The keys to successful TIPS in patients with portal vein thrombosis and cavernous transformation. / Trombosis y cavernomatosis portal: las claves para el éxito de un TIPS.

Portal vein thrombosis is a common complication in patients with cirrhosis. Anticoagulation involves a high risk of bleeding secondary to portal hypertension, so placing transjugular intrahepatic portosystemic shunts (TIPS) has become an alternative treatment for portal vein thrombosis. Three strategies for TIPS placement have been reported: 1) portal recanalization and conventional implantation of the TIPS through the jugular vein; 2) portal recanalization through percutaneous transhepatic/transsplenic) access; and (3) insertion of the TIPS between the suprahepatic vein and a periportal collateral vessel without portal recanalization. We describe different materials that can be used as fluoroscopic targets for the TIPS needle and for portal recanalization. This article aims to show the success of TIPS implantation using different combinations of the techniques listed above, which is a good treatment alternative in these patients whose clinical condition makes them difficult to manage, and to show that portal vein thrombosis/cavernous transformation should not be considered a contraindication for TIPS.

Optimizing the management of patients with BCLC stage-B hepatocellular carcinoma: Modern surgical resection as a feasible alternative to transarterial chemoemolization.

OBJECTIVE: To analyse the impact of liver resection (LR) in patients with Hepatocellular Carcinoma (HCC) within the Barcelona-Clinic-Liver-Cancer (BCLC)-B stage. METHODS: Analysis of patients with BCLC-B HCC treated with LR or transarterial chemoembolization (TACE) between 2007 and 2012 in our hospital. Survival/recurrence analyses were performed by log-rank tests and Cox multivariate models. Further analyses were specifically obtained for the HCC subclassification (B1-2-3-4) proposed recently. RESULTS: Eighty patients were treated (44-TACE/36-LR). Number of nodules was [1.8(1.1)], being multinodular in 50% of cases. Although resected patients had a higher hospital stay than those who underwent TACE (14 ± 13 vs 7 ± 6; P = 0.004), the rate and severity of complications was lower measured by Dindo-Clavien scale (P < 0.05). Overall survival was 40% with a median follow-up of 29.5 months (0.07-96.9). Five-years survival rates were 62.9%, 28.1% and 15.4%, respectively (P = 0.004) for B1, B2 and B3-4 stages. Cox model showed that only total bilirubin [OR = 2.055(1.23-3.44)] and BCLC subclassification B3-4 [OR = 2.439(1.04-5.7)] and B2 [OR = 2.79(1.35-5.77)] vs B1 were independent predictors of 5-years-survival. In B1 patients, surgical approach led a significant decrease in 5-years recurrence-rate (25% vs 60%; P = 0.018). In the surgical subgroup analysis, better results were observed if well/moderate differentiation combined with no microvascular-invasion (VI) in 5-years-survival (84.6%; P = 0.001) and -recurrence (23.1%; P = 0.041), respectively. These survival and recurrence trends were remarkable in B1 stages. CONCLUSIONS: Management of Intermediate BCLC-B HCC stage should be more complex and include updated criteria regarding B-stage subclassifications, VI and tumour differentiation. Modern surgical resection would offer improved survival benefit with acceptable safety in selected BCLC-B stage patients.

Drought impact on forest carbon dynamics and fluxes in Amazonia.

In 2005 and 2010 the Amazon basin experienced two strong droughts, driven by shifts in the tropical hydrological regime possibly associated with global climate change, as predicted by some global models. Tree mortality increased after the 2005 drought, and regional atmospheric inversion modelling showed basin-wide decreases in CO2 uptake in 2010 compared with 2011 (ref. 5). But the response of tropical forest carbon cycling to these droughts is not fully understood and there has been no detailed multi-site investigation in situ. Here we use several years of data from a network of thirteen 1-ha forest plots spread throughout South America, where each component of net primary production (NPP), autotrophic respiration and heterotrophic respiration is measured separately, to develop a better mechanistic understanding of the impact of the 2010 drought on the Amazon forest. We find that total NPP remained constant throughout the drought. However, towards the end of the drought, autotrophic respiration, especially in roots and stems, declined significantly compared with measurements in 2009 made in the absence of drought, with extended decreases in autotrophic respiration in the three driest plots. In the year after the drought, total NPP remained constant but the allocation of carbon shifted towards canopy NPP and away from fine-root NPP. Both leaf-level and plot-level measurements indicate that severe drought suppresses photosynthesis. Scaling these measurements to the entire Amazon basin with rainfall data, we estimate that drought suppressed Amazon-wide photosynthesis in 2010 by 0.38 petagrams of carbon (0.23-0.53 petagrams of carbon). Overall, we find that during this drought, instead of reducing total NPP, trees prioritized growth by reducing autotrophic respiration that was unrelated to growth. This suggests that trees decrease investment in tissue maintenance and defence, in line with eco-evolutionary theories that trees are competitively disadvantaged in the absence of growth. We propose that weakened maintenance and defence investment may, in turn, cause the increase in post-drought tree mortality observed at our plots.

