Dissociable Contributions of Basolateral Amygdala and Ventrolateral Orbitofrontal Cortex to Flexible Learning Under Uncertainty.

Reversal learning measures the ability to form flexible associations between choice outcomes with stimuli and actions that precede them. This type of learning is thought to rely on several cortical and subcortical areas, including the highly interconnected orbitofrontal cortex (OFC) and basolateral amygdala (BLA), and is often impaired in various neuropsychiatric and substance use disorders. However, the unique contributions of these regions to stimulus- and action-based reversal learning have not been systematically compared using a chemogenetic approach particularly before and after the first reversal that introduces new uncertainty. Here, we examined the roles of ventrolateral OFC (vlOFC) and BLA during reversal learning. Male and female rats were prepared with inhibitory designer receptors exclusively activated by designer drugs targeting projection neurons in these regions and tested on a series of deterministic and probabilistic reversals during which they learned about stimulus identity or side (left or right) associated with different reward probabilities. Using a counterbalanced within-subject design, we inhibited these regions prior to reversal sessions. We assessed initial and pre-/post-reversal changes in performance to measure learning and adjustments to reversals, respectively. We found that inhibition of the ventrolateral orbitofrontal cortex (vlOFC), but not BLA, eliminated adjustments to stimulus-based reversals. Inhibition of BLA, but not vlOFC, selectively impaired action-based probabilistic reversal learning, leaving deterministic reversal learning intact. vlOFC exhibited a sex-dependent role in early adjustment to action-based reversals, but not in overall learning. These results reveal dissociable roles for BLA and vlOFC in flexible learning and highlight a more crucial role for BLA in learning meaningful changes in the reward environment.

Pleural effusion in a child with a correctly placed ventricle-peritoneal shunt.

Pleural effusions in children (PE) due to ventricle-peritoneal shunt (VPS) is very rare, with few cases reported. We present a new case of an infant with VPS who had a massive hydrothorax not associated with misplacement or migration of the distal catheter or with ascites. After the evacuation of the PE we managed the patient by adjusting the pressure of the adjustable valve (AV). Sequential thoracic ultrasounds showed a satisfactory outcome. We review the literature thoroughly and describe the possible pathophysiological mechanisms.

La utilidad de la ecografía pulmonar en la pandemia por SARS-CoV-2 / The utility of lung ultrasound in the sars cov2 pandemic

La ecografía torácica es útil en la valoración de enfermedades del parénquima pulmonar, pared torácica, diafragma y mediastino, y también como guía en procesos intervencionistas diagnósticos y terapéuticos. Es una técnica que aporta gran cantidad de información además de poseer muchas ventajas: es sencilla y accesible, rápida, no utiliza radiación ionizante, etc. En el siguiente artículo comparamos la evolución radiológica y ecográfica de un paciente ingresado por neumonía por SARS-CoV-2.(AU)

Thoracic ultrasound is useful in the evaluation of lung parenchyma, chest wall, diaphragm and mediastinum and also as a guide in diagnostic and therapeutic interventional processes. This technique provides a large amount of useful information apart from having many advantages, such us: being simple, accesible and fast, not using ionizing radiation, etc. This paper aims to compare the radiological and ultrasound evolution of a patient admitted for SARS-CoV-2 pneumonia.(AU)

Hematoma cerebral agudo en la evolución de una encefalitis por virus herpes simple tipo 1. Una complicación infrecuente / Acute cerebral haematoma in the course of herpes simplex 1 encephalitis. A rare complication

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[Recovering lost vaccine coverage due to COVID-19 pandemic]. / Recuperando las coberturas vacunales perdidas en la pandemia de COVID-19.

The 2019 coronavirus disease pandemic can have an alarming impact on vaccination coverage. WHO, UNICEF and Gavi warn that at least 80 million children under the age of 1 are at risk of contracting diseases such as diphtheria, measles and polio due to the interruption of routine immunization and the temporary suspension of 93 campaigns of large-scale vaccination.In Spain, a new healthcare scenario, which prioritizes telematics over in person, fear of contagion by going to health centers, and recommendations for physical distance and restricted mobility, reduce attendance at primary care centers. Despite recommendations established by the health authorities, vaccination coverage has decreased in all Autonomous Communities between 5% and 60%, depending on the age and type of vaccine. School vaccinations have been suspended and only vaccination of pregnant women against tetanus, diphtheria and pertussis has been maintained. The decrease has been more evident for non gratuity vaccines: the first dose of meningococcal vaccine B has decreased by 68.4% in the Valencian Community, and Andalusia has observed a 39% decrease in the total doses of this vaccine and of 18% for that of rotavirus.The recovering of vaccinations should be planned, organized and carried out in the shortest possible time.This article discusses some aspects of the recovery of vaccination coverage for different groups: children, adolescents and adults, and patients at risk and in special situations.

