nur eindeutige Fakten miteinzubeziehen. Wir verwendeten die sogenannte survivorship Methode (Überlebenskurven) und untersuchten die cumulative Erfolgsrate und die Gründe für die Fehlschläge. Wir vertreten die Auffassung, daß alle Autoren, die Ergebnisse über Knie-Arthroplastiken vorstellen, diese Methode verwenden sollten, wenn immer möglich unter Gebrauch desselben oder mindestens vergleichbarer Erhebungsbogen (z. B.

     

Management of patients supported on the Hemopump cardiac assist system

The Hemopump Cardiac Assist System is a relatively new intraarterial, axial-flow circulatory assist device that offers temporary left ventricular support to patients in refractory cardiogenic shock, without requiring major surgery for insertion. Use of the Hemopump is associated with a low complication rate. Device-related morbidity is extremely rare. Because the Hemopump is safe for use in community hospitals, the number of patients supported by this device is expected to increase. In this report, we present general guidelines for the care of patients supported by the Hemopump. We describe techniques for the management of afterload reduction, supravalvular dislodgement, device malfunction, ventricular ectopy, intracardiac shunting, and inflow cannula obstruction.     

Soman intoxication-induced changes in serum acute phase protein levels,corticosterone concentration and immunosuppressive potency of the serum

We have studied the effect of soman intoxication on serum acute phase reactants (APR) levels, and the relationship of the APR and corticosterone concentrations and the immunosuppressive activity of the serum. One day after the injection of 1.8 LD₅₀ soman the concentrations of ₂-macroglobulin (₂-MG) and ₁-acid glycoprotein (AGP) in the serum of antidote protected rats increased 4- and 7-fold, respectively, whereas those of hemopexin (Hx), haptoglobin (Hp) and cysteine protease inhibitor (CPI) were two to three times higher than in the controls. A similar magnitude of increase of serum acute phase reactants levels was observed when 0.3 LD₅₀ soman was administered at 24-h intervals over the 5-day period. The relationship of changes in the APR concentration, corticosterone level and immunosuppressive activity of the serum was also comparable to that observed in the acute phase response to tissue injury.