Revisión bibliográfica de las actuaciones llevadas a cabo en materia de farmacogenética en farmacia comunitaria en distintos países / Bibliographic review of pharmacogenetic actions carried out in community pharmacy in different countries

JUSTIFICACIÓN: la farmacogenética se ha implementado principalmente para la dosificación de medicamentos en el ámbito hospitalario. Sin embargo, en los últimos 10 años ha tomado relevancia en el entorno de la farmacia comunitaria, especialmente en otros países europeos, EEUU y Canadá. Para plantear los futuros pasos a nivel nacional, se hace interesante conocer la situación en materia de investigación farmacogenética en farmacia comunitaria en estos países.OBJETIVO: conocer el tipo de estudios de investigación sobre farmacogenética en farmacia comunitaria desarrollados en distintos países.MATERIAL Y MÉTODOS: se realizó una revisión bibliográfica con el motor de búsqueda Pubmed, en la mayor base de datos de acceso libre de artículos científicos: Medline. Para encontrar los artículos de nuestro interés, es decir, que trataran de trabajos de investigación relacionados con la farmacogenética y que se hubieran llevado a cabo en farmacia comunitaria, se utilizaron los siguientes términos de búsqueda: pharmacogenetics; pharmacogenomics; community pharmacy; pilot study; service implementation; y testing. Las publicaciones identificadas se agruparon por temática relacionada en base a las similitudes metodológicas que presentaron.RESULTADOS: se identificaron 29 publicaciones relevantes para la revisión. De estas publicaciones, el 34,5 % se habían publicado entre los años 2020 y 2021. Además, el 65,5 % de ellas se basaban en trabajos realizados en farmacias comunitarias de EEUU y el 3,5 % en farmacias comunitarias españolas. Las temáticas de dichas publicaciones se agruparon de la siguiente forma: encuestas a farmacéuticos (37,9 %), ajustes de tratamientos guiados por test farmacogenéticos (34,5 %), entrevistas a pacientes (6,9 %), comparación de la implantación del servicio de farmacogenética y el servicio de farmacogenética junto con el manejo del tratamiento médico (6,9 %) y otros variados (13,8 %). (AU)

Evidencia farmacogenética disponible de los subgrupos terapéuticos más consumidos en España / Available pharmacogenetic evidence on the most widely used therapeutic subgroups in Spain

JUSTIFICACIÓN: la variabilidad interindividual en la respuesta a los medicamentos depende de muchos factores, entre los que se encuentra el perfil genético. Polimorfismos en los genes que codifican proteínas implicadas en la farmacocinética y farmacodinámica de los medicamentos pueden modificar su efecto, dando lugar a una respuesta pobre y por lo tanto un tratamiento inefectivo, o una respuesta exagerada lo que conlleva un riesgo alto de toxicidad. La presencia de polimorfismos en genes de transportadores, enzimas metabolizadoras o receptores podría implicar la necesidad o recomendación de un ajuste de dosis, sustitución y/o retirada de los medicamentos. Debido a esto, conocer qué evidencia existe en relación a la farmacogenética de los medicamentos de mayor consumo es de gran interés para los farmacéuticos comunitarios.OBJETIVO: identificar los medicamentos más consumidos en España y determinar la evidencia científica existente en cuanto al efecto que la farmacogenética tiene en ellos.MATERIAL Y MÉTODOS: se identificaron los 15 grupos de medicamentos más consumidos en España (clasificados por subgrupo terapéutico, ACT4) en base al último informe anual disponible de la Prestación Farmacéutica en el Sistema Nacional de Salud (2019).Para cada medicamento de dichos grupos se realizó una búsqueda de la evidencia científica disponible, en materia de farmacogenética, en las Guías Clínicas del CPIC y el DPWG y las anotaciones registradas en la base de datos sobre farmacogenética PharmGKB.RESULTADOS: los 15 subgrupos terapéuticos más dispensados en farmacia comunitaria en España en el 2019 sumaron el 48 % de todos los medicamentos dispensados. De ellos, 8 subgrupos disponen de guías clínicas publicadas de dosificación basada en farmacogenética (Antiulcerosos: inhibidores de la bomba de protones; Hipolipemiantes: inhibidores de la HMG CoA reductasa; Inhibidores de la agregación plaquetaria, excluyendo heparina. (AU)

Diagnostic yield of sentinel lymph node biopsy in oral squamous cell carcinoma T1/T2-N0: systematic review and meta-analysis.

