Prevalence of Dermatomycosis in a Brazilian Tertiary Care Hospital

A total of 233 specimens obtained from suspected cases of dermatomycosis from 189 patients were examined for causative fungi from December 2009 to May 2010 in a tertiary care hospital in the city of Belo Horizonte, state of Minas Gerais, southeastern Brazil. Yeast and fungal isolates obtained from specimens were regarded as conclusive diagnosis of mycoses in 82 cases (35.19?%), with the exception of two patients with pityriasis versicolor (2.4?%), in which the diagnosis was made only by direct examination plus clinical diagnostics of individuals. Forty-four subjects (23.28?%) were infected in more than one anatomical site. There was a higher occurrence on female patients (146, 77.2?%) than male (43, 22.8?%). Most of the infected patients were aged between 41 and 70?years (68.29?%). There were no statistically significant differences between occurrence of fungal infection and gender, presence of secondary disease and contact with animals. The largest number of examined material occurred in samples from toenails, which resulted in 50?% of positive cultures. Candida species were the most frequent group causing dermatomycosis in many anatomical sites, mainly in toenails and fingernails. Candida parapsilosis was the most representative (40.24?%) among all agents causing dermatomycosis of toenails and fingernails, followed by Candida tropicalis (20.73?%) and Trichophyton rubrum (10.98?%). Among the dermatophytes, Trichophyton genus represented over 80?% of the isolates, with T. rubrum representing 64.29?%, T. interdigitale (T. mentagrophytes) (21.43?%) and Microsporum gypseum (14.29?%).     

基于失效模式与效应分析法的临床药学服务风险研究

目的 探讨临床药学服务过程中的风险及引起风险的主要原因,通过一定的方式规避风险。方法 应用失效模式与效应分析法对临床药学服务模式进行风险识别管理和研究。结果 分析得出临床药学服务模式共计15项流程,21项失效环节,对其中排名靠前的高危风险提出了相应的干预措施。结论 失效模式与效应分析法可以前瞻地有效地识别高危风险,并结合风险产生的原因,针对性地采取干预措施,从而最大程度地规避风险的发生。     

The Effect of a Bidirectional Exchange on Faculty and Institutional Development in a Global Health Collaboration

Purpose

The MUYU Collaboration is a partnership between Mulago Hospital-Makerere University College of Health Sciences (M-MakCHS), in Kampala, Uganda, and the Yale University School of Medicine. The program allows Ugandan junior faculty to receive up to 1 year of subspecialty training within the Yale hospital system. The authors performed a qualitative study to assess the effects of this program on participants, as well as on M-MakCHS as an institution.

Methods

Data was collected via semi-structured interviews with exchange participants. Eight participants (67% of those eligible as of 4/2012) completed interviews. Study authors performed data analysis using standard qualitative data analysis techniques.

Results

Analysis revealed themes addressing the benefits, difficulties, and opportunities for improvement of the program. Interviewees described the main benefit of the program as its effect on their fund of knowledge. Participants also described positive effects on their clinical practice and on medical education at M-MakCHS. Most respondents cited financial issues as the primary difficulty of participation. Post-participation difficulties included resource limitations and confronting longstanding institutional and cultural habits. Suggestions for programmatic improvement included expansion of the program, ensuring appropriate management of pre-departure expectations, and refinement of program mentoring structures. Participants also voiced interest in expanding post-exchange programming to ensure both the use of and the maintenance of new capacity.

Conclusions

The MUYU Collaboration has benefitted both program participants and M-MakCHS, though these benefits remain difficult to quantify. This study supports the assertion that resource-poor to resource-rich exchanges have the potential to provide significant benefits to the resource-poor partner.     

Quality of Pharmaceutical Care in Surgical Patients

Background

Surgical patients are at risk for preventable adverse drug events (ADEs) during hospitalization. Usually, preventable ADEs are measured as an outcome parameter of quality of pharmaceutical care. However, process measures such as QIs are more efficient to assess the quality of care and provide more information about potential quality improvements.

Objective

To assess the quality of pharmaceutical care of medication-related processes in surgical wards with quality indicators, in order to detect targets for quality improvements.

Methods

For this observational cohort study, quality indicators were composed, validated, tested, and applied on a surgical cohort. Three surgical wards of an academic hospital in the Netherlands (Academic Medical Centre, Amsterdam) participated. Consecutive elective surgical patients with a hospital stay longer than 48 hours were included from April until June 2009. To assess the quality of pharmaceutical care, the set of quality indicators was applied to 252 medical records of surgical patients.

