EDITION #1
SEPTEMBER 2021
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A PARO PHARMACY EDUCATION MAGAZINE
Preface The constant updates in information regarding new health concepts, including new research and evolution of new therapies need a summary of the main research topics in order to guarantee a cohesive interpretation. This allows the dissemination of accessible information from reliable sources and has a special emphasis on academics in health courses. This need becomes more and more necessary given the delicate moment of the pandemic that the world faces, where the race for the vaccine and for constantly updated treatment guidelines often leads to a loss of important information. Therefore, due to the massification of content it is necessary to adapt the reality of publications of new studies to a routine of practice of exchange of information. This context exists in pharmaceutical practice, where innovation goes hand in hand with training, updated with the perception of the performance of this professional and its value for breaking its own paradigms, becoming responsible for maintaining knowledge and ensuring the promoting the rational use of medicines, which is a practice that can be achieved by sharing recurring and necessary information.
Index 05
07
Snakes can Save our lives Marck Leiva Méndez
The effects of COVID in pregnancy and the recommended care Vanessa Anton Muñoz & María Belén Salguero
Chemistry of ACE2 receptors (Angiotensin converting enzymes) and relationship to SARS-CoV-2
09
Rebeca Mamani Sosa, Hanxi Xu
COVID Vaccine Distribution in Latin America
11
Priscila Malavasi Conejo, Sonia Elena Avendaño Pinto, Aron Francisco Cortez Quispe
Rotary Evaporator
17
Melissa Núñez Mora
Index
Skills in a Young Pharmacist
19
Ruth Elizabeth Meza y Fernanda Saito Matsuhira
Challenges to the use of Medications in Space
21
Libni Melissa Pérez & Rubí Calderón
Pharmacogenetics in Cardiovascular Diseases: Important Focus Today
23
Luis Andrés Núñez Alpízar
SNAKES CAN SAVE OUR LIVES Marck Leiva Méndez 1,2 1. Facultad de Farmacia, Universidad de Costa Rica, Costa Rica, marck.leiva@ucr.ac.cr. 2. Escuela de Ciencias Naturales, Universidad Nacional, Costa Rica
The search for new therapeutic options with
Casewell et al. mention that some PLA2 isoforms
greater efficacy and fewer adverse effects has led
have shown a high ability to stimulate insulin
to the exploration of new areas of research. The
release in in vitro models of BRIN-BD11 cells,
diversity of proteins and other bio-composites
making it a possible avenue for the treatment of
present in the venom of different species of snakes
type 2 diabetes mellitus [4]. Phospholipase A2
are of great interest, because they mostly have
BnSP-6 obtained from
biological effects [1].
the ability to induce genotoxicity and cytotoxicity in cancer
breast
Bothrops pauloensis
cells,
in
addition,
has these
Due to the vast composition of biomolecules in
phospholipases showed greater affinity for these
snake venoms, such as proteins and peptides of
cancer cells compared to healthy cells, causing
which many have enzymatic activity, different
damage to the DNA of cancer cells, so the study
molecules
and characterization of these molecules could help
are
studied
metalloproteinases,
as
phospholipases,
deintegrins,
for
their
promising applications in medicine. Deintegrins
the development of biotechnological drugs for the treatment of breast cancer [5].
have been shown to possess anticoagulant activity by inhibiting platelet aggregation, as well as their
The antibacterial activity of some proteins present
ability
in snake venom is of great medical importance, just
to
block
metastasis
or
angiogenesis
processes in cancer [2].
as several studies have shown the ability to fight large-positive bacteria [6], including against some
Studies have demonstrated the cytotoxic activity
antibiotic-resistant
of different enzymes Phospholipases A2 (PLA2) in
Pseudomonas aeruginosa
cancer cells using in vitro
interest
and invivomodels, as
today,
microorganisms
given
such
as
[7]. This is of great
the
increasing
rate
of
well as the inhibition of cell proliferation and
antimicrobial resistance worldwide, both in human
tumor growth [1]. In addition, in vitro studies show
medicine
that Phospholipases also have antiangiogenic
importance lies in the fact that these biomolecules
properties
with antibacterial activity could be used in the
by
inhibiting
the
proliferation
of
and
endothelial cells, this effect is of great importance
treatment
for
multiple drugs.
future
treatments
in
different
diseases,
of
veterinary
microbial
medicine
infections
[8].
resistant
The
to
including cancer [3].
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References 1. Kalita, B., Saviola, A. J., & Mukherjee, A. K. From venom to drugs: a review and critical analysis of Indian snake venom toxins envisaged as anticancer drug prototypes. Drug Discovery Today, 2021 00(00), 1–13. https://doi.org/10.1016/j.drudis.2020.12.021 2. Schönthal, A. H., Swenson, S. D., Chen, T. C., & Markland, F. S. Preclinical studies of a novel snake venom-derived recombinant disintegrin with antitumor activity: A review. Biochemical Pharmacology,
2020,
181(May),
114149.
https://doi.org/10.1016/j.bcp.2020.114149 3. Polloni, L., Azevedo, F, Teixeira, S., Moura, E., Costa, T., Gimenes, S., Correia, L., Freitas, V., Yoneyama, K., Rodrigues, R. S., Lopes, D., & Rodrigues, V. de M. Antiangiogenic effects of phospholipase A2 Lys49 BnSP-7 from Bothrops pauloensis snake venom on endothelial cells: An in vitro and ex vivo approach. Toxicology in Vitro, 2021, 72(January). https://doi.org/10.1016/j.tiv.2021.105099 4. Casewell, N., Conlon, J., Attoub, S., & Musale, V. Toxicon : X Isolation and characterization of cytotoxic and insulin-releasing components from the venom of the black-necked spitting cobra Naja
nigricollis
(Elapidae)
Toxicon
X
2020
6
100030,
https://doi.org/10.1016/j.toxcx.2020.100030 5. Silva, M., Lopes, D., Teixeira, S., Gimenes, S., Azevedo, F., Polloni,
Figure 1. Stages of the research process in which drugs derived from snake venoms are found. [9]
L., Borges, B. C., da Silva, M., Barbosa, M., Oliveira Júnior, R., Elias, M. C., da Silva, C., Yoneyama, K.,, Rodrigues, V. de M., & Rodrigues, R. Genotoxic effects of BnSP-6, a Lys-49 phospholipase A 2 (PLA 2) homologue from Bothrops pauloensis snake venom, on MDA-
It
is
important
to
continue
researching
and
characterizing the biomolecules present in snake venom, because only about 0.01% of the known
MB-231 breast cancer cells. International Journal of Biological Macromolecules,
2018,
118,
311
–
319.
https://doi.org/10.1016/j.ijbiomac.2018.06.082
bioactive components have been studied their
6. Mehrdar, M. Two proteins from snake venom have potent
mechanisms of action, and many compounds may
antibacterial effects against bacillus anthracis and streptococcus
have pharmacological activity, and their ideal
pneumoniae. Iranian Journal of Toxicology, 2020 14(3), 139–144.
characteristics such as high selectivity by cellular
https://doi.org/10.32598/ijt.14.3.634.1
receptors are of great interest to researchers,
7. Saber, S., Mohamed, A., El-fiky, A., & Eldaly, H. In Vitro
because they can be used both for the treatment
Evaluation of Antibacterial Potential of Cerastes Vipera Venom
and diagnosis of diseases [10].
against Gram-Positive and Gram-Negative Bacterial Strains. 2019
In conclusion, the study and characterization of the
8. Palma, E., Tilocca, B., & Roncada, P. (2020). Antimicrobial
biomolecules present in snake venoms is of great
resistance in veterinary medicine: An overview. International
importance
Journal
because
the
77(October), 5804–5816.
molecules
currently
known have properties of great interest and utility
of
Molecular
Sciences,
21(6),
1–22.
https://doi.org/10.3390/ijms21061914
in medicine, and there are still many molecules to
9. Pérez-Peinado, C., Defaus, S., & Andreu, D. (2020). Hitchhiking
be analyzed, finally it is necessary to carry out
with nature: Snake venom peptides to fight cancer and
research in this field because they could have
superbugs. Toxins, 12(4). https://doi.org/10.3390/toxins12040255
multiple applications in this and other areas.
