Result of the implementation of telematic consultations in orthopaedic surgery and traumatology during COVID-19 laparoscopic surgery. / Resultado de la implantación de consultas telemáticas en cirugía ortopédica y traumatología durante la pandemia COVID-19.

The COVID pandemic has made telematic consultations a basic tool in daily practice. AIMS: The main objective of the study is to assess the results of the application of telematic consultations to limit the mobility of patients. The operational objectives are; to propose a consultation plan, to know how attendance limits consultations and to define which pathologies benefit the most from this plan. METHODS: A scheme is proposed with the creation of pre-scheduled clinic to assess suitability and the possibility of carrying them out in a single non face-to-face act. RESULTS: Phone call to 5,619 patients were made with a lack of response of 19%. The cases of 74% of the patients that answered were resolved virtually. There is a difference between units, obtaining a higher answering rate from patients appointed to specific clinic units, OR = 0.60, or to general trauma ones, OR = 0.67. The lowest answering rate was obtained from those derived from the emergency department. Twenty per cent of the consultations were not accompanied by complementary tests that would have favored the resolution in a single act. The general trauma consultations, OR = 0.34, postoperative control, OR = 0.49, and specific unit ones, OR = 0.40, were the ones that better met this requirement. Out of the remaining patients, the general trauma consultations, OR = 0.50, and those referred to units, OR = 0.54, were the ones that had a higher resolution rate without in- person consultation. CONCLUSIONS: The cases of 74% of the patients who answered the phone call were resolved virtually. Cases of 20% of the patients cannot be solved in a single act because they are derived without complementary tests. Osteosynthesis and postoperative arthroscopic follow-up consultations are the ones that need to be carried out in person the most.

Prevalence of schizophrenia and related disorders in Malaga (Spain): results using multiple clinical databases.

BACKGROUND: To calculate the 1-year prevalence of schizophrenia and related disorders in a catchment area of Malaga (Spain) and determine the prevalence by gender, dwelling (rural or urban) and socioeconomic area (deprived or non-deprived area). METHOD: This cross-sectional study comprised the mental health area covered by Carlos Haya Hospital. We used multiple large clinical databases and key informants to identify cases. RESULTS: The mean 1-year prevalence of schizophrenia and related disorders was 6.27 per 1000. It was nearly double in men (8.45 per 1000) than in women (4.26 per 1000) (p < 0.001), with a male-to-female ratio of 1.98. The rate was higher in urban (6.64 per 1000) than rural areas (3.95 per 1000) (p < 0.0001) and in socioeconomic deprived areas (7.56 per 1000) than non-deprived areas (6.12 per 1000) (p = 0.005). For the subgroup of schizophrenia, the rates were: men, 5.88 per 1000 and women, 2.2 per 1000 (p < 0.0001), with a male-to-female ratio of 2.67. The rate was also higher in urban (4.2 per 1000) than rural areas (2.49 per 1000) (p < 0.0001) and in socioeconomic deprived areas (4.49 per 1000) than non-deprived areas (3.9 per 1000) (p = 0.149). CONCLUSIONS: The use of multiple clinical sources of information not only from mental health services, but also from emergency departments, primary care and private settings revealed high prevalence rates of schizophrenia and related disorders. This diagnosis is more common in men and in cities. Such precise estimates of the prevalence of schizophrenia have important repercussions for resource allocation and policy planning.

[Opinions of healthcare professionals on the definition of severe mental illness: a qualitative study]. / Opiniones de los profesionales del ámbito sanitario acerca de la definición de trastorno mental grave. Un estudio cualitativo.

