Utilización de antibióticos restringidos en la práctica clínica: ceftolozano/tazobactam, ceftazidima/avibactam, ceftarolina y dalbavancina / Use of restricted antibiotics in clinical practice: ceftolozane/tazobactam, ceftazidime/avibactam, ceftaroline and dalbavancin

Objetivo: Evaluar la utilización en la práctica clínica de cuatro antibióticos de amplio espectro o innovadores: ceftolozano/tazobactam, ceftazidima/avibactam, ceftarolina y dalbavancina. Métodos: Estudio retrospectivo en que se han recogido datos de los pacientes que han recibido dichos antibióticos entre julio de 2018 y junio de 2019 en un hospital terciario. Se recogen las condiciones de uso y los resultados en efectividad a los 30 días para dalbavancina, y para el resto de antimicrobianos a los 3-5 días del inicio, a los 14 y a los 30 días para determinar mortalidad. Resultados: Se recogieron datos de 51 pacientes, con una mediana de edad de 63 años. La infección más comúnmente tratada fue neumonía (41,2%). Tres pacientes (5,9%) recibieron la terapia en estudio como primera línea y 43 (84,3%) recibieron antibióticos concomitantes. En el 66,7% de las infecciones se había aislado previamente un microorganismo sensible. En el 19,6% de los casos el cultivo fue negativo. En el grupo dalbavancina, el 75% de los pacientes se curaron a los 30 días. En el resto de antimicrobianos, el tratamiento resultó efectivo a los 3-5 días en el 65,1%. El 51,2% se curaron a los 14 días y un 30,2% fallecieron a los 30 días. Conclusiones: Los resultados de efectividad resultan comparables a estudios publicados con diseños similares. Se detecta la importancia de fomentar un uso adecuado de los antibióticos, como tratamientos dirigidos o empíricos en casos de riesgo de resistencias, priorizando su desescalada. Es esencial la implantación de equipos multidisciplinares PROA. (AU)

Objective: To evaluate the use in clinical practice of four recently marketed antibiotics: ceftolozane/tazobactam, ceftazidime/avibactam, ceftaroline, and dalbavancin. Methods: Retrospective study in which data have been collected from patients who have received these antibiotics between July 2018 and June 2019, in a third-level hospital. The conditions of use and the results in clinical efficacy measured in three periods have been studied: 3-5 days after the start of treatment, 14 days and 30 days to determine mortality. Results: Data were collected from a total of 51 patients, with a median age of 63 years. The most commonly treated infection was pneumonia (41.2%). Three patients (5.9%) received study therapy as the first line of treatment and 43 (84.3%) received concomitant antibiotics. In 66.7% of the infections, a sensitive microorganism to the antibiotic under study had been previously isolated. In 19.6% of the cases, the culture was negative. In the dalbavancin group, 75% of the pacients cured at day 30. In the other groups, the treatment was effective at 3-5 days in 65.1% of the cases. 51.2% experienced clinical cure at 14 days and 30.2% died at 30 days. Conclusions: The effectiveness results are comparable to published studies with similar designs. The importance of promoting an adequate use of antibiotics is detected, as directed or empirical treatments in cases of risk of resistance, prioritizing their de-escalation. The implementation of multidisciplinary PROA teams is essential. (AU)

Impact of a Maternal Motivational Interviewing on Oral Health in the Mother-Child Dyad.

Motivational Interviewing (MI) has been included in dentistry programs. There exists a need for interventions in the mother-child dyad. The aim of this paper was to compare the effects of a MI-based educational program on oral care knowledge, attitudes, and practices (KAP) in the mother-child dyad to a Traditional Education-based program (TE). A community intervention trial was carried out. The experimental and control groups were made up of women between 18 and 45 years of age in the sixth month of gestation. Both groups were provided with TE. The experimental group additionally received a session based on the principles of the MI. Socio-demographic data, children's oral health KAP (COHKAP), that of the mother (MOHKAP), and maternal self-efficacy (MSE) in relation to children's oral health (COHMSE) were recorded. A baseline measurement was made, as well as a six-month follow up. The participants included 135 women with an average age of 24.88 ± 6.00. After intervention, the experimental group's COHKAP, MOHKAP, and COHMSE all increased (p < 0.001). When MI-based interventions are combined with TE, MSE and dental care KAP for the mother-child dyad in pregnant women can be improved.

Evaluation of testicular echotexture with Ecotext as a diagnostic method of testicular dysfunction in stallions.