10. El-Aziz, T., Soares, A., & Stockand, J. Snake venoms in drug discovery: Valuable therapeutic tools for life saving. Toxins, 2019 11(10), 1–26. https://doi.org/10.3390/toxins11100564
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THE EFFECTS OF COVID IN PREGNANCY AND THE RECOMMENDED CARE María Belén Salguero1, Vanessa Anton Muñoz2 1 . Facultad de Ciencias Químicas y Farmacia, Universidad de San Carlos de Guatemala, Guatemala, mariabelensal@gmail.com 2 . Facultad de Farmacia y Bioquímica, Universidad Nacional Mayor de San Marcos, Lima-Perú, vanessa.anton@unmsm.edu.pe
INTRODUCTION:
Faced with the big question, can a pregnant woman with COVID-19 transmit the disease to her
Coronavirus disease 2019 (COVID-19) is caused by
baby? Recent studies have shown a small increase
severe acute respiratory syndrome coronavirus 2
in the risk to the mother of SARS-CoV-2 infection.
(SARS-CoV-2) and was declared a pandemic in
Transplacental transmission of SARS-CoV-2 from
March 2020 by the World Health Organization
mother to fetus may occur, but the immediate and
(WHO)[1]. Since then, several questions have arisen
long-term effects on the newborn remain unclear
about
unresolved.
[4]. They also mention that the risk of neonatal
However, what has become clear is that this virus
transmission is low and that neonatal disease most
poses a particular threat to
commonly varies from asymptomatic to mildly
the
disease
that
remain
vulnerable people,
that is, those who are most at risk of contagion
symptomatic [5].
and death, for example: the elderly, people with pre-existing
conditions,
as
well
as
pregnant
For now, the evidence for this new infection is
women, especially in their third trimester of
contradictory and the long-term sequelae are
gestation
[2]. For now, we'll focus on the latter
uncertain
and
group, so if you're pregnant in times of pandemic,
Therefore,
physicians
relax! we have the latest updates on the subject.
judgment
hypothetical
when
should
assessing
at
this
use the
time
their
[6].
clinical
need
for
hospitalization and treatment in their pregnant According to the WHO, pregnant women with
patients, as many COVID-19 symptoms mimic those
suspected or confirmed COVID-19 who have been
associated
treated in hospitals are usually less likely to
during pregnancy [7].
with
normal
physiological
changes
experience fever or muscle aches, but if they contract a severe form of the disease they are
Recommendations for care during pregnancy
more likely to need intensive care than nonpregnant women with COVID-19. Pregnant women
Measures to prevent COVID-19 during pregnancy
with COVID-19 who have pre-existing conditions,
are regularly the same as those used for the general
such as diabetes or chronic hypertension, or older
population. These include wearing a proper mask,
or overweight people, are more likely to suffer
washing
serious health complications due to COVID-19 [3].
importantly, avoiding crowded areas and parties,
your
hands
frequently,
and
most
such as baby showers.
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Among the most common recommendations during pregnancy are some such as: maintain a safety distance of 1 to 2 meters, avoid crowded areas, public transport and sick people.
[2] Elsaddig M, Khalil A. Effects of the COVID pandemic on
pregnancy outcomes. Best Pract Res Clin Obstet Gynaecol. 2021;73:125–36.
Disponible
en:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7969862/
You must attend the health centers only before already scheduled and essential visits, and with only one companion, at most. But, the consultation should be
[3] Gracias a nuevas investigaciones se conocen mejor los
efectos de la COVID 19 en las embarazadas y sus bebés [Internet]. Who.int. [citado el 25 de julio de 2021]. Disponible en: https://www.who.int/es/news/item/01-09-2020-new-research-
maintained between week 11-14 for screening in the
helps-to-increase-understanding-of-the-impact-of-covid-19-for-
first trimester, week 20 for morphological ultrasound
pregnant-women-and-their-babies
and the third trimester for fetal growth control. Otherwise, telematic control is ideal. Postpartum, for post-caesarean and postpartum wounds, telematic image control is also recommended (Sankaran et al., 2021). Also, the question about the safety of vaccines
[4] Parums DV. Editorial: Maternal SARS-CoV-2 infection and
pregnancy outcomes from current global study data. Med Sci Monit. 2021;27:e933831. [5] Barrero-Castillero A, Beam KS, Bernardini LB, Ramos EGC,
Davenport PE, Duncan AR, et al. COVID-19: neonatal-perinatal perspectives. J Perinatol. 2021;41(5):940–51.
designed to prevent infection and decrease symptoms and their use during pregnancy and lactation exists in some places.
[6] Cavalcante MB, Cavalcante CT de MB, Sarno M, Barini R,
Kwak-Kim J. Maternal immune responses and obstetrical outcomes of pregnant women with COVID-19 and possible health
In December 2020, a blog said it was concerned that antibodies from the vaccine could affect the placenta, as well as other rumors that it causes infertility. It should be noted that it is not the first vaccine of which such comments are made. However, during clinical
risks
of
offspring.
J
Reprod
Immunol.
2021;143(103250):103250. [7] Hapshy V, Aziz D, Kahar P, Khanna D, Johnson KE, Parmar MS.
COVID-19
and
pregnancy:
Risk,
symptoms,
diagnosis,
and
treatment. SN Compr Clin Med. 2021;3(7):1–7.
trials, a part of the sample became pregnant, thus
[9] S
discarding the hypothesis that the application of the
[9] Male, V. (2021). Are COVID-19 vaccines safe in pregnancy?.
vaccine prevents pregnancy [9].
https://doi.org/10.1038/s41577-021-00525-y [10] Sankaran, D., Nakra, N., Cheema, R., Blumberg, D., &
On the other hand, it has been shown that the vaccine
Lakshminrusimha, S. (2021). Perinatal SARS-CoV-2 Infection and
does not cause increased risk during pregnancy and it
Neonatal COVID-19: A 2021 Update. NeoReviews, 22(5), e284-
remains a personal decision whether or not to apply it during
pregnancy
and
lactation,
after
e295. https://doi.org/10.1542/neo.22-5-e1001
discussing
individual risks, as recommended by the American
Rich, M. (2020). Consejos para el embarazo durante la
College of Obstetricians and Gynecologists and the
pandemia de la enfermedad por coronavirus (COVID-19).
Society of Maternal-Fetal Medicine [10].
https://www.unicef.org/es/coronavirus/consejos-para-embarazo-
References
Wastnedge, E. A. N., Reynolds, R. M., van Boeckel, S. R., Stock, S. J.,
durante-pandemia-coronavirus-covid19.
Denison, F. C., Maybin, J. A., & Critchley, H. O. D. (2021). Pregnancy
[1] González-de la Torre H, Rodríguez-Rodríguez R, Martín-Martínez
A.
Recomendaciones
y
manejo
and
COVID-19.
Physiological
Reviews,
101(1),
303–318.
https://doi.org/10.1152/physrev.00024.2020
práctico de la gestante con COVID-19: scoping review. Enferm Clín (Engl Ed). 2021;31:100–6. Disponible en: https://doi.org/10.1016/j.enfcli.2020.05.009
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CHEMISTRY OF ACE2 RECEPTORS (ANGIOTENSIN CONVERTING ENZYMES) AND RELATIONSHIP TO SARS-COV-2 Rebeca Mamani Sosa1, Hanxi Xu2. 1 . Facultad ciencias de la salud, Escuela de Farmacia y Bioquímica, Universidad Nacional Jorge Basadre Grohmann, Tacna-Perú. rmamanis@unjbg.edu.pe 2 . Facultad de Ciencias Farmacéuticas, Universidad de São Paulo, Sao Paulo-Brasil. nancy@usp.br
The current 2019 coronavirus disease (COVID-19) outbreak is a global emergency due to its rapid spread and high mortality rate that have caused severe disruption.1 The pollution outbreak quickly spread around the world and left the health networks of several countries on the verge of collapse.2 The SARS-CoV-2 virus, like other coronaviruses, is introduced into lung cells by attaching to the angiotensin-converting enzyme II (ACE-2), which is found in different tissues such as the myocardium, kidney, respiratory tract and vascular level3. Unlike the classic ACE, ACE-2 degrades angiotensin II (Ang II), It seems that the main regulation of ACE2 on angiotensin II would be direct degradation, since it has been estimated that this effect is 400
Figure 1. Structure of the SARS-CoV-2 viral particles.The viral protein S (spike protein) fits into the ACE-2 like a key in a lock.