BACKGROUND: Over the years, a number of definitions of severe mental illness (SMI) have been proposed and substantial controversy about the definition still remains. The aim of this study was to evaluate the views of a group of mental health professionals on the appropriate criteria for defining SMI. METHODOLOGY: This was a qualitative study, based on five focus groups with mental health professionals (psychiatrists, psychologists, nurses, general practitioners, monitors and social workers) from Carlos Haya Hospital in Malaga, Spain. A content analysis was performed on the transcriptions by three independent researchers. RESULTS: The professionals agreed that a certain degree of dysfunctionality must be present for a definition of SMI. There was some disagreement between the different categories of professionals regarding the inclusion of dimensions such as diagnosis, family and social support, use of healthcare resources and duration of the illness as necessary and sufficient criteria for the definition of SMI. From the professionals' discourse, some personal patient variables such as age of onset of illness, lack of insight and level of education emerged as relevant for the definition of SMI. CONCLUSIONS: Apart from the dimensions considered in the literature, the interviewed mental health professionals discussed other criteria that could be taken into account in the definition of SMI. Perceptions differ between categories of professional and work settings in which they operate.

Adult stem cells applied to tissue engineering and regenerative medicine.

Regeneration takes place in the body at a moment or another throughout life. Bone, cartilage, and tendons (the key components of the structure and articulation in the body) have a limited capacity for self-repair and, after traumatic injury or disease, the regenerative power of adult tissue is often insufficient. When organs or tissues are irreparably damaged, they may be replaced by an artificial device or by a donor organ. However, the number of available donor organs is considerably limited. Generation of tissue-engineered replacement organs by extracting stem cells from the patient, growing them and modifying them in clinical conditions after re-introduction in the body represents an ideal source for corrective treatment. Mesenchymal stem cells (MSCs) are the multipotential progenitors that give rise to skeletal cells, vascular smooth muscle cells, muscle (skeletal and cardiac muscle), adipocytes (fat tissue) and hematopoietic (blood)-supportive stromal cells. MSCs are found in multiple connective tissues, in adult bone marrow, skeletal muscles and fat pads. The wide representation in adult tissues may be related to the existence of a circulating blood pool or that MSCs are associated to the vascular system.

La prescripción por principio activo en la Comunidad autónoma de Valencia / Prescription according to active ingredient in the community of Valencia, Spain

Con el objetivo de racionalizar el gasto farmacéutico e impulsada por los resultados alcanzados tras el acuerdo firmado con los Colegios Oficiales de Farmacéuticos de la Comunidad Autónoma de Valencia en 1996, la Cosellería de Sanidad desarrolla, a principios del presente año 2007, un nuevo sistema de precios máximos de financiación para aquellos medicamentos cuya prescripción se realice por principio activo. El resultado ha sido la firma de un acuerdo entre la Agencia Valenciana de Salud y los Colegios Oficiales de Farmacéuticos de las tres provincias. Tras una breve reflexión acerca de los antecedentes en la propia Comunidad y en otras donde se han firmado acuerdos similares, se pretende mostrar un análisis descriptivo de su desarrollo y principios, así como valorar su impacto a nivel tanto económico como sobre la práctica habitual de la profesión sanitaria desde los puntos de vista de los profesionales de la salud (facultativos y farmacéuticos), de los pacientes y de la propia administración pública (AU)

For the purpose of rationalizing pharmacy costs, and motivated by the results achieved after the agreement signed with the Official Pharmaceutical Associations of the Community of Valencia in1996, early this year, the Department of Health of the community developed a new system for establishing reference prices, or the maximum prices for public funding, for those drugs that are prescribed according to their active ingredient. The result was the signing of an agreement between the Valencia Health Agency and the Official Pharmaceutical Associations of the three provinces (Valencia, Alicante and Castellón). Following a brief reflection on the background in this community and in others in which similar agreements have been reached, the authors provide a descriptive analysis of its development and principles, and assess its impact both in economic terms and with respect to routine healthcare practice from the perspective of healthcare professionals 8physicians and pharmacists), of patients and of the public administration (AU)

Intestinal D-galactose transport in an endotoxemia model in the rabbit.

