ABSTRACT
Gregarines thrive in the digestive tract of arthropods and may be deleterious to their hosts, especially when present in high densities. The impact of parasites on these invertebrates may affect both the ecosystem equilibrium and human economic activities. However, information available on gregarines in Spain is limited. Therefore, a microscopic study on prevalence of gregarine infection in 560 insects and crustaceans was undertaken in Madrid and Tarragona.Gregarina ormierei (78 % prevalence), Stylocephalus gigas (56 %), Oocephalus hispanus (13 %) and Actinocephalus permagnus (only one infected out of six beetles examined) were found in coleopteran hosts. Gregarina ovata and G. chelidurellae showed moderate frequency of infection (35 %) in dermapterans. An undescribed Gregarina sp. (76 % prevalence) was observed for the first time in freshwater decapod crustaceans. Interestingly, G. ormierei showed a noticeable phenotypic dimorphism, which justifies its redescription based on modern taxonomic criteria. Sequences of the 18S rRNA gene could be obtained only in the presence of highly prevalent gregarines. G. ormierei and Gregarina sp. were related (85 and 94 % identity by BLASTN, respectively) to G. basiconstrictonea and G. cloptoni, respectively, whereas S. gigas was closely related to both Xiphocephalus ellisi and S. giganteus (>97 % identity). Phylogenetic trees based on ribosomal sequences unequivocally grouped these new isolates either with the Gregarinidae (G. ormierei and Gregarina sp.) or the Stylocephalidae (S. gigas).
Subject(s)
Apicomplexa/physiology , Arthropods/parasitology , Biodiversity , Animals , Apicomplexa/classification , Apicomplexa/genetics , Apicomplexa/isolation & purification , DNA, Ribosomal/genetics , Ecosystem , Host Specificity , Phylogeny , SpainABSTRACT
La preparación de nutrición parenteral pediátrica está sujeta a una gran variabilidad. Hay muchos puntos en los que todavía la falta de consenso es clara. Entre ellos destacan: el empleo de sales orgánicas o inorgánicas de fosfato o calcio, la elaboración de mezclas binarias o ternarias, el tipo de lípidos utilizados, el empleo o no de heparina o carnitina, etc. La estandarización en el proceso de elaboración es imprescindible para garantizar la estabilidad de las mezclas preparadas. Sin embargo, no hay información de cómo predecir de forma exacta dicha estabilidad, sobre todo cuando se trata de mezclas ternarias. Por ello, cualquier cambio introducido puede desencadenar un proceso de desestabilización que comprometa la seguridad de nuestros pacientes. Exponemos un caso de nutrición parenteral pediátrica ternaria en el que se produjo fenómeno decreaming. Describimos cuáles fueron los factores desencadenantes del mismo y las medidas introducidas para evitar su aparición (AU)
The preparation of paediatric parenteral nutrition admixtures varies greatly. There is still a clear lack of consensus on many points. These points include the use of organic or inorganic phosphate or calcium salts, preparing binary or ternary mixtures, the type of lipid used, and the addition or suppression of heparin or carnitine, etc. The process must be standardised in order to guarantee that prepared mixtures will be stable. However, there is still no information on how to predict their stability with any degree of precision, particularly for ternary mixtures. For that reason, any change applied may trigger a destabilisation process that places patient safety at risk.We describe a case of a ternary paediatric parenteral nutrition admixture in which creaming was observed. We indicate the factors that gave rise to this phenomenon and the measures taken to avoid it (AU)
Subject(s)
Humans , Female , Infant, Newborn , Heparin/adverse effects , Parenteral Nutrition Solutions/pharmacology , Drug Stability , Parenteral Nutrition , Lipids/administration & dosageABSTRACT
The preparation of paediatric parenteral nutrition admixtures varies greatly. There is still a clear lack of consensus on many points. These points include the use of organic or inorganic phosphate or calcium salts, preparing binary or ternary mixtures, the type of lipid used, and the addition or suppression of heparin or carnitine, etc. The process must be standardised in order to guarantee that prepared mixtures will be stable. However, there is still no information on how to predict their stability with any degree of precision, particularly for ternary mixtures. For that reason, any change applied may trigger a destabilisation process that places patient safety at risk. We describe a case of a ternary paediatric parenteral nutrition admixture in which creaming was observed. We indicate the factors that gave rise to this phenomenon and the measures taken to avoid it.
