[Autism spectrum disorder: the impact of an online training strategy on the knowledge of the healthcare staff of a tertiary care hospital]. / Trastorno del espectro autista: impacto de una estrategia de formación en línea en los conocimientos del personal sanitario de un hospital de tercer nivel.

INTRODUCTION: Autism spectrum disorder (ASD) often presents related medical disorders that require specialised healthcare. Professionals in the health sector therefore face difficulties that require specific training in the healthcare needs of this population. AIM: The aim of this study is to quantify paediatric healthcare professionals' knowledge about ASD and to assess the impact of online training. SUBJECTS AND METHODS: It is a quasi-experimental, longitudinal, prospective before-and-after study; study subjects: health professionals; independent variable: online training in ASD; dependent variable: knowledge about ASD. An online training course was held for paediatric professionals to address the core characteristics of diagnosis, as well as the needs they present in the hospital context and the adaptations it is recommended that should be carried out. Fifty-eight healthcare professionals took part. RESULTS: An increase in knowledge about ASD was observed at the end of the intervention (from 73.9% to 85% according to the ASD background knowledge questionnaire), which showed that more than 90% of the participants had the highest level of knowledge about ASD. CONCLUSIONS: Online training courses are a useful and effective way to increase knowledge about ASD and the adaptations that are recommended in the hospital setting. More training in ASD should be made available in these settings.

TITLE: Trastorno del espectro autista: impacto de una estrategia de formación en línea en los conocimientos del personal sanitario de un hospital de tercer nivel.Introducción. El trastorno del espectro autista (TEA) frecuentemente presenta trastornos médicos relacionados que requieren una atención sanitaria especializada. En este sentido, los profesionales del ámbito sanitario se enfrentan a dificultades que precisan una formación específica en las necesidades sanitarias que presenta esta población. Objetivo. Cuantificar los conocimientos sobre el TEA de los profesionales sanitarios del área pediátrica y valorar el impacto de una formación en línea. Sujetos y métodos. Estudio cuasi experimental del antes y después, longitudinal y prospectivo; sujetos a estudio: profesionales sanitarios; variable independiente: formación en línea en TEA; variable dependiente: conocimiento sobre el TEA. Se llevó a cabo una formación en línea para profesionales del área de pediatría en la que se abordaron las características nucleares del diagnóstico, así como las necesidades que presentan en el contexto hospitalario y las adaptaciones que se recomiendan llevar a cabo. Participaron 58 profesionales sanitarios. Resultados. Se observó un aumento en el conocimiento sobre el TEA al finalizar la intervención (del 73,9 al 85% según el cuestionario de conocimientos previos del TEA), que mostró que más del 90% de los participantes tenía el grado máximo de conocimiento sobre el TEA. Conclusiones. Las formaciones en línea son un método para ampliar conocimiento útil y eficaz para aumentar el conocimiento sobre el TEA y las adaptaciones que se recomiendan en el ámbito hospitalario. Se recomienda aumentar la disponibilidad de formación sobre TEA en estos entornos.

Oral and dental health status in patients with eating disorders in Madrid, Spain.

BACKGROUND: The aim of the present study was to describe and compare the oral and dental health status of two groups, one diagnosed with eating disorders (EDs), and another group without this pathology, assessing the following oral manifestations: dental alterations, periodontal disorders, soft tissue disorders, non-stimulated salivary flow, and oral pH. MATERIAL AND METHODS: This comparative transversal epidemiological study included 179 participants, of whom 59 were diagnosed with EDs (Eating Disorder Group: EDG) and 120 had no antecedents of EDs (No Eating Disorder Group: NEDG). All patients fulfilled the following inclusion criteria: women aged over 18 years, diagnosed with an ED by a specialist, patients who had undergone at least 1 year monitoring by the Clinical Nutrition Unit, and had not received any periodontal treatment during the previous 6 months. Both groups were homogeneous in terms of sex, age, education, and socioeconomic level. Oral exploration was performed, registering clinical variables, as well as sociodemographic and socioeconomic data, oral hygiene habits, and smoking. Statistical significance was established as p<0.05 (confidence level > 95%). RESULTS: The dental erosion (DE) was the most significative feature of dental alterations. The degree of DE was significantly greater in the EDG (p<0.001). A significant association between soft tissue lesions and EDs was found (p<0.001) A notable difference in non-stimulated salivary flow was found between the groups (p<0.001). No significant differences between the groups were found for periodontal status, dental caries, or oral hygiene practices. CONCLUSIONS: On the basis of the results obtained, it is necessary to carry out oral/dental examination as soon as an ED is diagnosed with regular check-ups thereafter.

