Psychological profiles and prescription opioid misuse, craving, and withdrawal in people with chronic pain.

BACKGROUND: The negative consequences of prescription opioid misuse and opioid use disorder make it relevant to identify factors associated with this problem in individuals with chronic pain. This cross-sectional study aimed at identifying subgroups of people with chronic pain based on their psychological profiles, prescription opioid misuse, craving, and withdrawal. METHODS: The sample comprised 185 individuals with chronic pain. We performed hierarchical cluster analysis on impulsivity, anxiety sensitivity, pain acceptance, pain intensity, opioid misuse, craving, and withdrawal. RESULTS: The four-cluster solution was the optimal one. Misuse, craving, and anxiety sensitivity were higher among people in the Severe-problems cluster than among people in the other three clusters. Withdrawal was the highest in the High-withdrawal cluster. Impulsivity was higher among people in the Severe-problems and High-withdrawal clusters than those in the Moderate-problems and Mild-problems clusters. Pain acceptance was higher among people in the Mild-problems cluster than among people in the other three clusters. Anxiety sensitivity and misuse were higher among people in the Moderate-problems cluster than among people in the Mild-problems cluster. CONCLUSIONS: These results support that impulsivity, anxiety sensitivity, and pain acceptance are useful constructs to identify subgroups of people with chronic pain according to their level of prescription opioid misuse, craving, and withdrawal. The results of this study may help in selecting the early intervention most suitable for each of the identified profiles. SIGNIFICANCE: The psychological profile of individuals with chronic pain, prescription opioid misuse, craving, and withdrawal is characterized by fearing anxiety-related symptoms due to the catastrophic interpretation of such symptoms and reacting impulsively to negative moods. In contrast, participants with high pain acceptance had less prescription opioid misuse, craving, and withdrawal. The profiles identified in this study could help clinicians select targets for intervention among profiles with similar needs and facilitate early interventions to prevent opioid misuse onset or aggravation.

The Effect of the Drug-Related Problems Prevention Bundle on Early Readmissions in Patients From the Emergency Department: A Randomized Clinical Trial.

BACKGROUND: Drug-related problems (DRPs) are prevalent and avoidable disease that patients experience due to drug use or nonuse. However, secondary prevention policies have not yet been systematized. OBJECTIVE: To assess the clinical impact of a secondary prevention bundle for DRPs in patients who visited the emergency department (ED) for medicine-related problems. METHODS: A single-center randomized clinical trial was conducted from August 28, 2019, to January 28, 2021, with 1-month follow-up. We included 769 adult patients who visited ED with a DRP associated with cardiovascular, alimentary tract, and metabolic system medications. For the intervention group, a DRP prevention bundle, consisting of a combined strategy initiated in the ED was applied. Patients in the control group received standard pharmaceutical care. Intervention was evaluated in terms of 30-day hospital readmission due to any cause. RESULTS: Final analysis included 769 patients, of which 68 (8.8%) were readmitted within 30 days (control group, 40 of 386 [cumulative incidence: 10.4%]; intervention group, 28 of 383 [cumulative incidence, 7.3%]). After adjustment of the model for chronic heart failure, there was a lower incidence of hospital readmission among patients in the intervention group compared with those in the control group, odds ratio: 0.59 [95% confidence interval: 0.37-0.97]; number needed to treat (NNT) = 32. No significant differences in other outcomes were observed. CONCLUSION AND RELEVANCE: In this clinical trial, DRP prevention bundle in adjusted analysis decreased the rate of 30-day hospital readmission for any cause in patients who visited ED for a DRP. TRIAL REGISTRATION: ClinicalTrials.gov (Identifier: NCT03607097).

Association between depressed mood and sexual function among mid-aged Paraguayan women.