Subject(s)
Heparin/pharmacology , Infant, Premature, Diseases/therapy , Parenteral Nutrition Solutions/chemistry , Parenteral Nutrition , Phospholipids/chemistry , Soybean Oil/chemistry , Calcium/chemistry , Chemistry, Physical , Drug Compounding/methods , Drug Stability , Emulsions/chemistry , Female , Heparin/chemistry , Humans , Infant, Low Birth Weight , Infant, Newborn , Infant, Premature , Phosphates/chemistry , SolubilityABSTRACT
Objetivo La lenalidomida (LDM) es un agente inmunomodulador y antiangiogénico que ha demostrado su eficacia en varios trastornos hematológicos (mieloma múltiple [MM], metaplasma mieloide con mielofibrosis [MF] y síndrome mielodisplásico [SMD]). El objetivo de este estudio fue evaluar la efectividad y la tolerabilidad de la LDM en nuestros pacientes. Método Estudio retrospectivo observacional que incluyó a los pacientes de nuestro hospital en seguimiento por la consulta de Hematología que fueron diagnosticados de MM, MF y SMD, y que eran candidatos a recibir tratamiento con LDM. La evaluación de la eficacia se realizó transcurridos aproximadamente 4 ciclos desde el inicio del tratamiento. Resultados Desde febrero de 2007 hasta marzo de 2008 fueron 16 los pacientes candidatos a recibir tratamiento con LDM (50% mujeres, 50% varones, con una edad media de 69,6 años), aunque 3 de ellos no llegaron a iniciarlo. De los 6 pacientes con MM tratados en nuestro hospital, 5 de ellos obtuvieron algún tipo de respuesta (83,3%). De los 4 pacientes con MF, 2 (66,6%) experimentaron algún tipo de respuesta al tratamiento. De los 6 pacientes diagnosticados de SMD, únicamente se inició el tratamiento en 3, y en 2 de ellos se tuvo que suspender por distintas causas. Destacamos que únicamente hubo que suspender el tratamiento en dos de los 13 pacientes que lo iniciaron (15,4%) por los efectos adversos. Conclusión La LDM consigue, con buena tolerancia, beneficio clínico mantenido sobre todo en el MM y la MF. Son necesarios más estudios que profundicen en la duración del tratamiento, en nuevas indicaciones y en el uso de tratamientos combinados con otros agentes (AU)
Objective Lenalidomide (LDM) is an immunomodulatory and anti-angiogenic drug which has been shown to be effective in several haematological disorders (multiple myeloma [MM], myeloid metaplasia with myelofibrosis [MF] and myelodysplastic syndrome [MDS]). The objective of this study is to evaluate the effectiveness and tolerability of LDM in our patients. Method Retrospective observational study which included patients at our hospital who were monitored by the haematology unit, diagnosed with MM, MF and MDS and candidates for LDM treatment. Treatment effectiveness was assessed after approximately 4 cycles of treatment. Results Between February 2007 and March 2008, 16 patients were listed as candidates for receiving treatment with LDM (50% female/50% male, with a mean age of 69.6 years); of these candidates, 3 never initiated treatment. Five of the six patients with MM treated at our hospital obtained some sort of response (83.3%). Of the 4 patients with MF, 2 (66.6%) experienced some sort of response to treatment. Of the 6 patients diagnosed with MDS, treatment was initiated in 3, and it had to be suspended in 2 cases due to different reasons. Treatment only had to be suspended in two of the 13 patients who began it (15.4%) due to adverse effects (AE).Conclusion LDM is well-tolerated and produces sustained clinical benefits, especially in MM and MF. More studies are needed for in-depth examination of treatment duration, new indications and the use of treatments combined with other drugs (AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Antineoplastic Agents/therapeutic use , Multiple Myeloma/drug therapy , Myelodysplastic Syndromes/drug therapy , Primary Myelofibrosis/drug therapy , Thalidomide , Retrospective Studies , Thalidomide/therapeutic useABSTRACT
OBJECTIVE: Lenalidomide (LDM) is an immunomodulatory and anti-angiogenic drug which has been shown to be effective in several haematological disorders (multiple myeloma [MM], myeloid metaplasia with myelofibrosis [MF] and myelodysplastic syndrome [MDS]). The objective of this study is to evaluate the effectiveness and tolerability of LDM in our patients. METHOD: Retrospective observational study which included patients at our hospital who were monitored by the haematology unit, diagnosed with MM, MF and MDS and candidates for LDM treatment. Treatment effectiveness was assessed after approximately 4 cycles of treatment. RESULTS: Between February 2007 and March 2008, 16 patients were listed as candidates for receiving treatment with LDM (50% female/50% male, with a mean age of 69.6 years); of these candidates, 3 never initiated treatment. Five of the six patients with MM treated at our hospital obtained some sort of response (83.3%). Of the 4 patients with MF, 2 (66.6%) experienced some sort of response to treatment. Of the 6 patients diagnosed with MDS, treatment was initiated in 3, and it had to be suspended in 2 cases due to different reasons. Treatment only had to be suspended in two of the 13 patients who began it (15.4%) due to adverse effects (AE). CONCLUSION: LDM is well-tolerated and produces sustained clinical benefits, especially in MM and MF. More studies are needed for in-depth examination of treatment duration, new indications and the use of treatments combined with other drugs.