La estimulación previa con rhTSH mejora la respuesta al tratamiento con radioyodo en pacientes con bocio multinodular tóxico de baja captación / Recombinant human thyrotropin stimulation prior to 131I therapy in toxic multinodular goitre with low radioactive iodine uptake

Introducción. La estimulación con TSH recombinante humana (rhTSH) aumenta la captación tiroidea de yodo, ayudando al tratamiento con radioyodo en el bocio multinodular (BMN) no tóxico. Sin embargo, son escasos los estudios que utilicen rhTSH previo a terapia con radioyodo en el BMN tóxico para controlar la hiperfunción y clínica compresiva. Material y método. Se llevó a cabo un estudio prospectivo en pacientes con BMN e hipertiroidismo. Los pacientes se reclutaron de forma consecutiva y se dividieron en un grupo I, estimulados con 0,3mg de rhTSH antes de recibir radioyodo, y un grupo control o grupo II, sin estimulación previa. Se midió función tiroidea, captación tiroidea de radioyodo, peso tiroideo y síntomas compresivos, y se siguió a los pacientes durante 9 meses. Resultados. Un total de 16 pacientes (14 mujeres) de edad media 69,7años constituyeron el grupo I y 16 pacientes (12 mujeres) de edad media 70,7años, el grupo II. Tras el estímulo con 0,3mg rhTSH en el grupo I, la captación de 131I a las 24h aumentó un 78,4% y la dosis estimada absorbida, un 89,3%. En el grupo II, la dosis estimada absorbida fue inferior a la del grupo I tras la estimulación con rhTSH (29,8Gy vs. 56,4Gy; p=0,001). A los 9 meses, se había controlado el hipertiroidismo en un 87,5% de pacientes en el grupo I, y en un 56,2% en el grupo II (p=0,049). La reducción media de peso tiroideo fue mayor en el grupo I que en el II (39,3% vs. 26,9%; p=0,017), con una tendencia a la mejoría subjetiva de la clínica compresiva en el grupo I, aunque no significativa. Solo 2 pacientes describieron taquicardias tras la administración de rhTSH, que se resolvieron con beta-bloqueantes. Conclusiones. La estimulación con rhTSH a dosis de 0,3mg previa al tratamiento con radioyodo consigue una reducción del tamaño tiroideo y mejoría funcional en pacientes con hipertiroidismo y BMN de baja captación, sin necesidad de ingreso hospitalario (AU)

Aim. Stimulation with recombinant human thyrotropin (rhTSH) increases thyroid radioiodine uptake, and is an aid to 131I therapy in non-toxic multinodular goitre (MNG). However, there are not many studies using rhTSH prior to 131I in toxic multinodular goitre to improve hyperthyroidism and compressive symptoms. Material and method. A prospective study was conducted on patients with MNG and hyperthyroidism. Patients were recruited consecutively and divided into group I, stimulated with 0.3mg of rhTSH before radioiodine therapy, and a control group or group II, without stimulation. Thyroid function, radioiodine thyroid uptake, thyroid weight, and compressive symptoms were measured, and patients were followed-up for 9 months. Results. Group I consisted of 16 patients (14 women), with a mean age 69.7 years, and group II with 16 patients (12 women), with a mean age 70.7 years. After stimulation with 0.3mg rhTSH in group I, 131I uptake (RAIU) at 24h increased by 78.4%, and the estimated absorbed dose by 89.3%. In group II, the estimated absorbed dose was lower than group I after stimulation with rhTSH (29.8Gy vs. 56.4Gy; P=0.001). At 9 months of follow-up, hyperthyroidism was controlled in 87.5% of patients in group I, and 56.2% in group II (P=0.049). The mean reduction in thyroid weight was higher in group I than in group II (39.3% vs. 26.9%; P=0.017), with a tendency towards subjective improvement of compressive symptoms in group I, although non-significant. Only 2 patients described tachycardias after rhTSH administration, which were resolved with beta-blockers. Conclusion. Stimulation with 0.3mg of recombinant human thyrotropin prior to radioiodine therapy achieves a reduction in thyroid weight and functional improvement in patients with hyperthyroidism and multinodular goitre with low uptake, and with no need for hospital admission (AU)