Histologic study of the effects of chemoembolization with preloaded doxorubicin beads in patients with hepatocellular carcinoma.

OBJECTIVE: To determine the degree of tumor necrosis in surgical specimens of hepatocellular carcinomas treated with microspheres preloaded with doxorubicin and to analyze the relationship between the degree of necrosis and a) morphologic factors and b) imaging biomarkers. MATERIAL AND METHODS: We studied the livers of 21 patients who had undergone selective arterial chemoembolization with DC beads (Biocompatibles, UK) before receiving liver transplants. RESULTS: Imaging techniques detected 43 nodules (mean size, 25 mm). Angiography showed 25 hypervascularized nodules, 12 slightly vascularized nodules, and 6 avascular nodules. A total of 81 hepatocellular carcinomas (mean size, 15 mm) were detected in the specimens: two were capsular and two had vascular infiltration. The mean degree of necrosis after chemoembolization was 39%; necrosis was greater than 60% in 28 hepatocellular carcinomas and less than 60% in 52. The degree of necrosis correlated significantly with the time elapsed between the last chemoembolization treatment and liver transplantation (the degree of necrosis decreased as time increased), with the number of nodules in the specimen, and with capsular infiltration. When imaging techniques detected 1 or 2 nodules, there was a greater probability of achieving greater than 90% necrosis. No relation with the degree of necrosis achieved was found for the size of the nodules detected at imaging, the enhancement pattern, or the number of chemoembolization treatments. CONCLUSION: The degree of necrosis achieved depends on the time spent on the waiting list, on the number of nodules in the specimen, and on whether capsular infiltration is present.

The sensitivity of wood production to seasonal and interannual variations in climate in a lowland Amazonian rainforest.

Understanding climatic controls on tropical forest productivity is key to developing more reliable models for predicting how tropical biomes may respond to climate change. Currently there is no consensus on which factors control seasonal changes in tropical forest tree growth. This study reports the first comprehensive plot-level description of the seasonality of growth in a Peruvian tropical forest. We test whether seasonal and interannual variations in climate are correlated with changes in biomass increment, and whether such relationships differ among trees with different functional traits. We found that biomass increments, measured every 3 months on the two plots, were reduced by between 40 and 55% in the peak dry season (July-September) relative to peak wet season (January-March). The seasonal patterns of biomass accumulation are significantly (p < 0.01) associated with seasonal patterns of rainfall and soil water content; however, this may reflect a synchrony of seasonal cycles rather than direct physiological controls on tree growth rates. The strength of the growth seasonality response among trees is significantly correlated to functional traits: consistent with a hypothesised trade-off between maximum potential growth rate and hydraulic safety, tall and fast-growing trees with broad stems had the most strongly seasonal biomass accumulation, suggesting that they are more productive in the wet season, but more vulnerable to water limitation in the dry season.

[Transjugular intrahepatic portosystemic shunting with covered stents in children: a preliminary study of safety and patency]. / TIPS recubierto en niños. Estudio preliminar sobre su seguridad y permeabilidad.

