Random co-polymers based on the poloxamer Bayfit® 10WF15 for biomedical applications.

Random co-polymers were prepared from the poloxamer Bayfit(®) 10WF15 and their thermal and biological properties analyzed. The poloxamer was characterized, functionalized with methacrylate groups (Bayfit-MA) and further co-polymerized with 2-hydroxyethyl methacrylate (HEMA) with Bayfit-MA feed contents of 1, 5 and 10 wt%. Co-polymers were partially soluble in organic solvents and exhibited a single glass transition temperature indicative of a random monomer distribution in the macromolecular chains. In thermogravimetric studies the co-polymers showed two degradation stages, around 210 and 350 °C, respectively. The thermosensitive behaviour of the poloxamer was studied by turbidimetry. Cloud point temperatures of aqueous solutions of Bayfit(®) 10WF15 (0.5-5 wt%) ranged from 15 to 18 °C and for Bayfit(®) 10WF15 methacrylate (0.5-1 wt%) from 6 to 7 °C. DSC thermograms of hydrated co-polymers showed the typical endothermic peaks with phase transition temperatures close to that of physiological medium. The biocompatibility of initial poloxamer and derivatives was analyzed with human fibroblasts cultures. The IC(50) value of Bayfit(®) 10WF15 was 1.4 mg/ml. Cellular extracts of the co-polymers were not cytotoxic and cellular proliferation and DNA content depended on co-polymer composition.

[Prescribing drugs to patients receiving out-patient care]. / Prescripción de medicamentos a pacientes ambulatorios.

Drug prescription has evolved to deal mainly with chronic diseases. Nowadays, repeating prescriptions using computers results in problems if this is not done with adequate control. Steps proposed for appropriate prescription are: defining the problem; specifying the objective; selecting the drug; initiating therapy with appropriate details; giving information; regular evaluation; considering cost; and using tools to reduce errors. Published recommendations for prescription, which have focused on elderly patients, include: avoiding polypharmacy; carrying out a regular medication review; stopping any current drugs that are not indicated and prescribing new drugs that have a clear indication; avoiding drugs that have deleterious effects; using dosages that are suitable for the age and renal function; using simple drug regimes and appropriate administration systems; considering non-pharmacological treatments; limiting the number of practitioners prescribing for each patient; and avoiding treating adverse drug reactions with further drugs. Examples of compliance with those recommendations in the Navarre Health Service, extracted from the prescription information system, are provided. The measures for improving prescription are: education, auditing, collaboration between health professionals and use of electronic tools.

[Development of a system of quality indicators for primary care prescriptions]. / Indicadores de calidad de prescripción seleccionados mediante una técnica de consenso.

OBJECTIVE: To identify and validate indicators to improve the assessment of prescribing by primary care paediatricians, incorporating the values and views of the professionals involved. MATERIAL AND METHODS: Nominal group technique, validated through a Delphi survey. PARTICIPANTS: Paediatricians and primary care pharmacists. A nominal group was formed with thirteen specialists. The question raised at the meeting was: "What indicators focusing on the drug and what indicators linked to diagnosis and treatment do you find most helpful in assessing the quality of prescription in paediatrics?", each panellist proposed indicators that were discussed and weighted on a scale from 1 to 9. The highest scored indicators were included in a two round Delphi survey, intended for all paediatricians and primary care pharmacists. MEASUREMENTS: Validity of the indicator; Indicators with a median score equal to or greater than 7 were considered valid. Degree of consensus; it was considered that there was consensus if the interquartile range was not more than 3 points. RESULTS: We generated 29 indicators focusing on the drug and 27 incorporating the diagnosis. Nineteen focusing on the drug and 13 incorporating the diagnosis were included in the survey. There was a high degree of agreement between the group and survey results. CONCLUSIONS: A set of quality indicators for paediatric prescribing has been generated using this tecnique, with consensus of a representative group of stakeholders and validated by all of them.