Radioinmunoterapia en el linfoma no Hodgkin, posicionamiento, seguridad y eficacia de 90Y-ibritumomab. Experiencia y seguimiento a los 10 años / Radioimmunotherapy for non-Hodgkin's lymphoma; positioning, safety, and efficacy of 90Y-Ibritumomab. 10 years of experience and follow-up

Introducción. La radioinmunoterapia (RIT) es uno de los tratamientos dirigidos contra dianas moleculares del linfoma no Hodgkin (LNH). Objetivo. Evaluar el posicionamiento de la RIT con 90Y-ibritumomab en pacientes con LNH, así como su seguridad y efectividad. Método. Estudio retrospectivo de pacientes con LNH que recibieron RIT con 90Y-ibritumomab. Se evaluaron la concordancia con las guías clínicas, la toxicidad según la clasificación Common Terminology Criteria for Adverse Events (CTCAE) y la efectividad en función de la respuesta al tratamiento y de la supervivencia global (SG) y la supervivencia libre de progresión (SLP). Resultados. Se solicitó RIT en 26 pacientes, de los que 21 (11 mujeres, edad media ± desviación estándar 56±10 años) fueron incluidos en el estudio, con la siguiente distribución: LNH folicular 67%, LNH del manto 14%, LNH difuso de células B grandes 9,5% y LNH transformado 9,5%. Se trató a 12 pacientes con LNH refractario, 7 para consolidación de respuesta y 2 para acondicionamiento a trasplante. El 71% de los pacientes presentó efectos adversos, generalmente manejables y transitorios, siendo la trombocitopenia el más frecuente. A los 3-4 meses, se obtuvo una tasa de respuesta global del 76,2% (completa en 71,4% y parcial en 4,8%) y el 19% mostró progresión de su enfermedad. Con una mediana de seguimiento de 70 meses, la SG fue 96±8 y la SLP de 54±11 meses. Conclusiones. La RIT presentó una moderada correlación con las guías clínicas y probablemente esté infrautilizada. Los efectos adversos fueron frecuentes, leves y manejables. Los datos muestran una alta tasa de respuesta completa y una prolongación de la SG y la SLP (AU)

Introduction. Radioimmunotherapy (RIT) is one of the therapies directed against molecular targets in non-Hodgkin's lymphoma (NHL). Objective. To evaluate the positioning, safety, and effectiveness of RIT with 90Y-Ibritumomab in NHL patients. Method. A retrospective study was conducted on patients with NHL who received RIT with 90Y-Ibritumomab. An evaluation was made of the concordance with clinical guidelines, toxicity as rated by the Common Terminology Criteria for Adverse Events (CTCAE), and effectiveness was assessed based on response to treatment, overall survival (OS), and progression-free survival (PFS). Results. RIT was requested in 26 patients, of whom 21 (11 women, mean age 56±10 years) were included in the study, with the following distribution: Follicular NHL, 67%, Mantle NHL, 14%, Diffuse large B-cell NHL, 9.5%, and Transformed NHL 9.5%. Twelve patients with refractory NHL, 7 for consolidation response, and 2 transplant conditioning, were treated. Adverse effects were observed in 71% of patients, which were usually manageable and transient, and with the most common being thrombocytopenia. At 3-4 months, overall response rate was 76.2% (71.4% complete and 4.8% partial response), and 19% had progression of disease. With a median follow up of 70 months, the OS was 96±8 months, and the PFS was 54±11 months. Conclusion. RIT showed a moderate correlation with clinical guidelines, and is probably underused. Adverse effects were common, mild, and manageable. The data show a high complete response rate and an increase in the OS and PFS (AU)

Recombinant human thyrotropin stimulation prior to 131I therapy in toxic multinodular goitre with low radioactive iodine uptake. / La estimulación previa con rhTSH mejora la respuesta al tratamiento con radioyodo en pacientes con bocio multinodular tóxico de baja captación.