The objective of this study was to conduct a systematic review and meta-analysis on the efficacy of sentinel lymph node biopsy (SLNB) in T1/T2-N0 oral squamous cell carcinoma (OSCC). A systematic review of the literature on SLNB until March 2019 was conducted. The review was organized according to the PRISMA protocol, considering the following PICO (population, intervention, comparison, outcome) question: What is the sensitivity of sentinel lymph node biopsy in OSCC? 'P' was patients with head and neck squamous cell carcinoma T1/2-N0; 'I' was SLNB; 'C' was neck treated with elective neck dissection and haematoxylin-eosin histopathology; 'O' was sensitivity and specificity. A meta-analysis and meta-regression were performed on the selected studies. The sensitivity of SLNB was up to 88% (95% confidence interval (CI) 72-96%) and specificity was up to 99% (95% CI 96-100%). The area under the summary receiver operating characteristic curve was 0.99 (95% CI 0.98-1.00). In the four studies where immunohistochemistry was performed, both the sensitivity and specificity were higher than in the studies without immunohistochemistry: 93% (95% CI 88-97%) and 98% (95% CI 96-100%), respectively. In conclusion, SLNB is an effective technique for treating patients with some types of stage T1/2-N0 OSCC. Some parameters such as immunohistochemistry could determine the level of diagnostic accuracy.

Informe especial: Coberturas de vacunación en residentes de la CABA en contexto Covid-19: 2 de octubre de 2020 / Special report: Vaccination coverage in CABA residents in context of Covid19

La vacunación es considerada una actividad esencial durante la pandemia de COVID-19 y se han desarrollado diferentes estrategias para el sostenimiento de la vacunación en el contexto actual, facilitar el acceso a través de la adaptación y reorganización de los servicios de salud, el no requerimiento de permisos de circulación para la vacunación, vacunación en instituciones fuera de salud, así como la elaboración de recomendaciones para realizar la vacunación de manera segura protegiendo tanto al vacunador como la persona a vacunar, entre otros. Con el objetivo de realizar la medición del impacto en las actividades de vacunación, se realiza el análisis comparativo de las vacunas aplicadas durante el primer semestre de los años 2018-2020, con la información recibida en el nivel central del Programa de Inmunizaciones. Se excluye del presente análisis la información referida a la vacuna antigripal ya que tiene una modalidad diferente de aplicación. (AU)

Experiencia argentina en la etapa final de erradicación de la polio: cambio de vacuna oral trivalente a bivalente / Argentinian experience to finish polio eradication: switch from trivalent to bivalent oral poliovirus vaccine

Entre el 17 de abril y el 1 de mayo de 2016, 155 países en todo el mundo cambiaron el uso de la vacuna oral trivalente, que protege contra los tres tipos de poliovirus (1, 2 y 3), por la vacuna oral bivalente, que protege contra los poliovirus tipo 1 y 3. Este cambio señala el mayor esfuerzocoordinado globalmente en la historia de las vacunas. En Argentina se realizó el pasado 29 de abril, con una intensa planificación previa y una posterior validación.

Clinical (but not cognitive) recovery in schizophrenia through the experience of fictional cinema.

INTRODUCTION: One of the criticisms of rehabilitation techniques is their limited application to the patient's daily life. In the past, cinema has been used as a psychiatric rehabilitation tool, with the primary objective of facilitating training in social abilities and communication. In this study, we consider the use of film not only as a clinical recovery tool but also as a novel cognitive recovery tool for additional rehabilitation not only for communication and social abilities but also for all of the basic cognitive and social cognition processes. METHODS: In this randomized clinical trial, 48 patients with schizophrenia were assigned to an experimental or control group. Both of the groups received treatment sessions that included viewing episodes of the television series The Sopranos. Next, the experimental group participated in a structured cognitive training session that featured questions and exercises based on the episodes. The control group participated in an idea-sharing session (of the same duration and frequency) about what the group members saw in the episode. RESULTS: At the end of the treatment, both the positive and negative clinical symptoms of the experimental group improved significantly compared with the control group. However, this improvement was not observed in basic or social cognitive functions. DISCUSSION: A brief intervention based on transforming the activities of daily life can be an effective tool for psychiatric rehabilitation. However, the study's current characteristics and sample did not produce benefits in cognitive parameters.

