Prevalence of chronic rhinosinusitis without/with nasal polyps according to severity in Spain.

BACKGROUND: The worldwide prevalence range of chronic rhinosinusitis (CRS) is 5-12%; from this, 20 % have nasal polyps. Due to the little epidemiological data about CRS in the Spanish population, this study analyses the prevalence and severity of CRS with (CRSwNP) or without (CRSsNP) nasal polyps, and their connection with other coexisting type 2 inflammatory diseases in Spain. METHODOLOGY: This is a retrospective, large-scale, nationwide, epidemiological study based on the electronic medical records from the BIG-PAC® database. Patients diagnosed of CRSsNP and CRSwNP were identified using specific disease codes. The severe form of the disease was defined as patients who received at least a long course of antibiotics in CRSsNP or ≥2 short courses of systemic corticosteroids in CRSwNP in ≤12 months during the last 2 years, and/or had previous sinus surgery. Physician-diagnosed prevalence, sociodemographic and clinical characteristics, and disease severity were assessed. RESULTS: Out of a cohort of 1,012,257 patients (≥18 years old), 42,863 and 7,550 patients with diagnosed CRSsNP and CRSwNP, respectively, were analysed. The overall prevalence of diagnosed CRS was 5.1%, being 4.3% and 0.8% for CRSsNP and CRSwNP, respectively. Patients with CRSwNP and severe forms of the disease were older and had higher levels of type 2 inflammatory biomarkers than CRSsNP patients and non-severe disease. CONCLUSIONS: Although CRSsNP was more prevalent than CRSwNP, the severe forms of CRS were more frequent in patients with CRSwNP. In addition, CRSwNP patients had a higher incidence of coexisting type 2 inflammatory diseases.

Preparedness, Hurricanes Irma and Maria, and Impact on Health in Puerto Rico.

OBJECTIVES: Only few studies evaluated whether hurricane preparedness impacts health. The PREPARE study addresses this gap. METHODS: We recruited participants who had pertinent pre-hurricane data from the San Juan Overweight Adults Longitudinal Study (SOALS: n=364) and 125 patients with diabetes from Federally Qualified Health Center (COSSMA) in Puerto Rico. Participants aged 42-75 years completed interviews 20-34 months after Hurricanes Irma and Maria. We evaluated associations between self-reported hurricane preparedness and health and other related associations using logistic regression controlling for age, location, education and interview date. RESULTS: Only 41% of participants reported high pre-hurricane preparedness; 25% reported gaps (moderate/low availability) in information and 48% reported gaps in resources for hurricane preparedness. Participants reporting lower pre-hurricane preparedness had higher reported hurricane-related detrimental health impact (OR=1.96; 95% CI: 1.31, 2.95) and higher odds (OR=2.07; 95% CI: 0.92, 4.68) of developing new non-communicable disease (NCD) compared to others. Post-hurricane drinking water disruption for ≥ 3 months versus none or less (OR=2.76; 95% CI: 1.39, 5.47) and similarly diet changes due to cooking/refrigeration access (OR=1.96; 95% CI: 1.24, 3.07), and diet changes for ≥ 20 months due to finances/access to shops (OR=2.83; 95% CI: 1.85, 4.32) were also associated with detrimental health impact. CONCLUSION: Lower preparedness was associated with higher detrimental impact of the hurricanes on overall health, and marginally significant impact on NCD. Future preparedness efforts could especially target means of coping with disruption of water services and regular diet, as these were also associated with detrimental health impact.

[Knowledge about Biosimilars in Primary Care: a study by the Spanish Society of Primary Care Physicians (SEMERGEN)]. / Conocimiento sobre biosimilares en Atención Primaria: Un estudio de la Sociedad Española de Médicos de Atención Primaria (SEMERGEN).

