An updated examination of the perception of barriers for pharmacogenomics implementation and the usefulness of drug/gene pairs in Latin America and the Caribbean

Pharmacogenomics (PGx) is considered an emergent field in developing countries. Research on PGx in the Latin American and the Caribbean (LAC) region remains scarce, with limited information in some populations. Thus, extrapolations are complicated, especially in mixed populations. In this paper, we reviewed and analyzed pharmacogenomic knowledge among the LAC scientific and clinical community and examined barriers to clinical application. We performed a search for publications and clinical trials in the field worldwide and evaluated the contribution of LAC. Next, we conducted a regional structured survey that evaluated a list of 14 potential barriers to the clinical implementation of biomarkers based on their importance. In addition, a paired list of 54 genes/drugs was analyzed to determine an association between biomarkers and response to genomic medicine. This survey was compared to a previous survey performed in 2014 to assess progress in the region. The search results indicated that Latin American and Caribbean countries have contributed 3.44% of the total publications and 2.45% of the PGx-related clinical trials worldwide thus far. A total of 106 professionals from 17 countries answered the survey. Six major groups of barriers were identified. Despite the region's continuous efforts in the last decade, the primary barrier to PGx implementation in LAC remains the same, the "need for guidelines, processes, and protocols for the clinical application of pharmacogenetics/pharmacogenomics". Cost-effectiveness issues are considered critical factors in the region. Items related to the reluctance of clinicians are currently less relevant. Based on the survey results, the highest ranked (96%-99%) gene/drug pairs perceived as important were CYP2D6/tamoxifen, CYP3A5/tacrolimus, CYP2D6/opioids, DPYD/fluoropyrimidines, TMPT/thiopurines, CYP2D6/tricyclic antidepressants, CYP2C19/tricyclic antidepressants, NUDT15/thiopurines, CYP2B6/efavirenz, and CYP2C19/clopidogrel. In conclusion, although the global contribution of LAC countries remains low in the PGx field, a relevant improvement has been observed in the region. The perception of the usefulness of PGx tests in biomedical community has drastically changed, raising awareness among physicians, which suggests a promising future in the clinical applications of PGx in LAC.

Psychosocial and biological predictors of resident physician burnout

BACKGROUND

A high proportion of health professionals in training suffer from work-related stress and may develop a burnout syndrome.

OBJECTIVES

To study the incidence of burnout after the first year of residency in a teaching hospital and to identify baseline psychological, psychosocial work conditions, and biological risk factors.

METHODOLOGY

We assessed the following in a prospective cohort of residents at baseline (first month residence) and after 1 year: background factors (socio-demographics, psychiatric history), perceived stress score (Perceived Stress Scale), Maslach Burnout Inventory score, and psychosocial factors (Job Content Questionnaire). Blood samples were obtained to study serum cortisol, IL-6, and TNF-α concentrations. The cumulative incidence was modelled by multivariate log-binomial regression analysis.

RESULTS

We included 71 participants with a female majority (64.8%), age 26.4 (2.65) years, psychiatric history in 20%, and burnout in 13%. Among those without burnout initially (N = 59), it had developed by 1 year in 22% of residents. Increased job demand (RR = 1.259, 95%CI = 1.019-1.556, p = 0.033) and decreased cortisol levels (RR = 0.877, 95%CI = 0.778-0.989, p = 0.032) predicted burnout after 1 year of residency among medical trainees.

CONCLUSION

Burnout syndrome develops in 22% of residents by 1 year of training and can be predicted by increased work demands and decreased cortisol levels.

Dynamics of suspended sediment borne persistent organic pollutants in a large regulated Mediterranean river (Ebro, NE Spain)