Indicadores de calidad de prescripción seleccionados mediante una técnica de consenso / Development of a system of quality indicators for primary careprescriptions

Objetivo: Seleccionar y validar indicadores que permitan mejorar la evaluación de la prescripción de los pediatras de atención primaria, incorporando los valores y la opinión de los profesionales implicados. Material y métodos: Técnica de grupo nominal, validación mediante encuesta tipo Delphi. Participaron pediatras y farmacéuticos de atención primaria. Se formó un grupo nominal con 13 expertos. En la sesión se planteó la pregunta: "¿Qué indicadores centrados en el fármaco y qué indicadores que relacionen diagnóstico y tratamiento consideras más útiles para evaluar la calidad de la prescripción en pediatría?", cada panelista propuso indicadores que se discutieron y ponderaron en una escala del 1 al 9. Los indicadores más valorados se incluyeron en una encuesta tipo Delphi a dos rondas dirigida a todos los pediatras y farmacéuticos de atención primaria. Las mediciones realizadas fueron: la validez del indicador, se consideraron válidos los indicadores con una mediana de la puntuación igual o superior a 7; el grado de consenso, se consideró que había consenso si el rango intercuartílico no incluía más de 3 puntos. Resultados: Se generaron 29 indicadores centrados en el fármaco y 27 que incorporaban el diagnóstico. Se incluyeron en la encuesta 19 centrados en el fármaco y 13 que incorporaban el diagnóstico. Hubo un alto grado de acuerdo entre el grupo y los resultados de la encuesta. Conclusiones: Mediante esta técnica se ha generando una serie de indicadores de calidad de prescripción para pediatría consensuados por un grupo representativo de los agentes implicados y validado para el conjunto de éstos (AU)

Objective: To identify and validate indicators to improve the assessment of prescribing by primary care paediatricians, incorporating the values and views of the professionals involved. Material and methods: Nominal group technique, validated through a Delphi survey. Participants: Paediatricians and primary care pharmacists. A nominal group was formed with thirteen specialists. The question raised at the meeting was: "What indicators focusing on the drug and what indicators linked to diagnosis and treatment do you find most helpful in assessing the quality of prescription in paediatrics?", each panellist proposed indicators that were discussed and weighted on a scale from 1 to 9. The highest scored indicators were included in a two round Delphi survey, intended for all paediatricians and primary care pharmacists. Measurements: Validity of the indicator; Indicators with a median score equal to or greater than 7 were considered valid. Degree of consensus; it was considered that there was consensus if the interquartile range was not more than 3 points. Results: We generated 29 indicators focusing on the drug and 27 incorporating the diagnosis. Nineteen focusing on the drug and 13 incorporating the diagnosis were included in the survey. There was a high degree of agreement between the group and survey results. Conclusions: A set of quality indicators for paediatric prescribing has been generated using this tecnique, with consensus of a representative group of stakeholders and validated by all of them (AU)

Velocidad de incorporación de nuevos medicamentos en la práctica clínica / Time required to introduce new drugs into clinical practive

Objetivo: Analizar la velocidad de incorporación de nuevos medicamentos en la práctica clínica. Diseño: Estudio descriptivo retrospectivo. Unidad de estudio: Principios activos comercializados entre enero de 2003 y junio de 2004, excluidos los de uso estacional y los que no tienen establecida la dosis diaria definida (DDD). Emplazamiento: Primeros 2 años de comercialización de cada fármaco en atención primaria y atención especializada, en Aragón. Unidad de medida: Facultativos distintos que prescriben mensualmente cada fármaco y consumo mensual (DDD y gasto). Se utilizan las medias móviles de 3 meses. Se analizan también las categorías de aportación terapéutica. Resultados: En el cuarto mes se han incorporado el 33% de los facultativos que realizan alguna prescripción durante el primer año (35,6% intervalo de confianza (IC) del 95% 25,5-45,8), en el cuarto mes en atención primaria (31,5%, IC del 95% 21,4-41,5) y el primer mes en atención especializada (22,5%, IC del 95% 11,2-33,7). El 33% del consumo mensual máximo en DDD se alcanza en el cuarto mes durante el primer año (31,3% IC del 95% 22,2-40,5), en el quinto mes en atención primaria (25,4$%, IC del 95%: 10,7-40,2) y el primer mes en atención especializada (34,0%, IC del 95% 25,9-42,2). Los resultados en el segundo años son similares y el consumo máximo de DDD se produce un mes más tarde. No se aprecian diferencias según las categorías de aportación terapéutica. Conclusiones. La atención especializada se incorpora más rápidamente que la atención primaria. La velocidad de incorporación no parece relacionada con la aportación terapéutica. Para que los profesionales tengan la información sobre la utilización de nuevos medicamentos en un tiempo útil es necesario que dispongan de evaluaciones objetivas sobre su aportación terapéutica, como mínimo, antes del cuarto mes tras su comercialización (AU)