AIM: Stimulation with recombinant human thyrotropin (rhTSH) increases thyroid radioiodine uptake, and is an aid to 131I therapy in non-toxic multinodular goitre (MNG). However, there are not many studies using rhTSH prior to 131I in toxic multinodular goitre to improve hyperthyroidism and compressive symptoms. MATERIAL AND METHOD: A prospective study was conducted on patients with MNG and hyperthyroidism. Patients were recruited consecutively and divided into group I, stimulated with 0.3mg of rhTSH before radioiodine therapy, and a control group or group II, without stimulation. Thyroid function, radioiodine thyroid uptake, thyroid weight, and compressive symptoms were measured, and patients were followed-up for 9 months. RESULTS: Group I consisted of 16 patients (14 women), with a mean age 69.7 years, and group II with 16 patients (12 women), with a mean age 70.7 years. After stimulation with 0.3mg rhTSH in group I, 131I uptake (RAIU) at 24h increased by 78.4%, and the estimated absorbed dose by 89.3%. In group II, the estimated absorbed dose was lower than group I after stimulation with rhTSH (29.8Gy vs. 56.4Gy; P=0.001). At 9 months of follow-up, hyperthyroidism was controlled in 87.5% of patients in group I, and 56.2% in group II (P=0.049). The mean reduction in thyroid weight was higher in group I than in group II (39.3% vs. 26.9%; P=0.017), with a tendency towards subjective improvement of compressive symptoms in group I, although non-significant. Only 2 patients described tachycardias after rhTSH administration, which were resolved with beta-blockers. CONCLUSION: Stimulation with 0.3mg of recombinant human thyrotropin prior to radioiodine therapy achieves a reduction in thyroid weight and functional improvement in patients with hyperthyroidism and multinodular goitre with low uptake, and with no need for hospital admission.

Radioimmunotherapy for non-Hodgkin's lymphoma; positioning, safety, and efficacy of 90Y-Ibritumomab. 10 years of experience and follow-up. / Radioinmunoterapia en el linfoma no Hodgkin, posicionamiento, seguridad y eficacia de 90Y-ibritumomab. Experiencia y seguimiento a los 10 años.

INTRODUCTION: Radioimmunotherapy (RIT) is one of the therapies directed against molecular targets in non-Hodgkin's lymphoma (NHL). OBJECTIVE: To evaluate the positioning, safety, and effectiveness of RIT with 90Y-Ibritumomab in NHL patients. METHOD: A retrospective study was conducted on patients with NHL who received RIT with 90Y-Ibritumomab. An evaluation was made of the concordance with clinical guidelines, toxicity as rated by the Common Terminology Criteria for Adverse Events (CTCAE), and effectiveness was assessed based on response to treatment, overall survival (OS), and progression-free survival (PFS). RESULTS: RIT was requested in 26 patients, of whom 21 (11 women, mean age 56±10 years) were included in the study, with the following distribution: Follicular NHL, 67%, Mantle NHL, 14%, Diffuse large B-cell NHL, 9.5%, and Transformed NHL 9.5%. Twelve patients with refractory NHL, 7 for consolidation response, and 2 transplant conditioning, were treated. Adverse effects were observed in 71% of patients, which were usually manageable and transient, and with the most common being thrombocytopenia. At 3-4 months, overall response rate was 76.2% (71.4% complete and 4.8% partial response), and 19% had progression of disease. With a median follow up of 70 months, the OS was 96±8 months, and the PFS was 54±11 months. CONCLUSION: RIT showed a moderate correlation with clinical guidelines, and is probably underused. Adverse effects were common, mild, and manageable. The data show a high complete response rate and an increase in the OS and PFS.

Plan estratégico integral de seguridad en el uso de medicamentos en un departamento sanitario / Comprehensive drug safety plan in a health department

Objetivo: Elaborar un plan estratégico integral para el uso seguro de los medicamentos en un hospital para el trienio 2009-2011 y su posterior puesta en marcha. Material y métodos: Aplicando la metodología de análisis de debilidades, amenazas, fortalezas, oportunidades (DAFO) se analizó la situación de partida y posteriormente se elaboró una gran estrategia o plan, definiendo el alcance, las responsabilidades, los objetivos y las actividades estratégicas e indicadores de medición de resultados de consecución de las mismas. Resultados: Se realizó un plan estratégico integral para el uso seguro de los medicamentos con el objetivo principal de identificar y disminuir los problemas relacionados con la medicación (PRM) en los pacientes atendidos en el Hospital San Juan de Alicante. Contenía 5 objetivos estratégicos, 20 actividades estratégicas y los correspondientes indicadores de resultado para evaluarlo tras su implantación. Además incluyó un cronograma para su establecimiento y posterior evaluación. Discusión: La elaboración de un plan integral estratégico puede facilitar el conocimiento de la situación de partida en materia de seguridad. Los resultados obtenidos tras su implantación definirán su aplicabilidad. Debido a la falta de publicación de planes similares y sus resultados, la evaluación de este plan será de utilidad tanto si estos resultados son o no favorables. Como posibles beneficios secundarios a la elaboración, el equipo multidisciplinar sigue trabajando en mejorar la seguridad del paciente en el proceso asistencial, y la cultura de seguridad sigue creciendo entre los profesionales implicados (AU)

