ResumenLa creciente longevidad de la población, el aumento de la morbilidad y del consumo de medicamentos han provocado que la polimedicación sea un problema de salud prioritario por sus consecuencias en el incremento de efectos adversos, interacciones farmacológicas y favorecer el deterioro funcional del paciente.La situación clínica de los pacientes cambia a lo largo del tiempo y es preciso ajustar la medicación en cada etapa, valorando la fragilidad, el nivel de dependencia y el deterioro funcional.La labor de deprescribir es compleja y requiere una adecuada formación clínica y farmacológica. En atención primaria reside el mayor conocimiento del paciente y su entorno, y de forma compartida con el paciente y cuidadores se debe valorar qué medicamentos mantener y cuáles retirar desde una perspectiva clínica, ética y social.Existen herramientas de ayuda a la deprescripción que pueden resultar útiles para el médico de familia para facilitar este proceso y que se detallan en este artículo.
Anterior pituitary differentiation is a well-established paradigm in mammalian organogenesis. PIT1/GHF1, a homoeotic gene, plays a key role in terminal pituitary differentiation. Recently, a new set of transcription factors involved in early pituitary differentiation have been identified: Lhx-3, Lhx-4, P-OTX and Prop1. A pituitary-specific transcriptional cascade regulating a developmental programme leads to the determination of the mature cell types.
The aim of this study was to develop a specific and highly sensitive method able to detect very low concentrations of Francisella tularensis in soil samples by real-time PCR (qPCR) with SYBR Green I. tul4 gene, which encodes the 17-kDa protein (TUL4) in F. tularensis strains, was amplified using a LightCycler (LC) device. We achieved a detection limit of 0.69 fg of genomic DNA from F. tularensis subp. holarctica live vaccine strain (LVS), corresponding to a value less than 3.4 genome equivalents per reaction. The qPCR was shown to be specific, highly sensitive and reproducible. In addition, we evaluated 2 new methods for recovering bacteria from soil based on 1-step filtration using glass fiber filters and PVDF filters. These filtration methods enabled us to recover F. tularensis efficiently from soil samples. As few as 50 CFU per 0.5 g of soil were detected by qPCR. Capture enzyme-linked immunosorbent assay (cELISA) allowed us to detect and quantify the amount of bacteria recovered from soil by an immunological method. Although qPCR was more sensitive than cELISA, we did not observe substantial differences in the amount of bacteria quantified by both methods.
The role of the POU domain transcription factor Pit-1 (GHF-1) in differentiation and proliferation of the somatotrophic lineage is well known. In our study of differential splicing of the PIT1 gene we found a new protein, Pit-2, in which 26 amino acids are inserted into the transactivation domain. Pit-2 can activate the growth hormone promoter but has lost the ability to activate the prolactin promoter or PIT1 promoter itself.
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