Objective: To analyze the time it takes for new medications to be introduced into clinical practice. Design: A retrospective, descriptive study focusing on the active ingredients commercialized between January 2003 and June 2004, with the exception of those of seasonal use and those for which the defined daily dose (DDD) had not yet been established. Study period and site: the first two years of commercialization of each drug employed in Primary Care and Specialized Care in Aragon, a region in northeastern Spain. Unit of measurement: The different physicians who prescribed each drug on a monthly basis and the monthly use (DDD and cost9. Moving averages of here months were utilized. Categories of therapeutic contribution were also analyzed. Results. By the fourth month, 33% of the physicians who made any prescriptions during the first year had become incorporated (35,6%, 95% CI:25,5%-45,8%) (4º month in Primary Care (31,5%, 95% CI; 21,4%-41,5%) and 1st month in Specialized Care (22,5%, 95% CI: 11.2%-33.7%). Thirty-three percent of the maximum monthly consumption in DDD was reached by the fourth month during the first year (31.3%, 95% CI: 22.2%-40,5%) (5th month in Primary Car (25,4%, 95% CI: 10,7%-40,2%) and 1st month in Specialized Care (34,0%, 95% CI: 25,9%-42,2%)). The results in the second year were similar, with the maximum consumption in terms of DDD occurring one month later. No differences were observed according to the category mary Care. The time required for incorporation does not appear to be related to the therapeutic contribution. In order for health care professionals to receive information on the utilization of new medications within a useful time frame, the must be provided with objective evaluations of the therapeutic contribution of these drugs within no more than four months of their commercialization (AU)

Carcinoma pulmonar con metástasis cerebelosa única / Pulmonary carcinoma with brain metastasis

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Metástasis cerebelosa con captación en anillo / Cerebelous metastasis and ring enhancement

No disponible

[Acute liver failure following heat stroke]. / Fracaso hepático agudo tras golpe de calor.

Hepatic involvement during heat stroke appears frequently. In some severe and rare cases liver transplantation is needed. We report a case of a 31 years old man, amateur runner, who suffered heat stroke-related acute liver failure, rhabdomyolysis, renal failure and coagulation im-pairment during a marathon. High environmental temperature, exercise duration and height where race took place could be involved. Patient had a favourable course with conservative treatment being discharged in a few days.

Hematoma subcapsular como complicación de biopsia hepática percutánea / Subcapsular hematoma as complication of percutaneous hepatic biopsy

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[Diagnostic utility of Osler's nodules in infectious endocarditis among parenteral drug users]. / Utilidad diagnóstica de los nódulos de Osler en la endocarditis infecciosa en usuarios de drogas por vía parenteral (UDVP).

BACKGROUND: The objective of study is to describe of clinic, microbiological and histological data of five cases of infective endocarditis (IE) with Osler's nodes in intravenous drug users. PATIENTS Y METHODS: Prospectively, 43 cases of IE in intravenous drugs users was revised. In 4 patients, a aspirate puncture of Osler's node was performed and in one patient a biopsy of Osler's node was done with Gram's stain and culture of specimen. RESULTS: From 43 episodes of IE, 33 were right-side IE, 9 left-side y 1 right and left side. No patients with right-side IE presented Osler's nodes, however five of 10 (50%) patients with left-side endocarditis. In all of cases gram positive cocci were observed in Gram's strain and Staphylococcus aureus growth on culture of lesion with the same antibiotype than isolated from blood culture. One case a cutaneous biopsy was performed, and inflammatory infiltrate with necrosis was found. CONCLUSIONS: The Gram's strain and culture of specimen aspirated from Osler's nodes were of high utility in the diagnosis of IE in intravenous drugs users. The presence of Osler's nodes in a patient with infective endocarditis must be suggest that the location in left-side. These data suggest that Osler's nodes in infective endocarditis by S. aureus in intravenous drugs users was originated by microvascular septic emboli.

