[Study of prescription-indication of proton pump inhibitors]. / Estudio de prescripción-indicación de inhibidores de la bomba de protones.

OBJECTIVES: To evaluate the adaptation of Proton Pump Inhibitors (PPI) prescriptions to the indications in the literature. To determine which doctors, patients and prescriptions characteristics are related to a correct prescription and to measure their relative importance. MATERIAL AND METHODS: Cross-sectional observational study of prescription indication in an Urban Primary Care Center. Simple Random Sampling was used from primary care center patients PPIs prescriptions between July and December of 2003. Non-electronic prescriptions (OMI-AP program) were excluded from the sample. 412 PPI prescriptions were necessary as sample size to obtain a 95% confidence with a 4.7% precision and a 50% expected proportion. Simple random sampling techniques were used. RESULTS: Prescription was correct under adequacy criteria in 36.4% of the cases. The effect of the "hiatal hernia" and "user activity status" variables showed the major impact on results with an OR: 0.361 and 1.672 respectively. NSAID treated patients PPIs prescriptions matched adequacy criteria in 79.5% of the cases. "Prescription source" and "User activity status" variables gave the highest impact with an OR: 2.5 and 4.52, respectively. CONCLUSIONS: The high percentage of non-adequate prescriptions together with the differences found between primary and specialized levels of attention, could suggest lack of knowledge of PPIs prophylactic indications and lack of coordination between different levels of attention that could be solved by creating common performing protocols.

Estudio de prescripción-indicación de inhibidores de la bomba de protones / Study of prescription-indication of proton pump inhibitors

Objetivos. Evaluar la adecuación de las prescripciones de inhibidores de la bomba de protones (IBP) a las indicaciones expuestas en la literatura y determinar qué características de los médicos, pacientes y de las prescripciones se asocian con su adecuada prescripción y cuantificar su importancia relativa. Material y métodos. Estudio observacional transversal de prescripción-indicación llevado a cabo en un centro de salud urbano. Se realizaron prescripciones de IBP a pacientes adscritos al centro de salud entre julio y diciembre del 2003 que figuran en el programa OMI-AP. Los criterios de exclusión que se aplicaron tuvieron en cuenta aquellas prescripciones no realizadas electrónicamente. Según el tamaño de la muestra, para una confianza del 95%, una precisión del 4,7% y una proporción esperada del 50% hacen falta 412 prescripciones de IBP. Se utilizaron técnicas de muestreo aleatorio simple. Resultados. La prescripción se ajusta en un 36,4% a los criterios de adecuación. El efecto de las variables «hernia de hiato» y «tipo de usuario» ha sido de odds ratio (OR) 0,361 y 1,672, respectivamente. La prescripción de IBP en pacientes en tratamiento con antiinflamatorios no esteroideos (AINE) cumple los criterios de adecuación en el 79,5% de los casos. El efecto de las variables «origen» y «tipo de usuario» ha sido de OR 2,5 y 4,52, respectivamente. Conclusiones. El elevado porcentaje de IBP prescritos sin indicación justificada y las diferencias encontradas entre Atención Primaria y Especializada, hacen sospechar de un desconocimiento de sus indicaciones profilácticas, y falta de coordinación entre los diferentes niveles de asistencia que podría solventarse con la creación de protocolos de actuación conjuntos

Objectives. To evaluate the adaptation of Proton Pump Inhibitors (PPI) prescriptions to the indications in the literature. To determine which doctors, patients and prescriptions characteristics are related to a correct prescription and to measure their relative importance. Material and methods. Cross-sectional observational study of prescription indication in an Urban Primary Care Center. Simple Random Sampling was used from primary care center patients PPIs prescriptions between July and December of 2003. Non-electronic prescriptions (OMI-AP program) were excluded from the sample. 412 PPI prescriptions were necessary as sample size to obtain a 95% confidence with a 4.7% precision and a 50% expected proportion. Simple random sampling techniques were used. Results. Prescription was correct under adequacy criteria in 36.4% of the cases. The effect of the «hiatal hernia» and «user activity status» variables showed the major impact on results with an OR: 0.361 and 1.672 respectively. NSAID treated patients PPIs prescriptions matched adequacy criteria in 79.5% of the cases. «Prescription source» and «User activity status» variables gave the highest impact with an OR: 2.5 and 4.52, respectively. Conclusions. The high percentage of non-adequate prescriptions together with the differences found between primary and specialized levels of attention, could suggest lack of knowledge of PPIs prophylactic indications and lack of coordination between different levels of attention that could be solved by creating common performing protocols

Obstrucción intestinal por Anisakis simplex / Intestinal obstruction due to Anisakis simplex

La anisakiasis es una zoonosis producida por larvas de Anisakis simplex. El hombre, huésped accidental de este parásito helminto, entra en su ciclo biológico al consumir pescado, crustáceos o cefalópodos infestados. En nuestro medio las tasas de parasitación del pescado de los mercados centrales son muy elevadas y la fuente de contagio más habitual son los boquerones en vinagre. Las manifestaciones clínicas comprenden formas gastrointestinales (desde cuadros leves con sintomatología inespecífica a formas más agresivas como úlcera gastroduodenal, obstrucción intestinal o ascitis hemorrágica), alérgicas, mixtas e invasivas en otros órganos. Aunque la mayoría son casos autolimitados, puede ser necesaria la extracción endoscópica de la larva adherida a la mucosa gástrica o la resección intestinal. El mejor tratamiento son las medidas profilácticas, evitando el consumo de larvas viables en pescado crudo o poco cocinado. Presentamos un caso de obstrucción intestinal causada por larvas de Anisakis simplex tras la ingesta de boquerones en vinagre

Anisakiasis is a zoonosis produced by larva of Anisakis simplex. Man, accidental host of this helminth parasite, enters into its biological cycle when eating infected fish, crustaceans or cephalopodas. In our setting, parasitation rates of fish from the central markets are very high and the most common source of infection is anchovies in vinegar. Clinical manifestations include gastrointestinal forms (from mild pictures with non-specific symptoms to more aggressive forms such as gastroduodenal ulcer, intestinal obstruction or hemorrhagic ascitis) and allergic, mixed and invasive forms in other organs. Although most are self-limited cases, endoscopic extraction of the larva attached to the gastric mucosa or intestinal resection may be necessary. The best treatments are prophylactic measures, avoiding intake of viable larvas in raw or undercooked fish. We present a case of intestinal obstruction caused by larvas of Anisakis simplex after intake of anchovies in vinegar