This study aimed to assess if Ecotext, a new software for evaluation of testicular echotexture, is a good method for diagnosis of stallions with testicular dysfunction (TD). Relationships between Ecotext parameters and sperm motility and production, testicular volume, and testicular blood flow were also studied. Ecotext provides a total of six echotexture parameters: Ecotext 1 (black pixels), 2 (white pixels) and 3 (grey pixels), and another 3 parameters related to hypoechogenic areas: Ecotext tubular density (ETD), Ecotext tubular diameter (ETd), and Ecotext tubular area (ETA). Stallions (n = 33) were assessed using proven diagnostic techniques (spermiogram, B-mode and Pulse Doppler ultrasound), and subsequent analysis with Ecotext. Animals were classified as "control stallions" (n:21, acceptable semen quality), and "stallions with TD" (n:12, poor semen quality (TM < 60%, PM < 45% and total nº of sperm with PM < 2000 × 106 spz), that were subdivided into "induced TD group" (immunized, anti-GnRH vaccine) and "acquired TD group". The acquired TD group showed differences in all Ecotext parameters in relation to controls (Ecotext 1:0.11 ± 0.17 vs 2.82 ± 2.52, Ecotext 2:1584.0 ± 575.8 vs 388 ± 368.2, Ecotext 3:134.2 ± 9.26; ETA: 2.14 ± 0.59 vs 5.40 ± 1.90; ETd: 65.66 ± 6.27 vs 86.93 ± 10.65 and ETD: 92.35 ± 11.24 vs 132.10 ± 16.35, p ≤ 0.001). Results suggest acquired TD stallions were suffering testicular degeneration with loss of architecture and function as all Ecotext parameters were altered in relation to controls. Induced TD horses only showed a reduction in ETD (116.2 ± 8.59 vs 132.10 ± 16.35, p ≤ 0.001), despite all sperm parameters being worse. These findings suggested immunized stallions probably only experience an acute loss of testicular functionality and parenchyma architecture is likely not affected since differences in Ecotext parameters with control stallions were not detected. ETD was the best parameter to identify animals with TD (AUC: 0.84, optimal cut-off value of 124.3 seminiferous tubules/cm2). Correlations were found between ETD and Doppler indices (PI: 0.60; RI: 0.47 p ≤ 0.001), total testicular volume (r: 0.48; p ≤ 0.05) and sperm motility (TM:0.51; and PM:0.54; p ≤ 0.001) and production (r:0.51; p ≤ 0.001). In summary, Ecotext could identify changes in testicular echotexture of stallions with TD. Results open the possibility for new research focused on establishing the relationship between Ecotext parameters and histomorphometry features in stallion testes.

Farmacocinética de dabigatrán y utilización de su antídoto idarucizumab / Pharmacokinetics of dabigatran and use of its antidote idarucizumab

Una de las ventajas de dabigatrán, un nuevo anticoagulante oral de acción directa, es la disponibilidad de un antídoto que permite revertir su actividad: idarucizumab. Este fármaco es utilizado en procedimientos o intervenciones quirúrgicas de urgencia y en hemorragias potencialmente mortales o no controladas.Dabigatrán presenta una semivida de 12-14 horas, alargándose si la función renal está afectada. La decisión de cuándo interrumpir su administración depende del valor del aclaramiento de creatinina y del riesgo hemorrágico de la intervención.Presentamos el caso de un paciente en tratamiento con dabigatrán que ingresa para la realización de una cirugía de cadera tras una caída. Al ingreso se suspende dabigatrán, llevándose a cabo la cirugía al décimo día tras su suspensión. Antes de la cirugía se decide la administración de idarucizumab por continuar alterados los tiempos de coagulación.Exponemos en este caso la falta de mejoría de los tiempos de coagulación tras el uso del antídoto, cuya explicación se pueda deber al largo periodo entre la administración de idarucizumab y la última dosis de dabigatrán administrada (10 días).Por lo tanto, en caso de no poder medir los niveles de dabigatrán, es importante tener en cuenta además de los tiempos de coagulación, aspectos farmacológicos del dabigatrán como la farmacocinética, para evitar la administración innecesaria del antídoto, que puede suponer un riesgo y costes innecesarios. (AU)

One of the advantages of dabigatran, a new direct-acting oral anticoagulant, is the availability of an antidote to reverse its activity: idarucizumab. This drug is used in emergency surgical procedures or interventions and in life-threatening or uncontrolled bleeding.Dabigatran has a half-life of 12-14 hours, lengthening if renal function is affected. The decision on when to interrupt the administration depends on the creatinine clearance rate and the bleeding risk of the procedure.We present the case of a patient on dabigatran treatment who was hospitalized for hip surgery after a fall. On admission, dabigatran was suspended, and surgery was performed on the tenth day after its suspension. Before surgery, it was decided to administer idarucizumab due to continued altered coagulation times.In this case, it is reported the lack of improvement in clotting times after the use of the antidote, which may be explained by the long period of time between the administration of idarucizumab and the last dose of dabigatran administered (10 days).Therefore, in case of dabigatran levels cannot be measured, it is important to consider, in addition to clotting times, pharmacological aspects of dabigatran such as pharmacokinetics, in order to avoid unnecessary administration of the antidote, which may entail unnecessary risk and costs. (AU)

Dental extraction following zoledronate, induces osteonecrosis in rat's jaw.