Lipopolysaccharide (LPS) is an endotoxin causing sepsis. Studies from our laboratory revealed impaired intestinal absorption of L-leucine and D-fructose in LPS-treated rabbits. The aim of this study was to examine intestinal D-galactose transport following intravenous administration of LPS in the rabbit and to identify the cellular mechanisms driving this process. Endotoxin treatment diminished the buildup of D-galactose in intestinal tissue, the mucosal to serosal transepithelial flux of the sugar and its uptake by brush border membrane vesicles (BBMVs). Intracellular signaling pathways associated with protein kinase C (PKC), protein kinase A (PKA), p38 mitogen-activated protein kinase (p38MAPK), Jun N-terminal kinase (JNK), MAPK/extracellular signal-regulated kinases 1 and 2 (MEK1/2) and proteasome were found to be involved in this reduction in sugar uptake. Na(+)/glucose cotransporter 1 (SGLT1) protein levels in BBMVs were lower for LPS-treated animals than control animals. These findings indicate that LPS inhibits the intestinal absorption of D-galactose via a complex cellular mechanism that could involve posttranscriptional regulation of the SGLT1 transporter.

Inhibitory effect of TNF-alpha on the intestinal absorption of galactose.

Sepsis is a systemic response to infection in which toxins, such as bacterial lipopolysaccharide (LPS), stimulate the production of inflammatory mediators like the cytokine tumor necrosis factor alpha (TNF-alpha). Previous studies from our laboratory have revealed that LPS inhibits the intestinal absorption of L-leucine and D-fructose in rabbit when it was intravenously administered, and that TNF-alpha seems to mediate this effect on amino acid absorption. To extend this work, the present study was designed to evaluate the possible effect of TNF-alpha on D-galactose intestinal absorption, identify the intracellular mechanisms involved and establish whether this cytokine mediates possible LPS effects. Our findings indicate that TNF-alpha decreases D-galactose absorption both in rabbit intestinal tissue preparations and brush-border membrane vesicles. Western blot analysis revealed reduced amounts of the Na+/glucose cotransporter (SGLT1) protein in the plasma membrane attributable to the cytokine. On the contrary, TNF-alpha increased SGLT1 mRNA levels. Specific inhibitors of the secondary messengers PKC, PKA, the MAP kinases p38 MAP, JNK, MEK1/2 as well as the proteasome, diminished the TNF-alpha-evoked inhibitory effect. LPS inhibition of the uptake of the sugar was blocked by a TNF-alpha antagonist. In conclusion, TNF-alpha inhibits D-galactose intestinal absorption by decreasing the number of SGLT1 molecules at the enterocyte plasma membrane through a mechanism in which several protein-like kinases are involved.

Establecimiento de un único modelo de atención farmacéutica en los centros sociosanitarios de la Comunidad Valenciana / No disponible

La elevada incidencia de problemas relacionados con la medicación en la población geriátrica ofrece unaoportunidad al farmacéutico para disminuir la morbilidad y el coste de los tratamientos farmacológicos. Larespuesta a esta demanda, en el ámbito sociosanitario de la Comunidad Valenciana, se plasmó en el Programade Atención Farmacéutica en centros sociosanitarios dependientes de la Dirección General de ServiciosSociales de la Conselleria de Bienestar Social.Este programa de atención farmacéutica sociosanitario, pionero en España, que se inició en el año 1990 enla Residencia Mixta de Carlet (Valencia), se realizó en coordinación con la Conselleria de Sanidad. Actualmente, el Programa de Atención Farmacéutica sociosanitario está implantado en Centros sociosanitarios Públicos y en Centros de Discapacitados Psíquicos, siendo cinco los Servicios de Farmacia ubicados en toda la Comunidad Valenciana, realizándose la dispensación de medicamentos en dosis unitarias.Desde el Servicio de Provisión y Asistencia Farmacéutica de la Dirección General de Farmacia y ProductosSanitarios de la Conselleria de Sanidad, se propone establecer un único modelo de Atención Farmacéuticaen Centros sociosanitarios, dando cobertura no sólo a los Centros de titularidad Pública sino también a losCentros de titularidad Privada. Dicho proyecto de futuro está basado en un análisis DAFO, donde se reflejanlas Debilidades, Amenazas, Fortalezas y Oportunidades del sistema