OBJECTIVE: To retrospectively analyze the safety and efficacy of transjugular intrahepatic portosystemic shunting (TIPS) using covered stents in children. MATERIAL AND METHODS: We present 6 children (mean age, 10.6 years; mean weight, 33.5kg) who underwent TIPS with 8mm diameter Viatorr(®) covered stents for acute (n=4) or recurrent (n=2) upper digestive bleeding that could not be controlled by endoscopic measures. Five of the children had cirrhosis and the other had portal vein thrombosis with cavernous transformation. We analyzed the relapse of upper digestive bleeding, the complications that appeared, and the patency of the TIPS shunt on sequential Doppler ultrasonography or until transplantation. RESULTS: A single stent was implanted in a single session in each child; none of the children died. The mean transhepatic gradient decreased from 16mmHg (range: 12-21mmHg) before the procedure to 9mmHg (range: 1-15mmHg) after TIPS. One patient developed mild encephalopathy, and the girl who had portal vein thrombosis with cavernous transformation developed an acute occlusion of the TIPS that resolved after the implantation of a coaxial stent. Three children received transplants (7, 9, and 10 months after the procedure, respectively), and the patency of the TIPS was confirmed at transplantation. In the three remaining children, patency was confirmed with Doppler ultrasonography 1, 3, and 5 months after implantation. None of the children had new episodes of upper digestive bleeding during follow-up after implantation (mean: 8.1 months). CONCLUSION: Our results indicate that TIPS with 8mm diameter Viatorr(®) covered stents can be safe and efficacious for the treatment of upper digestive bleeding due to gastroesophageal varices in cirrhotic children; our findings need to be corroborated in larger series.

Prevalencia del síndrome de «burnout» en farmacéuticos comunitarios titulares de oficina de farmacia rural en España / Prevalence of the burnout syndrome in community pharmacists head of the rural pharmacy office in Spain

Objetivo: Medir, mediante el Maslach Burnout Inventory (MBI), los tres aspectos de desgaste profesional que permitan determinar el grado de síndrome del trabajador «quemado» (burnout) que presentan los farmacéuticos comunitarios rurales de España, y correlacionarlo con las características sociodemográficas y de prestación farmacéutica de estos últimos. Metodología: Estudio descriptivo transversal con componentes analíticos realizado mediante encuestas autoadministradas por correo postal dirigidas a una muestra de farmacéuticos titulares de oficinas de farmacia de España de pueblos de hasta 5.000 habitantes. El muestreo tipo aleatorio estratificado se realizó en dos oleadas, entre junio y noviembre de 2009. Se diseñó un cuestionario que contiene tres tipos de variables: sociodemográficas, variables que permiten caracterizar el trabajo del farmacéutico en la oficina de farmacia rural, y los 22 ítems del MBI. La información encuestal se evaluó mediante un análisis descriptivo (frecuencias, medias y desviación estándar), así como con un tratamiento analítico basado en el análisis de la varianza simple y el test de la t de Student. Resultados: Un 9,52% de farmacéuticos padecen el síndrome de burnout, y los valores obtenidos para las tres subescalas, cansancio emocional (CE), despersonalización (DP) y realización personal (RP), muestran unos niveles medios de afectación para las tres, con medias y desviaciones estándar, de 16,4 (DE= 11,7), 5,4 (DE= 5,6) y 36,2 (DE= 9,3), respectivamente. La subescala CE presentó diferencias significativas en la variable «comunidad autónoma», la subescala DP en «población del municipio », «tipo de centro médico del municipio», «dispensaciones de productos de parafarmacia al día» y «facturación anual de la farmacia», y la subescala RP en «relaciones personales del farmacéutico » y «relaciones profesionales con el médico». Conclusiones: Se han obtenido niveles de burnout preocupantes, aunque inferiores a los de otras profesiones sanitarias, pero con mayor realización personal. Novedad del estudio: Se ha determinado por primera vez la afectación por síndrome de burnout de los farmacéuticos rurales de España (AU)

Objective: Measure by the Maslach Burnout Inventory (MBI) the three aspects of professional burnout, that allow to determine the extent of burn out worker syndrome (burnout) within the rural community pharmacists in Spain, correlating this with their socio-demographic characteristics and pharmaceutical care. Methodology: Transversal descriptive study with analytical components through self-administered surveys conducted by mail, addressed to a sample of head pharmacists in dispensing pharmacies in Spain from towns of up to 5,000 people. This stratified random sampling rate, was conducted in two waves, between June and November of 2009. A questionnaire that contained three types of variables was designed: socio-demographic, variables that allow characterizing the work of pharmacists in a rural pharmacy, and the 22 items of the MBI. The survey-based information was evaluated by descriptive analysis (frequencies, means and standard deviation) and an analytical approach based on simple analysis of variance and t-test of Student. Results: 9.52% of the pharmacists have burnout syndrome, and the values obtained for the three subscales, emotional exhaustion (EC), depersonalization (DP) and personal accomplishment (PA), showed average levels of affection for the three, with means and standard deviations of 16.4 (SD= 11.7), 5.4 (SD= 5.6) and 36.2 (SD= 9.3) respectively. The EC subscale showed significant differences within autonomous communities, DP within population of the town, type of medical center in the town, parapharmacy products dispensed daily and annual invoicing of the pharmacy. And PA pharmacist’s personal relationships and professional relationships with the physician. Conclusions: Worrying burnout levels have been obtained, albeit lower than those of other health professions, but with greater personal accomplishment. Latest news of the study: It has been determined for the first time the condition for burnout syndrome of rural pharmacists in Spain (AU)