BACKGROUND: Bisphosphonate-Related Osteonecrosis of the Jaw (BRONJ) is clinically characterized by the presence of exposed bone in the oral cavity that persists for more than eight weeks. Previous attempts to establish an animal model have not sufficiently considered disease features. Our aim was to establish an inexpensive and replicable animal model that develops BRONJ in a short time. MATERIAL AND METHODS: Thirty-two male Wistar rats were randomly divided into two groups: control and experimental. In the experimental group, we administered 0.06mg/kg intraperitoneal dose of zoledronic acid (ZA) 7 and 14 days prior to maxillary second molar extraction. At two, four and six weeks after tooth extraction, the animals were euthanized, and we dissected the maxilla following histological procedures. We stained serial slides with hematoxylin and eosin and Masson's trichrome. The samples were harvested for macroscopic, radiologic and histological evaluation of bone changes. RESULTS: At two weeks postextraction, we observed exposed necrotic bone in dental socket areas in experimental groups. Radiological analysis revealed osteolytic lesions accompanied by extensive destruction and sequestrum formation in the same group. Histological examination confirmed the absence of necrotic bone in control groups in contrast with the experimental groups. The percentage of empty lacunae and the number of osteoclasts and the necrotic bone area were significantly increased (p<0.05) in the experimental groups. CONCLUSIONS: The animal model using ZA administration to prior dental extraction successfully mimicked human BRONJ lesions. Also, the model was easily replicated, inexpensive and showed different features than other previous BRONJ models.

Cáncer en pacientes jóvenes (Parte 2) Carcinomas de cavidad bucal en sujetos de bajo riesgo: presentación de 4 casos y revisión de la literatura / Oral cancers in low-risk subjects: presentation of 4 cases and literature review

El cáncer en cavidad bucal y de la región de cabeza y cuello se presenta con mayor frecuencia entre la quinta y sexta década de la vida generalmente atribuido al uso indiscriminado de substancias como el alcohol y el tabaco por un periodo de tiempo considerable. Sin embargo estudios recientes demuestran un incremento en la incidencia en pacientes jóvenes que nunca estuvieron expuestos a estos y a otros factores como riesgo ocupacional, predisposición genética, dieta. Se presenta 4 casos de carcinomas en cavidad bucal y revisión de la literatura.

Oral cavity cancer and head and neck region occurs most often between the fifth and sixth decade of life and is generally attributed to the indiscriminate use of substances such as alcohol and snuff for a period of time. However, recent studies show an increased incidence in younger patients who have never been exposed to these and other risk factors such as occupational factors, genetic predisposition, diet. Four cases of oral carcinoma are presented as well as a literature review.

[An update in drug use during pregnancy: risk classification]. / Actualización del uso de fármacos durante el embarazo: categorías de riesgo.

OBJECTIVE: To review medicines pregnancy category and establish the degree of conformity between the two systems more used: FDA (Food and Drug Administration) and ACPM (advisory Committee on Prescription Medicines). METHODS: drugs used in most frequent pathologies during pregnancy have been selected and found its pregnancy category according to FDA and ACPM. The degree of conformity has been established between both categorisation systems. RESULTS: a total of 270 medicines were reviewed. 260 drugs had pregnancy category by FDA and 245 by ACPM system. 232 drugs had pregnancy category defined by both classifications (FDA and ACPM). We found 70,2% of them in the same pregnancy category. CONCLUSIONS: The discrepancies found in both pregnancy categorisation systems can be confused in order to prescribe and know its safety statement of medicines during pregnancy which can limits its utility. It would be desirable more studies after medicines registered to get more information which could help to use safety drugs during pregnancy and minimize discrepancies between both pregnancy categorisation systems.

OBJETIVO: Revisar la categoría de riesgo de los medicamentos durante el embarazo y establecer el grado de concordancia entre los dos sistemas de clasificación más empleados: FDA (Food and Drug Administration) y ACPM (advisory Committee on Prescription Medicines). MÉTODOS: Se seleccionaron los fármacos de prescripción más frecuente durante el embarazo y se buscó su categoría de riesgo en el embarazo de acuerdo con la FDA y el ACPM. Se estableció el grado de concordancia para ambos sistemas de clasificación. RESULTADOS: se revisó un total de 270 medicamentos. 260 fármacos tenían una categoría para el embarazo según la FDA y 245 en el sistema ACPM. 232 fármacos tenían una categoría para el embarazo definida por ambas clasificaciones (FDA y ACPM). Encontramos que el 70,2% de ellos estaban en la misma categoría. CONCLUSIONES: Las discrepancias encontradas entre ambos sistemas de categorización pueden generar confusión a la hora de la prescripción y conocer las advertencias de seguridad de los medicamentos durante el embarazo, lo cual puede limitar su utilidad. Sería deseable que se hiciesen más estudios tras el registro de los fármacos para obtener más información que podría ayudar al empleo de fármacos seguros durante el embarazo y minimizar las discrepancias entre ambos sistemas de categorización.