times greater than the one it has on angiotensin For SARS-CoV-2 viral entry, infection begins with a
I2.
ligand-receptor interaction, in which glycoprotein S Different structural components form the viral
binds to the host's angiotensin-converting enzyme
particle (Figure 1), among which are: a single-
(ACE2) receptor 2. The S1 subunit contains a
stranded RNA molecule (+), the nucleocapsid (N),
receptor binding domain (receptor binding domain
the envelope (E), membrane proteins (M), peak
or RBD) that binds to ACE2 (Figure 2) and is
glycoproteins (S) and the hemagglutinin-esterase
responsible for binding the virus to the host cell;
(HE) dimer.4
while the S2 subunit performs the fusion of the viral particle with the cell membrane. Protein and
ACE-2 is part of a biochemical pathway involved in
transcription expression (mRNA) analyses related to
the regulation of processes such as inflammation
the ACE2 receptor showed that intestinal, testicular,
or blood pressure and its usual function is to
and thyroid cells also express ACE2 during infection
modulate
caused by SARS-CoV-2, in contrast to the absence
the
activity
of
counteract its harmful effects.
angiotensin
2
to
of expression in blood cells.4
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To ACE-2 is formed by 2 domains: the catalytic
In conclusion, ACE-2 (angiotensin-converting enzyme
aminoterminal
its
2) is the receptor that allows coronavirus to enter
plasma
cells. ACE-2 in its full form is a membrane-bound
complete
and
form
it
the is
carboxyterminal,
anchored
in
the
In
membrane, while its shortened (or soluble) form circulates at low levels in the blood. 7 On the other hand, ACE-2 by degrading angiotensin II and
generating
angiotensin
1-7,
exerts
negative
regulation through the actions of the receptor that is coupled to G proteins and has actions contrary to angiotensin II. 7Preliminary studies in cell culture indicate that inhibitors of these pathways inhibit virus replication.6
enzyme, while its shorter (soluble) form circulates in the blood at very low levels. References: 1. Yang, L., Liu, S., Liu, J. et al. COVID-19: immunopathogenesis and Immunotherapeutics. Sig Transduct Target Ther 5, 128 (2020). https://doi.org/10.1038/s41392-020-00243-2. 2. Pereira, André, et al. “PRINCIPAIS ASPECTOS DO NOVO CORONAVÍRUS
SARS-CoV-2:
UMA
AMPLA
REVISÃO.”
Arquivos Do Mudi, vol. 25, no. 1, 16 Apr. 2021, pp. 73–90,
periodicos.uem.br/ojs/index.php/ArqMudi/article/view/55455, 10.4025/arqmudi.v25i1.55455. 3. Patel A.B., Verma A. COVID-19 and angiotensin-converting
Given that ACE-2 is the SARS-CoV-2 receptor and that
enzyme inhibitors and angiotensin receptor blockers: What is the evidence? JAMA. 2020 doi: 10.1001/jama.2020.4812.
its binding allows the virus to enter the target cell, it is
4. Donoghue M., Hsieh F., Baronas E., Godbout K., Gosselin M.,
very important to know how ACE-2 levels can be
Stagliano N. A novel angiotensin-converting enzyme-related
modulated. ACE-2 levels can be modulated by: 1) ACE-
carboxypeptidase
2 polymorphism and by inhibition of the classical renin-angiotensin preclinical inhibitors
system
models, have
the
been
pathway; drugs
and
ARA-II
observed
to
2)
and
increase
in ACE the
(ACE-2)
converts
angiotensin
I
to
angiotensin 1-9. Circ Res. 2000;87:E1–E9 5. Ziegler C GK, et al. SARS-CoV-2 Receptor ACE2 Is an Interferon-Stimulated Gene in Human Airway Epithelial Cells and Is Detected in Specific Cell Subsets across Tissues. Cell. 2020. Doi: https://doi.org/10.1016/j.cell.2020.04.035 6. Tolosa, A. (18 de Mayo de 2020). Coronavirus SARS-CoV-2:
expression and/or activity of ACE-2. 6
estructura, mecanismo de infección y células afectadas. Genotipia,
pág.
1.
https://genotipia.com/genetica_medica_news/coronavirusestructura-infeccion-celulas/ 7. Díaz-Barreiro LA, Cossio-Aranda J, Verdejo-Paris J, et al. COVID-19 y el sistema renina, angiotensina, aldosterona. Una relación compleja. Cardiovasc Metab Sci . 2020;31(Suppl: 3):182-189.
doi:10.35366/93945.
https://www.medigraphic.com/cgi-bin/new/resumen.cgi? IDARTICULO=93945&id2= 8. Ramírez-Sagredo, Andrea, Ramírez-Reyes, Andrés, Ocaranza, María Paz, Chiong, Mario, Riquelme, Jaime A, Jalil, Jorge E., & Lavandero, Sergio. (2020). Antihipertensivos en pacientes con
Figure 2. Molecular interaction between glycoprotein S and the ACE-2 receptor. (A) The S1 and S2 subunits of the S glycoproteins are shown, which form the peaks of SARSCoV-2: S1 in magenta and S2 in red. (B) The binding of glycoprotein S, portion S1, to the ACE-2 receptor in host cells is demonstrated. The ACE-2 receptor is indicated in blue and is part of a complex with the amino acid transporter B0AT1 (in green). Source: adapted from PDB (protein data bank): http: //pdb101.rcsb.org/motm/246.
COVID-19. Revista chilena de cardiología, 39(1), 66-74. Epub 01
de
abril
de
2020.
https://dx.doi.org/10.4067/S0718-
85602020000100066 9. Crackower, M. A., Sarao, R., Oudit, G. Y., Yagil, C., Kozieradzki, I., Scanga, S. E., Oliveira-dos-Santos, A. J., da Costa, J., Zhang, L., Pei, Y., Scholey, J., Ferrario, C. M., Manoukian, A. S., Chappell, M. C., Backx, P. H., Yagil, Y., & Penninger, J. M. (2002). Angiotensin-converting enzyme 2 is an essential regulator of heart function. Nature, 417(6891), 822–828. https://doi.org/10.1038/nature00786
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COVID VACCINE DISTRIBUTION IN LATIN AMERICA Priscila Malavasi Conejo1, Sonia Elena Avendaño Pinto2 , Aron Francisco Cortez Quispe3 1 . Facultad de Farmacia y Bioquímica, Universidad de Costa Rica, San José-Costa Rica, primalavassi@gmail.com 2 . Escuela Profesional de Farmacia y Bioquímica, Universidad Nacional Jorge Basadre Grohmann, Tacna-Perú. savendanop@unjbg.edu.pe 3 . Escuela Profesional de Farmacia y Bioquímica, Universidad Nacional San Luis Gonzaga de Ica, Ica-Perú. aroncortezquispe@gmail.com
Good Distribution Practices:
Good distribution practices (BPD) refer to the
For the proper distribution of vaccines, the
quality assurance part that ensures that a
relevant
authorities
should
pharmaceutical product is maintained through
distribution
proper control of the numerous activities that
regulatory body should be in a position to grant
take place in the distribution process (Pan
import permits quickly. As far as possible,
American Health Organization, 2008).
immediate
practices
customs
ensure
and
the
clearance
good
national
should
be
facilitated. On the other hand, all entities Different
distribution
pharmaceuticals
are
models
used
in
for
different
relevant to controls should coordinate their activities
with
the
improving
example in the public and private sectors.
vaccines. Caution should be exercised with
BPDs should apply to all individuals and
administrative
companies involved in the distribution of
customs
pharmaceuticals, from manufacturing facilities
potential conflicts in advance (World Trade
to the point of supply to patients in healthcare
Organization, 2020).
example,
private
processes
clearance
and
and
accelerating
for
import
of
countries or within the same country, for
facilities,
the
aim
clearance
that
processes
may and
of
delay resolve
pharmacies,
hospitals and clinics. On the other hand,
On the other hand, an important aspect to
governments,
assess is the shortage of specialized cold chain
international
policy-making donor
bodies,
organizations
and
agencies, certification bodies, as well as all parties that include health workers interested in any aspect of the trade and distribution of pharmaceutical
products
must
also
implement it.
prevent the distribution of falsified and belowmedicines.
storage containers. This situation could be made worse by slow or ineffective border clearance procedures. The obligation to deposit guarantees or financial bonds for cold chain equipment could delay the re-export of these
These guidelines can be used as a tool to standard
equipment, in particular reusable refrigerated
It
should
be
noted,
however, that these are general guidelines that
items and their timely reuse in the transport of additional
vaccines,
thewise
slowing
down
distribution on a global scale (World Trade Organization, 2020).
can be varied to adapt to the situations and conditions prevailing in different countries (Pan American Health Organization, 2008).