BACKGROUND: Depressive symptoms may affect female mid-life sexuality, whereas sexual problems tend to aggravate depression. Despite this, data assessing this association drawn from mid-aged Paraguayan women are scarce. OBJECTIVE: This study aimed to assess the association between depressed mood and the risk of sexual dysfunction during female mid-life. METHODS: Sexually active urban-living women from Asunción, Paraguay (n = 193, aged 40-60 years) were surveyed with the 6-item Female Sexual Function Index (FSFI-6), the 10-item Center for Epidemiological Studies Depression Scale (CESD-10), and a general questionnaire containing personal and partner information. Depressed mood was defined as a total CESD-10 score of 10 or more, and an increased risk for sexual dysfunction as an FSFI-6 total score of 19 or less. The association of depressed mood and an increased risk of sexual dysfunction was evaluated with multivariable Poisson regression. RESULTS: The mean age (±standard deviation) of surveyed woman was 48.3 ± 6.0 years and 61.1% (n = 118) were perimenopausal and postmenopausal. A total of 21.8% (n = 42) had depressed mood and 28.5% (n = 55) had an increased risk of sexual dysfunction. The final adjusted regression model determined that women with depressed mood were twice as likely to have an increased risk of sexual dysfunction, compared to women with normal mood (adjusted prevalence ratio = 2.14, 95% confidence interval 1.26-3.60). On the other hand, depressed mood was associated with a mean total FSFI-6 score that was 20% lower than that observed among women with normal mood (adjusted incidence rate ratio = 0.80, 95% confidence interval 0.68-0.93). CONCLUSION: In this mid-aged Paraguayan female sample there was a significant association between depressed mood and an increased risk of sexual dysfunction.

Spontaneous spermatic vein thrombosis in pediatric patients: A condition to be considered. / Trombosis espontánea de la vena espermática en la edad pediátrica: una entidad a tener en cuenta.

Spermatic vein thrombosis is a very rare pathology, with 25 cases published only, 6 of which in patients under 15 years of age. We present the case of a male patient, as well as a review of the literature. A 12-year old boy presented at emergency with 3-day progressive testicular pain. Following abdominal Doppler ultrasound imaging, he was diagnosed with left spermatic vein thrombosis and nutcracker syndrome. Admission and enoxaparin treatment were decided upon. Patient evolution was satisfactory, with subsequent ultrasound imaging demonstrating the absence of thrombus. The patient is currently under follow-up and without treatment. Various treatments are mentioned in the literature, with conservative management being the treatment of choice.

La trombosis de la vena espermática es una patología muy poco frecuente, con solo 25 casos publicados, 6 de los cuales menores de 15 años. De esta manera presentamos el caso de un varón, así como la revisión de la literatura. Un paciente de 12 años de edad acudió a Urgencias por dolor testicular de aumento progresivo, de 3 días de evolución. Mediante ecografía doppler abdominal se diagnosticó de trombosis de la vena espermática izquierda y síndrome de cascanueces. Se decidió ingreso y tratamiento con enoxaparina. La evolución del paciente fue satisfactoria, en la ecografía posterior se observó la desaparición del trombo. El paciente se encuentra en seguimiento y sin tratamiento. Existen varios tratamientos reflejados en la literatura, siendo el de elección el manejo conservador.

Vitamin D, menopause, and aging: quo vadis?

Menopause and aging are associated with changes in circulating gonadal steroid hormones, insulin sensitivity, body composition, and also lifestyle and social coordinates. Vitamin D status influences different metabolic adjustments, aside from calcium-phosphorus and bone metabolism. The main blood marker used to measure endogenous vitamin D status is 25-hydroxyvitamin D. Aging is associated with increases in serum parathyroid hormone and alkaline phosphatase, and a decrease of serum calcium, phosphorus, and vitamin D metabolites. 25-Hydroxyvitamin D status is also influenced by the circannual rhythm of sun irradiation. Results of clinical association studies have not correlated with intervention trials, experimental studies, and/or meta-analyses regarding the role of vitamin D on different outcomes in women during their second half of life and the vitamin D supplementation dose needed to improve clinical endpoints. Discordant results have been related to the method used to measure vitamin D, the studied population (i.e., sociodemographics and ethnicity), study designs, and biases of analyses. Vitamin D supplementation with cholecalciferol or calcifediol may improve some metabolic variables and clinical outcomes in young postmenopausal and older women. Studies seem to suggest that calcifediol may have some advantages over other forms of vitamin D supplementation. Further studies are needed to define interventions with supplements and effective food fortification.

Genetic parameters for carcass traits and body weight using a Bayesian approach in the Canchim cattle.