Alopecia rectangular transitoria tras embolización de aneurisma: a propósito de un caso / A Case of Transient Rectangular Alopecia After Aneurysm Embolization

No disponible

No disponible

Programa de Educación para los pacientes de diálisisperitoneal domiciliaria en España / No disponible

El objetivo de este trabajo es conocer el programa de formación que reciben los pacientes en Diálisis Peritoneal (DP) domiciliaria en España. Para el estudio se diseñó una encuesta con 50 preguntas cerradas y una abierta. Se envió a 104 hospitales y se obtuvo una participación del 78,84% (n = 82).La media de pacientes en DP en los centros encuestados fue de 27,6 pacientes: 15,8 en Diálisis Peritoneal Ambulatoria Continúa (DPCA) y 11,8 en Diálisis Peritoneal Automática(DPA).Con el resto de las preguntas investigamos sobre la metodología de enseñanza en las diferentes unidades, la implicación de la familia en los planes de formación, los conocimientos básicos que se daban al paciente sobre la Enfermedad Renal Crónica, las actividades necesarias para la realización del tratamiento, y la preparación que se proporciona para que puedan solucionar pequeñas eventualidades o emergencias y mejorar su calidad de vida. Se evaluó el plan de formación de los pacientes autosuficientes que estuvieran en DPA y por último, se dejó un apartado donde los diferentes centros añadieran aquello que no recogiera la encuesta. Con los resultados obtenidos pudimos concluir que en la mayoría de los centros de España existe un plan de formación en DP que puede capacitar a los pacientes o al cuidador informa la realizar el tratamiento de forma segura en su domicilio, proporcionarle los conocimientos básicos sobre la enfermedad y las actividades rutinarias para el tratamiento, poder solventar eventualidades y emergencias, así como mejorar su calidad de vida estando en diálisis (AU)

The objective of the present study is to obtain information about the training programme for patients undergoing Domiciliary Peritoneal Dialysis (DPD) in Spain. For the purposes of the study we designed a questionnaire comprising50 closed-ended items and one open response item. The questionnaire was sent to 104 hospitals and was completed by78.84% of them (n = 82).The average of patients undergoing peritoneal dialysis (PD) in the hospitals under study was 27.6: 15.8 of them receiving Chronic Ambulatory Peritoneal Dialysis (CAPD) and 11.8 Automatic Peritoneal Dialysis (APD).The questionnaire also served to investigate into the training methodology used in the different units, the involvement of the family in the programme, the basic knowledge patients received about Chronic Renal Insufficiency, the procedures associated with the therapy and the preparation they obtained to solve small-scale contingencies and emergency situations as well as the improvement of their quality of life. We also evaluated the training programme of autonomous patients on DPD and at the end of the questionnaire a blank space was left for facilities to add any comments or suggestions they considered relevant. From the results obtained we may conclude that most Spanish hospitals have devised a training planning for patients undergoing PD which helps them or caregivers to perform domiciliary treatment safely, provides them with basic knowledge about the disease and the routine procedures associated with the treatment, enables them to cope with contingencies and emergency situations and improves their quality of life during the dialysis period (AU)

[Educational scheme for patients on home peritoneal dialysis in Spain]. / Programa de educación para los pacientes de diálisis peritoneal domiciliaria en España.