Actualización del uso de fármacos durante el embarazo: categorías de riesgo / An update in drug use during pregnancy: risk classification

Objetivo: Revisar la categoría de riesgo de los medicamentos durante el embarazo y establecer el grado de concordancia entre los dos sistemas de clasificación más empleados: FDA( Food and Drug Administration) y ACPM (advisory Committeeon Prescription Medicines).Métodos: Se seleccionaron los fármacos de prescripción más frecuente durante el embarazo y se buscó su categoría de riesgo en el embarazo de acuerdo con la FDA y el ACPM. Se estableció el grado de concordancia para ambos sistemas de clasificación. Resultados: se revisó un total de 270 medicamentos. 260 fármacos tenían una categoría para el embarazo según la FDA y245 en el sistema ACPM. 232 fármacos tenían una categoría para el embarazo definida por ambas clasificaciones (FDA y ACPM). Encontramos que el 70,2% de ellos estaban en la misma categoría. Conclusiones: Las discrepancias encontradas entre ambos sistemas de categorización pueden generar confusión a la hora de la prescripción y conocer las advertencias de seguridad de los medicamentos durante el embarazo, lo cual puede limitar su utilidad. Sería deseable que se hiciesen más estudios tras el registro de los fármacos para obtener más información que podría ayudar al empleo de fármacos seguros durante el embarazo y minimizar las discrepancias entre ambos sistemas de categorización (AU)

Objective: To review medicines pregnancy category and establish the degree of conformity between the two systems more used: FDA (Food and Drug Administration) and ACPM (advisory Committee on Prescription Medicines). Methods: drugs used in most frequent pathologies during pregnancy have been selected and found its pregnancy category according to FDA and ACPM. The degree of conformity has been established between both categorization systems. Results: a total of 270 medicines were reviewed. 260 drugs had pregnancy category by FDA and 245 by ACPM system. 232 drugs had pregnancy category defined by both classifications (FDA and ACPM). We found 70,2% of them in the same pregnancy category. Conclusions: The discrepancies found in both pregnancy categorization systems can be confused in order to prescribe and know its safety statement of medicines during pregnancy which can limits its utility. It would be desirable more studies after medicines registered to get more information which could help to use safety drugs during pregnancy and minimize discrepancies between both pregnancy categorization systems (AU)

Colloidal centrifugation of stallion semen results in a reduced rate of sperm DNA fragmentation.

Stallion spermatozoa recovered and examined immediately after colloidal centrifugation resulted in a higher straight-line velocity (VSL) than sperm processed using direct conventional centrifugation (p = 0.000), but there was no differences in the progressive motility or sperm DNA fragmentation (SDF) as determined by the sperm chromatin dispersion assay. However, when centrifuged spermatozoa were incubated at 37 °C for 24 h to determine the rate of SDF (r-SDF), a lower r-SDF (p = 0.0011) was observed in those sperm recovered after colloidal separation (0.5 ± 0.1%/h) compared to direct (1.2 ± 0.4%/h) or no centrifugation (r-SDF = 1.2 ± 0.3%/h). These results confirm that colloidal separation of stallion spermatozoa results in prolonged sperm DNA longevity, but these differences were only apparent following a period of incubation and dynamic assessment. Consequently, we strongly recommend the use of the dynamic form of the SDF assay for evaluating centrifugation and/or other ex vivo procedures, as a single basal assessment of SDF may inadvertently result in a false-positive evaluation of DNA quality.

Prevalencia de complicaciones en cirugía bariátrica en una clínicaprivada de la ciudad de Cali (Colombia) / Prevalence of complications in bariatric surgery at a private

Objetivo: Se determinó la prevalencia de complicaciones precoces en pacientes con intervenciones quirúrgicasbariátricas en una clínica especializada de Cali- Colombia.MetodologíaSe realizó un estudio descriptivo retrospectivo, revisando 1388 registros de pacientes sometidos acirugía bariátrica entre el 2007 y el 2011 y se realizó un control de calidad de la información converificación aleatoria de 10 registros. Para la consolidación de las variables se elaboró una ficha técnicaque incluía las variables del estudio, actividad realizada directamente por el grupo investigador ypara el análisis se utilizó el programa Ep-Info, versión 2003.ResultadosLa prevalencia de complicaciones en todo el período fue de 4,8%, con tendencia a la disminución, de11,2% en el 2007 a 2,4% en el 2011. El 69,7% eran de sexo femenino con predominio de edades entre40 y 60 años.Al 56,1% de los pacientes que presentaron complicaciones, se les había realizado sleevegástrico, al 42,4% by-pass gástrico y al 1,5%retiro de banda gástrica.Las complicaciones presentadasfueron: absceso intra-abdominal (33,3%), fístula (19,7%), diarrea (16,7%), dehiscencia de sutura(13,6%), hemorragia digestiva (7,6%),desnutrición (4,5%),infección de herida quirúrgica (3,0%)e infección urinaria (1,5%). La fístula y la diarrea fueron más frecuentes en el sleeve gástrico ladehiscencia de sutura y la hemorragia digestiva lo fueron en el by-pass gástrico.ConclusionesLa baja prevalencia de complicaciones con una clara tendencia al descenso en los años analizados,expresa los esfuerzos realizados por perfeccionar la técnica y brindar la mejor calidad asistencial alpaciente intervenido.