Subject(s)
Antineoplastic Agents/therapeutic use , Multiple Myeloma/drug therapy , Myelodysplastic Syndromes/drug therapy , Primary Myelofibrosis/drug therapy , Thalidomide/analogs & derivatives , Adult , Aged , Aged, 80 and over , Female , Humans , Lenalidomide , Male , Middle Aged , Retrospective Studies , Thalidomide/therapeutic useABSTRACT
An 83-year-old woman presented to the emergency department with a history of pain in the left hip of gradual onset over several days. There was no history of trauma and the X rays showed degenerative changes in the hip joint but no apparent fracture. She was sent home after being given reassurance, analgesics and a cane. Three weeks later she returned unable to mobilise after falling while getting out of bed and injuring the left hip. On this occasion the X-rays showed an acetabular fracture with femoral head protrusio. A CT scan confirmed the diagnosis and also demonstrated the absence of a haematoma in the surrounding soft tissues. The latter is characteristic of insufficiency fractures. Orthopaedic surgeons require a high index of suspicion for insufficiency fractures of the pelvis, femoral head and femoral neck in elderly osteoporotic patients who complain of hip pain without any history of trauma.
Subject(s)
Acetabulum/injuries , Fractures, Stress/complications , Osteoporosis, Postmenopausal/complications , Acetabulum/diagnostic imaging , Aged, 80 and over , Arthroplasty, Replacement, Hip , Female , Fractures, Stress/diagnostic imaging , Fractures, Stress/surgery , Humans , Osteoporosis, Postmenopausal/pathology , Radiography , Treatment OutcomeABSTRACT
Objetivos: Estudio de la incidencia de intoxicaciones accidentales en la infancia, motivo de consulta en el servicio de urgencias del hospital para implementación de medidas preventivas. Diseño: Retrospectivo, descriptivo. Emplazamiento: Hospital comarcal, ámbito rural. Participantes: Pacientes en edad pediátrica cuyo motivo de consulta fue ingesta accidental de medicamentos o productos tóxicos. Medidas e intervenciones: Análisis del episodio asistencial recogiendo edad, género, naturaleza del producto ingerido, fecha, época del año en la que se produjo el accidente. Promover medidas de prevención mediante charlas divulgativas a determinados grupos sociales y en colaboración con profesionales sanitarios de Atención Primaria. Resultados: En el periodo 1997-2004 fueron tratados en el Servicio de Urgencias del hospital 76 casos de ingesta accidental de medicamentos o productos tóxicos por niños. El 47,4% (36 casos) por ingesta de medicamentos, el 36,8% (28 casos) por ingesta de productos de limpieza, y el 15,7% restante (12 casos) por productos varios. En 19 casos (25% del total de casos), se produjo por la ingesta de la propia medicación del niño, estando implicado el paracetamol solución en 13 de éstos (17% del total de casos). En 17 ocasiones la medicación ingerida pertenecía a un familiar adulto. La ingesta de lejía fue la causa en 13 de los 28 casos ocasionados por productos de limpieza. El 85,5% de los casos se produjo en el rango de edad de 1 a 3 años. El 17% ocasionó ingreso hospitalario superior a 24 horas. Conclusión: La ingesta accidental en niños de medicamentos y productos domésticos es un problema cotidiano. Se proponen como medidas preventivas, campañas de información a la población general a través de los profesionales sanitarios de atención primaria. También consideramos muy importante la implicación de la industria farmacéutica para que adopte medidas en el cambio de la presentación de sus envases y así disminuir dicho problema (AU)
Objective: The study of the incidence of accidental poisoning in children as the reason for visits to the hospital emergency service, for the implementation of preventive measures. Design: A retrospective descriptive study. Site: A regional hospital in a rural setting. Participants: Pediatric patients brought to the hospital after accidental ingestion of medications or toxic products. Measurements and interventions: Analysis of each episode, recording the age and sex of the child, type of product ingested and the date and season of the year in which the accident took place. Promotion of preventive measures through informative talks to certain social groups, in collaboration with primary health care professionals. Results: Between 1997 and 2004, 76 cases of accidental ingestion of medications or toxic products by children were treated in our emergency service. Thirty-six of the children (47.4%) had taken some type of medication, 28 (36.8%) had swallowed cleaning products and the remaining 12 (15.7%) had ingested some other toxic product. In 19 cases, (25% of the entire population), the cause was the childs own medicine, involving a paracetamol solution in 13 cases (17% of the entire population). In 17 cases, the medication ingested was that of an adult relative. Bleach was the cause in 13 of the 28 cases in which cleaning products had been ingested. In all, 85.5% of the incidents involved children between the ages of 1 and 4 years, and a hospital stay of more than 24 hours was required in 17%. Conclusion: The accidental ingestion of medications and household products is an everyday problem. The preventive measures proposed include public information campaigns involving the primary health care professionals. We also consider it to be highly important that the drug industry become implicated, making changes in the packaging and, thus, helping to reduce the problem (AU)
Subject(s)