Global population variability in Qiagen Investigator HDplex STRs.

Supplementary short tandem repeats (STRs) can be added to forensic analyses if the 15-24 core STRs in routine use fail to give sufficient discrimination power in complex identification or relationship testing scenarios. In this study, 10 of 12 supplementary STRs in the Qiagen Investigator HDplex kit (SE33, D2S1360, D3S1744, D4S2366, D5S2500, D6S474, D7S1517, D8S1132, D10S2325, D21S2055) were genotyped in 941 individuals from the 51 populations of the CEPH Human Genome Diversity Panel (HGDP-CEPH). The other two components of the 12-STR HDplex kit are established STRs D12S391 and D18S51 that we previously genotyped for the HGDP-CEPH panel. We describe the rare alleles identified and outline allele frequency distributions in the seven population groups of the HGDP-CEPH panel. The HDplex STRs novel to forensic application were found to be both highly informative and comparable in their power across all populations studied: at least six of the nine loci showing above average forensic discrimination power in each population group. In some rare instances certain low frequency alleles in D2S1360 were found to overlap in mobility with the neighbouring allele size ranges of D12S391, as well as those of D7S1517 with neighbouring D3S1744 and D10S2325 with neighbouring SE33. Lastly, since expanded five-dye multiplex kits of 20 STRs (Promega Powerplex 21) and 22 STRs (Promega Powerplex Fusion) have recently been introduced, we assess through simulations the increased power to analyse pairwise relationships in deficient pedigrees that can be expected from an optimum kit pair: combining HDplex with either of the above sets to provide 30 or 32 unique STRs and just two overlapping loci.

Síndromes neurológicos asociados al uso de medicamentos. Frecuencia y caracterización / Neurological syndromes associated with drug use. Frequency and characterisation

Introducción: La necesidad de una asistencia sanitaria segura en la que los cuidados y tratamientos no supongan daños diferentes a los derivados de la enfermedad de base, ha motivado este estudio. Nuestro objetivo ha sido determinar la frecuencia y describir los síndromes neurológicos atribuibles a fármacos, su evitabilidad y los niveles asistenciales implicados. Métodos: Estudio observacional. Cohorte prospectiva de todos los sujetos derivados desde atención primaria y especializada, en el período de diciembre de 2008 a enero de 2010, por síntomas neurológicos atribuibles a fármacos y enfermos neurológicos conocidos con clínica distinta o agravada de la enfermedad de base causada por fármacos. Las notificaciones quedaron reflejadas en un cuestionario. Se realizaron distribuciones de frecuencias, medidas de tendencia central, pruebas de la 2 o Fisher y pruebas no paramétricas correspondientes. Resultados: La prevalencia de efectos adversos neurológicos respecto a la muestra total fue 0,586%. De los 105 pacientes seleccionados, los principales efectos adversos fueron: 25,7% síndrome rígido-acinético; 18,1% discinético; 11,4% síntomas neuropsiquiátricos, y 10,5% síndrome confusional. Los grupos farmacológicos más registrados fueron, en orden decreciente: antiepilépticos, dopaminérgicos, antidepresivos, neurolépticos, antivertiginosos y procinéticos. Describimos la población más susceptible y las asociaciones estadísticamente significativas entre la presencia de determinados grupos farmacológicos y síndromes neurológicos concretos.Conclusiones: La baja prevalencia detectada puede deberse al diseño del estudio, aunque los efectos adversos neurológicos suponen el 2,84% de los ingresos en una unidad de neurología.Conocer la epidemiología permitirá identificar los abordajes más seguros, aplicarlos correctamente a la población de mayor riesgo y reducir necesidades asistenciales y recursos médicos (AU)