INTRODUCTION: The objective of this study was to evaluate the awareness and training needs on biosimilar drugs in Primary Care (PC) physicians. MATERIAL AND METHODS: Descriptive cross-sectional study based on an on-line questionnaire with a total of 34 multiple choice questions, published on the SEMERGEN website. The main Knowledge areas were: biosimilar definition; regulatory and legal framework; prescription, traceability, interchangeability and pharmacovigilance; availability of biosimilars in the PC setting, and the biosimilars contribution to sustainability. The software used for the analysis and data processing was the Barbwin 7.5. RESULTS: An analysis was performed on the responses from 701 questionnaires completed. There was a slight majority (57%) of women participants. The majority of participant worked in urban centres (60.91%). The definition of biosimilar was not known by 58% of those that responded, and 73% were unaware that the management of biosimilars and generics was not comparable. Most (84%) of those that responded were not aware that the studies required for the approval of biosimilars is different from reference biological medicines. Around two-thirds (66%) those that responded did not know of any biosimilars available in PC setting, and the 94% were also unaware of the Spanish legal framework for the management of biosimilar medicines. CONCLUSIONS: The current knowledge about biosimilars among PC physicians is low. The critical areas in need of further training include specific information on biosimilars currently available in PC setting, as well as key aspects regarding prescription, interchangeability and pharmacovigilance requirements. Six out of ten doctors do not know of any biosimilar used in PC in Spain.

[Intravenous drugs infusion safety through smart pumps]. / Seguridad en la administración intravenosa de medicamentos mediante bombas de infusión inteligentes.

OBJECTIVE: To analyze the role of smart infusion pumps in reducing errors related with the administration of intravenous medications. METHOD: Retrospective, observational study analyzing the implementation of a system with smart intravenous infusion pumps (Hospira MedNetTM) and the role of the safety system for the detection of errors during the administration of drugs, sera, and blood. We included infusions administered at the day-care hospitals of hematology, oncology, rheumatology, and oncopediatrics. We analyzed adherence to the safety system, the number of programming errors detected, the commonly implicated drugs in these errors, and improvement actions. RESULTS: During the study period, 120 smart pumps were implemented and data on 70,028 infusions were gathered. The rate of adherence to the safety program was 62.30% in hematology (6,887 infusions), 60,30% in oncology (28,127 infusions), 46,50% in rheumatology (1,950 infusions) and 1.8% in oncopediatrics (139 infusions). 3,481 out of the established limits programming alerts were generated by the pumps: 2,716 of relative limit and 765 of absolute limit. En 807 infusions (2.17%), errors that could have had consequences for the patients could be prevented. These findings allowed implementing a series of strategies aimed at minimizing these errors in the future. CONCLUSIONS: The Hospira MedNetTM system detects deviations from the established protocols of intravenous infusion, preventing in this way potential adverse events for the patients. It also allows establishing correction measures and implementing the improvement strategies.

OBJETIVO: Analizar el papel de las bombas de infusión inteligentes en la reducción de errores relacionados con la administración de medicación intravenosa. MÉTODO: Estudio observacional, retrospectivo que analiza la implementación de un sistema de bombas inteligentes de infusión intravenosa (Hospira MedNetTM) y el papel de este sistema de seguridad en la detección de errores en la fase de administración de fármacos, sueros y sangre. Se incluyeron infusiones administradas en los hospitales de día de hematología, oncología, reumatología y oncopediatría. Se analizó la adherencia al sistema de seguridad, el número de errores de programación detectados, los fármacos comúnmente implicados en estos errores y las acciones de mejora. RESULTADOS: Durante el periodo de estudio se implementaron 120 bombas inteligentes y se recogieron los datos de 70.028 infusiones. La adherencia al programa de seguridad fue del 62,30% en hematología (6.887 infusiones), del 60,30% en oncología (28.127 infusiones), del 46,50% en reumatología (1.950 infusiones) y del 1,8% en oncopediatría (139 infusiones). Se notificaron 3481 alertas por programación de las bombas fuera de los límites establecidos: 2716 de límite relativo y 765 de límite absoluto. En 807 infusiones (2,17%), se evitaron errores que podrían haber tenido consecuencias para los pacientes. Gracias a estos hallazgos, se implementaron una serie de estrategias con objeto de minimizar dichos errores en el futuro. CONCLUSIONES: El sistema Hospira MedNetTM intercepta desviaciones con respecto a los protocolos establecidos en la infusión intravenosa, evitando potenciales efectos adversos a pacientes. También permite establecer medidas correctoras e implementar estrategias de mejora.

[Evaluation and maintenance of heart donors]. / Evaluación y mantenimiento del donante cardíaco.

Heart transplantation is currently the best treatment option to improve hope and quality of life in patients with terminal heart failure that is refractory to conventional treatment. The scarcity of donors remains a difficult problem and is the main factor limiting the number of transplants that can be performed. Given the current situation of stagnation and disparity between the number of potential organ donors, actual donors, and patients requiring transplants, we need effective strategies to reduce the differences between supply and demand and to ensure the best possible prognosis in organ recipients. These strategies should aim to ensure optimal donor selection. Likewise, it is essential to increase the number of potential donors by widening the criteria for donation and to improve our ability to take advantage of suboptimal donors. Moreover, we need to achieve acceptable physiological maintenance of donated organs. All these actions, together with the standardization of future treatments like hormone replacement therapy and genomic evaluation, will undoubtedly lead to an increase in the rate of transplants in the short and mid term, because the option of heart transplantation continues to have only slight repercussions in the high prevalence of terminal heart failure in our environment.