Physical Contact and Loneliness: Being Touched Reduces Perceptions of Loneliness.

OBJECTIVE: This article addresses the connection between loneliness and physical contact. Evolutionary and psychological research has shown that touch is an important part of bond-building and emotion communication; loneliness is intimately related to these elements as well. In this paper, we ask whether physical contact reduces feelings of loneliness -which might derive from evolutionary ancient bonding mechanisms-despite a cultural context that is relatively non-tactile. METHOD: An experimental study (40 participants, 13 males) tested for observable effects of touch on loneliness scores in a low-contact culture to analyse whether they respond positively to that stimulus despite cultural training against it. RESULTS: Participants exposed to physical contact reported significantly lower neglect scores from their close relationships in a short loneliness scale, thus suggesting that there is an underlying mechanism that persists despite enculturation. The effects were particularly strong among single people, which could mean that lower loneliness among married people might be partly explained by the regular availability of physical contact. Participants in the experimental condition also showed a faster reduction in heart rate, interpreted as a sign of physiological wellbeing. CONCLUSIONS: These findings help to specify mechanisms within the evolutionary theoretical framework of loneliness that link internal feelings to environmental cues. This article aims at contributing to a more complex discussion on the interactions between emotions, cultural practices and psychological well-being.

Determination of the fundamental absorption and optical bandgap of dielectric thin films from single optical transmittance measurements.

In this work, we propose a method to retrieve the thickness and optical constants of dielectric thin films from single optical transmittance measurements. The method is based on the envelope method and requires a simple dispersion model for the real part of the refractive index with few fitting parameters, while the absorption coefficient can be determined without the aid of a dispersion model. The wavelength-dependent optical constants can be obtained even from spectra that exhibit few interference fringes. We have tested the method with simulated and real transmittance data from thin films in the spectral range covering the fundamental absorption. In order to assess the method's reliability to retrieve the optical constants and optical bandgap, a comparison is performed with the method by Chambouleyron, known as the Pointwise Unconstrained Minimization Approach, and a fit using the Cody-Lorentz dispersion model. We evaluate the methods' capability to retrieve the fundamental absorption and optical bandgap, and their compromise with film thickness accuracy. Finally, the methods are tested and contrasted using optical transmittance of three different semiconductor material thin films.

Psychological impact of multigene cancer panel testing in patients with a clinical suspicion of hereditary cancer across Spain.

OBJECTIVE: Patients' psychological reactions to multigene cancer panel testing might differ compared with the single-gene testing reactions because of the complexity and uncertainty associated with the different possible results. Understanding patients' preferences and psychological impact of multigene panel testing is important to adapt the genetic counselling model. METHODS: One hundred eighty-seven unrelated patients with clinical suspicion of hereditary cancer undergoing a 25-gene panel test completed questionnaires after pretest genetic counselling and at 1 week, 3 months, and 12 months after results to elicit their preferences regarding results disclosure and to measure their cancer worry and testing-specific distress and uncertainty. RESULTS: A pathogenic variant was identified in 38 patients (34 high penetrance and 4 moderate penetrance variants), and 54 patients had at least one variant of uncertain significance. Overall, cancer panel testing was not associated with an increase in cancer worry after results disclosure (P value = .87). Twelve months after results, carriers of a moderate penetrance variant had higher distress and uncertainty scores compared with carriers of high penetrance variants. Cancer worry prior to genetic testing predicted genetic testing specific distress after results, especially at long term (P value <.001). Most of the patients reported the wish to know all genetic results. CONCLUSIONS: Our results suggest that patients can psychologically cope with cancer panel testing, but distress and uncertainty observed in carriers of moderate penetrance cancer variants in this cohort warrant further research.

Compliance with national guidelines for HIV treatment and its association with mortality and treatment outcome: a study in a Spanish cohort.