Correlation between genetic parameters and factors such as backfat thickness (BFT), rib eye area (REA), and body weight (BW) were estimated for Canchim beef cattle raised in natural pastures of Brazil. Data from 1648 animals were analyzed using multi-trait (BFT, REA, and BW) animal models by the Bayesian approach. This model included the effects of contemporary group, age, and individual heterozygosity as covariates. In addition, direct additive genetic and random residual effects were also analyzed. Heritability estimated for BFT (0.16), REA (0.50), and BW (0.44) indicated their potential for genetic improvements and response to selection processes. Furthermore, genetic correlations between BW and the remaining traits were high (P > 0.50), suggesting that selection for BW could improve REA and BFT. On the other hand, genetic correlation between BFT and REA was low (P = 0.39 ± 0.17), and included considerable variations, suggesting that these traits can be jointly included as selection criteria without influencing each other. We found that REA and BFT responded to the selection processes, as measured by ultrasound. Therefore, selection for yearling weight results in changes in REA and BFT.

Síndrome de dolor regional complejo en niños: posibilidades de tratamiento / Complex regional pain syndrome in children: treatment options

Introducción: La IASP define el síndrome de dolor regional complejo (SDRC) como "una variedad de condiciones dolorosas de localización regional", posterior a una lesión, que presentan predominio distal de síntomas anormales, excediendo en magnitud y duración al curso clínico esperado del incidente inicial, ocasionando con frecuencia un deterioro motor importante, con una progresión variable en el "tiempo". El SDRC se caracteriza por dolor intenso, acompañado de otros síntomas entre los que destaca la alodinia. Es una entidad clínica muy bien definida en los adultos, pero hasta hace poco tiempo se dudaba de su presencia en niños y adolescentes, hoy este hecho se acepta plenamente. Presenta algunas diferencias con el SDRC del adulto, entre ellas que es más frecuente en niñas y que afecta fundamentalmente a las extremidades inferiores. Casos clínicos: Nueve niños (cinco niños y cuatro niñas) con edades comprendidas entre los 8 y los 13 años de edad diagnosticados de SDRC; el desencadenante del cuadro ha sido en la mayoría de los pacientes la presencia de un traumatismo de intensidad leve. A todos los pacientes se les aplicó el mismo algoritmo de tratamiento: a) tratamiento farmacológico más terapia rehabilitadora asociado a la aplicación del parche de capsaicina al 8 %; y b) técnicas intervencionistas (infusión epidural de anestesia local y/o estimulación eléctrica medular) en aquellos pacientes cuyo alivio no es el adecuado. La remisión obtenida ha sido completa en los nueve pacientes con la utilización del algoritmo de tratamiento. Discusión: El diagnóstico del SDRC debe hacerse lo más precoz posible lo que permitirá que el inicio del tratamiento también lo sea. Si bien la mayoría de los niños van a responder al tratamiento convencional, existen casos donde se encuentran indicadas la utilización de las técnicas intervencionistas (AU)

Background: The IASP defined complex regional pain syndrome (CRPS) as "a variety of painful conditions" of regional location alter a injury with distal predominance of abnormal symptoms,exceeding in magnitude and duration the expected clinical course of the initial incident, often rausing significant motor impairment, with variable progression over "time". CRPS is characterized by severe pain, accompanied by other symptoms among which allodynia. It is a well-defined clinical entity in adults, but until recently lie doubted his presence in children and adolescents, today fully accepted this fact. Presents some differences with adult CRPS, including that is more common in girls and affects mainly the lower extremities. Case reports: Nine children (five boys and four girls) aged between 8 and 13 years old diagnosed with CRPS, the trigger box has been in most patients for the presence of mild trauma. All patients are subject to the same treatment algorithm: a) Drug tretment and rehabilitative therapy associated with the application of the capsaicin patch 8 %; and b) interventional techniques (epidural infusion of local anesthetic and/or electrical stimulation spinal cord) in patients whose relief is not adequate. The complete remission was obtained in nine patients using the treatment algorithm. Discussion: The diagnosis of CRPS should be done as early as possible which will allow initiation of treatment also is. While most children will respond to conventional treatment, there are cases where they are given the use of interventional techniques (AU)

