[Expert opinion on strategies to improve vaccination coverage against seasonal influenza]. / Documento de opinión de expertos para la mejora de la cobertura vacunal frente a la gripe estacional.

Seasonal flu continues to be a major public health concern, and the influenza vaccine remains the most effective preventive measure. In Spain, vaccination coverage data from previous seasons show vaccination rates well below official targets; however, these figures improved significantly after the COVID-19 pandemic. Given the importance of achieving and maintaining high vaccination rates in order to avoid the clinical and economic impact of influenza, our multidisciplinary group of experts on vaccines analyzed the impact of low vaccination rates in Spain and drafted a series of measures to boost influenza vaccination coverage, particularly among priority groups.

Efecto de una acción formativa en cuidados intensivos sobre la tasa de contaminación de hemocultivos / Effect of a training programme on blood culture contamination rate in critical care

La contaminación de hemocultivos puede ocurrir desde la extracción al procesamiento, y su tasa no debería exceder del 3%. Objetivo: Evaluar el impacto de una acción formativa sobre la tasa de hemocultivos contaminados tras la instauración de recomendaciones de extracción de muestras basadas en la mejor evidencia. Método: Estudio prospectivo antes-después en una unidad de cuidados intensivos polivalente de 18 camas. Se establecieron dos fases (enero-junio 2012, octubre 2012-octubre 2015) con un período formativo entre ellas. Principales recomendaciones: técnica estéril, mascarilla quirúrgica, doble desinfección de piel (alcohol 70° y clorhexidina alcohólica 2%), desinfección con alcohol 70° de tapones de frascos de cultivo e inyección de muestras sin cambiar aguja. Incluidos todos los hemocultivos de pacientes con solicitud facultativa de extracción. Variables: demográficas, gravedad, patología, motivo de ingreso, estancia y resultados de hemocultivos (negativo, positivo y contaminado). Estadística descriptiva básica: media (desviación estándar), mediana (rango intercuartílico) o porcentaje (intervalo de confianza del 95%). Calculadas tasas de contaminación por 100 hemocultivos extraídos. Análisis bivariado entre períodos. Resultados: Incluidos 458 pacientes. Extraídos 841 hemocultivos, 33 de ellos contaminados. En las variables demográficas, gravedad, diagnóstico y estancia en pacientes con contaminación de la muestra, no se observaron diferencias con no contaminados. Tasas de contaminación pre-formación vs post-formación: 14 vs 5,6 por 100 hemocultivos extraídos (p = 0,00003). Conclusión: Una acción formativa basada en la evidencia ha reducido la contaminación de las muestras. Es necesario seguir trabajando en la planificación de actividades y cuidados para mejorar la detección de contaminantes y prevenir la contaminación de las mismas

Blood culture contamination can occur from extraction to processing; its rate should not exceed 3%. Objective: To evaluate the impact of a training programme on the rate of contaminated blood cultures after the implementation of sample extraction recommendations based on the best evidence. Method: Prospective before-after study in a polyvalent intensive care unit with 18 beds. Two phases were established (January-June 2012, October 2012-October 2015) with a training period between them. Main recommendations: sterile technique, surgical mask, double skin disinfection (70° alcohol and 2% alcoholic chlorhexidine), 70° alcohol disinfection of culture flasks and injection of samples without changing needles. Including all blood cultures of patients with extraction request. Variables: demographic, severity, pathology, reason for admission, stay and results of blood cultures (negative, positive and contaminated). Basic descriptive statistics: mean (standard deviation), median (interquartile range) and percentage (95% confidence interval). Calculated contamination rates per 100 blood cultures extracted. Bivariate analysis between periods. Results: Four hundred and eight patients were included. Eight hundred and forty-one blood cultures were taken, 33 of which were contaminated. In the demographic variables, severity, diagnosis and stay of patients with contaminated samples, no differences were observed from those with uncontaminated samples. Pre-training vs post-training contamination rates: 14 vs 5.6 per 100 blood cultures extracted (P = .00003). Conclusion: An evidence-based training programme reduced the contamination of samples. It is necessary to continue working on the planning of activities and care to improve the detection of pollutants and prevent contamination of samples

Effect of a training programme on blood culture contamination rate in critical care. / Efecto de una acción formativa en cuidados intensivos sobre la tasa de contaminación de hemocultivos.