OBJECTIVES: The aim of the study was to assess the adequacy of initial antiretroviral therapy (ART), in terms of its timing and the choice of regimens, according to the Spanish national treatment guidelines [Spanish AIDS Study Group-National Plan for AIDS (GeSIDA-PNS) Guidelines] for treatment-naïve HIV-infected patients. METHODS: A prospective cohort study of HIV-positive ART-naïve subjects attending 27 centres in Spain from 2004 to 2010 was carried out. Regimens were classified as recommended, alternative or nonrecommended according to the guidelines. Delayed start of treatment was defined as starting treatment later than 12 months after the patient had fulfilled the treatment criteria. Multivariate logistic and Cox regression analyses were performed. RESULTS: A total of 6225 ART-naïve patients were included in the study. Of 4516 patients who started treatment, 91.5% started with a recommended or alternative treatment. The use of a nonrecommended treatment was associated with a CD4 count > 500 cells/µL [odds ratio (OR) 2.03; 95% confidence interval (CI) 1.14-3.59], hepatitis B (OR 2.23; 95% CI 1.50-3.33), treatment in a hospital with < 500 beds, and starting treatment in the years 2004-2006. Fourteen per cent of the patients had a delayed initiation of treatment. Delayed initiation of treatment was more likely in injecting drug users, patients with hepatitis C, patients with higher CD4 counts and during the years 2004-2006, and it was less likely in patients with viral loads > 5 log HIV-1 RNA copies/ml. The use of a nonrecommended regimen was significantly associated with mortality [hazard ratio (HR) 1.61; 95% CI 1.03-2.52; P = 0.035] and lack of virological response. CONCLUSIONS: Compliance with the recommendations of Spanish national guidelines was high with respect to the timing and choice of initial ART. The use of nonrecommended regimens was associated with a lack of virological response and higher mortality.

Evaluación de la vacuna pandémica antigripal A/H1N1 adyuvada MF59. Revisión sistemática de la literatura / Assessment of the MF59-adjuvanted pandemic influenza A/H1N1 vaccine. Systematic review of literature

Objetivo: Evaluar la eficacia y la seguridad de la vacuna adyuvada MF59 en la gripe pandémica en población infantil. Métodos: Se ha elaborado una revisión sistemática de la literatura médica (2005-2012). Para ello se realizó una búsqueda bibliográfica en fuentes de datos electrónicas como MedLine o Embase y búsqueda manual en revistas especializadas, utilizando descriptores MeSH y términos de búsqueda libre. Los criterios de inclusión fueron ensayos clínicos que incluyeran a niños vacunados frente a la gripe A/H1N1 con la vacuna adyuvada MF59 y se comparaba frente a otras dosis vacunales con o sin adyuvante MF59, registrando resultados de seguridad e inmunogenicidad. La calidad de los ensayos clínicos se evaluó utilizando los criterios del cuestionario CASPe. Resultados: Se seleccionaron 4 ensayos clínicos de calidad moderada. Los efectos adversos locales y sistémicos fueron de carácter leve o moderado, sin diferencias entre los grupos vacunados. Los porcentajes de seroconversión y seroprotección alcanzados fueron superiores con las vacunas que utilizaron el adyuvante MF59. Los títulos de anticuerpos alcanzados también fueron mayores en las vacunas adyuvadas. Conclusiones: La vacuna pandémica antigripal adyuvada con MF59 presenta un buen perfil de eficacia y seguridad. Los efectos adversos que puede ocasionar son comunes y se presentan de manera similar a los que acontecen al utilizar vacunas no adyuvadas (AU)

Objective: To assess the efficacy and safety of MF59-adjuvanted pandemic influenza A/H1N1vaccine in children. Methods: A systematic review of the literature was performed after searching the MedLine and Embase electronic databases, and manual search in specialties journals, with MeSH terms and free terms. Inclusion criteria were clinical trials with children vaccinated with MF59-adjuvanted influenza A/H1N1 vaccine, compared with other vaccines doses with/without MF59-adjuvanted. The immunogenicity and safety of the vaccine was recorded. The quality of the studies included was assessed by CASPe checklist. Results: Four clinical trials with moderate quality were selected. The local and systemic adverse effects were rare and mild, with no differences between groups. Seroconversion and seroprotection levels were higher with MF59-adjuvanted vaccines. Antibody titres were also higher with the adjuvant vaccines. Conclusions: The adjuvant vaccine has a good efficacy and safety profile. The adverse effects that may occur are common and appear similarly in both vaccination groups (AU)

Safety and immunogenicity of 13-valent pneumococcal conjugate vaccine in infants: a meta-analysis.

