Adecuación de la utilización de benzodiazepinas en ancianos desde la oficina de farmacia. Un estudio de colaboración médico-farmacéutico / Suitability of the use of benzodiazepines prescribed by the pharmacist in the elderly. A doctor-pharmacist collaboration study

Objetivos: Mejorar el uso de benzodiazepinas (BZD) en ancianos desde una colaboración farmacéutico-médica. Diseño: Se realizó un estudio controlado simple ciego durante un año en farmacias con la finalidad de conseguir que las BZD sean eficaces, seguras y se utilicen el tiempo necesario. Emplazamiento: Once farmacias comunitarias de la Comunidad Valenciana. Participantes: Pacientes mayores de 65años tratados con BZD que acudieron a las farmacias participantes durante el periodo del estudio. Intervenciones: Entrevistas y seguimiento farmacoterapéutico durante un año. Medidas principales: Detección de duplicidades, reacciones adversas al medicamento, interaccciones farmacológicas y medida de la efectividad del tratamiento. Resultados: Se estudiaron 314 pacientes, distribuidos de forma aleatoria al grupo control o intervención, que utilizaban 346 BZD. El 67% utilizaban BZD durante más de 1 año. Solo el 5% de los pacientes con insomnio conocía que la duración del tratamiento debía ser inferior al mes. El 20% utilizaban BZD de vida larga, 76% de vida media y el 4% de vida corta. Se detectaron 132 interacciones farmacológicas y 278 RAM: 32% pérdida de memoria, 21% somnolencia, 12% incoordinación motora, 8,3% mareo y confusión, 8,3% desorientación y 10% otras. Se realizaron 426 intervenciones farmacéuticas, 30 aceptadas por el médico, y se resolvieron 78 al finalizar el año. El 30% de los casos del grupo intervención fueron satisfactorios, y solo 11% del control. Conclusiones: Las benzodiazepinas se utilizan en los pacientes ancianos de la Comunidad Valenciana con mayor frecuencia y por periodos más prolongados de lo recomendado por la Agencia Española del Medicamento(AU)

Aims: To improve the use of benzodiazepines (BZD) in the elderly by a pharmacist-physician collaboration, and to insure that BZD are effective, safe, and used as long as necessary. Design: A single blind controlled study was conducted on 11 pharmacies in the Community of Valencia. Setting: Eleven pharmacies in the Community of Valencia. Participants: Patients older than 65years treated with BZD attending the participating pharmacies. Interventions: Interviews and pharmaceutical care for a year. Main measurement: detection of duplications, adverse drug reactions, drug interactions and measuring the effectiveness of the treatment. Results: We studied 314 patients, randomised to control or intervention and who used 346 BZD. The majority (67%) of patients used BZD for more than 1 year. Only 5% patients with anxiety knew the duration of treatment should be one month. Long-acting BZD were used by 20% of the patients, 76% used medium-acting (39% lorazepam and 37% other BZD) and 4% short-acting BZD. A total of 132 drug interactions were detected and 278 adverse drug reactions: 32% memory loss, 21% drowsiness, 12% lack of coordination, 8.3% dizziness and confusion, 8,3% disorientation and 10% others. A total of 426 pharmacist interventions were performed, 30 accepted by the doctor and 78 were resolved at the end of the year of study. Eleven per cent of cases were considered satisfactory in the control group and 30% in the intervention group. Conclusion: The use of benzodiazepines in the Community of Valencia exceeds the recommendations of the Spanish Medicines Agency(AU)

[Suitability of the use of benzodiazepines prescribed by the pharmacist in the elderly. A doctor-pharmacist collaboration study]. / Adecuación de la utilización de benzodiazepinas en ancianos desde la oficina de farmacia. Un estudio de colaboración médico-farmacéutico.

AIMS: To improve the use of benzodiazepines (BZD) in the elderly by a pharmacist-physician collaboration, and to insure that BZD are effective, safe, and used as long as necessary. DESIGN: A single blind controlled study was conducted on 11 pharmacies in the Community of Valencia. SETTING: Eleven pharmacies in the Community of Valencia. PARTICIPANTS: Patients older than 65 years treated with BZD attending the participating pharmacies. INTERVENTIONS: Interviews and pharmaceutical care for a year. MAIN MEASUREMENT: detection of duplications, adverse drug reactions, drug interactions and measuring the effectiveness of the treatment. RESULTS: We studied 314 patients, randomised to control or intervention and who used 346 BZD. The majority (67%) of patients used BZD for more than 1 year. Only 5% patients with anxiety knew the duration of treatment should be one month. Long-acting BZD were used by 20% of the patients, 76% used medium-acting (39% lorazepam and 37% other BZD) and 4% short-acting BZD. A total of 132 drug interactions were detected and 278 adverse drug reactions: 32% memory loss, 21% drowsiness, 12% lack of coordination, 8.3% dizziness and confusion, 8,3% disorientation and 10% others. A total of 426 pharmacist interventions were performed, 30 accepted by the doctor and 78 were resolved at the end of the year of study. Eleven per cent of cases were considered satisfactory in the control group and 30% in the intervention group. CONCLUSION: The use of benzodiazepines in the Community of Valencia exceeds the recommendations of the Spanish Medicines Agency.