Mediterranean rivers are characterized by highly variable hydrological regimes that are strongly dependent on the seasonal rainfall. Sediment transport is closely related to the occurrence of flash-floods capable to deliver enough kinetic energy to mobilize the bed and channel sediments. Contaminants accumulated in the sediments are likely to be mobilized as well during such events. However, whereas there are many studies characterizing contaminants in steady sediments, those devoted to the transport dynamics of suspended-sediment borne pollution are lacking. Here we examined the occurrence and transport of persistent organic microcontaminants present in the circulating suspended sediments during a controlled flushing flow in the low part of the River Ebro (NE Spain) 12 km downstream of a well-known contaminated hot-spot associated to a nearby chloro-alkali industry. Polycyclic aromatic hydrocarbons (PAHs) and semi-volatile organochlorine pollutants (DDT and related compounds, DDX; polychlorinated byphenils, PCBs; and other organochlorine compound, OCs) were measured in the particulate material by GC-MS and GC-MS/MS, using previously developed analytical methods. The concentration levels observed were compared to previously reported values in steady sediments in the same river and discussed on a regulatory perspective. Hydrographs and sedigraphs recorded showed a peak-flow of 1,300 m(3)s(-1) and a corresponding peak of suspended sediments of 315 mg L(-1). Combination of flow discharge, suspended sediments and pollutants' concentrations data allowed for quantifying the mass flows (mass per unit of time) and setting the load budgets (weight amount) of the different pollutants transported by the river during the monitored event. Mean mass-flows and total load values found were 20.2 mg s(-1) (400 g) for PAHs, 38 mg s(-1) (940 g) for DDX, 44 mg s(-1) (1,038 g) for PCBs and 8 mg s(-1) (200 g) for OCs. The dynamic pattern behavior of PAHs differs substantially to that of organochlorine pollutants, thus reflecting different pollution origins.

Testing abnormality in the spatial arrangement of cells in the corneal endothelium using spatial point processes

The study of central corneal endothelium morphology is important in Ophthalmology. Some of the pathologies that could compromise endothelial cell morphology are trauma, cataract, surgery, use of contact lenses, corneal dystrophies or degenerations. The quantitative analysis of cell shape and cellular pattern is more sensitive in detecting subtle changes in endothelial morphology than cell density measurement or cell area analysis. In this paper, the morphology of the central cornea, the most important area from the point of view of vision, is studied through an associated bivariate spatial point pattern: the centroids of the cells and the triple points, that is, the points where three different cells converge. Nine different summary descriptors (widely used in the statistical analysis of spatial point patterns) have been used: the empty space distribution function; the nearest neighbour distribution function and Ripley's K-function for each type of point separately (centroids and triple points), plus the corresponding three versions of these functions in the bivariate case. A control sample with similar age and cell density and no known abnormality is associated to each patient. The above descriptors are calculated for the patient and the controls. Each descriptive of the patient is compared with the corresponding descriptors from the controls by means of a graphical analysis and a formal test. Some patients presenting different pathologies are analysed in detail. Endothelia considered morphologically abnormal by visual inspection, which were not detected by hexagonality or density analysis, could be distinguished from control endothelia by these new descriptors.

Functional and biochemical characteristics of a soluble B lymphocyte proliferation-inhibiting activity produced by bone marrow cells from multiple myeloma patients

Several mechanisms are discussed as inducers for polyclonal hypogammaglobulinemia in multiple myeloma. A soluble noncytotoxic activity which inhibits in vitro the proliferation of normal polyclonal spleen B lymphocytes was measured in the supernatant of cultured bone marrow mononuclear cells from multiple myeloma patients. In addition, human B lymphoblastic cell lines (CESS, Daudi) and human T lymphocytes were sensitive to the antiproliferative effect of the suppressor activity, while other cell lines (RPMI 8226, IM9, CTL6, L1210, HL-60, and K562) were not. The activity was detected in a 5-kDa fraction and was stable to heating (30 min, 56 degrees C) and proteolytic enzymes. Extraction experiments using chloroform:methanol (2:1) suggest a lipid character of the suppressor activity.

[Magnitude of acid gastroesophageal reflux measured by 24-hour esophageal pH monitoring compared to the degree of endoscopic esophagitis]

Twenty four hour esophageal pH monitoring was performed in 110 patients, placing a pH electrode 5 cm above the proximal border of the lower esophageal sphincter. This test allows to measure the total lapse in which there is an acid pH in the esophagus, the ability of the esophagus to get rid of the acid reflux and documents the relationship between esophageal pH and symptoms. Upper GI endoscopy showed a normal esophagus in 38 patients, and esophagitis grade I in 25, grade II in 11, grade III in 25 and grade IV in 11. There was a high correlation between the severity of esophagitis and the total time in which the esophagus was exposed to an acid pH. It is concluded that this test can be used as a "gold standard" for gastroesophageal reflux detection.