Objective: To develop and implement a comprehensive drug safety plan in a hospital for the years 2009-2011.Material and methods: Applying the Strengths Weaknesses/Limitations Opportunities Threats(SWOT) methodology, the baseline situation was analyzed and a broad strategy or plan was subsequently developed, defining the scope, responsibilities, objectives and strategic actions and indicators in order to measure the achievement of the results. Results: A comprehensive drug safety plan with the main objective of identifying and reducing the medication-related problems in patients treated in the Hospital de San Juan in Alicante has been developed. The plan contains five strategic objectives, twenty strategic actions and the indicators to assess its outcomes. It also contains a timetable for its establishment and evaluation. Discusion: Developing a comprehensive strategic plan allows the current situation relating to drug safety to be determined. The results obtained after its introduction will define its applicability. Due to the lack of publications of similar plans and results, the evaluation of this plan will be useful whether it is favorable or not. As a side benefit of the development, the multidisciplinary team continues to work on improving patient safety in the care process, and the safety culture continues to grow among the professionals (AU)

[Early statin therapy in acute myocardial infarction]. / Tratamiento precoz con estatinas en el infarto agudo de miocardio.

OBJECTIVES: To evaluate the effects of the early administration of statins during acute myocardial infarction (MI). DESIGN: A retrospective cohort study was carried out. SETTING: National (Spain). PATIENTS OR PARTICIPANTS: Patients included in the ARIAM registry from January 1999 to December 2008 with a diagnosis of MI. INTERVENTIONS: None. MAIN VARIABLES: We used logistic regression analysis and propensity scoring to determine whether the administration of statins during the first 24h of MI acts as a protective factor against: 1) mortality, 2) the incidence of lethal arrhythmias, or 3) cardiogenic shock. RESULTS: A total of 36 842 patients were included in the study. Statins were administered early in 50.2% of the patients. Statin administration was associated with younger patients with known previous dyslipidemia, obesity, a history of ischemic heart disease, heart failure, presence of sinus tachycardia, use of beta-blockers, angiotensin-converting enzyme inhibitors, thrombolysis and percutaneous coronary intervention. Mortality was 8.2% (13.2% without statin versus 3% with statin, P<.001). Multivariate analysis demonstrated that statin administration acted as a protective factor against mortality (adjusted OR 0.518, 95%CI 0.447 to 0.601). Continued use of statins was associated with a reduction in mortality (adjusted OR 0.597, 95%CI 0.449 to 0.798), and the start of treatment was a protective factor against mortality (adjusted OR 0.642, 95%CI 0.544 -0.757). Statin therapy also exerted a protective effect against the incidence of lethal arrhythmias and cardiogenic shock. CONCLUSIONS: These results suggest that early treatment with statins in patients with MI is associated with reduced mortality.

[Comprehensive drug safety plan in a health department]. / Plan estratégico integral de seguridad en el uso de medicamentos en un departamento sanitario.

OBJECTIVE: To develop and implement a comprehensive drug safety plan in a hospital for the years 2009-2011. MATERIAL AND METHODS: Applying the Strengths Weaknesses/Limitations Opportunities Threats (SWOT) methodology, the baseline situation was analyzed and a broad strategy or plan was subsequently developed, defining the scope, responsibilities, objectives and strategic actions and indicators in order to measure the achievement of the results. RESULTS: A comprehensive drug safety plan with the main objective of identifying and reducing the medication-related problems in patients treated in the Hospital de San Juan in Alicante has been developed. The plan contains five strategic objectives, twenty strategic actions and the indicators to assess its outcomes. It also contains a timetable for its establishment and evaluation. DISCUSION: Developing a comprehensive strategic plan allows the current situation relating to drug safety to be determined. The results obtained after its introduction will define its applicability. Due to the lack of publications of similar plans and results, the evaluation of this plan will be useful whether it is favorable or not. As a side benefit of the development, the multidisciplinary team continues to work on improving patient safety in the care process, and the safety culture continues to grow among the professionals.

Dietary fat intake and the risk of osteoporotic fractures in the elderly.