[Blood viscosity profile in rapidly progressive sensorineural hearing loss with positive Western-blot]. / Perfil de la viscosidad sanguínea en la hipoacusia rápidamente progresiva con Western-blot positivo.

OBJECTIVE: To value a possible association between disorders in blood viscosity of patients with rapidly progressive sensorineural hearing loss (RPSHL) of autoimmune origin. PATIENTS AND METHODS: We studied the viscoelastic properties of blood in 43 subjects bearing of RPSHL and a positive Western-blot for anticochlear antibodies: whole blood viscosity (WBV) at different shear rates and erythrocyte filterability (EF). These results were related to hearing loss initially detected and recovery average one year later from steroid therapy. RESULTS: Just WBV at 230 sec(-1) shear rate was significatively higher in cases than in controls (p < 0.01). Hearing recovery degree correlated in an statistically way to increased values of EF (p < 0.01). There was no relation between initial hearing loss level and any rheology parameter. CONCLUSIONS: Autoimmune RPSHL does not show a pathophysiology mechanism associated to blood hyperviscosity. So, rheoactive therapies as plasmapheresis warrant no clinical improvement.

Seguimiento del paciente en indicación farmacéutica / No disponible

Durante cuatro meses se registraron las consultas de los pacientes que solicitaban algún remedio para el alivio de síntomas menores, con el objeto de hacer un seguimiento de su evolución (mediante llamada telefónica), mostrar la necesidad del consejo farmacéutico en el uso de medicamentos de venta sin receta y su eficacia en el alivio de síntomas menores. Utilizando protocolos, el farmacéutico aconsejaba la derivación al médico o seleccionaba el medicamento (de venta sin receta) más idóneo para paliar los síntomas consultados, indicándoles las medidas a seguir. El resultado de la intervención farmacéutica se valoró como solución eficaz, si el paciente refería haber solucionado su problema o mejorado mucho, o no eficaz en los demás casos.Se recogieron 263 casos, el 69,58% sobre resfriados y síntomas asociados. El 28,52% de los pacientes presentaban alguna patología de base, el 4,94% alergia a algún medicamento y el 38,02% tomaba medicamentos habitualmente. Se remitieron al médico directamente al4,94% de los pacientes; el resto se trató con medidas higiénico-dietéticas y/o medicamentos de venta sin receta. Se hizo seguimiento al 85,55% de los pacientes.El 73,49% refirió evolucionar de forma favorable (solución eficaz). Un 15,81% acudió al médico por no observar mejoría de los síntomas en el tiempo recomendado, o por revisión, conforme a lo que se les indicó. El registro de este tipo de consultas y su seguimiento deja constancia de la actuación del farmacéutico y de la evolución del proceso. La participación de los pacientes es muy alta, así como la proporción de problemas resueltos, que no han precisado la derivación al médico (AU)

A follow-up for a period of four months was developed by phone call about all the consultations of patients asking for a treatment to improve lesser symptoms. This was made to value the need of pharmaceutical counsel on use and useful of medicines with no medical prescription to solve these symptoms. By mean of protocols the pharmacist recommended to consult to a medical practitioner or directly selected a suitable medicine (without prescription required) to achieve this improvement, ruling over its use. The result of pharmaceutical intervention was considered effective if patients reported to have solved their problem, and ineffective in the rest of cases.We reported two hundred and sixty-three cases, and their consultation was about cold and related symptoms in69,58%. Patients bearing of any concomitant disease were28,52%, drug allergic subjects were 4,94% and cases usually consumers of medicines were 38,02%. The 4,94% of patients was directly remitted for a medical consultation; the rest was treated with hygienic-dietary measurements or non-prescription required medicines.A follow-up was completed in 85,55% of patients.In 73,49% of them an improvement was confirmed(effective solution). The 15,81% made a medical consultation because of not to observe disappearance of symptoms, or if it was necessary to review the disorder.This study about consultations and follow-up places the pharmacist activity on record, as well as the course of health problems. Patients participation and the average of good results obtained without visiting a physician were really high (AU)

[Hearing loss associated to ulcerative colitis]. / Hipoacusia asociada a colitis ulcerosa.