Blood culture contamination can occur from extraction to processing; its rate should not exceed 3%. OBJECTIVE: To evaluate the impact of a training programme on the rate of contaminated blood cultures after the implementation of sample extraction recommendations based on the best evidence. METHOD: Prospective before-after study in a polyvalent intensive care unit with 18 beds. Two phases were established (January-June 2012, October 2012-October 2015) with a training period between them. Main recommendations: sterile technique, surgical mask, double skin disinfection (70° alcohol and 2% alcoholic chlorhexidine), 70° alcohol disinfection of culture flasks and injection of samples without changing needles. Including all blood cultures of patients with extraction request. VARIABLES: demographic, severity, pathology, reason for admission, stay and results of blood cultures (negative, positive and contaminated). Basic descriptive statistics: mean (standard deviation), median (interquartile range) and percentage (95% confidence interval). Calculated contamination rates per 100 blood cultures extracted. Bivariate analysis between periods. RESULTS: Four hundred and eight patients were included. Eight hundred and forty-one blood cultures were taken, 33 of which were contaminated. In the demographic variables, severity, diagnosis and stay of patients with contaminated samples, no differences were observed from those with uncontaminated samples. Pre-training vs post-training contamination rates: 14 vs 5.6 per 100 blood cultures extracted (P=.00003). CONCLUSION: An evidence-based training programme reduced the contamination of samples. It is necessary to continue working on the planning of activities and care to improve the detection of pollutants and prevent contamination of samples.

Non-visible colovesical fistula located by cystoscopy and successfully managed with the novel Padlock® device for endoscopic closure.

INTRODUCTION: The development of novel mechanical endoscopic closure systems allows now the management of some gastrointestinal fistula types in a minimally invasive way. However, the correct location of the fistulous tract is essential to achieve successful endoscopic closure. CASE REPORT: A 69-year-old woman with high risk for surgery presented with recurrent cystitis, pneumaturia, and enteruria 2 months after medical-treated diverticulitis. Computerized tomography demonstrated colovesical fistula but colonoscopy could not locate the fistulous opening. A cystoscopy was performed and the fistulous tract was shown using a guidewire. Then, a novel over-the-scope clip device Padlock® system was released in the sigmoid colon, with successful endoscopic closure through this not previously described collaborative approach between urologists, surgeons, and gastroenterologists.

[Peri-operative management of disease modifying anti-rheumatic drugs: recommendations based on a meta-analysis]. / Manejo perioperatorio de los fármacos modificadores de la enfermedad en Reumatología: recomendaciones basadas en un metaanálisis.

The objective of this paper is make recommendations for the perioperative management of antirheumatic treatment based on the best available evidence. A systematic review was performed including studies in which patients with rheumatic diseases treated with biological and non-biological disease-modifying antirheumatic drugs (DMARDs) had undergone surgery. A total of 5,285 studies were recorded, of which 27 were finally included. These contained information on 5,268 patients and 7,933 surgeries. The majority were women (mean age 55 years) were diagnosed with rheumatoid arthritis, and the most studied drug was methotrexate (MTX). The final recommendations include: maintaining treatment with MTX or leflunomide in the perioperative period in the absence of other risk factors for postoperative complications (Level of Evidence 1c, Grade D recommendation). Biological DMARDs should be temporarily suspended, or the surgery scheduled as far as possible from the last dose, and, if there were other risk factors a space at least two doses (Level of Evidence 2c; Grade D recommendation).

Upper gastrointestinal findings detected by capsule endoscopy in obscure gastrointestinal bleeding.

OBJECTIVE: We analyzed our experience with the use of capsule endoscopy in areas that can be explored with gastroscopy to justify obscure bleeding, as well as the outcome after a new recommended gastroscopy in order to determine if a second gastroscopy before the capsule study can provide any benefit in the management of this disease. METHODS: We retrospectively studied 82 patients who were explored with capsule endoscopy for obscure gastrointestinal bleeding who had undergone previously only one gastroscopy. Findings in the zones which were accessible by gastroscopy were normal, mild/known and severe/unknown. In the latter cases we recommended a second gastroscopy, and their treatment and outcome were subjected to further study. RESULTS: Capsule endoscopy did not find any unknown esophageal findings. In 63% of cases, no gastric or duodenal lesions were shown; in 20%, lesions were mild or had been previously diagnosed, and in 17%, a new gastroscopy was recommended due to the discovery of an unknown condition which could be the cause of the obscure bleeding. This new information brought about a change in treatment for 78% of patients in this group, all of whom improved from their illness. Capsule endoscopy found significant intercurrent alterations in the small intestine in only 14% of cases. CONCLUSIONS: The performance of a second gastroscopy, previous to capsule endoscopy, in the study of obscure gastrointestinal bleeding can offer benefits in diagnostic terms and may introduce therapeutic changes. A detailed analysis of the upper tract frames in intestinal capsule endoscopy studies is mandatory since it may provide relevant information with clinical impact on the management of these patients.