Results

Thirty-four quality indicators were composed and tested on acceptability and content- and face-validity. The selected 28 candidate quality indicators were tested for feasibility and ‘sensitivity to change’. This resulted in a final set of 27 quality indicators, of which inter-rater agreements were calculated (kappa 0.92 for eligibility, 0.74 for pass-rate). The quality of pharmaceutical care was assessed in 252 surgical patients. Nearly half of the surgical patients passed the quality indicators for pharmaceutical care (overall pass rate 49.8%). Improvements should be predominantly targeted to medication care related processes in surgical patients with gastro-intestinal problems (domain pass rate 29.4%).

Conclusions

This quality indicator set can be used to measure quality of pharmaceutical care and detect targets for quality improvements. With these results medication safety in surgical patients can be enhanced.     

The Effect of Moisture on the Flowability of Pharmaceutical Excipients

The effect of moisture content on flowability of six pharmaceutical powders (microcrystalline cellulose (MCC), hydroxypropyl methylcellulose (HPMC), carboxymethyl cellulose (CMC), polyvinylpyrrolidone (PVP), corn starch, and potato starch) was investigated. Powder flowability was measured using established static techniques and emerging dynamic avalanche behavior measurements. Static techniques did not provide enough resolution to clearly identify changes in flowability due to increasing powder moisture content. Avalanche time and its standard deviation showed that flowability of MCC, CMC, PVP, and potato starch decreased after a critical moisture content, flowability of corn starch increased and flowability did not significantly change for HPMC. The moisture decreased flowability by forming stronger interparticle liquid bridges and increased flowability by acting as a lubricant. The dynamic density of the celluloses and PVP decreased linearly with increasing moisture content as the particles swelled with water. The starches also swelled and decreased in dynamic density, but only after a moisture content corresponding to monolayer coverage of water around the particles was reached. As flowability and dynamic density change with moisture content, to ensure consistent production of high-quality tablets, the moisture content of the powders must be measured and controlled.     

The Effect of Microcrystalline Cellulose Crystallinity on the Hydrophilic Property of Tablets and the Hydrolysis of Acetylsalicylic Acid as Active Pharmaceutical Ingredient Inside Tablets

The crystal structures of active pharmaceutical ingredients and excipients should be strictly controlled because they influence pharmaceutical properties of products which cause the change in the quality or the bioavailability of the products. In this study, we investigated the effects of microcrystalline cellulose (MCC) crystallinity on the hydrophilic properties of tablets and the hydrolysis of active pharmaceutical ingredient, acetylsalicylic acid (ASA), inside tablets by using tablets containing 20% MCC as an excipient. Different levels of grinding were applied to MCC prior to tablet formulation, to intentionally cause structural variation in the MCC. The water penetration and moisture absorbability of the tablets increased with decreasing the crystallinity of MCC through higher level of grinding. More importantly, the hydrolysis of ASA inside tablets was also accelerated. These results indicate that the crystallinity of MCC has crucial effects on the pharmaceutical properties of tablets even when the tablets contain a relatively small amount of MCC. Therefore, controlling the crystal structure of excipients is important for controlling product qualities.     

药学监护对肝肾移植术后他克莫司浓度的个体内变异性影响研究

目的:评估药学监护(PhC)对剂量校正全血他克莫司(TAC)谷浓度,免疫抑制治疗依从性及临床预后的影响。方法:纳入238例肝肾移植接受者,将患者随机分为PhC(n=119)组与对照组(n=119),从肝肾移植术后3天到90天,PhC组接受由药剂师提供的PhC治疗,对照组由医护人员进行标准治疗,在移植后第1、3、5、和7天检测并比较患者校正全血TAC低谷浓度,并计算个体内变异性变异系数(CV)。比较两组患者巴塞尔坚持免疫抑制药物治疗量表(BAASIS)评分与临床预后。结果:PhC和对照组CV比较差异无统计学意义(31.5±12.4%vs 32.6±16.2%,P=0.674);预定义TAC目标浓度范围内患者比例无显著差异(均P0.05);第28天(16.7%vs.25.8%,P=0.135)与第90天(27.1%vs.24.6%,P=0.457)时,PhC与对照组的依从性差患者所占的百分率比较,差异无统计学意义。两组患者临床预后比较,差异无统计学意义(均P0.05)。结论:肝肾脏移植后3个月内,应用药学监护治疗与剂量校正全血TAC谷浓度的个体内变异性降低、依从性或早期移植患者预后无关。     

Effect of the Brazilian Conditional Cash Transfer and Primary Health Care Programs on the New Case Detection Rate of Leprosy

Background

Social determinants can affect the transmission of leprosy and its progression to disease. Not much is known about the effectiveness of welfare and primary health care policies on the reduction of leprosy occurrence. The aim of this study is to evaluate the impact of the Brazilian cash transfer (Bolsa Família Program-BFP) and primary health care (Family Health Program-FHP) programs on new case detection rate of leprosy.