Tratamiento del SDRC en niños mediante estimulación eléctrica medular / No disponible

Introducción: El SDRC lo define la IASP como "un cuadro de dolor desproporcionado a la causa que lo produce, acompañado de alteraciones sensoriales tales como alodinia/hiperalgesia, disfunción autonómica y motora que ocurre después de un trauma que, con frecuencia, es trivial y que se presenta, por lo general, en una extremidad". Estos síntomas están bien descritos en los adultos, pero existen pocos datos sobre la prevalencia en la población pediátrica. A diferencia del adulto, el 90 % de los casos aparecen en niñas, en edades comprendidas entre los 8-16 años con afectación, sobre todo, de una extremidad inferior. Material y método: Presentamos un total de dos pacientes, de 11 y 13 años de edad, con un cuadro severo de SDRC de extremidad inferior, tratadas previamente mediante tratamiento farmacológico y rehabilitador sin alivio de sus síntomas. En las dos pacientes se realizó un bloqueo simpático lumbar continuo mediante la colocación de un catéter epidural y la administración de una infusión continua de anestesia local, con lo que se consiguió una mejoría tanto del dolor como del resto de la sintomatología acompañante. Se implantó, en quirófano y bajo anestesia general un electrodo octopolar a nivel epidural dorsal iniciándose la estimulación eléctrica de la extremidad afectada. En las dos pacientes se valoró tanto la evolución de la intensidad del dolor así como su repercusión en la calidad de vida antes del inicio de la estimulación y a las dos semanas de haber iniciado el tratamiento, momento en el que se dio por terminado el periodo de prueba y se procedió a la implantación (en quirófano y bajo anestesia general) de un generador programable (AU)

Introduction: The IASP defined CRPS as "pain box disproportionate to the cause that produces it, accompanied by sensory disturbances such as allodynia/hyperalgesia, autonomic and motor dysfunction that occurs after a trauma that often is trivial andi s presents ussually a limb". These symptoms are well described in adults, but there are few data on the prevalence in the pediatric population. Unlike the adult, 90% of cases occur in girls aged between 8 - 16 years with involvement mainly of a lower limb. Materials and methods: We present a total of two patients, aged 11 and 13 years old with severe symptoms of lower extremity CRPS, previously treated with medication and rehabilitation without relief from their symptoms. In the two patients underwent continuous lumbar sympathetic block by placing on epidural catheter and administration of a continuous infusión of local anesthetic, so the patient improved both pain and the resto f the accompanying symptoms. Was implanted in the operating room under general anesthesia octupole electrode starting at dorsal epidural electrical stimulation of the affected limb. In the two patients was evaluated both the evolution of the intensity of pain and its impacto n quality of life befote the Honest of stimulation and within two weeks of starting treatment, at which time it terminated the period of proceeded to test the implementation (in the operating room under general anesthesic) programmable generator (AU)

Actuaciones profesionales realizadas en la farmacia comunitaria / Professional services carried out in the community pharmacy

Objetivo: Describir todas las actuaciones profesionales (AP) que se llevan a cabo como respuesta a las demandas realizadas por los usuarios en la farmacia comunitaria (FC). Material y métodos: Estudio observacional, descriptivo y transversal, realizado durante 6 meses en dos farmacias comunitarias de Denia (Alicante). La población de estudio fueron todas las demandas de servicio que realizaron los usuarios de ambas farmacias. La variable de estudio fue la AP, es decir, cada uno de los servicios demandados por el usuario en la FC: dispensación, indicación, automedicación, consultas y ventas, clasificándose cada uno en sus resoluciones e incidencias. Resultados: En el estudio se realizaron 30.617 AP, correspondiendo un 42% a la dispensación con receta, y se registró casi un 23% de incidencias. Las indicaciones farmacéuticas supusieron un 9% del total, resolviéndose en la mayoría de casos con la recomendación de un medicamento. Un 33% fueron demandas de automedicación, cursando con casi un 20% de incidencias. Un 7% fueron consultas y un 10% ventas de productos sanitarios. Conclusiones: Del total de AP realizadas, el 90% se consideran farmacéuticas. El 83% fueron dispensaciones de medicamentos, más de la mitad de éstas sin prescripción médica, lo que revela la importancia del asesoramiento farmacéutico en las dispensaciones sin receta. El hecho de que 9 de cada 10 incidencias que se producen en la dispensación con receta y en la automedica ción sean por la falta de información del paciente nos pone en alerta sobre la necesidad de implementar medidas que mejoren esta carencia(AU)