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The distribution of vaccines in each country varies
Countries:
according to a series of variables, among which is
The
the dispatch at the border. Where countries have
requested, complications with this, comply with
taken steps where customs and other agencies
BPD, internal distribution of the country, for whom
involved at the border, to speed up clearance
it is directed.
distribution,
to
which
industry
it
was
procedures. Among these is that establishments give priority in customs clearance to goods related
Costa Rica:
to COVID-19, simplification of forms, acceptance of for
In Costa Rica, vaccination is the main strategy
others.
envisioned by international and national public
Depending on the country, it may be necessary to
health authorities, in order to reduce the number
take
proper
of cases of COVID-19, and contain the current
distribution, in order to make access to vaccines as
emergency currently caused by COVID-19, thus
easy as possible (World Trade Organization, 2020).
reducing care and hospitalizations, since it would
the
electronic
processing
presentation
prior
additional
to
of
arrival,
measures
to
documents among ensure
complement Statistics:
the
other
non-pharmacological
measures that are already being used to prevent the transmission of the disease. and to return little
Argentina, Chile, Costa Rica and Mexico were the
by little, in the medium-term future, to the
first countries to start vaccination, in the last week
normality of all sectors of the country. Costa Rica
of December 2020, in Latin America. Most countries
purchased three million doses of the Pfizer-
began vaccination over the course of 2021.
BioNtech vaccine and one million doses of the
Chile
currently
leads
the
number
of
people
vaccinated with 43.91% of the population with the
AstraZeneca vaccine (Ministry of Public Health Costa Rica, 2021; Ugarte, 2021b, 2021a).
two doses and 58.26% with one dose. Chile is followed by Uruguay with 30.73% of the population
Vaccination in Costa Rica is segregated into five
vaccinated with two doses and 55.75% with one
groups. The first group are first responders, workers
dose (Horwitz & Zissis, 2021).
in long-stay power stations and elderly people who inhabit them; in the second group there are people over 58 years of age and in the third group there are people between 12 and 58 years old with some risk factor. In the fourth group are officials of the Ministry of Public Education, officials of shelters of the National Children's Trust (PANI), prisoners, workers of the Judiciary and 9-1-1. As the fifth and final group are health science students and related technicians in clinical fields of CCSS and the population
without
any
risk
described
above
(Brenes, 2021; Ministry of Public Health Costa Rica, 2021; Ugarte, 2021).
Figura 1. Datos de vacunación América Latina.
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12
Peru:
In Peru, the vaccination system is one of its priorities due to the great mortality that has arisen from Peruvians as foreigners who reside in the nation, so the Directorate General of Medicines, Supplies and Drugs (DIGEMID) of the Ministry of Health replied that so far, the only vaccines against COVID-19 that have conditional sanitary registration or exceptional authorization are those of the laboratories BioNTech
Pfizer, has
Sinopharm
joined;
and
and its
currently accredited
representatives, reaching a supply of 7,065,700 doses. The vaccines that have arrived in Peru and that will continue to arrive in the coming months will be: AstraZeneca: 14 million doses already agreed that will arrive from September 2021.Covax Facility: through this mechanism 13.2 million doses will arrive. 400 thousand of AstraZeneca in July 2021, subsequently
Peru
continues
to
carry
out
negotiations to be able to acquire more vaccines for its population, developing since April 16 begins the
new
vaccination
approach, professionals
strategy
with
territorial
prioritizing vaccination to frontline (health
personnel),
against
the
coronavirus, within this group is considered all citizens over 18 years old and foreigners living in the country, being one of the first to be vaccinated the population at risk over 50 years, pregnant women, children with down syndrome and autistic people so far carried out in vaccination centers located at strategic points near their places of residence. The strategy seeks to provide a more efficient response with the coverage of vaccination against COVID-19 in the country, adding important allies such as Es Salud, the Health Of the Armed Forces and Police, and the integrated health networks that depend directly on the Ministry of Health(MINSA). being this one that has confirmed that vaccination centers must be open to all citizens, according to their age range, without distinction of any kind, and according to their places of residence for the good of the Peruvian population.
Brazil:
In Brazil, the vaccine is considered a synonym of hope in the face of the Covid-19 pandemic, so the Ministry of Health reaffirms its commitment to the lives of all Brazilians for a vaccinated homeland and defeat the coronavirus. Brazil being one of the countries with the highest acquisition
of
vaccines
AstraZeneca-Oxford,
Covishield, J & J, Pfizer-BioNTech, Sinovac, Sputnik V with a current amount of 109,266,944 doses distributed throughout the country, being applied until June 10 an amount of 74,812,794 vaccines, between the first dose 51,465,240 vaccines and in second dose 23,347,554 vaccines, with surveillance of the Ministry of Health safeguarding the life of the population in the application for priority groups making use of the vaccination portfolio called "Coecte SUS" (Unified Health System) and digital services. A
vaccination
card
has
been
implemented
available through a QR code, which works as identification before public and private health services,
that certifies vaccinated persons who
have
official
an
record
and
functions
as
a
vaccination passport with data such as information on
the
type
of
vaccine
applied,
batch
of
manufacture and date on which the dose or doses were administered. In case of second dose, the application also shows the exact day when you should receive it and currently it has been possible to vaccinate more than 47% of the Brazilian population currently.
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Until May 2021, it was aimed at vaccinating people 60 years or older and remaining health personnel, where 69% of older adults were vaccinated, equivalent to 10,068,013. The
third
stage
of
the
vaccination
process,
continued in May 2021 until June 2021, was aimed at vaccinating people aged 50 to 59 years and pregnant women aged 18 years and over from the third month of pregnancy, where 58% of the total México:
population of adults between 50 and 59 were vaccinated, equivalent to 7,424,714.
In Mexico, the COVID-19 pandemic, in terms of lethality, may show that socioeconomic inequalities
The
of the population can affect the development of
continued in June 2021 until July 2021, will be
worst scenarios, so the government has taken
aimed at vaccinating people aged 40 to 49 years,
concrete measures to improve the quality of life
where currently it has been possible to vaccinate
and equip itself with essential elements to face the
6% of the total population of adults between 40
current health emergency, such as vaccination to
and 49 years, equivalent to 953,666.
fourth
stage
of
the
vaccination
process,
mitigate morbidity and mortality.
The fifth stage of the Vaccination process, which The strategy that has been implemented for
will begin in July 2021 until March 2022, will be
vaccination is through a web page implemented by
aimed at vaccinating the rest of the population.
the Ministry of Health of the Government of Mexico, which is: http://mivacuna.salud.gob.mx. In this the
Guatemala:
personal data of the patient are entered, following the
proposed
stages,
for
their
respective
vaccination in the corresponding place.
In Guatemala, the vaccine, provided by the state, is considered the hope and response they asked for in the face of the scourge of Covid 19. The
The following vaccines are being used: BioNTech,
government
Pfizer-CanSino- Corona Vac- Oxford Astrazeneca-
vaccination
Sputnik V.
implementation of measures, with the priority objective
The first stage of the Vaccination process, which
of
is
facing
systems reducing
this
pandemic
and the
the mortality
through constant of
the
population.
began in December 2020 until February 2021, was aimed at vaccinating frontline health personnel, covid-19 control, where 92% of the total population of health personnel were vaccinated, equivalent to 1,101,972. The second stage of the Vaccination process continued in February 2021.