Methodology/Principal Findings

We conducted the study with a mixed ecological design, a combination of an ecological multiple-group and time-trend design in the period 2004–2011 with the Brazilian municipalities as unit of analysis. The main independent variables were the BFP and FHP coverage at the municipal level and the outcome was new case detection rate of leprosy. Leprosy new cases, BFP and FHP coverage, population and other relevant socio-demographic covariates were obtained from national databases. We used fixed-effects negative binomial models for panel data adjusted for relevant socio-demographic covariates. A total of 1,358 municipalities were included in the analysis. In the studied period, while the municipal coverage of BFP and FHP increased, the new case detection rate of leprosy decreased. Leprosy new case detection rate was significantly reduced in municipalities with consolidated BFP coverage (Risk Ratio 0.79; 95% CI  = 0.74–0.83) and significantly increased in municipalities with FHP coverage in the medium (72–95%) (Risk Ratio 1.05; 95% CI  = 1.02–1.09) and higher coverage tertiles (>95%) (Risk Ratio 1.12; 95% CI  = 1.08–1.17).

Conclusions

At the same time the Family Health Program had been effective in increasing the new case detection rate of leprosy in Brazil, the Bolsa Família Program was associated with a reduction of the new case detection rate of leprosy that we propose reflects a reduction in leprosy incidence.     

金银花活性成分、药理作用及其应用

本文综述了中药金银花的活性成分、药理作用的研究进展及开发利用概况.说明金银花在医药、食品、轻化产品等方面具有广泛的用途.     

The Effect of Lubricants on Powder Flowability for Pharmaceutical Application

Pharmaceutical tablets are manufactured through a series of batch steps finishing with compression into a form using a tablet press. Lubricants are added to the powder mixture prior to the tabletting step to ensure that the tablet is ejected properly from the press. The addition of lubricants also affects tablet properties and can affect the behavior of the powder mixture. The objective of this research was to investigate the effect of lubricants on powder flowability as flowability into the tablet press is critical. Four lubricants (magnesium stearate, magnesium silicate, stearic acid, and calcium stearate) were mixed, in varying amounts, with spray-dried lactose. In addition, magnesium stearate was also mixed with placebo granules from a high-shear granulator. Measurements based on avalanche behavior indicated flowability potential and dynamic density and were more sensitive to changes in the mixture and provided a more accurate and reproducible indication of flowability than traditional static measurements. Of the tested lubricants, magnesium stearate provided the best increase in flowability even in the low amounts commonly added in formulations.     

The Use of Machine Learning Methodologies to Analyse Antibiotic and Biocide Susceptibility in Staphylococcus aureus

Background

The rise of antibiotic resistance in pathogenic bacteria is a significant problem for the treatment of infectious diseases. Resistance is usually selected by the antibiotic itself; however, biocides might also co-select for resistance to antibiotics. Although resistance to biocides is poorly defined, different in vitro studies have shown that mutants presenting low susceptibility to biocides also have reduced susceptibility to antibiotics. However, studies with natural bacterial isolates are more limited and there are no clear conclusions as to whether the use of biocides results in the development of multidrug resistant bacteria.

Methods

The main goal is to perform an unbiased blind-based evaluation of the relationship between antibiotic and biocide reduced susceptibility in natural isolates of Staphylococcus aureus. One of the largest data sets ever studied comprising 1632 human clinical isolates of S. aureus originated worldwide was analysed. The phenotypic characterization of 13 antibiotics and 4 biocides was performed for all the strains. Complex links between reduced susceptibility to biocides and antibiotics are difficult to elucidate using the standard statistical approaches in phenotypic data. Therefore, machine learning techniques were applied to explore the data.

Results

In this pioneer study, we demonstrated that reduced susceptibility to two common biocides, chlorhexidine and benzalkonium chloride, which belong to different structural families, is associated to multidrug resistance. We have consistently found that a minimum inhibitory concentration greater than 2 mg/L for both biocides is related to antibiotic non-susceptibility in S. aureus.