Evaluación y mantenimiento del donante cardíaco / Evaluation and maintenance of heart donors

Actualmente el trasplante de corazón es la mejor opción terapéutica para aumentar la esperanza y la calidad de vida en los pacientes con insuficiencia cardíaca terminal refractaria al tratamiento convencional. La escasez de donantes es un problema difícil y pendiente de resolver, y constituye el principal factor limitante en el incremento de las cifras de trasplante. En la actual situación de estancamiento y disparidad entre el número de donantes de órganos potenciales, donantes reales y las necesidades clínicas de implantación se requieren estrategias efectivas para reducir esta diferencia y para mantener las mejores posibilidades de éxito en el pronóstico de los receptores. Estas estrategias deben ir dirigidas hacia una óptima selección del donante, así como hacia un incremento del número de potenciales donantes mediante la ampliación de los criterios de aceptación de éstos y hacia una mejora en el aprovechamiento de los donantes subóptimos. Además, debemos lograr un mantenimiento fisiológico adecuado del órgano. Todo este tipo de actuaciones, junto con la estandarización de tratamientos futuros (tratamiento hormonal de reemplazamiento o valoración genómica), nos tiene que llevar, sin duda, a un aumento en las cifras de transplantes a corto y a medio plazo, ya que la opción del transplante cardíaco sigue teniendo escasa repercusión en el gran alto grado de prevalencia de la insuficiencia cardíaca terminal en nuestro medio (AU)

Heart transplantation is currently the best treatment option to improve hope and quality of life in patients with terminal heart failure that is refractory to conventional treatment. The scarcity of donors remains a difficult problem and is the main factor limiting the number of transplants that can be performed. Given the current situation of stagnation and disparity between the number of potential organ donors, actual donors, and patients requiring transplants, we need effective strategies to reduce the differences between supply and demand and to ensure the best possible prognosis in organ recipients. These strategies should aim to ensure optimal donor selection. Likewise, it is essential to increase the number of potential donors by widening the criteria for donation and to improve our ability to take advantage of suboptimal donors. Moreover, we need to achieve acceptable physiological maintenance of donated organs. All these actions, together with the standardization of future treatments like hormone replacement therapy and genomic evaluation, will undoubtedly lead to an increase in the rate of transplants in the short and mid term, because the option of heart transplantation continues to have only slight repercussions in the high prevalence of terminal heart failure in our environment (AU)

[C reactive protein as marker of infection among patients with severe closed trauma]. / Proteína C reactiva como marcador de infección en pacientes con traumatismo cerrado grave.

BACKGROUND: Injury and infection are characterized by the activation of the acute phase proteins response. C-reactive protein (CRP), an acute phase protein, has been mentioned as an useful indicator of infection and sepsis in critically ill patients. OBJECTIVE: To study the evolution of serum CRP in patients with severe blunt trauma and to ascertain its ability as a biological marker of infection during the first seven days after injury. METHODS: We prospectively studied 54 patients with blunt trauma (injury severity score>=16) age>14 years and length of the Intensive Care Unit (ICU) estay>= 7 days, over a 4-month period. Culture-proven infections were collected and serum CRP was determinated every day, during the first week after ICU admission. RESULTS: Twenty-eight patients (51.8%) developed an infection during the first week, and the median day of diagnosis of infection was day 6. Pneumonia was the most common infection (50%) and Gram-negative bacilli (63.3%) were the most common microorganisms recovered. Serum CRP levels were significantly higher in the infected patients group after day 4, showing a median value higher than 170 mg/l. Based on the receiver operating characteristic (ROC) curve analysis, a cutoff value of 109.5 mg/l for CRP gives a sensitivity of 78.6% and a specifity of 73.1% in predicting the presence of infection. CONCLUSIONS: The course of serum CRP levels is different in the group of patients with severe blunt trauma and infection, compared with the non-infected group during the first week after injury and it could be an useful supplementary marker for infection after postinjury day 4. A value of 110 mg/l or higher for CRP should suggest an underlying infectious complication.