OBJECTIVE: To explore the association between fat intake, serum lipids and the risk of osteoporotic fractures in the elderly. DESIGN: A hospital-based case-control study. SETTING: The study was conducted at a tertiary centre and referral hospital for the province of Jaén (Spain). SUBJECTS: Cases (n=167) were patients aged 65 years or more with a low-energy fracture selected from the population attended at the hospital. Controls (patients without antecedents of any fracture) were 1:1 matched to cases by sex and age (n=167). METHODS: Diet was assessed by a semiquantitative food frequency questionnaire. Serum total cholesterol and high-density lipoprotein (HDL) cholesterol were also measured. RESULTS: Participants in the two upper quartiles of polyunsaturated fat (PUFA) intake showed an increased risk of fracture, with statistically significant differences with respect to the first quartile in the adjusted model (odds ratio (OR)=3.59; 95% confidence interval (CI)=1.06-12.1 and OR=5.88; 95% CI=1.38-25.02); P=0.01 for the trend test). A higher ratio of monounsaturated fat (MUFA) to PUFA was associated with a reduced risk of fracture (OR=0.20; 95% CI=0.07-0.60 for the fourth quartile; P=0.002 for the trend test). The intake of omega-6 fatty acids was associated with an elevated risk of fracture (OR=3.41; 95% CI=1.05-11.15 for the fourth quartile; P=0.01 for the trend test). HDL-cholesterol levels were inversely associated with the risk of fracture (test for trend P=0.03 across quartiles). CONCLUSIONS: PUFA intake was associated with an increased risk of osteoporotic fractures in the elderly, whereas a high ratio of MUFA:PUFA was associated with decreased risk.

[Detection of bulimia nervosa in primary health care consultations]. / Detección de bulimia nerviosa en las consultas de Atención Primaria.

INTRODUCTION: To estimate the prevalence of bulimia nervosa and bulimic behavior in women who come to Primary Health Care consultations, using the DSM-IV criteria. DESIGN: Descriptive, observational study Setting. Primary Health Care. PARTICIPANTS: Women over 14 years who come to general medicine consultations. Selection by systematic sampling of 175 women (proportion expected: 4%; confidence index: 95%; accuracy: 3%). MAIN MEASURES: Examination, by semi-structured interview, of diagnostic criteria of bulimia (recurrent binge eating, compensatory behaviors and excessive concern about weight or body image), socio-demographic variables and variables on morbidity (health problems according to CIPSAP-2-defined). RESULTS: Prevalence of bulimia was 5.3% (95% CI: 2.4-9.7), there being recurrent binge-eating in 23.4%. Among the compensatory behaviors, fasting (13.5%), intense exercise (8.2%) and self-induced vomiting (4.7%) were the most frequent. In women with bulimia, a background of anorexia and establishment of goals to lose weight appeared more frequently (p <0.05). Their average age was significantly lower (p <0.05) (31.2 14.7 SD). By logistic regression, the associated variables with the presence of bulimia were age (OR: 0.94), existence of previous psychiatric morbidity (OR: 9.0) and having previously set goals to lose weight (OR:7.3). CONCLUSIONS: In the women who came to the Primary Health Care consultations, prevalence of bulimia is greater than that described in the general female population. This disorder is more frequent in younger women and in those who present a background of psychiatric morbidity. Examination of the diagnostic criteria makes its detection easy in Primary Health Care consultations.

Detección de bulimia nerviosa en las consultas de Atención Primaria / Detection of bulimia nervosa in primary health care consultations