Objective: To describe all the professional actions (PA) carried out by the community pharmacy in response to the requests made by pharmacy users. Methods: Observational, cross-sectional, descriptive study in two pharmacies in Spain, over a 6 month-period. Population: all service requests made by pharmacy users. Study variable: Professional action, each of the services requested by pharmacy users: prescription-drug-dispensing, patient-counseling in minor ailments, self-medication, pharmacist-consultations, and sales-services. Classifying each of them in their decisions and incidents. Results: The study involved 30,617 PA, of which 42% were requests for prescription-drug-dispensing. Incidences were also recorded (23%). Nine percent of requests were for patient-counseling in minor ailments, and these were solved in 99% of cases with recommending of a drug, herbal or homeopathy product. Of the total PA, 33% were self-medication cases, with 20% of incidences. Seven percent were inquiries to the pharmacist and 10% of total requests were sales-services. In one out of four prescription-drug-dispensing event an incidence was detected, and in self-medication cases, in one out of every five. Conclusions: Of all the PA performed in the pharmacies under study, 90% were pharmaceutical activities. Most of these (83%) are directly associated with drug delivery (with/without prescription). The fact that more than a half of the total PA requested were without medical prescription should be further analyzed. The fact that nine out of ten incidents that occur in prescription-drug-dispensing and self-medication are the lack of patient information, it alerts us to implement measures to improve this shortcoming(AU)

Tratamiento del dolor secundario al síndrome de ATM mediante estimulación nerviosa periférica / No disponible

Introducción: con el nombre de síndrome témporomandibular o síndrome de Costen se hace referencia a una patología cuyos síntomas más frecuentes son: dolor y chasquidos articulares, dificultad para abrir la boca e incomodidad en la articulación témporo-mandibular. Su diagnóstico es básicamente clínico. La ATM está inervada por el nervio aurículo-temporal rama colateral del nervio mandibular, III rama del trigémino. Material y método: presentamos un total de seis pacientes, tratadas entre el 2008 al 2010, todas ellas con un cuadro de dolor secundario a un síndrome ATM, unilateral en cinco pacientes y bilateral en una de ellas. Todas las pacientes habían sido tratadas de forma previa en Cirugía Maxilofacial así como distintos tratamientos farmacológicos y rehabilitadores sin resultado en el alivio del dolor ni el la mejoría de la apertura de la boca. Previo al implante del sistema de estimulación se realizó, en todos los casos, bloqueos nerviosos aurículo-temporales con lidocaína al 2%, con el fin de determinar la zona y el nivel de analgesia obtenidos. En todos los casos se implantó en quirófano un electrodo en la región preauricular de la articulación témporo-mandibular afectada. Se valoró tanto la intensidad del dolor como la situación general de las pacientes antes del inicio del tratamiento y a las dos semanas, en las cuales se dio por terminado el periodo de prueba y se procedió a la implantación de un generador definitivo. Resultados: todas las pacientes fueron del sexo femenino, con una edad media de 32 años. Todas ellas presentaban dolor continuo con gran dificultad en la apertura de la boca y estaban en tratamiento farmacológico sin obtener un alivio adecuado del dolor. En todas las pacientes el resultado analgésico obtenido fue del 84% a las cuatro semanas de la implantación del electrodo (AU)