Objective: To determine the prevalence of early complications in patients with bariatric surgery in a specializedhospital in Cali, Colombia.MethodologyA descriptive, retrospective study was conducted, by reviewing 1388 records of patients undergoingbariatric surgery between 2007 and 2011. It was performed a quality control check of the information,with the verification of 10 records at random. In order to consolidate the variables, the research groupdesigned a data sheet that included such variables of the study. An EpiInfo program, version 2003,was used for the analysis of the results.ResultsThe prevalence of complications throughout the period was 4,8%, with a tendency to decrease, from11,2% in 2007 to 2,4% in 2011. 69,7% were female, predominantly aged between 40 and 60. 56,1%of patients with complications had undergone gastric sleeve, 42,4% gastric bypass and 1,5% gastricband removal. The complications observed were: intra-abdominal abscess (33,3%), fistula (19,7%),diarrhea (16,7%), suture dehiscence (13,6%), gastrointestinal bleeding (7,6% ), malnutrition (4,5%),wound infection (3,0%) and urinary tract infection (1,5%). Fistula and diarrhea were more commonin the gastric sleeve, while suture dehiscence and gastrointestinal bleeding were more common in thegastric bypass.ConclusionsThe low prevalence of complications with a clear downward trend in the years analyzed, expresses theefforts to perfect the technique and to provide the best quality care for the surgical patient.

Tumors of the salivary gland in Mexicans. A retrospective study of 360 cases.

OBJECTIVE: To establish distribution frequency and demographic characteristics of salivary gland tumours (SGT) in order to identify possible risk profiles. DESIGN OF STUDY: The present report constitutes an eight year retrospective study (January 2000-August 2007). The archives of the Clinical and Experimental Pathology Laboratory (Graduate and Research Division, Dental School, National Autonomous University of Mexico) as well as archives of the Surgical Pathology Service (General Hospital, Mexico City) were subject to revision in order to select all cases where SGT tumour diagnoses were emitted. Age and gender of patients as well as SGT topography were obtained from medical records. Selected cases were classified according to location of the lesion, histological lineage and biological behaviour. RESULTS: 360 cases of SGT were included, 227 (67%) cases were benign tumours, while 83 cases (23%) were malignant tumours. SGT were most frequent in women with ages ranging from their 3rd to 5th decades of life. 275 tumours were located in major salivary glands, 78.9% of them were identified in the parotid gland. The most frequent location of tumours arising from minor salivary glands (33 cases, 38%) was found in the palatine glands. Tumours of epithelial lineage were the predominant histological type. The most frequent benign tumours were pleomorphic adenomas (86.1%) and papillary cystadenoma lymphomatosum (7.3%). The most frequent malignant tumours were adenoid cystic carcinomas (25%) and mucoepidermoid carcinomas (23.6%). CONCLUSIONS: Salivary gland tumours in Mexican population appear principally in major salivary glands of women in their 3rd to 5th decade of life.

Simple and economic colloidal centrifugation protocols may be incorporated into the clinical equine sperm processing procedure.

For many years in human assisted-reproduction procedures there have been special protocols to prepare and improve sperm quality. Colloidal centrifugation (CC) is a useful technique that has been proved to enhance semen quality by selection of the best spermatozoa for different species. Its use is recommended to improve fertility of subfertile stallions but current CC protocols are clinically complicated in the equine sperm processing technique due to economic and technical difficulties. The aim of this study was to determine the optimal processing procedures to adapt the use of a CC product (EquiPure™) in the equine reproduction industry. A total of nineteen ejaculates were collected from 10 Purebred Spanish Horses (P.R.E horses) using a Missouri artificial vagina. Gel-free semen aliquots were analyzed prior to treatment (control). Semen was subjected to one of six CC protocols with EquiPure™ and centrifuged samples were statistically evaluated by ANOVA and Duncan tests (p<0.05) for sperm quality and recovery rate. We obtained higher values by colloidal centrifugation in LIN, STR and BCF variables and DNA fragmentation index trended to be lower in most of the CC protocols. The studied protocols were shown to be as efficient in improving equine sperm quality as the current commercial EquiPure™, with the added advantage of being much more economical and simple to use. According to these results it seems to be possible to incorporate single layer and or high colloidal centrifugation volume protocols what would make them simple, economic and clinically viable for the equine sperm processing procedure.

Reclassification of odontogenic keratocyst as tumour. Impact on the odontogenic tumours prevalence.