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So Guatemala became the third country in the region of the Americas (after Colombia and Peru) to receive the vaccine, through the COVAX Mechanism. The first shipment was 81,600 doses of the AstraZeneca vaccine approved for use in emergencies by the World Health Organization (WHO), which arrived on March 11, 2021. These doses are the first shipment of the purchase that the Ministry of Public Health and Social Assistance (MSPAS) of a total of 6.6 million doses that are expected to receive this year to immunize 20% of the Population, Using the resources approved in Decree 1-2021 of the Congress of the Republic of Guatemala, Law for the Financing and Acquisition of Vaccines against the Coronavirus COVID - 19. (March 10, Ministry of Public Health and Social Assistance).
Guatemala will be carried out through a system of appointments,
appropriate
to
the
conditions of the target groups, through a web page implemented by the Ministry of Public Health and Social
Assistance:
https://registrovacunacovid.mspas.gob.gt/mspas/login. In this the personal data of the patient are entered, following the phases proposed by the Government, for their respective vaccination in the corresponding premises.
the health system, and for the effectiveness in fulfilling this, it has been divided into subphases. First, Health facility workers who care for COVID-19 patients on the front line. Second, Workers from health facilities not included in the above subphase and community support, including midwives, volunteer promoters and therapists.
Third,
Students
of
Health
Sciences and related who carry out internships in health establishments. Fourth, firefighters, paramedics, funeral home workers and staff working in nursing homes. Fifth, Older adults interned in nursing homes. Sex,
burden
of
severe
disease,
and
for
the
effectiveness in complying with this, it has been divided into subphases. First, Adults Over 70 and older. Second, Adult from 60 to 69 years old. Third, Adults from 50 to 59 years old. Fourth, Adults 18 or older with the following conditions: High blood pressure requiring medication, diabetes mellitus, chronic
lung
disease,
cardiovascular
chronic
and
kidney
disease,
cerebrovascular
diseases,
(HIV,
use
cancer,
of
immunosuppressants) or obesity. Fifth, Workers in the education sector (including teachers and professors
at
the
pre-primary,
primary,
basic,
diversified and university levels) who have not been included in the previous subphases. The
Third
Phase
is
aimed
socioeconomic
impact
continuity
basic
of
at
and services,
reducing
protecting and
for
the the the
effectiveness in the fulfillment of this, it has been divided into national
subphases. First, workers in the
security
sector
(including
PNC,
PMT,
military and prison system personnel). Second,
The First Phase is aimed at maintaining the integrity of
traditional
and
immunosuppression
The National Vaccination Plan of the Government of staggered
The Second Phase is aimed at reducing mortality
Health
sector
workers
(administrative)
included in the first two subphases.
not
Workers registered in municipalities and entities that provide essential services of electricity, water, garbage collection, customs and migration. Third, Authorities Ministry
of
and
other
public
Education
and
servants workers
of
the
of
the
Universities of the Country. Fourth, Justice sector workers, (includes judges, court staff, prosecutors, assistants, prosecutors and investigations of the Public Prosecutor's Office). The Fourth Phase, the latter is aimed at reducing the burden of disease, and for the effectiveness in complying with it, it has been divided into subphases. First, Adults from 40 to 49 years old. Second, Adults from 18 to 39 years old.
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References:
Brenes, L. (2021). ¡Inició la vacunación! Ministerio de Salud
Costa
Rica.
https://www.ministeriodesalud.go.cr/index.php/centro-
Horwitz, L., & Zissis, C. (2021, junio 7). Timeline: Tracking Road
to
Vaccination.
Ministerio
de
Salud
Costa
Rica.
https://www.ministeriodesalud.go.cr/index.php/centro-
vacunacion America’s
factores de riesgo, incorporados al plan de vacunación contra COVID-19.
de-prensa/noticias/741-noticias-2020/2020-inicio-la-
Latin
Ugarte, K. V. (2021c). Personas de 12 a 16 años, con y sin
AS/COA.
https://www.as-coa.org/articles/timeline-tracking-latin-
de-prensa/noticias/746-noticias-2021/2109-personas-de12-a-16-anos-con-y-sin-factores-de-riesgo-incorporadosal-plan-de-vacunacion-contra-covid-19
americas-road-vaccination Ministerio de Salud Pública Costa Rica. (2021). LS-SS-013. Lineamientos sobre la vacunación contra el virus SARSCoV-2
para
la
prevención
de
la
COVID-19.
https://www.ministeriodesalud.go.cr/sobre_ministerio/pre nsa/docs/lineamientos_vacunacion_contra_covid19_v2_2 5012020.pdf
CMSBlueTheme. Ministerio de Salud Pública y Asistencia Social - Fase IV [Internet]. Gob.gt. [citado el 12 de junio de 2021]. Disponible en: https://www.mspas.gob.gt/covid19/vacunacion-contra-covid-19/fases-vacunacion-covid19/fase-4-vacunacion-covid-19.html
Organización Mundial del Comercio. (2020, diciembre). Desarrollo y Distribución de Vacunas Contra la COVID-9 en
Todo
el
Mundo.
https://www.wto.org/spanish/tratop_s/covid19_s/vaccine_r eport_s.pdf Organización Panamericana de la Salud. (2008). Red Panamericana de Armonización de la Reglamentación Farmacéutica.
https://www.paho.org/hq/dmdocuments/2008/VConferen cia_ANEXOS.pdf Ugarte, K. V. (s. f.). Comisión Nacional de Vacunación y Epidemiología aprobó el uso de vacuna contra COVID-
Guatemala recibe primeras vacunas del Mecanismo COVAX [Internet]. Paho.org. [citado el 12 de junio de 2021]. Disponible en: https://www.paho.org/es/noticias/113-2021-guatemala-recibe-primeras-vacunas-mecanismocovax Saludpublica.mx. [citado el 12 de junio de 2021]. Disponible
en:
https://saludpublica.mx/index.php/spm/article/view/1227 8/12092
19 de AstraZeneca en Costa Rica. Ministerio de Salud
Costa
Rica.
Recuperado
10
de
junio
de
2021,
de
Vacuna Covid – Sitio Informativo [Internet]. Gob.mx.
https://www.ministeriodesalud.go.cr/index.php/centro-
[citado
de-prensa/noticias/746-noticias-2021/2084-comision-
http://vacunacovid.gob.mx/wordpress/
el
12
de
junio
de
2021].
Disponible
en:
nacional-de-vacunacion-y-epidemiologia-aprobo-el-usode-vacuna-contra-covid-19-de-astrazeneca-en-costa-rica vacunas
COVID-19: Resumen de las principales medidas, acciones
Pfizer/BioNTech contra Covid-19 es por $36 millones.
y políticas implementadas por los Estados miembros del
Ministerio
SELA [Internet]. Sela.org. [citado el 12 de junio de 2021].
Ugarte,
K.
V.
(2021a).
de
Compra
Salud
de
Costa
Rica.
https://www.ministeriodesalud.go.cr/index.php/centro-
Disponible
de-prensa/noticias/746-noticias-2021/2026-compra-de-
documentacion/base-de-datos-
vacunas-pfizer-biontech-contra-covid-19-es-por-36-
documental/bdd/62873/covid-19-resumen-de-las-
millones
principales-medidas-estados-miembros-sela
en:
http://www.sela.org/es/centro-de-
Ugarte, K. V. (2021b). Costa Rica firma acuerdo con AstraZeneca para suministro de vacuna candidata contra el
SARS-CoV-2.
Ministerio
de
Salud
Costa
Rica.
https://www.ministeriodesalud.go.cr/index.php/centrode-prensa/noticias/741-noticias-2020/1982-costa-ricafirma-acuerdo-con-astrazeneca-para-suministro-devacuna-candidata-contra-el-sars-cov-2
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ONE DAY AT LAB: ROTARY EVAPORATOR Melissa Núñez Mora1 1. Facultad de Farmacia, Universidad de Costa Rica, Costa Rica, melissa.nunezmora@ucr.ac.cr.