Introducción. Estimar, mediante criterios DSM-IV, la p revalencia de bulimia nerviosa y conductas bulímicas en mujeres que utilizan las consultas de Atención Primaria .Métodos. Estudio observacional descriptivo emplazado en el ámbito de Atención Primaria, cuyas participantes son mujeres mayores de 14 años que acuden a las consultas de medicina general. Selección mediante muestreo sistemático de 175 mujeres (proporción esperada: 4 por ciento; intervalo confianza: 95 por ciento; precisión: ñ 3 por ciento). La exploración se hizo mediante entrevista semiestructurada de criterios diagnósticos de bulimia (atracones recurrentes, conductas compensatorias y preocupación excesiva por el peso o la imagen corporal), variables sociodemográficas y variables sobre morbilidad (problemas de salud según CIPSAP-2-definida) .Resultados. La prevalencia de bulimia fue del 5,3 por ciento (IC 95 por ciento: 2,4-9,7), apareciendo atracones recurrentes en el 23,4 por ciento. Entre las conductas compensatorias, el ayuno (13,5 por ciento), el ejercicio intenso (8,2 por ciento) y los vómitos autoinducidos (4,7 por ciento) fueron las más frecuentes. En mujeres con bulimia aparecieron con más frecuencia (p<0,05) antecedentes de anorexia y fijación de metas para adelgazar. Su edad media fue significativamente inferior (p <0,05) (31,2ñ 14,7 DE).Mediante regresión logística las variables asociadas con la presencia de bulimia fueron la edad (OR: 0,94), la existencia de morbilidad psiquiátrica previa (OR: 9,0) y el haber fijado metas para perder peso con anterioridad (OR: 7,3).Conclusiones. En las mujeres que utilizan las consultas de Atención Primaria la prevalencia de bulimia es superior a la descrita en población general femenina. Dicho trastorno es más frecuente en mujeres de menor edad y en las que presentan antecedente de morbilidad psiquiátrica. La exploración de los criterios diagnósticos permite fácilmente su detección en las consultas de Atención Primaria (AU)

Escabiosis: revisión y actualización / Scabies: checking and update

La sarna o escabiosis es una ectoparasitosis producida por Sarcoptes scabiei. Existen dos formas clínicas, la típica y la llamada sarna noruega, con lesiones hiperqueratósicas generalizadas y con un gran potencial para provocar brotes en situaciones de hacinamiento. La infestación es más frecuente en aquellas circunstancias en que existe un contacto prolongado con los afectados. En ocasiones, esta enfermedad plantea problemas diagnósticos y terapéuticos, dependiendo de la edad y situación del sujeto. El tratamiento se basará en el uso correcto de escabicidas, medidas higiénicas y la realización de una adecuada profilaxis en todos los sujetos conviventes (AU)

Hallucinations with therapeutic doses of clarithromycin.

OBJECTIVE: Hallucinations caused by adverse reactions to medication are not uncommon and a wide variety of drugs may be involved. We present a case of hallucinations caused by therapeutic doses of oral clarithromycin (500 mg b.i.d). CASE REPORT: A 32-year-old woman attended the Emergency Department of the hospital with severe visual hallucinations together with marked anxiety and nervousness following the second dose of clarithromycin, which was the only medication she was taking. The antibiotic was identified as the possible cause of the clinical manifestations and was stopped immediately. The patient did not require hospitalization and was discharged a few hours later with no signs of neurological disturbances. Clarithromycin was substituted by amoxycillin-clavulanic acid (500/125 mg) t.i.d. CONCLUSIONS: The temporal relationship between commencement of antibiotic therapy and the appearance of hallucinations, together with the fact that the symptoms disappeared once the antibiotic was suspended, support a causal relationship between clarithromycin and the hallucinations. Further support for a causal relationship was obtained by application of Naranjo's algorithm which gave a likelihood level for causality of PROBABLE.

Estabilidad de una mezcla de Tobramicina 0,01 mg/ml y Vancomicina 0,05 mg/ml en BSS-PLUS para irrigación-lavado intraocular / Stability of tobramycin 0,01 mg/mL and vancomycin 0,05 mg/mL mixture in BBS-PLUS for intraocular irrigation and washing

Objetivo: Conocer la estabilidad de una mezcla de vancomicina 0,05 mg/ml y tobramicina 0,01 mg/ml en BSS-plus, empleada para irrigación y lavado en cirugía de cataratas.Material y métodos: A partir de seis frascos de BSS-plus, aditivados de Vancomicina y Tobramicina a las concentraciones de 0,05mg/ml y 0,01mg/ml, preparados de idéntica manera, en cabina de flujo laminar horizontal, se estudia la estabilidad en dos condiciones distintas de conservación, a Tª ambiente y en nevera (4º-8ºC), durante 14 días, determinando la concentración de tobramicina por inmunofluorescencia polarizada TDx/FLx y la concentración de vancomicina por cromatografía líquida de alta resolución (HPLC), la ausencia de precipitados por observación visual, el pH y la esterilidad por cultivo microbiológico.Resultados: Ausencia de precipitados en ambas soluciones durante los 14 días del estudio. Incremento progresivo del pH desde 7,4 hasta 8,7 en la solución conservada entre 4-8ºC, que llega hasta 9,2 en la conservada a Tª ambiente. Ausencia de crecimiento bacteriano en todas las muestras. La concentración de tobramicina se mantuvo por encima del 90 por ciento de la concentración inicial al menos durante 14 días en la solución conservada en refrigeración y 12 días a Tª ambiente. La concentración de vancomicina se mantuvo por encima del 90 por ciento de la concentración inicial durante al menos 14 días en la solución conservada en refrigeración y 8 días a Tª ambiente.Conclusión: Se establece una estabilidad de al menos 14 días cuando la mezcla binaria antibiótica se conserva en refrigeración (48ºC) y de 8 días cuando se conserva a Tª ambiente. Estos resultados permiten al Servicio de Farmacia establecer un protocolo de preparación programado de la mezcla de antibióticos en BSS-plus evitando la necesidad de preparar extemporáneamente la solución previa a cada intervención quirúrgica y minimizar los costes de preparación al garantizar que no se pierde ninguna de las soluciones preparadas (AU)