AIM: The aim of this study was to establish the impact of the redefinition and reclassification of odontogenic keratocyst (OKC) as a tumour on the prevalence of odontogenic tumours (OT). METHODS: We revised 15 435 files of a teaching head and neck histopathology service in the time period from January 1981 to December 2008 and 478 cases of OT were selected. The 342 cases from 1981 to 2004 were classified according 1992 to the World Health Organization (WHO)-classification (excluding keratocystic OT) while the 136 cases from 2005 onwards were classified according to the 2005 WHO-classification (including keratocystic OT). Age and gender were obtained from medical records. The frequency distribution and prevalence of OT from each periods of time were compared. A chi-square test was performed (P < 0.05 95% confidence interval). RESULTS: The prevalence of OT increases 92% in the 2005-2008 period; from 2.6% (1981-2004 period) to 5% (2005-2008 period) (P 0.000).The most frequent OT in the 1981-2004 period was odontoma (45% of all OT) while in the 2005-2008 period was Keratocystic Odontogenicv Tumour (38.9%). CONCLUSIONS: The redefinition of OKC as a tumour produced an increase in the frequency and prevalence of OT.

Regulation of visceral adipose tissue-derived serine protease inhibitor by nutritional status, metformin, gender and pituitary factors in rat white adipose tissue.

Visceral adipose tissue-derived serine protease inhibitor (vaspin) is a recently discovered adipocytokine mainly secreted from visceral adipose tissue, which plays a main role in insulin sensitivity. In this study, we have investigated the regulation of vaspin gene expression in rat white adipose tissue (WAT) in different physiological (nutritional status, pregnancy, age and gender) and pathophysiological (gonadectomy, thyroid status and growth hormone deficiency) settings known to be associated with energy homeostasis and alterations in insulin sensitivity. We have determined vaspin gene expression by real-time PCR. Vaspin was decreased after fasting and its levels were partially recovered after leptin treatment. Chronic treatment with metformin increased vaspin gene expression. Vaspin mRNA expression reached the highest peak at 45 days in both sexes after birth and its expression was higher in females than males, but its levels did not change throughout pregnancy. Finally, decreased levels of growth hormone and thyroid hormones suppressed vaspin expression. These findings suggest that WAT vaspin mRNA expression is regulated by nutritional status, and leptin seems to be the nutrient signal responsible for those changes. Vaspin is influenced by age and gender, and its expression is increased after treatment with insulin sensitizers. Finally, alterations in pituitary functions modify vaspin levels. Understanding the molecular mechanisms regulating vaspin will provide new insights into the pathogenesis of the metabolic syndrome.

Short communication: oral lesions in HIV/AIDS patients undergoing HAART including efavirenz.

Oral lesions (OL) have an important prognostic value for HIV/AIDS patients. However, the behavior of OL in HIV/AIDS patients undergoing highly active antiretroviral therapy including efavirenz (HAART/EFV) has not been documented. Our objective was to establish the prevalence of OL in HIV/AIDS patients undergoing HAART/EFV and to compare it with the prevalence of OL in patients undergoing antiretroviral therapy including a protease inhibitor (HAART/PI). Seventy-three HIV/AIDS patients undergoing antiretroviral treatment for at least for 6 months at "La Raza" Medical Center's Internal Medicine Unit (IMSS, Mexico City) were included. To detect OL, a detailed examination of oral soft tissues was performed in each patient. Patient records recorded gender, seropositivity time, route of contagion, antiretroviral therapy type and duration, CD4 lymphocyte count/ml, and viral load. Two groups were formed: 38 patients receiving HAART/EFV [two nucleoside analogue reverse transcriptase inhibitors (NARTI) plus efavirenz] and 35 patients receiving HAART/PI (two NARTIs plus one PI). OL prevalence was established in each study group. The Chi-square test was applied (p < 0.05(IC95%)). OL prevalence in the HAART/EFV group (32%) was lower (p < 0.007) than in the HAART/PI group (63%). Candidosis was the most prevalent OL in both groups. Herpes labialis, HIV-associated necrotizing periodontitis, xerostomia, hairy leukoplakia, and nonspecific oral sores were identified. The highest prevalence for all OL was found in the HAART/PI group. These findings suggest that HIV/AIDS patients undergoing HAART/EFV show a lower prevalence of oral lesions than patients undergoing HAART/PI.

[Prescription errors after the implementation of an electronic prescribing system]. / Errores de prescripción tras la implantación de un sistema de prescripción electrónica asistida.

OBJECTIVE: This study sets out to identify, compare and evaluate the medication errors of a manual prescribing system and an electronic prescribing system during the prescription and transcription phases. METHOD: A prospective study of two clinical in-patient units (pneumology and infectious diseases) in one general hospital. Two phases were studied; before and after an electronic prescribing system was implemented. Each phase lasted one month. A comparative analysis was carried out of the medication errors in the medical prescription process, the transcription process and the administration recording process carried out by nursing staff as well as the pharmacist s transcriptions/validations. RESULTS: A total of 3,908 patient treatment errors and 129 patient identification errors were detected during both of the periods studied. The rate of errors in patient identification or treatment orders using the manual prescribing system was 14.4 against 1.3% after the electronic system was implemented. The relative risk reduction for infectious diseases and pneumology was 100 and 85.44%, respectively (statistically significant). In general, relative risk reduction was achieved in both units, oscillating between 78.91 and 100%. The absolute risk reduction oscillated between 5.09 and 30.45% for errors in drug data, doses, frequency/time and route of administration. These results were statistically significant. CONCLUSIONS: The electronic prescribing system has reduced errors in the identification, prescription and transcription of pharmacological treatment and has consequently helped to improve the quality and safety of drug treatment received by patients.