Introduction: The need for safe health care, in which the care and treatment of the patient does not cause any injuries in addition to those already arising from their baseline disease, hasled to the present study. Our objective has been to determine the frequency and describe the neurological syndromes attributable to drugs, their preventability and the levels of medical care involved. Methods: Observational study. Cohort of subjects referred from Primary and Specialized Care between December 2008 and January 2010 due to neurological symptoms attributable to drugs, and previously known neurology patients who began to have symptoms other than those of the baseline disease, also caused by drugs. The notifications were recorded in a questionnaire. Frequency distributions, central tendency measurements, X2 or Fisher tests and non-parametric tests were performed. Results: The prevalence of adverse neurological events was 0.586% of the total sample. Of the 105 patients selected, the most frequent adverse events were: 25.7%, akinetic-rigid syndrome, 18.1%, dyskinetic syndrome, 11.4% neuro-psychiatric symptoms, and 10.5% confusional syndrome. The most commonly recorded pharmacological groups were, in decreasing order: anti-epileptic, dopaminergic, antidepressant, neuroleptic, antivertiginous and prokinetic drugs. We describe the most susceptible population and the statistically significant relationships between the presence of certain pharmacological groups and neurological syndromes. Conclusions: The low prevalence detected may be due to the study design, although adverse neurological events accounted for 2.84% of the admissions to a Neurology Unit. Understanding the epidemiology should help to identify the safest approaches, apply them correctly to the population at a higher risk, and reduce healthcare needs and consumption of medical resources (AU)

Early otic development depends on autophagy for apoptotic cell clearance and neural differentiation.

Autophagy is a highly regulated program of self-degradation of the cytosolic constituents that has key roles during early development and in adult cell growth and homeostasis. To investigate the role of autophagy in otic neurogenesis, we studied the expression of autophagy genes in early stages of chicken (Gallus gallus) inner ear development and the consequences of inhibiting the autophagic pathway in organotypic cultures of explanted chicken otic vesicles (OVs). Here we show the expression of autophagy-related genes (Atg) Beclin-1 (Atg6), Atg5 and LC3B (Atg8) in the otocyst and the presence of autophagic vesicles by using transmission electron microscopy in the otic neurogenic zone. The inhibition of the transcription of LC3B by using antisense morpholinos and of class III phosphatidylinositol 3-kinase with 3-methyladenine causes an aberrant morphology of the OV with accumulation of apoptotic cells. Moreover, inhibition of autophagy provokes the misregulation of the cell cycle in the otic epithelium, impaired neurogenesis and poor axonal outgrowth. Finally, our results indicate that autophagy provides the energy required for the clearing of neuroepithelial dying cells and suggest that it is required for the migration of otic neuronal precursors. Taken together, our results show for the first time that autophagy is an active and essential process during early inner ear development.

Analysis of a claimed distant relationship in a deficient pedigree using high density SNP data.

DNA markers are routinely used to reveal both simple and complex family relationships. Likelihood based approaches have been traditionally used to estimate relationships using relatively few unlinked markers. However it is widely recognized that when using such limited numbers of loci distant relationships between two individuals cannot be distinguished from the average level of allele sharing found in random pairwise comparisons in the same population. As a real example, we demonstrate the usefulness of genome-wide SNP genotyping to analyze a claimed second cousin relationship that could not be resolved using standard forensic markers, confirming theoretical expectations for very distant relationships. Genome profiles derived from Affymetrix 6.0 SNP arrays obtained from the claimed second cousins were compared to profiles obtained from unrelated individuals and simulated data. Significance of the high estimated probabilities in favor of the second cousin relationship hypothesis was proved from the results obtained with both real and simulated unrelated pairs. As a final cautionary note, it is important to consider that successful identification of the claimed distant relationship reported here is largely due to a well-founded hypothesis being compared to the alternative hypothesis of the claimants being unrelated, but where there are several possible alternative hypotheses, the approach we outline here can yield false indications of unfounded alternative relationships.

Neurological syndromes associated with drug use. Frequency and characterisation.