Pneumococcal infections are a major cause of morbidity and mortality worldwide. Pneumococcal conjugate vaccines represent major progress in the prevention of invasive pneumococcal disease in the paediatric population. We performed a meta-analysis, in accordance with the PRISMA statement, in order to assess the immunogenicity and safety of 13-valent pneumococcal conjugate vaccines in infants. A literary search was conducted using electronic databases and specialized journals were searched manually. Inclusion criteria were: clinical trials with infants vaccinated with 13-valent pneumococcal conjugate, compared to 7-valent vaccine. We recorded the results in terms of the immunogenicity and safety of the vaccines. The quality of the studies included was assessed using the CASP and Jadad checklists. We included nine randomized clinical trials of 258 potentially relevant references in the meta-analysis. The studies included had high-moderate quality. Both vaccines were well tolerated in all groups of infants, and most local reactions and systemic events were of mild or medium intensity and typical of any injected vaccine. All studies included in the meta-analysis showed high immunogenicity for both pneumococcal vaccines in all tested serotypes. An anti-polysaccharide antibody concentration of ≥0.35 µg/mL was achieved in at least 89% of the infants. Our results suggest that the 13-valent pneumococcal conjugate vaccine has a similar safety profile, and is as effective as, the 7-valent vaccine in the prevention of invasive pneumococcal disease caused by the seven common serotypes, and could provide expanded protection against the six additional serotypes.

Cell cycle inhibition therapy that targets stathmin in in vitro and in vivo models of breast cancer.

Stathmin is the founding member of a family of microtubule-destabilizing proteins that have a critical role in the regulation of mitosis. Stathmin is expressed at high levels in breast cancer and its overexpression is linked to disease progression. Although there is a large body of evidence to support a role for stathmin in breast cancer progression, the validity of stathmin as a viable therapeutic target for breast cancer has not been investigated. Here, we used a bicistronic adenoviral vector that co-expresses green fluorescent protein and a ribozyme that targets stathmin messenger RNA in preclinical breast cancer models with different estrogen receptor (ER) status. We examined the effects of anti-stathmin ribozyme on the malignant phenotype of breast cancer cells in vitro and in xenograft models in vivo both as a single agent and in combination with chemotherapeutic agents. Adenovirus-mediated gene transfer of anti-stathmin ribozyme resulted in a dose-dependent inhibition of proliferation and clonogenicity associated with a G2/M arrest and increase in apoptosis in both ER-positive and ER-negative breast cancer cell lines. This inhibition was markedly enhanced when stathmin-inhibited breast cancer cells were exposed to low concentrations of taxol, which resulted in virtually complete loss of the malignant phenotype. Interestingly, breast cancer xenografts treated with low doses of anti-stathmin therapy and taxol showed regression in a majority of tumors, while some tumors stopped growing completely. In contrast, combination of anti-stathmin ribozyme and adriamycin resulted in only a modest inhibition of growth in vitro and in breast cancer xenografts in vivo. Although inhibition of tumor growth was observed in both the combination treatment groups compared with groups treated with single agent alone, combination of anti-stathmin therapy and taxol had a more profound inhibition of tumorigenicity, as both agents target the microtubule pathway. Clinically, these findings are highly relevant because taxol is one of the most active chemotherapeutic agents in breast cancer. These studies provide the proof-of-principle that stathmin provides an attractive molecular target, which could serve as a primary focus of novel approaches to breast cancer.

[Assessment of the MF59-adjuvanted pandemic influenza A/H1N1 vaccine. Systematic review of literature]. / Evaluación de la vacuna pandémica antigripal A/H1N1 adyuvada MF59. Revisión sistemática de la literatura.

OBJECTIVE: To assess the efficacy and safety of MF59-adjuvanted pandemic influenza A/H1N1 vaccine in children. METHODS: A systematic review of the literature was performed after searching the MedLine and Embase electronic databases, and manual search in specialties journals, with MeSH terms and and free terms. Inclusion criteria were clinical trials with children vaccinated with MF59-adjuvanted influenza A/H1N1 vaccine, compared with other vaccines doses with/without MF59-adjuvanted. The immunogenicity and safety of the vaccine was recorded. The quality of the studies included was assessed by CASPe checklist. RESULTS: Four clinical trials with moderate quality were selected. The local and systemic adverse effects were rare and mild, with no differences between groups. Seroconversion and seroprotection levels were higher with MF59-adjuvanted vaccines. Antibody titres were also higher with the adjuvant vaccines. CONCLUSIONS: The adjuvant vaccine has a good efficacy and safety profile. The adverse effects that may occur are common and appear similarly in both vaccination groups.