The objective of the present study is to obtain information about the training programme for patients undergoing Domiciliary Peritoneal Dialysis (DPD) in Spain. For the purposes of the study we designed a questionnaire comprising 50 closed-ended items and one open response item. The questionnaire was sent to 104 hospitals and was completed by 78.84% of them (n > or = 82). The average of patients undergoing peritoneal dialysis (PD) in the hospitals under study was 27.6: 15.8 of them receiving Chronic Ambulatory Peritoneal Dialysis (CAPD) and 11.8 Automatic Peritoneal Dialysis (APD). The questionnaire also served to investigate into the training methodology used in the different units, the involvement of the family in the programme, the basic knowledge patients received about Chronic Renal Insufficiency, the procedures associated with the therapy and the preparation they obtained to solve small-scale contingencies and emergency situations as well as the improvement of their quality of life. We also evaluated the training programme of autonomous patients on DPD and at the end of the questionnaire a blank space was left for facilities to add any comments or suggestions they considered relevant. From the results obtained we may conclude that most Spanish hospitals have devised a training planning for patients undergoing PD which helps them or caregivers to perform domiciliary treatment safely, provides them with basic knowledge about the disease and the routine procedures associated with the treatment, enables them to cope with contingencies and emergency situations and improves their quality of life during the dialysis period.

Flavonoid profile of green asparagus genotypes.

The determination of flavonoid profiles from different genotypes of triguero asparagus and their comparison to those from green asparagus commercial hybrids was the main goal of this study. The samples consisted of 32 commercial hybrids and 65 genotypes from the Huetor-Tajar population variety (triguero). The analysis of individual flavonoids by HPLC-DAD-MS has allowed the determination of eight naturally occurring flavonol derivatives in several genotypes of triguero asparagus. Those compounds included mono-, di-, and triglycosides of three flavonols, that is, quercetin, isorhamnetin, and kaempferol. The detailed analysis of the flavonoid profiles revealed significant differences among the distinct genotypes. These have been classified in three distinct groups as the result of a k-means clustering analysis, two of them containing both commercial hybrids and triguero asparagus and another cluster constituted by 21 genotypes of triguero asparagus, which contain several key flavonol derivatives able to differentiate them. Hence, the triglycosides tentatively identified as quercetin-3-rhamnosyl-rutinoside, isorhamnetin-3-rhamnosyl-rutinoside, and isorhamnetin-3-O-glucoside have been detected only in the genotypes grouped in the above-mentioned cluster. On the other hand, the compound tentatively identified as isorhamnetin-3-glucosyl-rutinoside was present in most genotypes of triguero asparagus, whereas it has not been detected in any of the commercial hybrids.

Abdomen agudo por leiomioma complicado en gestante de 16 semanas / A 16-week pregnancy complicated by acute abdomen due to leiomyoma

Presentamos un caso de embarazo del segundo trimestre (16 semanas) complicado con cuadro de abdomen agudo por leiomioma gigante pediculado con torsión del pedículo y necrosis tumoral. Se practicó miomectomía de urgencias evolucionando favorablemente el postoperatorio. La gestación continúa con normalidad a las 28 semanas (AU)

We describe a second-trimester pregnancy (16 weeks) complicated by acute abdomen due to giant pedunculated leiomyoma with torsion of the pedicle and necrosis. Emergency myomectomy was performed with favorable postoperative course. The pregnancy continues with no abnormalities at 28 weeks (AU)

[Practical aspects in the percutaneous extraction of foreign bodies using a Goose-Neck Snare]. / Aspectos prácticos de la extracción percutánea de cuerpos extraños con lazo recuperador.

OBJECTIVE: To present our clinical experience in the extraction of different foreign bodies (from vascular or other sites) using a goose-neck snare in 13 patients, with emphasis on practical and technical aspects used during the procedures. MATERIAL AND METHODS: A total of 13 foreign bodies, including 9 intravascular objects and 4 in other locations, were included. The intravascular foreign bodies were stents (n = 2), coils (n = 2), fragments of broken central venous catheters (n = 3), and fragments of broken balloon catheters (n = 2). The nonvascular foreign bodies were fragments of broken double-J catheters (n = 2), one double-J catheter located entirely within the calyces of the kidney, and a fragment of a broken metallic guide wire in an intrahepatic bile duct. Goose-Neck Snares of different diameters (depending on the location) were used to extract the foreign bodies. Forceps were used as an auxiliary device in one patient with a fragment of double-J catheter, and in another case with a catheter fragment in a pulmonary vein, a pigtail catheter was also used to move the fragment and facilitate its extraction with the Goose-Neck Snare. RESULTS: All of the foreign bodies were successfully extracted except a transjugular intrahepatic portosystemic shunt that migrated to the right heart cavities and was correctly repositioned in the right brachiocephalic venous trunk. No complications of any kind were seen during the procedures. CONCLUSIONS: The Goose-Neck Snare is very useful, safe, and versatile for the extraction of different types of foreign bodies in different territories. Especially in vascular territories, it is necessary to have ample knowledge about and experience in the different techniques used for catheterization.