Conclusions

Two important results emerged from our work, one methodological and one other with relevance in the field of antibiotic resistance. We could not conclude on whether the use of antibiotics selects for biocide resistance or vice versa. However, the observation of association between multiple resistance and two biocides commonly used may be of concern for the treatment of infectious diseases in the future.     

The Effect of Female Condition on Maternal Care in the European Earwig

Parental care typically enhances offspring fitness at costs for tending parents. Asymmetries in genetic relatedness entail potential conflicts between parents and offspring over the duration and the amount of care. To understand how these conflicts are resolved evolutionarily, it is important to understand how individual condition affects offspring and parental behaviour and whether parents or offspring make active choices in their interactions. Condition effects on offspring have been broadly studied, but the effect of parental condition on parent–offspring interactions is less well understood, in particular in species where care is facultative and offspring have the option to beg for food from the parents or to self‐forage. In this study, we carried out two experiments in the European earwig Forficula auricularia, a system where females provide facultative care, in which we manipulated female condition (through a high‐food and low‐food treatment) and the degree by which mothers and offspring could make active choices. In a first experiment, where female mobility was limited, female condition had no significant effect on the rate of offspring self‐foraging, which increased with nymph age. In a second experiment, nymph access to food was limited and females in poor nutritional condition provided food to significantly fewer nymphs than high condition females. In both experiments, offspring attendance remained at a constantly high level and was independent of female condition even after experimental separation of females and offspring. Our results show that earwig nymphs do not use cues of female condition to adjust rates of self‐foraging, that females control food provisioning depending on their own condition, and that females and nymphs share control over offspring attendance, a form of care not influenced by female condition.     

The Effect of Shortening on the Time-Course of Active State Decay

The active state describes the force developed in a muscle when the contractile elements are neither lengthening nor shortening. Recently it was suggested that perturbations used to measure the active state also alter the time-course of the active state. The present research was undertaken to assess quantitatively the effect of two such perturbations, isotonic shortening and quick release, on the active state in frog sartorius muscle. Methods were developed which allowed the determination of active state points following periods of controlled isotonic shortening or quick release early in the contraction cycle. All experiments were carried out within the plateau region of the length-tension curve. Both isotonic shortening and quick release altered the active state decay. The active state force decreased as the extent of shortening or release was increased. For each 0.1 mm of isotonic shortening there was a 2% decrease in active state force. Quick release produced a larger decrement. From this data we conclude that the time-course of active state can be measured only in relative terms because it is altered by the motion which takes place in the contractile machine while the active state is being measured. This finding helps to resolve paradoxes in the literature relating to the time-course of the active state, calculated and experimentally determined isometric tetanic myograms, and the heat of shortening.     

红三叶草活性成分及其在保健食品和医药中的应用

微量元素硒(Se)和异黄酮类化合物具有重要的生物学功能和药理作用,是目前食品保健、生物医学等领域的研究热点。红三叶草因富合异黄酮,同时具有较高富硒能力,是天然的植物有机硒资源,被认为是目前最有开发前途的保健食品和医药新资源之一,对其活性物质的研究也是相关领域最为炽热的研究热点。本文主要介绍了目前国内外对红三叶草主要活性成分、药理作用及其在保健食品和医药方面应用的研究进展,并对其进一步的应用进行了展望。     

Effect of biomass on assemblages of large mammals in a seasonally dry forest in the Brazilian Amazonia

Aiming to understand the relationship between body mass and abundance, a community of middle-sized and larger mammals was studied in a seasonally dry forest in the far north of the Brazilian Amazonia. Diurnal and nocturnal surveys were carried out by the line-transect method along a 10-km transect. Data were collected on density, biomass, use of forest types, forest strata, diet and feeding strategies by the mammals. Biomass explained animal abundance better than did body mass across the two forest types: Terra Firme forest and mixed forest. There was a statistically significant positive relationship between the biomass of all the 33 mammals studied and group density, as well as between biomass and group size, in both forests. When terrestrial and arboreal mammals, and also different feeding guilds were considered separately, they exhibited very similar results, where biomass alone was positively associated with group density and group size. The slope of the relationships between body mass and group density, body mass and group size, biomass and group density, and biomass and group size varied considerably, with significant scatter around the regression line. Food and food competition shaped the relationship between animal mass and abundance, and this relationship can even vary widely between assemblages. As a result of competition for the available resources, group density increased with increasing biomass.