Have you ever thought about how a flower's compound
can
be
part
of
essential
oils,
a
medicines' composition, or even a cooking recipe? To answer this question, you have to think about the several separation and purification techniques made in organic chemistry or pharmaceutical laboratories. Most of these methods, such as recrystallization and chromatography, must be done in conjunction with a solvent – a substance that helps to dilute reagents – which most of the time is not part of the desired compound. (1,2) Therefore,
to
remove
the
solvent,
another
technique must be applied.
as it is efficient, quick, and easy to use. A rotary also
known
the final product will be a mixture of cinnamon's essential oil and some remains of water. During the extraction, these two substances are separated with the
help
of
another
solvent,
in
this
case,
dichloromethane. Once this is done, you have a solution
of
dichloromethane
and
cinnamon
essential oil. At this point, the main characters' role is for the RE. Start by placing the solution in the distilling flask. Next, turn on the motor to start the rotations and then the vacuum pump to reduce the pressure. (1,3,4) Both compounds have very different boiling points, 246 °C for cinnamon essential oil and 40 °C for dichloromethane. As a result, it is easy to
Rotary evaporation (RE) is the most common one evaporator,
In the first one, you will use water as a solvent, and
as
"rotavap,"
is
the
laboratory instrument that makes it possible to apply this process. It has a distilling flask, where the solution – the wanted substance and the solvent – is placed. Connected to the flask is the glass joint of the vapor tube, which makes the flask rotate. There is also a vacuum attached to the
separate them by evaporation; however, as the RE lowers the systems' pressure, the compounds' boiling
points
decrease
too,
making
the
evaporation, condensation, and collection of the solvent easier. (1,3,5,6) Simultaneously, the rotations increase the surface area of the solvent, raising the evaporations' rate. As a final result, the cinnamon's essential
oil
is
successfully
purified
from
the
cinnamon sticks. (1,3)
flask through the vapor tube. A condenser and a solvent collector are part of it too. (1,3,4) In simple words, this machine produces a reduced pressure distillation. (2) The big question here is how this instrument can separate different substances. The
.
RE principle explanation may get a little tricky, so using an example makes it more accessible. Imagine that you want to obtain the cinnamon essential oil. Before using the rotary evaporator, you
have
to
follow
two
processes:
steam
Figure 1. Representation of a rotary evaporator. (3)
distillation and extraction.
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This
technique
has
other
applications,
such
as
1- Make sure the rotavap is turned off, clean, and
preparing samples and synthesizing. Even recycling
the flasks are empty.
solvents is possible. In the pharmaceutical field, it is
2- Prepare a cooling bath and locate it in the
crucial for discovering, fabricating, and optimizing
solvent collector to prevent volatile solvents from
drugs. (7) For instance, by RE, a way of preparing an
evaporating. You can also use a dry-ice condenser.
amorphous solid dispersion (ASD) of acetyl-11-keto- β-
3- Connect the vacuum pump but do not turn it on.
boswellic acid (AKBA) – a compound with anti-
4- Connect the distilling flask with the solution
inflammatory and oncological properties, extracted
inside it to the vapor tube and attached it.
from the flower Boswellia serrata – was successfully
5- Hold it softly. Even though it is already attached
done. Because this drug's water-solubility is poor and
to the rotavap, sometimes the distilling flask might
so affects its bioavailability, a group of researchers
fall. Hence, support it while the evaporation is
decided to develop an ASD of AKBA to improve these
done.
characteristics
6- Turn on the vacuum pump.
since
ASDs
are
capable
of
supersaturating and increasing dissolution rates. (8)
7- Turn on the motor and start the rotations. 8- By moving the whole assembly, bring the flask
RE is such a well-designed method that it has even
towards the water bath or vice versa – depending
reached the kitchen of many well-known chefs around
on
the world. With the rotary evaporator's help, a lot of
Remember, you must not exceed the solvent's
chefs have improved the quality of their recipes by
boiling point.
concentrating,
9- The solvent will start to evaporate.
extracting,
and
separating
juices,
the
rotavap
model
–
and
start
heating.
colors, sugars, acids, flavors, and more. The now called
10- Once all the solvent is collected, stop de
"molecular cooking" has been expanding worldwide
rotation, release the vacuum and take out the
since this new kind of food tastes and smells
distilling flask from the water bath.
completely different. (9)
11- Clean the rotavap and the flasks.
When Lyman C. Craig created RE, he had no idea of the enormous legacy he left to humankind. (10) It has become not only an incredible tool for scientists but
Bibliography
also many other areas outside of a laboratory. Since it
Connections A How-To Guide for Organic Chemistry Lab Techniques.
1.
Padías AB. Chapter 3: Purification Techniques. En: Making the
has helped create medicines, purify the unique flavors
United States of America: Hayden HM McNeil; 2007. p. 107-74.
and odors of nature, and even brought new ways of
2. Nichls L. Overview of Rotary Evaporation [Internet]. 5.6A: Overview of
understanding cuisine, it truly has reached the goal of
Rotary
improving people's lives.
Evaporation.
2021.
Disponible
en:
https://chem.libretexts.org/@go/page/95729 3. Pravia L D, Gary M. L, George S. K, Randall G. E. Part 6: The Techniques. En: A Small Scale Approach to Organic Laboratory Techniqes. Third. Canada: Brooks/Cole. Cengage Learning; 2011. p. 545-959. 4.
Labrotovap. What is the usage of a rotary evaporator (rotovap)?
[Internet]. Well-Known. Disponible en: https://www.labrotovap.com/whatis-true-about-usage-of-a-rotary-evaporator-rotovap/
Figure 2. Chemical structure of acetyl-11-keto--boswellic acid (AKBA). (8)
5. National Center for Biotechnology Information. PubChem Compound Summary for CID 6344, Dichloromethane [Internet]. National Center for Biotechnology
Information.
2021.
Disponible
en:
https://pubchem.ncbi.nlm.nih.gov/compound/Dichloromethane 6. National Center for Biotechnology Information. PubChem Compound
Remember! You have to be careful!
Summary for CID 637511, Cinnamaldehyde [Internet]. National Center for
A rotavap is a costly machine, so you have to follow specific instructions to use it properly: (1,4)
Biotechnology
Information.
2021.
Disponible
en:
https://pubchem.ncbi.nlm.nih.gov/compound/Cinnamaldehyde
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SKILLS IN A YOUNG PHARMACIST - Fernanda Saito Matsuhira, USP, Farmacia, Brasil.1 E-mail: fernandasmat@yahoo.com.br - Ruth Elizabeth Meza, Facultad de Ciencias Químicas y Farmacia, Universidad San Carlos de Guatemala, Guatemala2 E-mail: elizaeliza16garsa@gmail.com - Solange t. O. Saito- Farmacéutica, AQIA. Brasil.3 - Alberto Keidi Kurebayashi - Farmacéutico-Bioquímico - FCF- USP; Especialización en Dermato-Cosmética en la Universidad de Vrije - Bélgica 4
We have always been led to believe that what is
The World Health Organization (WHO) published a
truly valuable is on the report card, on an exam
document entitled "The role of the pharmacist in
note, on the passing of a course. However, the
health care" ("The role of the pharmacist in the
reality in the Industry is different.
health system") in which seven qualities that the professional must present, which was then calleda
Speaking a little about the educational field from
7-star pharmacist, are highlighted, these qualities
the primary levels of schooling, for many years we
being:
have been instructed or guided consciously or unconsciously to obtain high grades or scores
1. Pharmaceutical service provider in a health team
being that a reflection of a "prosperous future", "a
2. Able to make decisions
good student", "level of intelligence", simply, the
3. Communicator
score, was a way or is currently the way to
4. Leader
categorize students 1.
5. Manager 6. Permanent update
Over time, different ways of learning, types of
7. Educator
intelligence, have been discovered and classified, we go from objectives to competences, because
>>SOLANGE, COMMENT<<
the desire is no longer the "knowing" but, the knowing "being", to be competent in life2 .