Neumomediastino y enfisema subcutáneo como manifestación de una perforación duodenal / Pneumomediastinum and subcutaneous emphysema like manifestation of duodenal ulcer perforation

No disponible

Carcinoma adenoide quístico de la glándula de Bartholino, una rareza clínica / Adenoid cystic carcinoma of Bartholin's gland: a clinical rarity

Presentamos un caso de carcinoma adenoide quístico de la glándula de Bartholino (GB) de diagnóstico diferido por su rareza y con un tratamiento diferenciado respecto a los carcinomas del tracto genital bajo, dada su menor agresividad y su especial comportamiento biológico que lo hacen diferente; esta neoplasia es más típica del área orofaríngea

We report a case of adenoid cystic carcinoma of Bartholin's gland with delayed diagnosis because of its rarity. The treatment of this entity differs from that of other carcinomas of the female genital tract because it is a less aggressive tumor with particular biological behavior. This tumor is more common in the salivary glands, oral cavity and nasopharynx

Atresia de íleon distal: diagnóstico prenatal ecográfico / Atresia of the distal ileum: prenatal ultrasound diagnosis

Presentamos un caso de atresia ileal distal diagnosticada por ultrasonidos en la semana 32 de gestación en un control prenatal ecográfico rutinario (figs. 1, 2 y 3). El parto aconteció a las 35 semanas de embarazo mediante cesárea, y se obtuvo un recién nacido de 1900g. de peso, y fue sometido a corrección quirúrgica de su defecto congénito a las 24h, con evolución favorable (AU)

We present a case of atresia of the distal ileum, diagnosed during routine ultrasound in the 32nd week of gestation (figures 1, 2 and 3). A 1900g infant was delivered by caesarean section at 35 weeks, and had successful correction of the atresia twenty-four hours later (AU)

Validez del cribado bioquímico clásico del segundo trimestre en el diagnóstico prenatal / The validity of classical biochemical screening in prenatal diagnosis during the second trimester

Analizamos la validez del cribado bioquímico del segundo trimestre instaurado en nuestro hospital en los primeros 10 meses desde su establecimiento. Los resultados obtenidos demuestran un alto índice de falsos positivos (el 14,47 por ciento de manera global; el 9,16 por ciento en pacientes menores de 35 años, y el 47,61 por ciento en pacientes de 35 años o más), lo que hace replantearse la adquisición de un nuevo programa de laboratorio donde se incluyan marcadores sanguíneos más específicos con la finalidad de mejorar esta prueba (AU)

La información escrita del farmacéutico mejora el cumplimiento de la antibioterapia / The effect of written information provided by pharmacists on compliance with antibiotherapy

El incumplimiento terapéutico es un riesgo potencial para la salud pública al contribuir al incremento de las resistencias bacterianas. Una de las estrategias utilizadas para mejorar el cumplimiento terapéutico es el de mejorar la información del paciente mediante información escrita. Los objetivos fueron evaluar la influencia de la información escrita del farmacéutico comunitario sobre el cumplimiento antibiótico, verificar sus consecuencias sobre la salud y descubrir otros factores que influyan en el cumplimiento. Se trata de un estudio experimental en pacientes que acuden a una farmacia comunitaria con una prescripción antibiótica. Al grupo control se le da información verbal sobre su tratamiento, y al grupo de intervención la misma información, pero también por escrito. Se mide el cumplimiento mediante encuesta telefónica al día siguiente de haber tenido que finalizar el tratamiento. 214 pacientes finalizaron el estudio. Los pacientes del grupo de intervención incrementaron el cumplimiento terapéutico en un 14,2 por ciento. Los pacientes que cumplen el tratamiento tienen una mejor percepción de salud respecto de los incumplidores. Otro factor que influye significativamente en el cumplimiento es la pauta posológica diaria. Este trabajo concluye que la información escrita del farmacéutico mejora el cumplimiento terapéutico. El cumplimiento terapéutico mejora la percepción de salud de los pacientes (AU)