Effectiveness of oxaliplatin desensitization protocols

INTRODUCTION: Hypersensitivity reaction (HSR) to antineoplastic drugs can force doctors to stop treatment and seek other alternatives. These alternatives may be less effective, not as well tolerated and/or more expensive. Another option is to use desensitization protocols that induce a temporary state of tolerance by gradually administering small quantities of the antineoplastic drug until the therapeutic dosage is reached. The aim of this study is to assess the effectiveness of oxaliplatin desensitization protocols. MATERIALS AND METHODS: A retrospective observational study was carried out between January 2006 and May 2011. The inclusion criteria were patients undergoing chemotherapy treatment with oxaliplatin who had developed an HSR to the drug and who were candidates for continuing the treatment using a desensitization protocol. The patients' clinical records were reviewed and variables were gathered relating to the patient, the treatment, the HSR, and the desensitization protocol administered. The data were analysed using version 18.0 of the statistics program SPSS. RESULTS: A total of 53 desensitization protocols were administered to 21 patients. In 89 % of these cases, no new reactions occurred while the drug was being administered. New reactions of mild severity only occurred in 11 % of cases, and none of these reactions were severe enough for treatment to be stopped. All patients were able to complete the desensitization protocol. CONCLUSION: This study confirms that oxaliplatin desensitization protocols are safe and effective and allow patients to continue with the treatment that initially caused an HSR (AU)

A non-compulsory stewardship programme for the management of antifungals in a university-affiliated hospital.

Antimicrobial stewardship programmes promote excellence in the use of antimicrobials by selecting the appropriate antimicrobial agent and the correct dose, route of administration and duration of treatment. However, there is limited experience with such programmes targeting antifungal treatments. We present the results of a non-compulsory programme for the control of antifungals. For 12 months, prescriptions of oral voriconazole or intravenous voriconazole, caspofungin and liposomal amphotericin B were reviewed, and non-compulsory recommendations were made. The incidence and outcome of fungal infections were examined. The results for the dispensed defined daily doses (DDDs) and expenditure on antifungals were compared with those for the previous 12 months. The number of antifungal treatments reviewed was 662. A recommendation to change treatment was made in 29% of the cases, including a change from intravenous to oral treatment (15%), cessation of antifungal treatment (8%), and a change to fluconazole (6%). The DDDs of intravenous voriconazole and caspofungin were reduced by 31.4% and 20.2%, respectively. The DDDs of oral voriconazole and dispensed vials of liposomal amphotericin B were increased by 8.2% and 13.9%, respectively. Expenditure on antifungals was reduced by US$370681.78 (11.8% reduction). The programme was not related to significant increases in the incidence of candidaemia, percentage of persistent/relapsing candidaemia cases, percentage of fluconazole-resistant Candida species, incidence of infections by filamentous fungi, or 12-month mortality in patients with filamentous fungal infections. In conclusion, a stewardship programme targeting antifungals achieved a reduction in antifungal expenditure without reducing the quality of care provided.

[Evaluation of drug administration through enteral feeding tubes in hospitalized patients]. / Evaluación de las prácticas de administración de fármacos por sonda nasoentérica y enterostomía en pacientes hospitalizados.

OBJECTIVE: To describe the administration of drugs through nasogastric tubes by the nursing staff of a tertiary hospital and to identify the most common administration errors. METHODS: An observational study was carried out between November of 2010 and March of 2011. The study population was the nursing staff of the hospital. A questionnaire was created asking about the daily practice of drugs administration through the nasogastric tube; a score was assigned to each question. A document on correct administration techniques of drugs through the nasogastric tube was elaborated, which served for the comparison of the answers obtained. RESULTS: A total of 162 surveys were answered. Most of the staff (44.5%) had a deficient knowledge on the proper administration techniques. 69.7% of the staff stated to have grinded some time a tablet with enteric coverage, and 66.2% a tablet with modified release. A significant lower number of perceived obstructions per month was obtained in those nurses with higher degree of knowledge, in those consulting the Pharmacy Department when they had doubts, and in those never having grinded a tablet with enteric coverage of modified release. CONCLUSIONS: It is observed that the knowledge on proper administration of drugs through the nasogastric tube by the nursing staff is deficient; therefore, it would be convenient to carry out specific training courses as well as a closer collaboration between the Pharmacy department and the Nursing units.