Humans , Male , Female , Child , Drug-Related Side Effects and Adverse Reactions/complications , Drug-Related Side Effects and Adverse Reactions/therapy , Acetaminophen/toxicity , Retrospective Studies , Drug-Related Side Effects and Adverse Reactions/prevention & control , Pediatric Emergency Medicine/trendsABSTRACT
As part of the activities on the World Day for Diabetes in 2002, nine professors, one nurse who teaches about diabetes and 126 nursing students at University Schools of Nursing in Barcelona, Lleida, Tarragona, Tortosa and Girona, in collaboration with the Association of Diabetics in Catalonia and with the help of the Advisory Council for Diabetes in Catalonia participated in a diabetes screening campaign on the population residing in Catalonia. This campaign studied the prevalence of type two diabetes in a random sample of the Catalan population. This campaign also proposed to raise the awareness among the general population and among nursing students about the important health consequences diabetes has and to increase investigation and social support measures by nurses related to diabetes. This study checked 4083 persons and discovered 77 cases of altered blood-sugar levels among people who did not know they had diabetes. This finding means that there is a 2.2% prevalence of altered blood-sugar levels in the population who are not diagnosed diabetics. Professors and student participants all gave this experience positive marks and the students' degree of satisfaction was very high.
Subject(s)
Diabetes Mellitus, Type 1/diagnosis , Adult , Aged , Aged, 80 and over , Diabetes Mellitus, Type 1/epidemiology , Female , Humans , Male , Middle AgedABSTRACT
Con motivo del Día Mundial de la Diabetes de 2002, nueve profesoras, una enfermera educadora en diabetes y 126 estudiantes de enfermería de Escuelas Universitarias de Enfermería de Barcelona, Tarragona, Tortosa y Girona, en colaboración con la Asociación de Diabéticos de Cataluña y con el soporte del "Consell Asesor de la Diabetis a Catalunya", participan en una campaña de cribado de diabetes en la población residente en Cataluña. Esta campaña estudia la prevalencia de diabetes tipo 2 en una muetra oportunista de la población catalana. También pretende sensibilizar a la población general y a los estudiantes de enfermería de la importancia sanitaria de esta enfermedad y potentar el rol investigador y social de la enfermera. Se estudian 4.083 personas y se encuentran 77 glucemias alteradas entre la población sin diabetes conocida. Esto supone una prevalencia de glucemias alteradas del 2,2% en la población no diagnosticada de diabetes. Tanto los profesores como los alumnos participantes valoran positivamente esta experiencia y el ni vel de satisfacción de los estudiantes es muy elevado
As part of the activities on the World Day for Diabetes in 2002, nine professors, one nurse who teaches about diabetes and 126 nursing students at University Schools of Nursing in Barcelona, Lleida, Tarragona, Tortosa and Girona, in collaboration with the Association of Diabetics in Catalonia and with the help of the Advisory Council for Diabetes in Catalonia participated in a diabetes screening campaign on the population residing in Catalonia. This campaign studied the prevalence of type two diabetes in a random sample of the Catalan population. This campaign also proposed to raise the awareness among the general population and among nursing students about the important health consequences diabetes has and to increase investigation and social support measures by nurses related to diabetes. This study checked 4083 persons and discovered 77 cases of altered blood-sugar levels among people who did not know they had diabetes. This finding means that there is a 2.2% prevalence of altered blood-sugar levels in the population who are not diagnosed diabetics. Professors and student participants all gave this experience positive marks and the students' degree of satisfaction was very high
Subject(s)
Humans , Diabetes Mellitus/diagnosis , Diabetes Mellitus, Type 2/epidemiology , Chronic Disease , Blood Glucose/analysis , Hyperglycemia/diagnosis , Students, Nursing , Mass ScreeningABSTRACT
OBJECTIVE: To report the case of a patient who developed a life-threatening agranulocytosis and acute tubular necrosis after the administration of allopurinol and rofecoxib. CASE REPORT: After minor surgery, a 70-year-old male underwent a routine blood test which encountered: anemia, leucopenia, neutropenia, thrombopenia, and altered creatinine levels. Both marrow and renal biopsies were performed, yielding the following results: acute tubular necrosis and agranulocytosis in the recovery stage. One month and a half before the aforementioned surgery a routine blood test had been performed, which showed normal values. The patient had then received allopurinol 100 mg/day for around 2 months, and rofecoxib 2.5 mg/day for 14 days. DISCUSSION: After ruling out other possible causes, a diagnosis of iatrogenically induced agranulocytosis and acute tubular necrosis was reached. We used a (modified) Karch-Lasagna algorithm with both drugs, and found the following imputability values: possible for rofecoxib and probable for allopurinol. In view of the widespread use of rofecoxib and COX-2 inhibitors, despite their recent availability, and of their potential role in the severe adverse effects discussed, healthcare professionals must be on the alert for the development of symptoms suggesting said or other adverse effects.