The high incidence of drug-related problems among the geriatric population provides an opportunity for thepharmacist to reduce the morbidity and costs associated with drug treatments. The response to this demand,in the social health care setting of the Community of Valencia, Spain, was reflected in the PharmaceuticalCare Program in the social health care centers under the General Social Services Administration of the SocialWelfare Department.This program of social health pharmaceutical care, a pioneering effort in Spain, initiated in 1990 at theResidencia Mixta in Carlet, Valencia, was carried out in cooperation with the Health Care Department. To date, the social health pharmaceutical care program has been introduced into public social health care centers and centers for the mentally handicapped. There are now five pharmacy services throughout the Community of Valencia that dispense medications in unit doses.The Pharmaceutical Care and Provision Service of the General Pharmacy and Health Care Products Administrationof the Health Care Department proposes to establish a single model for pharmaceutical care in social health care centers, providing coverage not only to public centers but to private centers as well. Thisprojection for the future is based on a SWOT analysis reflecting the strengths, weaknesses, opportunities and threats of the system (AU)

The effect of tumor necrosis factor-alpha on D-fructose intestinal transport in rabbits.

Tumor necrosis factor-alpha (TNF-alpha) is an important immunoregulatory cytokine involved in septic responses during bacterial infection. The aim of this study was to examine the effect of TNF-alpha on the transport of D-fructose across rabbit jejunum. A sepsis condition was evoked by intravenous administration of this cytokine and hematological and plasma parameters were analyzed and body temperature was recorded. D-Fructose transport was assayed in rabbit jejunum. Sugar absorption in TNF-alpha treated rabbits was lower than in control animals. TNF-alpha decreased both the mucosal-to-serosal transepithelial flux and the transport across brush border membrane vesicles of D-fructose. The number of D-fructose transporters (GLUT5) was analyzed by Western blot in an attempt to explain this inhibition. TNF-alpha treated animals had lower levels of GLUT5, indicating a reduction in the expression of GLUT5 protein and therefore in transport capacity. The inhibition could also be related with the secretagogue effect of TNF-alpha on the gut since the intracellular tissue water was affected and the absence of chloride ion in the incubation medium partly removed the cytokine inhibition on sugar intestinal transport in treated rabbits. Finally, in terms of possible mediators involved in the TNF-alpha effect, nitric oxide and prostaglandins appeared to play a role in the inhibition of D-fructose intestinal uptake.

La nueva reglamentación sobre ensayos clínicos multicéntricos y su repercusión en el funcionamiento de los actuales Comités Éticos de Investigación Clínica / New regulation for multicenter clinical trials and its repercussions on the function of current clinical trial ethics committees

No disponible

Effect of lipopolysaccharide on D-fructose transport across rabbit jejunum.

OBJECTIVE: To investigate alterations in the transport of D-fructose across the rabbit jejunum when the gut is exposed in vitro to lipopolysaccharide (LPS), an endotoxin causative agent of sepsis. MATERIALS AND METHODS: D-fructose intestinal transport was assesed employing three techniques: sugar uptake measurements in rings of everted jejunum (micromol/D-fructose/ml cell water), transepithelial flux measurements in Ussing-type chambers (micromol D-fructose/cm2/h) and transport assays in preparation of brush border membrane vesicles (pmoles D-fructose/mg protein). Samples were taken from the bathing solution and from the extracts of the tissue for radioactivity counting. RESULTS: Adding LPS (3 microg/ml) to tissue decreased the uptake and mucosal to serosal flux of 5 mM D-fructose across the enterocyte. LPS did not modify sugar uptake across brush border membrane vesicles. The inhibitory effect of LPS was suppressed by W-13 (5 x 10(-6) M), a Ca-calmodulin antagonist, and staurosporine (10(-7) and 10(-6) M) and GF-109203X (10(-6) M) a nonselective and selective protein kinase C (PKC) inhibitor respectively. Tumor Necrosis Factor (TNF-alpha), an immunoregulatory cytokine involved in septic responses occurring during bacterial infection at concentrations 3 x 10(-4) to 3 microg/ml, did not affect the sugar transport. CONCLUSIONS: LPS can inhibit the intestinal uptake of D-fructose across the rabbit jejunum in vitro by intracellular processes related to PKC and calmodulin protein.