Early risk factors for sepsis in patients with severe blunt trauma.

We studied 43 patients with blunt trauma (injury severity score, > or =25), age >14 years and length of the intensive care unit (ICU) stay >48 h in order to estimate the frequency of sepsis and to identify early risk factors related to its development. Clinical data were collected during the first 24 h and several inflammatory mediators were determined from serum samples of the first 2 days after injury.Twenty-one patients (48.8%) met sepsis criteria during their ICU stay, 9 (20.9%) fulfilled only criteria for sepsis; 6 (13.9%) fulfilled criteria for severe sepsis and another 6 (13.9%) criteria for septic shock. An APACHE II score > or =14, the presence of hypovolemic shock, the need for three or more units of blood to be transfused and the administration of a total volume of fluids > or =10 l were all factors associated significantly with the development of sepsis. In the multivariant analysis, the need for a total volume of fluids > or =10 l was the only independent risk factor (adjusted odds ratio=10.49, 95% CI, 2.34-47.02; P=0.002). No significant differences were documented in relation to the behaviour of the serum markers.

A method for the purification of phospho(Tyr)calmodulin free of nonphosphorylated calmodulin.

Phosphocalmodulin has been shown to have a differential biological activity compared to nonphosphorylated calmodulin when assayed on a variety of calmodulin-dependent systems. However, the phosphocalmodulin preparations used so far in those experiments were not necessarily free of nonphosphorylated calmodulin. Therefore, the results obtained may not unquestionably show the real effect of pure phosphocalmodulin on the systems under study. To solve this problem, we describe here a method for the purification of phospho(Tyr)calmodulin free of nonphosphorylated calmodulin. The procedure consists of the following steps: (i) phosphorylation of calmodulin by a fraction enriched in epidermal growth factor receptor tyrosine kinase from rat liver isolated by calmodulin affinity chromatography, (ii) isolation of a calmodulin/phosphocalmodulin mixture by Ca(2+)-dependent chromatography in phenyl-Sepharose, (iii) purification of phospho(Tyr)calmodulin using an anti-phosphotyrosine antibody immobilized in agarose upon elution with phenyl phosphate, and (iv) removal of phenyl phosphate from the phospho(Tyr)calmodulin preparation by filtration chromatography in a Bio-Gel P-2 column. The obtained phospho(Tyr)calmodulin preparation was highly pure and essentially free of nonphosphorylated calmodulin because of the use of anti-phosphotyrosine affinity chromatography. We demonstrate that this ultrapure phospho(Tyr)calmodulin preparation is totally incapable of activating the calmodulin-dependent cyclic nucleotide phosphodiesterase. In contrast, when a nonpurified phospho(Tyr)calmodulin preparation was used a partial activation of this enzyme was observed.

[Supply of blood to heart surgery patients. Can transfusion habits be changed?]. / Aportes de sangre a pacientes intervenidos de cirugía cardíaca. Pueden cambiarse los hábitos transfusionales?

OBJECTIVE: In cardiac surgery, patients might receive unnecessary blood transfusions, due to the lack of a uniform criteria for blood replacement. We set out to evaluate the effect of a transfusion education program on the homologous blood requirements of subjects undergoing cardiac surgery. METHODS: In June of 1993 a transfusion education program based on international criteria was designed and put into effect in the intensive care unit. Since that date, 133 patients (group 1), on whom we attempted to evaluate the effects of the program, were included, comparing them with 150 control patients (group 2) from the previous year. Multiple variables were analyzed, in order to confirm that the factors that could affect the use of blood did not differ between the two groups. The impact of these variables and the program on the homologous blood expenditures was measured with uni and multivariant analyses. RESULTS: Blood requirements of the patients during the first day of the postoperative period were 0.9 +/- 0.1 U in group 1 versus 1.8 +/- 0.1 U in group 2 (p < 0.001) and the requirements during their entire stay in ICU were 1.8 +/- 0.1 versus 2.6 +/- 0.1 (p < 0.005). There were significant differences between both groups: Hemoglobin level at the admission in ICU, anoxia time, extracorporal circulation time, and blood losses in the first 24 hours of their stay in ICU. However, the analysis of covariance showed that the transfusion program exerted an independent influence, apart from other variables, over the decrease of blood transfusions. Morbidity and mortality were similar in both groups. CONCLUSIONS: Transfusion habits can be modified, permitting a lesser consumption of homologous blood through the adoption of education programs adapted to the diseases in which they will be applied.