Utilidad diagnóstica de los nódulos de osler en la endocarditis infecciosa en usuarios de drogas por vía parenteral (UDVP) / Diagnostic utility of osler's nodes in the infective endocarditis in intravenous drug users

Fundamento: Se describen los datos clínicos, microbiológicos e histológicos de cinco episodios de endocarditis infecciosa (EI) con nódulos de Osler en usuarios de drogas por vía parenteral (UDVP).Pacientes y métodos: Se han estudiado de forma prospectiva 43 casos de EI en UDVP. En 4 pacientes se realizó punción aspiración y en otro biopsia de un nódulo de Osler, con tinción de Gram y cultivo de la muestra. Resultados: De los 43 episodios de EI 33 fueron derechas, 9 izquierdas y 1 mixta. Cinco de los 10 (50 por ciento) pacientes con endocarditis izquierda o mixta presentaron nódulos de Osler, pero no se encontraron en ninguno de los pacientes con EI derecha. En todas las muestras tomadas por punción aspiración se observaron cocos grampositivos en racimos en la tinción de Gram y se obtuvo crecimiento de Staphylococcus aureus con el mismo antibiotipo que los aislados en los hemocultivos. En el único caso en el que se realizo biopsia del nódulo se apreciaba trombos sépticos en la microcirculación. Conclusiones: La tinción de Gram y el cultivo del material aspirado de los nódulos de Osler tiene una alta rentabilidad en el diagnóstico etiológico de la EI en los usuarios a drogras por vía parenteral. La presencia de nódulos de Osler en un paciente con EI nos debe sugerir que la localización es izquierda. Estos datos sugieren que los nódulos de Osler, en la EI por S. aureus en los UDVP se origina como consecuencia de embolismos sépticos microvasculares (AU)

Afectación multicéntrica en el sarcoma de Kaposi clásico agresivo / Systemic afectation in the classical kaposi's sarcoma of agresive course

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¿Es la cartera de servicios un instrumento útil para la asignación de recursos farmacéuticos en atención primaria? / Is the portfolio of services a useful instrument for allocating pharmaceutical resources in primary care?

Objetivo. Conocer si en ciertos equipos de atención primaria ha existido asociación entre el grado de cobertura en determinados servicios y el gasto en fármacos para las patologías incluidas en ellos. Diseño. Estudio descriptivo, retrospectivo. Emplazamiento. Atención primaria. INSALUD. Área 1, Huesca. Mediciones y resultados principales. Usando los datos de coberturas de cartera de servicios de 1999 y de gasto en farmacia por subgrupos terapéuticos durante el período enero-octubre del mismo año se analizó: - El servicio de atención a pacientes crónicos: hipercolesterolemia, y se comparó con el gasto en el subgrupo B04A (hipolipemiantes/antiateromatosos). El servicio de atención a pacientes crónicos: diabetes, y se comparó con el gasto en los subgrupos A10A (insulinas) y A10B (antidiabéticos orales). El gasto se expresó como gasto ajustado por 100 asegurados, usando para el ajuste los coeficientes del INSALUD (coeficiente activos, 0,732; coeficiente pensionistas, 0,268). La relación entre ambas variables se representó gráficamente por una nube de puntos. La existencia de asociación entre ellas se midió utilizando el coeficiente de correlación de Pearson. No se ha encontrado asociación estadísticamente significativa entre el resultado en coberturas y el gasto en farmacia en estos subgrupos. Hipercolesterolemia/hipolipemiantes: coeficiente de Pearson, 0,334; IC del 95 por ciento, -0,115 a 0,669.Diabetes/antidiabéticos orales e insulina: coeficiente de Pearson < 0,1.Conclusiones: Extraemos dos conclusiones: Las diferencias en coberturas de los servicios analizados no tienen relación directa con el gasto en fármacos. La cartera de servicios no resulta un buen método en la asignación de recursos para el consumo de fármacos (AU)