Introduction: the term temporomandibular joint syndrome or Costen’s syndrome refers to a disorder whose most common symptoms include: joint pain and clicking, difficulty opening the mouth, and temporomandibular joint discomfort. Basically, its diagnosis is clinical. The TMJ is supplied by the auriculotemporal nerve, a collateral branch of the mandibular nerve, V3 branch of the trigeminal nerve. Material and method: we report on a total of six female patients who were treated between 2008 and 2010, all of them with pain secondary to TMJ syndrome, unilateral in five cases and bilateral in one. All these patients had previously received maxillofacial surgery, as well as various drug therapies and rehabilitation, with no pain or mouth opening improvements. All patients were subjected to auriculotemporal nerve blocks using 2% lidocaine to determine analgesia extent and level prior to stimulation system implantation. In all cases an electrode was surgically implanted in the preauricular area of the involved temporomandibular joint. Both pain severity and general health status were assessed before treatment onset and after two weeks, at which time the trial period ended and a definitive stimulator was implanted. Results: all patients were females with a mean age of 32 years. All of them had continuous pain and great difficulty opening their mouths, and all were on drug therapy without adequate pain relief. All patients had their pain reduced by 84% at four weeks after electrode implantation (AU)

F8 gene dosage defects in atypical patients with severe haemophilia A.

We performed molecular analysis of the factor 8 gene (F8) in 272 unrelated Spanish patients with haemophilia A (HA) and detected a mutation by routine analysis in 267 of them (98.1%). No mutation was detected in the remaining five patients despite clinical and laboratory confirmation of HA. The aim is to describe the molecular alterations in F8 discovered by gene dosage methodologies in three of these patients. For methodology, F8 sequencing, intragenic marker analysis, multiplex ligation-dependent probe amplification and quantitative real time-PCR were followed. One patient had Klinefelter syndrome (47,XXY) and a large deletion spanning exons 1-12 masked by the other F8 allele; the second patient showed a large duplication spanning exons 2-10 and the third patient revealed a non-contiguous double duplication of exons 14 and 23-25. The remaining two patients had mild HA and dosage results were normal. The application of gene dosage methods is useful to define haemophilic patients in whom mutations are not detected using other routine methods. Nevertheless, in a small percentage of patients (<1%), no molecular pathology can be identified after testing several genetic methodologies.

Photoisomerizable metallomesogens and soft crystals based on orthopalladated complexes.

With the aim of obtaining light-responsive liquid-crystalline palladium complexes, six palladium complexes derived from an orthometalated imine, bearing one or two azocarboxylato bridges, have been synthesized: [Pd(2)(µ-SC(10)H(21))(µ-O(2)CAzo)(L(1,2))(2)] (7 and 8), [Pd(2)(µ-SC(10)H(21))(µ-O(2)CAzo3C(10))(L(1,2))(2)] (9 and 10), [Pd(µ-O(2)CAzo)L(1)](2) (11), and [Pd(µ-O(2)CAzo3C(10))L(1)](2) (12), in which L(1) = p-H(21)C(10)OC(6)H(3)CH═NC(6)H(4)OC(10)H(21)-p, L(2) = p-H(21)C(10)OC(6)H(3)CH═NC(14)H(29), AzoCO(2)(-) = p-(phenylazo)benzoate, and Azo3C(10)CO(2)(-) = p-(2',3',4'-tris-n-decyloxyphenylazo)benzoate. Three of them (7-9), as well as the precursor Azo3C(10)CO(2)H (3), are thermotropic liquid crystals displaying nematic and smectic A mesophases, while 10-12 have been identified by X-ray diffraction to give rise to "soft" crystal phases. Electronic spectroscopy and (1)H NMR show that all of them undergo a trans-cis isomerization of the azobenzene moiety at λ = 365 nm. The molecular structure determines the photoresponse in solution, which is faster and more stable when the trisubstituted azocarboxylate is present and the motion of the azo group is not hindered by the orthometalated imine. The photoresponse has also been observed in the condensed phases, which change from the ordered phase to the isotropic liquid upon irradiation, except for compound 10, a soft crystal in which a permanent photoalignment highly sensitive to light polarization is produced. The latter is a behavior with potential applications, rather unusual in low-molecular-weight compounds.