INTRODUCTION: The need for safe health care, in which the care and treatment of the patient does not cause any injuries in addition to those already arising from their baseline disease, has led to the present study. Our objective has been to determine the frequency and describe the neurological syndromes attributable to drugs, their preventability and the levels of medical care involved. METHODS: Observational study. Cohort of subjects referred from Primary and Specialized Care between December 2008 and January 2010 due to neurological symptoms attributable to drugs, and previously known neurology patients who began to have symptoms other than those of the baseline disease, also caused by drugs. The notifications were recorded in a questionnaire. Frequency distributions, central tendency measurements, X(2) or Fisher tests and non-parametric tests were performed. RESULTS: The prevalence of adverse neurological events was 0.586% of the total sample. Of the 105 patients selected, the most frequent adverse events were: 25.7%, akinetic-rigid syndrome, 18.1%, dyskinetic syndrome, 11.4% neuro-psychiatric symptoms, and 10.5% confusional syndrome. The most commonly recorded pharmacological groups were, in decreasing order: anti-epileptic, dopaminergic, antidepressant, neuroleptic, antivertiginous and prokinetic drugs. We describe the most susceptible population and the statistically significant relationships between the presence of certain pharmacological groups and neurological syndromes. CONCLUSIONS: The low prevalence detected may be due to the study design, although adverse neurological events accounted for 2.84% of the admissions to a Neurology Unit. Understanding the epidemiology should help to identify the safest approaches, apply them correctly to the population at a higher risk, and reduce healthcare needs and consumption of medical resources.

Analysis of global variability in 15 established and 5 new European Standard Set (ESS) STRs using the CEPH human genome diversity panel.

The CEPH human genome diversity cell line panel (CEPH-HGDP) of 51 globally distributed populations was used to analyze patterns of variability in 20 core human identification STRs. The markers typed comprised the 15 STRs of Identifiler, one of the most widely used forensic STR multiplexes, plus five recently introduced European Standard Set (ESS) STRs: D1S1656, D2S441, D10S1248, D12S391 and D22S1045. From the genotypes obtained for the ESS STRs we identified rare, intermediate or off-ladder alleles that had not been previously reported for these loci. Examples of novel ESS STR alleles found were characterized by sequence analysis. This revealed extensive repeat structure variation in three ESS STRs, with D12S391 showing particularly high variability for tandem runs of AGAT and AGAC repeat units. The global geographic distribution of the CEPH panel samples gave an opportunity to study in detail the extent of substructure shown by the 20 STRs amongst populations and between their parent population groups. An assessment was made of the forensic informativeness of the new ESS STRs compared to the loci they will replace: CSF1PO, D5S818, D7S820, D13S317 and TPOX, with results showing a clear enhancement of discrimination power using multiplexes that genotype the new ESS loci. We also measured the ability of Identifiler and ESS STRs to infer the ancestry of the CEPH-HGDP samples and demonstrate that forensic STRs in large multiplexes have the potential to differentiate the major population groups but only with sufficient reliability when used with other ancestry-informative markers such as single nucleotide polymorphisms. Finally we checked for possible association by linkage between the two ESS multiplex STRs closely positioned on chromosome-12: vWA and D12S391 by examining paired genotypes from the complete CEPH data set.

Resolving relationship tests that show ambiguous STR results using autosomal SNPs as supplementary markers.

When using a standard battery of STRs for relationship testing a small proportion of analyses can give ambiguous results - where the claimed relationship cannot be confirmed by a high enough paternity index or excluded with fully incompatible genotypes. The majority of such cases arise from unknowingly testing a brother of the true father and observing only a small number of exclusions that can each be interpreted as one- or two-step mutations. Although adding extra STRs might resolve a proportion of cases, there are few properly validated extra STRs available, while the commonly added hypervariable SE33 locus is four times more mutable than average, increasing the risk of ambiguous results. We have found SNPs in large multiplexes are much more informative for both low initial probabilities or ambiguous exclusions and at the same time provide a more reliable genotyping approach for the highly degraded DNA encountered in many identification cases. Eight relationship cases are outlined where the addition of SNP data resolved analyses that had remained ambiguous even with extended STR typing. In addition we have made simulations to ascertain the frequency of failing to obtain exclusions or conclusive probabilities of paternity with different marker sets when a brother of the true father is tested. Results indicate that SNPs are statistically more efficient than STRs in resolving cases that distinguish first-degree relatives in deficient pedigrees.