Adhesión al tratamiento antirretrovírico en pacientes VIH+ / Adherence to antiretroviral treatment in HIV-positive patients

La adhesión al tratamiento antirretrovírico es difícil de conseguir al 100 por ciento debido a la complejidad del mismo.Objetivo. Conocer la adhesión terapéutica de los pacientes VIH+ a los tratamientos antirretrovíricos en nuestra área sanitaria y relacionarlo con la efectividad virológica de los mismos.Método. Estudio observacional prospectivo de los pacientes adultos con tratamiento antirretrovírico que acudieron a retirar la medicación desde marzo a junio de 1998 al servicio de farmacia del Hospital d'Elx. Se hizo un seguimiento de las dispensaciones mensuales de todos los pacientes seleccionados durante seis meses.Resultados. El número total de pacientes analizados fue de 188. Un 59,5 por ciento (112 pacientes) son cumplidores, mientras que el 40,5 por ciento (76 pacientes) son no cumplidores. Al relacionar la adhesión terapéutica con la carga viral obtenemos que de los 112 pacientes cumplidores, 80 (71,4 por ciento) tienen éxito virológico y 32 (28,6 por ciento) fracaso. De los 46 pacientes no cumplidores, nueve (19,6 por ciento) tienen éxito virológico y 37 (80,4 por ciento) fracaso.Discusión. La utilización de los registros de las dispensaciones del servicio de farmacia y el seguimiento individualizado de las mismas por paciente, si se hace de forma informatizada, es un método sencillo que nos permite conocer las fechas y las cantidades de medicamentos dispensados. Los fallos en la recogida de medicación nos pueden informar de incumplimiento, siempre que se tengan controladas otras variables como son los cambios de domicilio, los ingresos hospitalarios o carcelarios, etc (AU)

[The short-term effects of air pollution on mortality: the results of the EMECAM project in the city of Pamplona, 1991-95. Estudio Multicéntrico Español sobre la Relación entre la Contaminación Atmosférica y la Mortalidad]. / Efectos a corto plazo de la contaminación atmosférica sobre la mortalidad: resultados del proyecto EMECAM en la ciudad de Pamplona, 1991-95.

BACKGROUND: To assess the short-term impact of air pollution on the daily death rate in the city of Pamplona. METHOD: Ecological study with a population of 212,000 inhabitants. A time series data analysis is conducted by means of multiple linear regression and Poisson regression, with the daily death rate data, air pollution levels for Particles and SO2, weather parameters of average relative humidity and temperature daily and number of cases weekly of flu for the 1991-1995 period. RESULTS: The average number of deaths daily for non-external causes is that of 4.15 deaths, with a range from zero to 13 deaths. The city of Pamplona has a mean annual temperature of 12.7 degrees C (-2.3 degrees C to 31.6 degrees C) and a relative humidity of 68.5%. In the model, the temperature (with a one-day time lag and a six-day time lag temperature squared) and the humidity (with a one-day time lag) is related to the death rate for all causes. But the death rate for non-external causes is only related in the model with the temperature (one-day time lag, P: 0.035) and five-day time lag with temperature squared (p: 0.028). The timely estimates of the relative particle-related risk show that the highest risk of dying stems from respiratory causes with a relative risk of 1.13. However, none of these relationships is statistically significant. In the case of Sulfur Dioxide, the estimates closely near the zero figure, and none of them is significant. CONCLUSIONS: The Temperature has an impact of the death rate for all causes, both external and non-external, and the relative humidity solely has an impact on the death rate for non-external causes. It has not been possible to prove any influence of the daily environmental pollution levels on the daily death rate.