Prevalencia de la enfermedad tiroidea autoinmune en pacientes con diabetes mellitus tipo 1 / Prevalence of autoimmune thyroid disease in patients with type 1 diabetes

Objetivo: Evaluar la prevalencia de enfermedad tiroidea autoinmune (ETA) enpacientes con diabetes tipo 1 (DM1) y su relación con variables clínicas y analíticas.Material y métodos: Estudio observacional descriptivo en pacientescon DM1 en el que se analiza la prevalencia de ETA y los factores relacionados.Resultados: Se estudiaron 507 pacientes con DM1 (50,4% mujeres)de 33,5 ± 11,8 años de edad y 16,1 ± 9,5 años de evolución de la DM1, ycon un nivel medio de HbA1c del 7,8 ± 1,4%. El 17,8% de los pacientes presentabaETA (9,9% hipotiroidismo primario, 7,1% hipotiroidismo subclínico y0,8% enfermedad de Graves). Los pacientes DM1 y ETA eran, con mayor frecuencia,mujeres (24,6 frente a 10,8%; p <0,001) y fumadores (15,6 frentea 2,2%; p= 0,039) y presentaban niveles séricos de colesterol LDL (c-LDL)más elevados (110,1 ± 31,4 frente a 102,9 ± 28,8 mg/dL; p <0,043).Conclusión: Observamos una elevada prevalencia de ETA en pacientes conDM1, asociándose a sexo femenino, tabaquismo activo y niveles elevados dec-LDL. Recomendamos el cribado sistemático de ETA en pacientes con DM1,que permita un precoz diagnóstico y tratamiento(AU)

Objective: To evaluate the prevalence of autoimmune thyroid disease in type1 diabetes patients and their association to clinical and analytical parameters.Methodology: A retrospective observational study of type 1 diabetes patientswas designed to analyze the prevalence of autoimmune thyroid disease andrelated factors. Results: The study included 507 patients with type 1 diabetes(50.4% women), aged 33.5 ± 11.8 years with an average duration of diabetesof 16.1 ± 9.5 years. The average level of HbA1c was 7.8 ± 1.4%.Theprevalence of autoimmune thyroid function disorder was 17.8% (9.9% primaryhypothyroidism, 7.1% subclinical hypothyroidism, and 0.8% Graves disease).There was a positive association between thyroid disease and femalegender (24.6% versus 10.8% in men, p <0.001), smoking (15.6% versus2.2%, p= 0.039) and serum LDL levels (110.1 ± 31.4 mg/dL versus 102.9± 28.8 mg/dL; p <0.043). Conclusion: Prevalence of autoimmune thyroiddisease in type 1 diabetes patients is high and it is associated with femalegender, smoking and increased LDL levels. We suggest a systematic screeningfor autoimmune thyroid disease in type 1 diabetes to establish an early diagnoseand treatment(AU)

Antena metálica en árbol traqueobronquial / No disponible

No disponible

[Negative results related to drugs required in hospitalisation]. / Resultados negativos asociados con medicamentos como causa de ingreso hospitalario.

OBJECTIVE: To assess the prevalence of negative clinical outcomes associated with medication as a cause of hospital admission and to determine their characteristics (types, categories, avoidability, severity and the drug groups involved.) To determine possible risk factors related to the appearance of this problem. METHOD: An observational study carried out over a three month period in a department of the university hospital, 163 patients were selected at random. The information obtained from the patient interview, the revision of clinical records and clinical sessions were used to then identify negative clinical outcomes using the Dader method. RESULTS: In 27 cases (16.6 %; 95 % confidence interval [CI], 1.6 to 23.0), negative clinical outcomes associated with medication were considered to be the main cause of hospital admission. The most frequent negative clinical outcomes associated with medication were untreated health problems, non-quantitative ineffectiveness and quantitative safety problems respectively. The overall prevalence of preventable admissions due to negative clinical outcomes associated with medication was 88.9 %; (95 % CI, 71.9 to 96.1 %.) With regards to severity, 74.1 % (95 % CI, 55.3 to 86.1 %) of the total admissions were moderate. The most common drugs implicated in hospital admissions were: antibacterial for systemic use, cardiovascular and non steroidal anti-inflammatory agents. Apart from age, no other factors were found for hospital admissions due to negative results associated with medication. CONCLUSIONS: Negative clinical outcomes associated with medication as cause of hospital admission are a prevalent problem and most of them are avoidable with pharmacotherapeutic follow-up.