Errores de prescripción tras la implantación de un sistema de prescripción electrónica asistida / No disponible

Objetivo: El objetivo de este estudio es detectar, cuantificar ycomparar los errores de medicación producidos con un sistema deprescripción manual comparado con un sistema de prescripciónelectrónica asistida en las fases de prescripción y transcripción.Método: Estudio prospectivo realizado en dos unidades clínicasde hospitalización (neumología y enfermedades infecciosas) deun hospital general. El estudio ha tenido dos fases (antes y despuésde la implantación de la prescripción electrónica asistida) ycada una tuvo una duración de un mes. Se han analizado y comparadolos errores de medicación producidos en los procesos deprescripción médica, transcripción y registro de la administraciónpor el personal de enfermería, así como en la transcripción/validaciónpor el farmacéutico.Resultados: Durante los dos periodos de estudio se detectaronun total de 3.908 errores referentes al tratamiento de lospacientes y 129 correspondientes a los datos identificativos de losmismos. Respecto a los errores cometidos en la identificación delpaciente o la orden de tratamiento, con la prescripción manual seobtuvo una tasa de error del 14,4%, mientras que tras la implantaciónde la prescripción electrónica fue del 1,3%, siendo lareducción relativa del riesgo del 100 y del 85,44% en el serviciode infecciosas y neumología respectivamente (estadísticamentesignificativo). Se ha conseguido una reducción relativa del riesgo,de forma global en ambas unidades, que oscila entre el 78,91% yel 100% y una reducción absoluta del riesgo que oscila entre el5,09 y el 30,45% respecto a los errores en los datos del medicamento,dosis, frecuencia/hora y vía/modo de administración,siendo estos resultados estadísticamente significativos.Conclusiones: La utilización de la prescripción electrónicaasistida ha disminuido los errores en la identificación, prescripcióny trascripción del tratamiento farmacológico y por tanto ha contribuidoa mejorar la calidad y la seguridad de la farmacoterapia aplicadaa los pacientes

Objective: This study sets out to identify, compare and evaluatethe medication errors of a manual prescribing system and anelectronic prescribing system during the prescription and transcriptionphases.Method: A prospective study of two clinical in-patient units(pneumology and infectious diseases) in one general hospital. Twophases were studied; before and after an electronic prescribingsystem was implemented. Each phase lasted one month. A comparativeanalysis was carried out of the medication errors in themedical prescription process, the transcription process and theadministration recording process carried out by nursing staff aswell as the pharmacist’s transcriptions/validations.Results: A total of 3,908 patient treatment errors and 129patient identification errors were detected during both of the periodsstudied. The rate of errors in patient identification or treatmentorders using the manual prescribing system was 14.4against 1.3% after the electronic system was implemented. Therelative risk reduction for infectious diseases and pneumology was100 and 85.44%, respectively (statistically significant). In general,relative risk reduction was achieved in both units, oscillatingbetween 78.91 and 100%. The absolute risk reduction oscillatedbetween 5.09 and 30.45% for errors in drug data, doses, frequency/time and route of administration. These results were statisticallysignificant.Conclusions: The electronic prescribing system has reducederrors in the identification, prescription and transcription of pharmacologicaltreatment and has consequently helped to improvethe quality and safety of drug treatment received by patients

[Detection and analysis of adverse drug reactions in a general hospital's emergency department]. / Detección y análisis de reacciones adversas a medicamentos en el servicio de urgencias de un hospital general.

OBJECTIVE: To detect and analyze adverse drug reactions (ADR) leading to emergency room visits in our hospital, as well as their severity and outcome, and medications most commonly involved, from selected alerting diagnoses. METHOD: A retrospective study for the period from January 2003 to December 2004, where all reports by the emergency department including our wanted diagnoses were reviewed. RESULTS: A total of 1,626 reports with alerting diagnoses were found, of which 444 (27.3%) were confirmed as potential adverse drug reactions. Of 444 cases, 345 (77.7%) were discharged to their homes and 90 (20%) were admitted. In all, 52.9% of adverse drug reactions were considered moderate, and 19.6% were considered serious. The major age group involved was that of patients older than 65 years (65.1%), and was involved in 83.9% of adverse drug reactions. Drugs most commonly involved included insulins (26.1%), diuretics (17.3%), digoxin (10.9%), and oral antidiabetics (9.5%). Major organs and systems involved included the endocrine system (55.6%), musculoskeletal system (11%) and cardiovascular system (10.8%). CONCLUSIONS: Drugs commonly used in clinical practice, including insulins, diuretics or oral antidiabetics induce many of the adverse reactions that lead patients to visit emergency departments. A closer monitoring of therapies is still needed to prevent adverse drug reactions.