Aplicación de un modelo politómico de TRI al test ASSIST para el estudio de sus propiedades métricas / Application of a IRT polytomous model to ASSIST test for the study of psychometric properties

La cocaína es, tras el cannabis, la sustancia de comercio ilegal más consumida en Europa y España. Su uso está fundamentalmente vinculado a los contextos recreativos de ocio y a jóvenes-adultos, quienes son reticentes a contactar con los servicios asistenciales, acudiendo a estos cuando desarrollan problemas graves. Por ello, resulta necesario disponer de herramientas de cribado que ayuden a la detección temprana de problemas relacionados con el consumo de cocaína. Objetivo. El objetivo de este trabajo es analizar las propiedades psicométricas de la versión auto-aplicada on line del test de cribado ASSIST (Alcohol, Smoking and Substance Involvement Screening Test). Método. La muestra está formada por 1176 consumidores de cocaína que cumplimentaron el ASSIST on line. Las propiedades psicométricas serán estudiadas empleando el Modelo del Crédito Parcial, dentro de la familia de la Teoría de la Respuesta al Ítem (TRI). Resultados. En términos generales, se observa un adecuado ajuste de los datos al modelo. No obstante, se aprecia un funcionamiento deficiente de las categorías de respuesta. Igualmente, se aprecia un desplazamiento de la posición de los ítems en el continuo con respecto a las personas, siendo deficientemente medidas las personas con niveles bajos de riesgo asociado al consumo. Conclusiones. El análisis del ASSIST desde la perspectiva de la TRI ha mostrado algunas deficiencias de este test cuando se aplica sobre este tipo de muestra consumidora de cocaína. A pesar de una calibración de los ítems adecuada, se proponen mejoras que permitan reducir el error de medida en las personas que presentan niveles bajos de riesgo asociado al consumo de cocaína (constructo) y modificaciones respecto a las alternativas de respuestas (AU)

Cocaine is, second after cannabis, the most used illegal drug in Europe and Spain. Its use is primarily linked to recreational nightlife settings and young adults who are reluctant to contact with health services and draw on these when they develop serious drug problems. Therefore, screening tools are needed to help early detection of problems related to cocaine use. Aim. The aim of this paper is to analyse the psychometric properties of an online self-applied version of ASSIST (Alcohol, Smoking and Substance Involvement Screening Test). Method. The sample consisted of 1176 cocaine users who completed the ASSIST online. The psychometric properties are studied using the Partial Credit Model, within the family Item Response Theory (IRT). Results. In general terms, the degree to which the test response data are as expected from the model is good. However, ASSIST test shows a poor fit of the response categories. Similarly, the relative positions of the items on the continuum imply poor measurement of people with low levels of risk associated with drug use. Conclusion. ASSIST analysis from the perspective of IRT has showed some shortcomings in this test when applied to this type of sample of cocaine users. Despite good item calibration, several improvements to reduce the measurement error in people with low levels of risk associated with cocaine use (construct) and changes in responses categories are proposed (AU)

Evaluación de las prácticas de administración de fármacos por sonda nasoentérica y enterostomía en pacientes hospitalizados / Evaluation of drug administration through enteral feeding tubes in hospitalized patients

Objetivos: Describir la administración de fármacos a través de sondas por parte del personal de enfermería de un Hospital terciario e identificar los errores más comunes de administración. Métodos: Se realizó un estudio observacional entre noviembre 2010 y marzo 2011. La población de estudio fue el personal de enfermería del Hospital. Se elaboró un cuestionario con preguntas acerca de su práctica habitual a la hora de administrar fármacos por sonda, a cada una de las cuales se asignó una puntuación. Se elaboró también un documento de prácticas correctas de administración de fármacos por sonda con el que se compararon las respuestas obtenidas en los cuestionarios. Resultados: Fueron cumplimentadas un total de 162 encuestas. La mayoría del personal (44,5%) obtuvo un grado de conocimiento deficiente de las prácticas adecuadas de administración de fármacos por sonda. El 69,7% del personal afirmó haber triturado en alguna ocasión un comprimido con cubierta entérica y el 66,2% algún comprimido de liberación modificada. Se observó un número percibido significativamente menor de obstrucciones al mes en aquellos encuestados con mayor grado de conocimiento, en aquellos que consultaron con el Servicio de Farmacia en caso de duda y en aquellos que nunca habían triturado un comprimido de cubierta entérica o liberación modificada. Conclusiones: Se observa que el conocimiento de las prácticas correctas de administración de fármacos por sonda por parte del personal de enfermería es deficiente, por lo que sería muy adecuado realizar cursos formativos específicos así como una colaboración más estrecha entre el Servicio de Farmacia y las Unidades de Enfermería (AU)