PKU Clásica. Errores congénitos del metabolismo / Metabolic congenital errors. Classical PKU or phenylketonuria

Se expone en qué consiste la pku o fenilcetonuria, alteración metabólica de tipo congénito que obliga a las personas que la padecen a mantener un tratamiento dietético de por vida. Se analizan las alteraciones bioquímicas que se producen en el organismo y que dan lugar a la aparición de la misma; la genética; las manifestaciones clínicas que se producen en las personas que la padecen; el diagnóstico de la enfermedad; la incidencia sobre la población; un apartado más extenso acerca del tratamiento nutricional y el seguimiento y control del mismo; los cuidados de enfermería, basados fundamentalmente en educación y asesoramiento a pacientes y familias en cuanto al control y los problemas que suelen surgir en el tratamiento dietético a lo largo de las distintas etapas de la vida; y, por último, las conclusiones de este trabajo, cuya idea surge tras una intensa toma de contacto con la Asociación Gallega de Fenilcetonuria y del estudio de la situación epidemiológica y nutricional de estos enfermos en Galicia. Este estudio fue presentado en el III Congreso Nacional de la SENC, celebrado en Las Palmas de Gran Canaria. (AU)

[Classical phenylketonuria. Metabolism inborn errors]. / PKU clásica. Errores congénitos del metabolismo.

The authors describe pku or phenylketonuria, a congenital type of metabolic alteration which forces those patients who suffer it to follow a dietetic treatment for their entire lives. The authors analyze 1, the biochemical alterations which are produced in the organism and which cause the appearance of them; 2, the genetics involved; 3, the clinical manifestations shown by those who suffer from pku; 4, the diagnosis of this disease; 5, the number of cases in the general public; 6, a bit more extensive section dealing with the nutritional treatment, follow-up and control of this disease; 7, nursing care, fundamentally based on how to educate and counsel patients and their families regarding control methods and problems which commonly occur in dietetic treatment over the course of the various phases in one's life; and 8, the conclusions of this study, whose origin came after intensive contact with the Galician Association of Phenylketonuria and a study of the epidemiological and nutritional situation of sufferers of this disease in Galicia. This study was presented at the Third National "SENC" Congress held in Las Palmas de Gran Canaria.

[Effect of chlorhexidine on Staphylococcus aureus hospital isolates under different environmental conditions]. / Efecto de clorhexidina sobre aislamientos hospitalarios de Staphylococcus aureus en diferentes condiciones ambientales.

Antiseptic agents are widely used in hospitals, being essential when prevention and control of nosocomial infections are required. It is necessary to consider several aspects that affect the biocide activity, since they have direct incidence in hospital hygiene, health and also in the nosocomial infection rate. Organisms belonging to Staphylococcus genus are involved in such infections and, digluconate of chlorhexidine is one of the most used antiseptic agents for human and animal health. The current study involved the evaluation of this biocide agent against 19 nosocomial isolates of Staphylococcus with and without organic substances and applying distilled water and water of 300 ppm hardness as dilution means. Results show that hard water was one of the factors that most highly affected the bactericidal activity of chlorhexidine. Moreover we found that it affected bactericidal activity more than the interference generated by organic substances. Our study proves that chlorhexidine is an effective antiseptic for these gram-positive microorganisms.

Efecto de clorhexidina sobre aislamientos hospitalarios de Staphylococcus aureus en diferentes condiciones ambientales / [Effect of chlorhexidine on Staphylococcus aureus hospital isolates under different environmental conditions]

Antiseptic agents are widely used in hospitals, being essential when prevention and control of nosocomial infections are required. It is necessary to consider several aspects that affect the biocide activity, since they have direct incidence in hospital hygiene, health and also in the nosocomial infection rate. Organisms belonging to Staphylococcus genus are involved in such infections and, digluconate of chlorhexidine is one of the most used antiseptic agents for human and animal health. The current study involved the evaluation of this biocide agent against 19 nosocomial isolates of Staphylococcus with and without organic substances and applying distilled water and water of 300 ppm hardness as dilution means. Results show that hard water was one of the factors that most highly affected the bactericidal activity of chlorhexidine. Moreover we found that it affected bactericidal activity more than the interference generated by organic substances. Our study proves that chlorhexidine is an effective antiseptic for these gram-positive microorganisms.