Subject(s)
Agranulocytosis/chemically induced , Allopurinol/adverse effects , Cyclooxygenase Inhibitors/adverse effects , Enzyme Inhibitors/adverse effects , Kidney Tubular Necrosis, Acute/chemically induced , Lactones/adverse effects , Aged , Humans , Male , SulfonesABSTRACT
Objetivo: Describir el caso de un paciente que desarrolló una agranulocitosis y una necrosis tubular aguda que comprometió su vida tras la administración de alopurinol y rofecoxib. Descripción del caso: Varón de 70 años, al que se le realizó una analítica de control tras una intervención menor, observándose anemia, leucopenia, neutropenia, trombopenia y alteración de los niveles de creatinina. Se efectuó biopsia renal y medular con el resultado de necrosis tubular aguda y médula compatible con agranulocitosis en fase de recuperación. Mes y medio antes de la intervención indicada se le había realizado una analítica de control encontrando valores dentro de la normalidad. Anteriormente el paciente había iniciado tratamiento con alopurinol 100 mg al día durante aproximadamente 2 meses, y rofecoxib 2,5 mg al día durante 14 días. Comentario: Tras descartar otras posibles causas, se llegó al diagnóstico de agranulocitosis y necrosis tubular aguda de origen iatrogénico. Aplicamos el algoritmo de Karsch-Lasagna (modificado) para ambos fármacos, encontrando los siguientes valores de imputabilidad: posible para el rofecoxib y probable para el alopurinol. Debido al amplio uso de rofecoxib y los inhibidores de la COX-2, a pesar de su reciente comercialización, y su posible implicación en los graves efectos adversos descritos, los profesionales sanitarios deben estar alertados ante la aparición de síntomas que puedan hacer sospechar la aparición de éstos u otros efectos adversos (AU)
Subject(s)
Aged , Male , Humans , Cyclooxygenase Inhibitors , Agranulocytosis , Allopurinol , Kidney Tubular Necrosis, Acute , Lactones , Enzyme InhibitorsABSTRACT
A new commercial hub device designed to minimise catheter-related infections was evaluated in a prospective, randomised trial in the intensive care and surgical units of the Hospital de Tortosa Verge de la Cinta in patients in whom the central venous catheters were expected to remain indwelling for at least 7 days. The assessments conducted at catheter withdrawal included cultures of the skin at the catheter site and cultures of the catheter tip and the catheter hubs; moreover, in cases of suspected catheter-related sepsis, samples of peripheral blood and infusion solutions were also cultured. Of the 130 catheters evaluated, 26 (20%) were withdrawn because of suspected catheter-related sepsis; 10 (15%) were in the control group and 16 (24%) in the new product group. Catheter-related sepsis was diagnosed in nine patients, six of whom were in the new product group and three in the control group; all infections in the former group and only one in the latter group were caused by the catheter connection. The rates of catheter hub colonisation (10 cfu) and catheter colonisation (15 cfu in semiquantitative culture and/or >1,000 cfu in quantitative culture) of hub origin were not significantly different between the groups (15 cases in the control group vs. 20 cases in the new product group, and 5 cases in the control group vs. 11 cases in the new product group, respectively). The data indicate that the use of the new catheter hub device is no more effective in preventing catheter-related infection than standard good clinical procedures.