Public opinion survey after capsule endoscopy: patient s point of view on its utility.

AIM: When programming a medical test such as capsule endoscopy (CE), finding the closest point between the patient's experience and his/her expectation is essential to improve any further explorations. For this purpose we designed a form which tries to collect the information required. MATERIAL AND METHODS: From December 2003 to January 2005 we examined the small intestine of 98 patients with the help of CE. Later they were sent an anonymous questionnaire in July 2005, which included 10 questions upon the origin and previous knowledge of the patient about this technique, their tolerance to it, and the value they attached to it with regard to finding a new diagnosis and assigning different treatments, and also the incidence in the positive or negative evolution of their disease in particular and of medicine in general. RESULTS: Answer rate reached 58% and was slightly higher among women and people over 70 years; 80% of repliers had been informed about CE by a physician, while nearly all the rest had received previous information from the media; 37% had had symptoms for more than 12 months, while only 17% had suffered them for one month before the exploration. A bit over 30% did not know what the specific diagnostic field of the test was (most of them women and young people), although most of them were not surprised by the procedure. Over 75% showed "acceptable" or "excellent" tolerance, while 5.5% (most of them young people) found it hard to bear. The opinion about its utility in the diagnosis was 37%, and although 70% thought that CE had revealed nothing new about their pathology, over 60% declared feeling better after the test; 84% pointed out that it had achieved a breakthrough for their quality of life (most of them men and very old people), and only 13% thought it was worthless. However, nearly all the answers agreed in that CE was an "important" or "very important" diagnostic device. CONCLUSIONS: After the test using CE, the diagnostic benefit detected by the patient is not the same as that shown by technical studies. Nevertheless, the test can be highly satisfactory for the patient in particular, and also in an overall view. CE is a well-tolerated test, applied in our setting to chronic diseases and that, contrary to what we supposed, is explained to patients mainly by a physician. Most of them are not familiar with its specific indications.

Hemorragia digestiva incohercible por metástasis pancreática de cáncer renal / Persistent intestinal bleeding secondary to pancreatic metastasis from renal cell carcinoma

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Proyecto de un sistema de gestión de calidad, según la norma ISO 9001:2000, en el servicio de compras y suministros de la gerencia de atención primaria de Lugo

La aplicación de sistemas de gestión de calidad según la norma ISO 9001:2000 se ha considerado muy adecuada a las actividades y características de las administraciones públicas. En este artículo presentamos un proyecto de gestión de calidad en el ámbito del aprovisionamiento sanitario en atención primaria, del que no existen muchas experiencias. El proyecto del servicio de compras y suministros de la Gerencia de Atención Primaria (GAP) de Lugo es un proyecto sencillo y al mismo tiempo novedoso, en el que se ha diseñado un plan de comunicación y de trabajo en equipo. Para comenzar el proyecto se creó una estructura orgánica y funcional adecuada y dirigida a la distribución de competencias y responsabilidades en materia de calidad. El sistema de elaboración de procedimientos abierto a la participación de todo el personal implicado y con continuas reuniones de los grupos de trabajo debe garantizar la adecuación de dichos procedimientos a las necesidades de la organización. Además de los resultados prácticos, ya alcanzados antes de lograr la certificación, es muy destacable que el solo intento de planificar y empezar a desarrollar e impulsar un proyecto de estas características ha supuesto hasta la fecha unos beneficios importantes en la metodología de trabajo y en la propia realización de las actividades de nuestra organización. Estos resultados, por la mejora que suponen, deben servir de motivación a otros servicios de nuestra gerencia y de otras (AU)

[Dietary intake of a group of patients with irritable bowel syndrome; relation between dietary fiber and symptoms]. / Patrón de ingesta en un grupo de pacientes con síndrome de intestino irritable; relación de la ingesta de fibra con los síntomas.