Tumor necrosis factor-alpha mediates inhibitory effect of lipopolysaccharide on L-leucine intestinal uptake.

Tumor necrosis factor-alpha (TNF-alpha) has been proposed as an early proximal mediator of many metabolic and physiologic responses during septic shock. We have previously shown that direct addition to tissue (local effect) or intravenous administration (systemic effect) of lipopolysaccharide (LPS) reduces L-leucine absorption across rabbit jejunum. In the present study, we investigated whether the inhibitory effect of LPS on L-leucine intestinal absorption in rabbit is related to TNF-alpha. The results shown that the addition of TNF-alpha to tissue does not produce any effect on L-leucine uptake by the enterocyte. When TNF-alpha was inoculated by intravenous administration, a strong inhibition on the L-leucine uptake (about 40%), mediated by a secretagogue effect on water and Cl-ions was induced. We also found that the LPS intestinal effect induced by intravenous administration, was blocked by a TNF-alpha antagonist, indicating that TNF-alpha is a mediator of the LPS systemic effect on L-leucine intestinal uptake inhibition. The study of possible mediators involved in the TNF-alpha effect showed that nitric oxide and prostaglandins are implicated in the L-leucine intestinal uptake.

Cellular mechanism underlying LPS-induced inhibition of in vitro L-leucine transport across rabbit jejunum.

Lipopolysaccharide (LPS) is a known causative agent of sepsis. In previous studies, we have shown that it reduces L-leucine mediated transport across the rabbit jejunum by about 30%. In this study, the mechanism(s) of LPS inhibition on amino acid transport were analysed in detail. LPS did not inhibit L-leucine transport across brush border membrane vesicles, suggesting the need for an intracellular step. The inhibitory effect of LPS was not altered by the addition of protein kinase A (PKA) inhibitor (IP(20), 10(-7) M) or an analog of cAMP (DB-cAMP, 3 x 10(-4) M), indicating that the PKA signal transduction pathway was not involved in the LPS effect. However, the inhibitory effect of LPS was suppressed by trifluoroperazine (10(-7) M), a Ca(2+)/calmodulin inhibitor and staurosporine (10(-7) M), an protein kinase C (PKC) inhibitor. Likewise, LPS inhibition disappeared in media without calcium. These results suggest that LPS could inhibit the intestinal uptake of L-leucine across the small intestine in vitro by intracellular processes related to calcium, involving PKC and calmodulin protein.

[Peripheral thromboembolic complications in heart transplantation: prevalence and review of the literature]. / Complicaciones tromboembólicas periféricas en el trasplante cardíaco: prevalencia y revisión de la literatura.