Efecto de clorhexidina sobre aislamientos hospitalarios de Staphylococcus aureus en diferentes condiciones ambientales. / [Effect of chlorhexidine on Staphylococcus aureus hospital isolates under different environmental conditions]

Antiseptic agents are widely used in hospitals, being essential when prevention and control of nosocomial infections are required. It is necessary to consider several aspects that affect the biocide activity, since they have direct incidence in hospital hygiene, health and also in the nosocomial infection rate. Organisms belonging to Staphylococcus genus are involved in such infections and, digluconate of chlorhexidine is one of the most used antiseptic agents for human and animal health. The current study involved the evaluation of this biocide agent against 19 nosocomial isolates of Staphylococcus with and without organic substances and applying distilled water and water of 300 ppm hardness as dilution means. Results show that hard water was one of the factors that most highly affected the bactericidal activity of chlorhexidine. Moreover we found that it affected bactericidal activity more than the interference generated by organic substances. Our study proves that chlorhexidine is an effective antiseptic for these gram-positive microorganisms.

Acidums de la Materia Medica / Acids of the Materia Medica

Este trabajo tiene por finalidad realizar el analisis entre los Acidums mas conocidos de la materia medica y demostrar ademas, la relacion existente entre la quimica de cada sustancia, su origen, su toxicidad, su mecanismo de accion, con la totalidad sintomatica de cada medicamento. (AU)

Risperidona en el tratamiento de la manía aguda: rapidez de la respuesta y tiempo de estancia / Risperidone in the treatment of acute mania: speed of onset of response and length of stay

Fundamento: La asociación de neurolépticos con estabilizadores del ánimo es de primera elección en los episodios agudos de manía. Se ha comprobado que risperidona es eficaz en la tratamiento de la manía. Por otro lado, la reducción de los días de estancia hospitalaria para este tipo de pacientes se ha relacionado con la mejoría psicofarmacológica. El objetivo del presente estudio fue comprobar la eficacia a corto plazo de risperidona asociada en el tratamiento de los episodios agudos de manía, y si la eficacia a corto plazo guarda relación con los días de estancia hospitalaria. Métodos: Se incluyó a 15 pacientes ingresados en la unidad de agudos con diagnóstico de trastorno bipolar, episodio actual maníaco según criterios de la CIE-10, en un estudio observacional no controlado con muestreo aleatorio. Se administró risperidona (dosis media, 6,68 ñ 2 mg/día) asociada a un estabilizador del ánimo y a benzodiacepinas, según criterio clínico. Se evaluó a los pacientes mediante la escala de Young para la Manía (YMRS) al ingreso y la semana del tratamiento. Se estableció el criterio de mejoría en una reducción del 50 por ciento o más en dicha escala. Para el análisis de la rapidez de acción del tratamiento en relación con los días de estancia hospitalaria, se realizó un análisis de supervivencia entre los pacientes que respondieron y los que no lo hicieron mediante las curvas de Kaplan-Meier y la prueba de rangos logarítmicos. Resultados: Risperidona asociada con estabilizadores del ánimo y benzodiacepinas resultó eficaz a corto plazo en el tratamiento de los episodios agudos de manía (p = 0,001). Las limitaciones del tamaño de la muestra no permitieron encontrar diferencias estadísticamente significativas en los días de estancia hospitalaria entre los pacientes que respondieron a corto plazo a risperidona y los que no lo hicieron. Conclusiones: Risperidona asociada es un neuroléptico eficaz a corto plazo en el tratamiento de los episodios agudos de manía. Se necesitan más estudios centrados específicamente en los días de estancia hospitalaria para determinar qué variable o variables influyen en ésta (AU)