OBJECTIVES: The aim of our study was to evaluate the oral dietary intake of a group of patients with irritable bowel syndrome and to compare with international recommendations. PATIENTS AND METHODS: A total of 53 patients with irritable bowel syndrome was enrolled in a non-propabilistic sample. Patients were diagnose with Roma II criteria. In all patients were determined, weight, height, body mass index, dietary intake of 3 days and a symptoms scoring system. RESULTS: The average age of 53 patients was 45.67+/-13.6 years with a distribution of sex (22 males/31 females). Caloric intakes was right in absolute terms and corrected by weight. Distribution of calories was 41.5% of carbohydrates, a 19.8% of proteins, and a 38.7% of lipids, showing a high intake of lipids and low of carbohydrates. A low intake of vitamin A and D was detected. High intake of vitamin B12, vitamin C and niacine was observed. A low intake of calcium, magnesium, yodo and zinc was detected. Intake of soluble fiber was lower than insoluble fiber (1.46+/-0.74 g/day) (19%) vs 6.21+/-2.67 g/day (71%). Intake of fiber corrected by calories was low 4.5+/-1.2 g/1000 calories. In correlation analysis, insoluble fiber (r=0.46; p < 0.05) and soluble fiber (r=0.42; p < 0.05) were inverse correlated with general symptoms. CONCLUSIONS: Patients with irritable bowel syndrome showed a deviation of mineral and vitamin dietary. Fiber intake is low, a correlation between fiber intake and general symptoms was detected.

[Effects of oxytetracycline on rat liver]. / Efectos de la oxitetraciclina sobre el hígado de rata.

OBJECTIVES: This experimental project was designed to evaluate: a) the capacity of oxytetracycline to induce microvesicle steatosis in rat liver when administered over long time periods; b) whether female rats are more susceptible to this substance, and c) the possible ultrastructural alterations and their relation to the mechanisms of steatosis. METHODS: Sixty-two Wistar rats (31 males and 31 females) were distributed into six groups, two control groups and four experimental groups. The experiment lasted three months. Blood and hepatic tissue samples were extracted under anesthesia for morphologic study (optical and electron microscopy). RESULTS: Steatosis was of the microvesicular type with mainly periportal distribution. Steatosis developed in the treated groups and the degree was significantly greater in the females (p = 0.004). No relationship was found with dose. Ultrastructural study revealed microsome dilation in all experimental groups, with no differences according to sex. Despite the steatosis, no proliferation of peroxisomes or mitochondrial alterations were observed. CONCLUSIONS: Oxytetracycline produced predominantly periportal microvesicular hepatic steatosis, appearing mostly in the females. As a possible mechanism for tetracycline-induced steatosis, we postulate a decrease in mitochondrial, peroxisome and microsome function as a result of protein synthesis inhibition in these cell compartments.

[Anti-ulcer drug consumption in Spain]. / Consumo de fármacos antiulcerosos en España.

OBJECTIVE: To check whether therapy to eradicate Helicobacter pylori has succeeded in reducing the consumption of traditional ulcer medication. DESIGN: A longitudinal, retrospective study of the use of medication. SETTING: Spain in the decade from 1988 to 1997. PARTICIPANTS: Pharmaceutical products belonging to the anatomical therapeutic group AO2B (for ulcers) and dispensed at the Social Security's expense. MEASUREMENTS AND MAIN RESULTS: Despite the widespread use of treatments to eradicate H. pylori, it was found that consumption of ulcer medication continued to increase markedly, from 5 daily doses per 1000 inhabitants in 1988 to 19 in 1997. In 1997 the two most frequently taken active principles in the group were omeprazole and ranitidine. Drugs indicated for gastric protection were also used much more. However, in absolute values, they stayed well below anti-H2 drugs and proton pump inhibitors. CONCLUSION: The introduction into Spain of therapy to eradicate H. pylori has failed to reduce the use of ulcer medication. The use of anti-H2 drugs and proton pump inhibitors for gastric protection may explain a part of the increase in consumption experienced by these two pharmacological groups.

Successful treatment of postoperative external biliary fistulas by endoscopic sphincterotomy.

External biliary fistulas occur as a complication of biliary tract surgery. Until recently, excision of the fistula was the primary therapeutic modality. We describe seven cases of postoperative external biliary fistula successfully treated by endoscopic papillotomy. Fistulation occurred in four patients after operations for hydatid cysts of the liver, in one patient after cholecystectomy for acute cholecystitis, in one patient with carcinoma of the periampullary region after a decompression procedure, and in the remaining patient after an intraoperative biopsy of a carcinoma of the gallbladder. Endoscopic sphincterotomy is a reliable and effective therapeutic alternative in patients with external biliary fistulas.