Objective: To describe the administration of drugs through nasogastric tubes by the nursing staff of a tertiary hospital and to identify the most common administration errors. Methods: An observational study was carried out between November of 2010 and March of 2011. The study population was the nursing staff of the hospital. A questionnaire was created asking about the daily practice of drugs administration through the nasogastric tube; a score was assigned to each question. A document on correct administration techniques of drugs through the nasogastric tube was elaborated, which served for the comparison of the answers obtained. Results: A total of 162 surveys were answered. Most of the staff (44.5%) had a deficient knowledge on the proper administration techniques. 69.7% of the staff stated to have grinded some time a tablet with enteric coverage, and 66.2% a tablet with modified release. A significant lower number of perceived obstructions per month was obtained in those nurses with higher degree of knowledge, in those consulting the Pharmacy Department when they had doubts, and in those never having grinded a tablet with enteric coverage of modified release. Conclusions: It is observed that the knowledge on proper administration of drugs through the nasogastric tube by the nursing staff is deficient; therefore, it would be convenient to carry out specific training courses as well as a closer collaboration between the Pharmacy department and the Nursing units (AU)

Revisión de las reacciones de hipersensibilidad a antineoplásicos / Review of hypersensitivity reactions to antineoplastic agents

Objetivo Revisar las características y el manejo de las reacciones de hipersensibilidad causadas por agentes antineoplásicos. Método Se realizó una búsqueda bibliográfica en las bases de datos Pubmed y EMBASE de los últimos 10 años. Resultados Casi todos los quimioterápicos tienen potencial para causar una reacción de hipersensibilidad, pero determinados grupos han sido asociados con un mayor riesgo, como los derivados del platino, los taxanos, las asparraginasas, los anticuerpos monoclonales y las epipodofilotoxinas. Las manifestaciones clínicas de estas reacciones son variables e impredecibles incluyendo síntomas cutáneos, respiratorios, cardiacos y gastrointestinales. El mecanismo asociado con su desarrollo aún no se conoce en su totalidad. El diagnóstico se basa en los signos y síntomas que desarrolle el paciente y en la realización de pruebas cutáneas. El manejo de los pacientes que sufran una reacción de hipersensibilidad a un quimioterápico variará según el grado de severidad de la reacción, de la necesidad de continuar con el tratamiento y de las alternativas terapéuticas disponibles. Conclusiones Al producirse un incremento progresivo en la utilización de los agentes quimioterápicos, se puede esperar un aumento de la incidencia de las reacciones de hipersensibilidad. Los protocolos de desensibilización destacan como una alternativa que nos van a permitir reintroducir en la terapia del paciente el agente causal de la reacción de hipersensibilidad. Su utilización debe valorarse individualmente sopesando los beneficios y los riesgos (AU)

Objective To review the characteristics and management of hypersensitivity reactions caused by antineoplastic agents. Method We conducted a search in the Pubmed and EMBASE databases for the last 10 years. Results Almost all chemotherapeutic agents have the potential to cause hypersensitivity reactions, but some groups have been associated with increased risk, such as platinum compounds, taxanes, asparaginase, monoclonal antibodies and epipodophyllotoxins. The clinical manifestations of these reactions are variable and unpredictable, including symptoms affecting the skin and the pulmonary, cardiac and gastrointestinal systems. The mechanism associated with their development is not yet fully understood. Diagnosis is based on patients’ signs and symptoms and skin testing. The management of patients who suffer a hypersensitivity reaction to a chemotherapeutic agent varies with the severity of the reaction, the need to continue treatment, and the availability of alternative therapies. Conclusions Due to a progressive increase in the use of chemotherapeutic agents an increased incidence of hypersensitivity reactions is to be expected. Desensitisation protocols are a noteworthy alternative that make it possible to re-initiate patients’ therapy with the causative agent of the hypersensitivity reaction. Their use should be assessed individually, weighing risks and benefits (AU)