The pharmacist has a very wide field of activity. You
We would like that together we can perceive
can work in a pharmaceutical, cosmetic, food and
Education as something integral, although a good
chemical industry, either in the manufacture of
average is important what really makes it valuable
pharmaceutical inputs or products. Within the
is the -PROCESS- 2.
industry, there are different areas in which you can work:
Research
and
Development,
Innovation,
A good professional must "know how to be",
Application, Quality Control, Processes, Regulatory,
empathetic,
Supply Chain, Marketing and Sales.
upright,
enthusiastic,
generous,
proactive, be able to work as a team, and we call all these characteristics and personal skills soft
"The growth of the pharmacist, within
skills (Castro R., 2020).
of an industry, depends on factors such as: Predisposition to Continuous Learning"
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19
To be a Capable Professional, it is necessary that from our beginning in university education we get involved in activities that strengthen our Skills2. We
can
see
that
it
is
not
References
Castro, R. (19 de Noviembre de 2020). Dpersonas. Obtenido
enough
for
future
Pharmacists to dedicate themselves only to the subjects of the Curriculum, what will make a big difference at the time of an interview will be to have a Proactive Profile3. A proactive profile has complementary activities, practices, participation in events or academic centers from the beginning of his University training, which allows him to be an Integral Professional3.
de
https://dpersonas.com/2020/01/31/habilidadesblandas-que-son-y-por-que-sonimportantes/#:~:text=Las%20competencias%20bla ndas%20(soft%20skills,habilidades%20sociales%20 o%20habilidades%20interpersonales. González Pech, Harim Ernesto, Scior, Thomas Rainer F., & Vries, Wietse De. (2019). La profesión del farmacéutico
mexicano,
una
comparación
internacional. Perfiles educativos, 41(165), 148-164. Epub
16
de
abril
de
2020.https://doi.org/10.22201/iisue.
>>KUREBAYASHI, COMMENTS<<
24486167e.2019.165.59101
Currently, with this new scenario in which we find ourselves in the home office, there is a great opportunity for future Pharmaceutical Professionals, still in graduate, to look for courses, talks, webinars to expand their horizons of knowledge4. "Much success for all future graduation colleagues"
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CHALLENGES TO THE USE OF MEDICINE IN SPACE Libni Melissa Pérez1,, Rubí Calderón2
1 . Facultad de Ciencias Químicas y Farmacia, Universidad de San Carlos de Guatemala, Guatemala, prezlibni37 @gmail.com Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Perú, rubi.calderon@upch.pe
In a changing world, human beings must adapt to
and there is resupply from the International Space
different situations in their environment. It is
Station (ISS), a kit is not the solution for longer trips,
estimated that since 1910, the year in which
as is the three-year mission to Mars. Because of
arsphenamine, discovered by Paul Erlich, began to
these challenges, scientists have been researching
be used for the treatment of the then deadly
and developing new methods and technologies to
syphilis, the average life expectancy of a human
facilitate
extended by more than 23 years [1], reaching 72.6
supplies. In this way, it is sought that trips and stays
years in 2019 [2]. Therefore, advances in medicine
are less invasive and that they do not threaten the
have been exceptional tools to prolong life on
health of individuals for long periods of time.
access
to
medicines
and/or
medical
Earth, but what happens outside of it? One of the biggest challenges is radiation, as it One of the great advances of modern science has
would not only affect astronauts, but also the
been space travel that increasingly seeks to
stability of medicines. At a greater distance from
explore and discover beyond. In fact, until the
Earth, the protection provided by Earth's magnetic
beginning of 2020, more than 560 people have
fields is getting smaller and smaller. Consequently,
made trips to space of varied duration, from 15
it increases exposure to galactic cosmic radiation,
minutes to 437 days [3]. However, there is one
which is composed of high-energy ions that travel
persistent problem and that is the fact of how
almost at the speed of light, ionize virtually
these trips affect the health and quality of life of
everything in their path [6] and cause DNA damage
the men and women who carry out these
that is difficult to repair [7]. Since the radiolytic
missions.
species that are generated can react with the active
The
medical
and
environmental
challenges astronauts face vary according to the
ingredients
and
excipients
and
alter
the
length of travel, the type and time they stay out of
physicochemical and pharmacological properties.
Earth's atmosphere [4].
Some studied ways to protect drugs are the use of polymeric packaging of low atomic number and
Due to the limited capacity to carry supplies on
microemulsions,
as
well
as
the
inclusion
of
each flight, astronauts are provided with medical
antioxidants and radioprotective excipients (such as
kits whose drug and device contents are pre-
mannitol and pyridoxine) in formulations [8].
established. While the drug content is quite robust (a single kit can contain more than 117 types of medications!) [5]
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An even more striking option contemplated is the use
In practice, the "organ-on-a-chip" system has not
of
active
yet been used to study microgravity, but it has
molecules in the same space. Currently, it is being
been used to observe the neurovascular effects
studied whether the highly stressful environment of
that cosmic radiation has at the level of the blood-
space can activate secondary metabolic pathways in
brain barrier [13].
radiation-resistant
Aspergillus
nidulans,a
fungi
to
produce
filamentous
fungus
whose
genome was sequenced in 2016 [9].
In conclusion, much remains to be known about
Another challenge is microgravity, which is defined as that condition in which "gravitational acceleration is one hundredth to one millionth of the gravitational acceleration present on the Earth's surface" [10].
objects appear to be weightless and float. The effects
that
microgravity
has
on
astronauts are known almost for sure: redistribution of fluids,
reduction
of
muscle
mass
and
that have been implemented for its study are increasingly innovative. It would come as no surprise if in the future drugs could be produced in the same space, so that astronauts have immediate
In other words, in microgravity conditions, people and physiological
the behavior of drugs in space. The technologies
strength,
alteration of gastric emptying and intestinal transit, alteration of cytokine production and modification of
access to them during long-duration missions. References 1. Hutchings M, Truman A, Wilkinson B. Antibiotics: past, present and future. Current Opinion in Microbiology. 2019;51:72-80. https://doi.org/10.1016/j.mib.2019.10.008 2. World Population Prospects 2019: Highlights | Multimedia Library - United Nations Department of Economic and Social Affairs [Internet]. 2019 [citado 2021
Jun
10].
Disponible
en:
https://www.un.org/development/desa/publications/world-population-
the activity of transmembrane proteins, ion channels
prospects-2019-highlights.html
and enzymes [11].
space?. Expert Opinion on Drug Metabolism & Toxicology. 2020;16(5):353-356.
3. Eyal S. How do the pharmacokinetics of drugs change in astronauts in https://doi.org/10.1080/17425255.2020.1746763
However, there is still a large knowledge gap about
4. Stepanek J, Blue R, Parazynski S. Space Medicine in the Era of Civilian Spaceflight. New England Journal of Medicine. 2019;380(11):1053-1060.
how microgravity affects the absorption, distribution,
https://doi.org/10.1056/NEJMra1609012
metabolism and excretion of drugs. Compared to the
5. Eyal S, Derendorf H. Medications in Space: In Search of a Pharmacologist’s
traditional models of "head-down bed rest" (HDBR)
https://doi.org/10.1007/s11095-019-2679-3
Guide to the Galaxy. Pharmaceutical Research. 2019;36(10).
and immersion in water used to simulate microgravity
6. Perez J, Dunbar B. Why Space Radiation Matters [Internet]. NASA. 2019
conditions on Earth, an interesting possibility that has
space-radiation-matters
been contemplated is that of conducting automated research on the same spacecraft through the use of "organ-on-a-chip" systems [3]. These systems, based on microfluidic technology, simplify the organism, but
[citado 2021 Jun 10]. Disponible en: https://www.nasa.gov/analogs/nsrl/why7. Elgart S, Little M, Chappell L, Milder C, Shavers M, Huff J et al. Radiation Exposure and Mortality from Cardiovascular Disease and Cancer in Early NASA Astronauts. Scientific Reports. 2018;8(1). https://doi.org/10.1038/s41598-018-25467-9 8. Mehta P, Bhayani D. Impact of space environment on stability of medicines: Challenges and prospects. Journal of Pharmaceutical and
have the advantage of being portable and accurately
Biomedical Analysis. 2017;136:111-119.
simulating the physiological environment of human
9. Wang C. Experiment Details: Influence of microgravity on the production
organs,
since
parameters
such
as
concentration
gradients and shear forces, among others, can be controlled [12]. In this way, "organ-on-a-chip" systems could
be
useful
extrapolations [3].
for
performing
in
vitro-in
vivo
https://doi.org/10.1016/j.jpba.2016.12.040 of Aspergillus secondary metabolites (IMPAS) – a novel drug discovery approach with potential benefits to astronauts’ health [Internet]. Nasa.gov. 2021
[citado
2021
Jun
10].
Disponible
en:
https://www.nasa.gov/mission_pages/station/research/experiments/explorer/I nvestigation.html?#id=1164 10. Carrillo Esper Raúl, Díaz Ponce Medrano Juan Alberto, Peña Pérez Carlos Alberto, Flores Rivera Oscar Iván, Ortiz Trujillo Adriana, Cortés Antonio Osvaldo et al . Efectos fisiológicos en un ambiente de microgravedad. Rev. Fac. Med. (Méx.) [revista en Internet]. 2015 [citado 2021 Jun 10] ; 58( 3 ): 13-24. Disponible
en:
http://www.scielo.org.mx/scielo.php?
script=sci_arttext&pid=S0026-17422015000300013&lng=es.