Resultados negativos asociados con medicamentos como causa de ingreso hospitalario / Negative results related to drugs required in hospitalisation

Objetivo: Estimar la prevalencia de resultados negativos asociados a medicamentos como causa de ingreso hospitalario y determinar sus características (dimensiones, tipos, evitabilidad, gravedad y grupos terapéuticos implicados). Buscar posibles factores asociados a la aparición de este problema. Método: Estudio observacional transversal, durante 3 meses, en una unidad del hospital universitario, seleccionando al azar mediante el método de extracción de bolas de una urna a 163 pacientes. La información obtenida de la entrevista con el paciente, de la revisión de historias clínicas y la procedente de las sesiones clínicas se empleaba para la identificación posterior de los resultados negativos asociados con medicamentos mediante el método Dáder. Resultados: En 27 de los 163 pacientes estudiados (16,6 %; intervalo de confianza [IC] del 95 %, 1,6-23,0), el ingreso fue causado principalmente por un resultado negativo asociado con los medicamentos. Los pacientes ingresaron por problemas de salud no tratados, inefectividades no cuantitativas e inseguridades cuantitativas respectivamente. Un 88,9 % (IC del 95 %, 71,9-96,1) de los ingresos por resultados negativos asociados con medicamentos fueron evitables. En cuanto a la gravedad, el 74,1 % (IC del 95 %, 55,3-86,1) fueron moderados. Los principales grupos farmacológicos implicados en los ingresos fueron antiinfecciosos sistémicos, fármacos relacionados con el aparato cardiovascular y antiinflamatorios no esteroideos. A excepción de la edad, no se encontraron factores asociados a la aparición de ingresos por resultados negativos asociados con medicamentos. Conclusiones: Los ingresos por resultados negativos asociados con medicamentos son un problema de elevada prevalencia y la mayoría son evitables mediante seguimiento farmacoterapéutico (AU)

Objective: To assess the prevalence of negative clinical outcomes associated with medication as a cause of hospital admission and to determine their characteristics (types, categories, avoidability, severity and the drug groups involved.) To determine possible risk factors related to the appearance of this problem. Method: An observational study carried out over a three month period in a department of the university hospital, 163 patients were selected at random. The information obtained from the patient interview, the revision of clinical records and clinical sessions were used to then identify negative clinical outcomes using the Dader method. Results: In 27 cases (16.6 %; 95 % confidence interval [CI], 1.6 to 23.0), negative clinical outcomes associated with medication were considered to be the main cause of hospital admission. The most frequent negative clinical outcomes associated with medication were untreated health problems, non-quantitative ineffectiveness and quantitative safety problems respectively. The overall prevalence of preventable admissions due to negative clinical outcomes associated with medication was 88.9 %; (95 % CI, 71.9 to 96.1 %.) With regards to severity, 74.1 % (95 % CI, 55.3 to 86.1 %) of the total admissions were moderate. The most common drugs implicated in hospital admissions were: antibacterial for systemic use, cardiovascular and non steroidal anti-inflammatory agents. Apart from age, no other factors were found for hospital admissions due to negative results associated with medication. Conclusions: Negative clinical outcomes associated with medication as cause of hospital admission are a prevalent problem and most of them are avoidable with pharmacotherapeutic follow-up (AU)

Quality of life of neurogenic patients: translation and validation of the Portuguese version of Qualiveen.

OBJECTIVE: Questionnaires for adequate assessment of the urinary function of neurological patients are not available in Portuguese. The Qualiveen, developed in France for evaluation of general and urinary-related impact on QoL, has been successfully used in neurological patients. AIM: To translate the Qualiveen, to adapt it crossculturally, and to validate it for Portuguese. METHODS: Fifty-one patients with spinal cord injury (SCI), multiple sclerosis (MS), and myelomeningocele (MMC) completed both Qualiveen and the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) twice, at an mean interval of 15.5 days. RESULTS: A reliability study revealed internal consistency (Cronbach's alpha coefficients 0.75-0.90 for all four domains). Test-retest reliability demonstrated moderate to strong stability (intraclass correlation coefficient range from 0.62 to 0.86). Construct validity was assessed using the Qualiveen's scores and ICIQ-SF final score. It was significant for the majority of Qualiveen's score domains compared with the ICIQ-SF final score. CONCLUSION: The Portuguese version of the Qualiveen was successfully adapted and validated. It can be used for evaluation of general and urinary QoL in neurological patients.