Peripheral thrombotic complications were retrospectively analyzed in a series of 164 consecutive patients undergoing orthotopic cardiac transplantation (CT) at the University Clinic of Navarra from 1984 to 1999. The overall survival during the first year after CT was 82%. All patients, besides the immunosuppressive regimen, received antiplatelet treatment postoperatively. The prevalence of thrombotic complications was 18% (29 events in 25 patients): 21 (13%) corresponded to arterial thrombosis, mainly cerebrovascular, whereas 8 (5%) were venous thrombosis. The time between the CT and the onset of thrombosis was 2 +/- 1.8 years. Mortality in patients with thrombosis did not differ significantly from the global mortality. The analysis in relation to the presence of cardiovascular risk factors only showed statistical significant differences for the age (older in the group with thrombosis, p = 0.02). In conclusion, there is a high prevalence of peripheral thrombotic complications in patients undergoing CT despite the antithrombotic regimen administered. The lack of correlation with the traditional cardiovascular risk factors suggest additional mechanisms for thrombosis in these patients.

Effect of lipopolysaccharide on small intestinal L-leucine transport in rabbit.

In the present study, we have investigated whether the lipopolysaccharide (LPS) endotoxin from Escherichia coli is able to alter the jejunal transport of L-leucine when the tissue is exposed to endotoxin. The results have shown that the LPS at 3 x 10(-5) microg/ml decreases the uptake of L-leucine into the enterocyte, as well as the mucosal to serosal flux of L-leucine. The secretagogue effect of LPS on the gut did not affect the inhibitory effect of LPS on the intestinal absorption of the amino acid. The endotoxin did not modify amino acid diffusion across the intestinal epithelium. However, from the mediated transport, only the Na+-dependent transport system was affected by LPS with a diminution of the transporter affinity (the apparent Km was increased). In addition, we found a reduction of the Na+, K+-ATPase activity, which could explain the L-leucine Na+-dependent transport inhibition.

The administration of lipopolysaccharide, in vivo, induces alteration in L-leucine intestinal absorption.

The objective of the present study was to determine the alterations in L-leucine intestinal uptake by intravenous administration of Lipopolysaccharide (LPS), which is a constituent of gram negative bacterial, causative agent of sepsis. The amino acid absorption in LPS treated rabbits was reduced compared to the control animals. The LPS effect on the amino acid uptake was due to an inhibition of the Na+-dependent system of transport, through both reduction of the apparent capacity transport (Vmax) and diminution of the Na+/K-ATPase activity. The results have also shown that the LPS decreases the mucosal to serosal transepithelial flux and the transport across brush border membrane vesicles of L-leucine. The study of possible intracellular mechanisms implicated in the LPS effect, showed that the second messengers calcium, protein kinase C and c-AMP did not play any role in this effect. However, the absence of ion chloride in the incubation medium removes the LPS inhibition and the intracellular tissue water was affected by the LPS treatment. Therefore, the inhibition in the L-leucine intestinal absorption, by intravenous administration of LPS, could be mainly produced by the secretagogue action of this endotoxin on the gut.

[Failure of an educational intervention to change anticholesteremic drug prescription in primary care]. / Fracaso de una intervención educativa para modificar la prescripción de hipocolesterolemiantes en atención primaria.

OBJECTIVE: To evaluate the effectiveness of an intervention for decreasing hypocholesterolemic drugs prescription in patients with low cardiovascular risk profile. DESIGN: Quasi-randomized intervention study. SETTING: Public primary health care centres in the province of Valencia (Spain). PARTICIPANTS: 238 general/family practitioners from 23 primary health care centres. INTERVENTIONS: The centres were assigned to either an experimental group that received the educational intervention (individual scientific information by outreach detailing and invitation to a workshop about treatment of hypercholesterolemia in the primary care setting with the participation of an opinion leader) or a control group. MEASUREMENTS AND MAIN RESULTS: The effectiveness of the intervention was measured through the monthly mean daily defined doses (DDD) from the 4 months prior to the intervention until 5 months thereafter. Mean DDD increased along the study period in both groups, with no detectable differences between them. Similarly, there were no between-group differences after controlling the initial prescription levels using a mixed lineal model. CONCLUSIONS: The educational intervention as it was implemented was ineffective for changing overall hypocholesterolemic drug prescription in primary care. Consequently, this intervention is not justified for reducing pharmaceutical expenditure.