Detección y análisis de reacciones adversas a medicamentos en el servicio de urgencias de un hospital general / Detection and analysis of adverse drug reactions in a general hospital's emergency department

Objetivo: Detectar y analizar a partir de unos diagnósticos alertantes seleccionados las reacciones adversas a medicamentos (RAM) que ocasionaron consultas al servicio de urgencias de nuestro hospital, su gravedad y la evolución de los pacientes afectados, así como los fármacos más comúnmente implicados en las mismas. Método: Estudio retrospectivo perteneciente al periodo enero 2003-diciembre 2004, en el que se revisaron todos aquellos informes elaborados por el servicio de urgencias en los que figuraban los diagnósticos buscados. Resultados: Se encontraron un total de 1.626 informes con los diagnósticos alertantes, de los cuales 444 (27,3%) se confirmaron como posibles reacciones adversas a medicamentos. De los 444 casos, 345 (77,7%) recibieron el alta domiciliaria y 90 (20%)fueron ingresados. El 52,9% de las reacciones adversas fueron consideradas moderadas y el 19,6% graves. El principal grupo de edad afectado fue el de los mayores de 65 años (65,1%) y estuvo implicado en el 83,9% de las reacciones adversas graves. Los fármacos más comúnmente implicados fueron las insulinas (26,1%), los diuréticos (17,3%), la digoxina (10,9%) y los antidiabéticos orales (9,5%). Los principales órganos y aparatos afectados fueron el sistema endocrino (55,6%), el aparato músculo esquelético (11%) y el aparato cardiovascular (10,8%). Conclusiones: Fármacos de uso muy habitual en la práctica clínica como las insulinas, diuréticos o antidiabéticos orales ocasionan muchas de las reacciones adversas que llevan a los pacientes a los servicios de urgencias. El control más estrecho de los tratamientos sigue siendo necesario para prevenir la aparición de reacciones adversas a medicamentos

Objective: To detect and analyze adverse drug reactions (ADR) leading to emergency room visits in our hospital, as well as their severity and outcome, and medications most commonly involved, from selected alerting diagnoses. Method: A retrospective study for the period from January 2003 to December 2004, where all reports by the emergency department including our wanted diagnoses were reviewed. Results: A total of 1,626 reports with alerting diagnoses were found, of which 444 (27.3%) were confirmed as potential adverse drug reactions. Of 444 cases, 345 (77.7%) were discharged to their homes and 90 (20%) were admitted. In all, 52.9% of adverse drug reactions were considered moderate, and 19.6% were considered serious. The major age group involved was that of patients older than 65 years (65.1%), and was involved in 83.9% of adverse drug reactions. Drugs most commonly involved included insulins (26.1%), diuretics (17.3%), digoxin (10.9%), and oral antidiabetics (9.5%). Major organs and systems involved included the endocrine system (55.6%), musculo skeletal system (11%) and cardiovascular system (10.8%). Conclusions: Drugs commonly used in clinical practice, including insulins, diuretics or oral antidiabetics induce many of the adverse reactions that lead patients to visit emergency departments. A closer monitoring of therapies is still needed to prevent adverse drug reactions

[Implementation of an assisted electronic prescription system applied to parenteral nutrition in a general hospital]. / Implantación de un sistema de prescripción electrónica asistida aplicada a la nutrición parenteral en un hospital general.

Integrated and shared information systems allow obtaining a high degree of information about processes, costs and outcomes, and considerably reducing prescription errors. Assisted electronic prescription, in the setting of total parenteral nutrition, integrated with other hospital databases and with the hospital drugs management system, is a tool that allows increasing patient' safety (by reducing prescription errors), improving quality assistance, improving information systems and information management and the efficiency of used resources. In this work, implementation of an assisted electronic prescription system applied to parenteral nutrition in a hospital and processes reengineering performed in the nutrition setting are described. This implementation was performed by medical staff from the Nutrition and Diet Department and pharmacists from the Pharmacy Department of Ramón y Cajal Hospital using "Nutriwin" computer software. For two months prior and after its implementation, a follow-up of time consumed in the circuit prescription-validation-elaboration-dispensation of parenteral nutrition formulas has been performed. After implementation, treatment orders reach on average 1 h and 15 minutes sooner the Pharmacy Department; by avoiding transcription, a saving of 3 min per nutrition formula calculations is achieved, besides reducing potential errors; elaboration of nutrition formulas can be started on average 1 h and 20 minutes sooner as compared to manual prescription. Besides, the staff that writes down the prescription may know in real time the nutritional profile for each patient in the current episode and the patient's historic. Electronic prescription of treatment orders in this area has represented for our hospital an optimization of the employed resources, a reduction of potential errors that may occur, an improvement in consumption management, and an increase in the whole process quality.