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PHARMACOGENETICS IN CARDIOVASCULAR DISEASES: IMPORTANT FOCUS TODAY Luis Andrés Núñez Alpízar Facultad de Farmacia de la Universidad de Costa Rica, Costa Rica, luis.nunezalpizar@ucr.ac.cr.
As is well known, genetics is one of the most
Due to the large number of enzymes in humans
important branches of biology, since it describes
that are responsible for the metabolism of drugs, it
the characteristics obtained from our ancestors,
was found that there are polymorphisms that act
whether they are the distinctive physical traits of
differently in each patient, so they raise the amount
each human being, or the physiological activity in
of medication remaining in the body (which could
our body. At present, many factors have changed
cause toxicity) or reduce this amount of medication
in society, and thus new genetic variations have
to an ineffective level, therefore, the doses used for
appeared in humans, so this affects the desired
each patient are adapted separately, thus giving
aspects in medicines, since it has been seen the
greater
different reactions that patients have specifically
pharmacogenetics is the area that is responsible for
when ingesting medicines. It is interesting and
looking for the genetic values of each patient and
important, since, in the variation of a single base, it
see if these generate a change in the enzymes and
can
the
proteins that are responsible for the metabolism of
intermediate proteins of the process, so it is
the drug, thus generating a change in the response
reflected in a change in the efficacy of the drug or
time of the drug and, therefore, its desired effect.
even reaching a high level of toxicity of the drug.
(2)
trigger
an
unwanted
reaction
with
follow-up
to
the
variation.
Basically,
(1) Of course, the side effects of a drug are not only The beginning of pharmacogenetics occurs after
due to genetic factors, since there are other
the great project already known called Human
characteristics in each human being that differ in
Genome, which managed to decipher that each
different
human being is constituted by at least 30,000
medications and even the consumption of alcohol,
different genes, in which, about 10% can present
tobacco and other substances,
ways,
such
as
age,
sex,
additional
alterations, which are known as SNP, or single nucleotide
polymorphisms,
where
a
single
nucleotide is altered in the DNA chain and this is the
one
that
causes
the
greatest
incidents
observed with medications. In the clinical area, it seeks to perform individual genetic profiles for
.
patients who show unexpected results in specific drugs.
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These are extremely important to prevent and treat in
There are several cases where the activity of
time, since in most of the time they are silent and
genetic polymorphisms is observed, such as, for
appear when they are least expected.
example, in the use of Warfarin, this is a drug used as an anticoagulant and must have a regulated and
They are recognized for being one of the largest
individualized prescription, since depending on the
causes of death in the world, so in recent years
dose can cause serious bleeding problems. This
research has increased to find more efficient solutions
drug is metabolized by a liver enzyme called
and try to raise awareness in society a balanced care in
CYP2C9, which has two NSP-type polymorphisms
the diet of each one, as well as the practice of sports
called CYP2C9 *2 and CYP2C9 *3, responsible for
and avoid the consumption of tobacco. In addition,
the decrease in warfarin metabolism, so a previous
there are factors which cannot be changed, such as
genetic examination of the patient should be done
age, sex and genetic inheritance of each one, so if
to decrease the dose as necessary. In addition, an
there is any suspicion of being prone to these diseases,
enzyme called epoxide K reductase (VKOR) is also
the aforementioned preventions should be applied
known, which has a variation called VKORC1 that
with greater care. (3)
affects the sensitivity of Warfarin and therefore
Later, it was determined that there is a relationship between the drugs used for cardiovascular diseases and genetics, so pharmacogenetics began to take on more importance in the field of research. To analyze pharmacogenetics from the beginning, you have to initially know the types of patients there are, since each one has a different metabolism. Starting with the slow metabolizers, they are those patients who generate a minimum response of the drug due to a genotypic variation, altering the side effects of the drug and, therefore, forcing the medical manager to increase the required dose. Intermediate metabolizers have more pronounced side effects as do slow ones, however, they are not as strong effects. Extensive
metabolizers
are
normal
patients, who admit the drug in the expected way, resulting in the desired therapeutic effect. Finally, there are ultrafast metabolizers, which metabolize metabolizing
enzymes in double or even triple amounts. (4) addition,
these
emergence
of
bad
practices
common
cardiovascular diseases.
It is known that most drugs are metabolized by the enzymes of the CYP3A family, having these two common isoforms: CYP3A4 and CYP3A5. It is known that there is an NSP in CYP3A4, which does not allow the metabolism of some cardiovascular drugs of the statin type, such as lovastatin, simvastatin and atorvastatin. In the case of atorvastatin, a change in the differences in LDL cholesterol levels (commonly called ''bad'' cholesterol) was observed, so the doses of patients who present the polymorphism in the CYP3A4 genotype should be adjusted. (1)
considered
drugs too quickly, as they produce
affects the desired result. (2)
attribute
diseases,
to
In the
including
Drugs such as clopidogrel act in the same way as the previous ones, with an enzyme called CYP2C19, which contains an NSP called CYP2C19 *2, which can cause bleeding in some patients as in the previous case with Warfarin. In this case, the patient's dose must be adapted to a more stable one in order to obtain the benefit over the desired patient. (5)
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References
All these cases have been investigated in various locations around the world, where these differences
1.
have been shown, however, in Latin America these
FARMACOGENÉTICA
polymorphisms have not been investigated so much,
(Ribeirão Preto). 30 de diciembre de 2006;39(4):535-
since the population is a racial mixture since ancient times and this hinders the research processes, so it seeks to raise interest in this topic and encourage the student and professional population to carry out more formal research on the subject in order to help the Latin American population in a more efficient way. (6) Knowledge in this area is extremely important in each pharmacy professional, since each patient is different and may or may not have these genetic variations previously mentioned, so knowing them can mean a successful treatment, without aggressive side effects
Sandrim VC, Rezende VB, Tanus-Santos JE. CARDIOVASCULAR.
Medicina
42. 2.
Fernández
APLICACIONES
JM. EN
FARMACOGENÉTICA: LA
ENFERMEDAD
CARDIOVASCULAR. :34. 3.
García Riesco N. Prevención de enfermedades
cardiovasculares desde atención primaria: revisión bibliográfica
[Internet]
[info:eu-
repo/semantics/bachelorThesis]. 2020. Disponible en: http://uvadoc.uva.es/handle/10324/41967 4.
Stein
R,
Beuren
T,
Cela
LR,
Ferrari
F.
Farmacogenômica e Doença Cardiovascular: Onde Estamos e Para Onde Vamos. Arquivos Brasileiros de Cardiologia. 13 de octubre de 2020;115(4):690-700.
(main objective in taking medications), or a treatment
5.
with strong and harmful adverse effects for the patient
Hilal-Dandan R, Knollmann BC, editores. Goodman &
and being even worse, cause the death of the patient.
Gilman’s: The Pharmacological Basis of Therapeutics,
Because of this, knowing the pharmacogenetics has
13e [Internet]. New York, NY: McGraw-Hill Education;
important advantages for the patient, such as, for
2017 [citado 6 de mayo de 2021]. Disponible en:
example,
accesspharmacy.mhmedical.com/content.aspx?
obtaining
more
effective
therapeutic
Roden DM. Pharmacogenetics. En: Brunton LL,
benefits and in less time, as well as reducing the cases
aid=1162533468
of poisoning present in this type of drugs.
6.
Scudeler
FARMACOGENÉTICA
MM, NA
Rodrigues-Soares AMÉRICA
F.
LATINA.
2020;3(2):17.
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E D I T O R I A L CREATOR OF THE MAGAZINE
SR. GREIVIN ÁLVAREZ VEGA Pharmacy Education Subcoordinator PARO 2020-21
GENERAL SUPERVISOR SRA. LAURA PÉREZ Regional Projects Officer PARO 2020-21
EDITORIAL DESIGN SR. MAURICIO ABEL MIRANDA CH. Regional Media and Publications Officer PARO 2020-21
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