OBJECTIVE: To value the eventual immunomediation in sensorineural hearing loss (SHL) on patients bearing of ulcerative colitis (UC). MATERIAL AND METHODS: In a group of forty-nine cases with a mean age of 41.6+/-9.3 years old we studied the hearing loss level, the disease activity index, the peripheral blood inflammation markers and the anticochlear antibodies by mean of Western-blot technique (WB). RESULTS: The 26.5% knew about their deafness, although SHL was detected in 59.1% of cases. The mean age of onset was 40.3+/-9.8 years. 48.9% showed a positive WB, always in 68-70 kDa molecular weight blots. Moreover, patients with positive WB showed more severe deafness, higher disease activity and more altered parameters, especially erythrosedimentation rate. CONCLUSIONS: Audiologic and peripheral blood findings observed allow us to establish a reasonable suspicion of an autoimmune or immunomediated pathway of hearing loss on UC.

Papel del farmacéutico en la información al paciente sobre la THS / No disponible

Los efectos adversos de la terapia hormonal sustitutoria (THS) se han publicado recientemente y difundido por los grandes medios de comunicación. Durante los meses de Febrero a Marzo de 2003 se realizó en dos oficinas de farmacia un estudio, con el objetivo de analizar la información que tienen las pacientes usuarias de THS sobre la indicación y efectos adversos de esta terapia y el cumplimiento de la misma en cuanto a las revisiones médicas periódicas que precisa. Además, se propuso averiguar la fuente de información y demostrar si la red de oficinas de farmacia es un estamento válido para llegara la totalidad de las pacientes que la utilizan. Se registraron 39 pacientes, de las que el 12,82% refirieron estar en tratamiento entre cinco y diez años, y el 10,26%, durante más de diez. El 17,95% de las pacientes entrevistadas no asistían a las revisiones médicas de forma periódica. A todas se les informó y aconsejó acerca de la necesidad de llevar un buen control médico. Se consiguió que al menos el 71,43% de estas últimas acudieran al ginecólogo. Por otro lado, sólo el 48,71% tenían conocimientos actualizados al respecto. La fuente de información mayoritaria fue su médico en el 52,63% de los casos, seguido por su farmacéutico (26,32%) y los medios de comunicación (21,05%). El farmacéutico es, en ocasiones, el único sanitario que va a poder informar adecuadamente a las usuarias de THS, educar en materia sanitaria, animándolas a acudir a sus revisiones, contribuyendo a la prevención de problemas relacionados con los medicamentos (AU)

Adverse effects of the Sustitute Therapy Hormonal (SHT) have recently been published and widespread on the media. From February to March of 2003, a study was carried out in two pharmacies with the purpose of analyze the information given by the patients user of this treatment about the prescription and adverse effects of the SHT, and on the check up which have to be achieved. It was also set out to find out the source of the information and to prove if the organization of pharmacies is valid to reach all patients users of it. From 39 patients registered, the 2.82% stated to use the SHT between five to ten years, and 10.26% for more than ten years. The 17.95% of the interviewed patients were not checked up. All of them were advised and informed about the need of a medical control. It was achieved that al least the 71.43% of them went to the gynecologist. Apart from that, only the 48.71% had update information. The main source of information was their doctor in the 52.63% of the cases, followed by their pharmacist (26.32%) and the media (21.05%). The pharmacist is, occasionally, the only one who can properly inform users of SHT, educate them in health, motivate them to check up, and contribute to prevent problems related to drugs (AU)

[Anticochlear antibodies titles measured by Western-blot and hearing recovery level after corticoid therapy in patients with sudden deafness]. / Titulación de anticuerpos anticocleares mediante Western-bloty grado de recuperación auditiva tras corticoterapia en pacientes con sordera súbita.

OBJECTIVES: Detection of antichoclear antibodies in patients with sudden deafness (SD) ranges from five to forty one percent depending on authors. We tried to correlate the level of antibodies measured by Western-blot (WB) and hearing loss. PATIENTS AND METHODS: Forty nine subjects bearing of SD and a positive WB for bovine cochlear antigen. Hearing loss average was measured at the onset and after treatment with deflazacort 1 mg/kg per day by means of audiometry, and antibody titles were quantified in the diluted sera. RESULTS: Initial loss was 49.4+/-20.6%, and after corticotherapy it was 15.9+/-18.0%. There was no statistically significative correlation titles-hearing loss (y=0.1122x+30.613; R2=0.7552) nor titles-recovery (y=-0.0818x+8.,65; R2=0.3229). CONCLUSIONS: Although predictive capability for treatment response is accepted for WB, quantifying of the antibody titles in patients with SD does not allow to make a prognosis about the average hearing recovery.

[A patient with hereditary spherocystosis and sudden deafness after splenectomy]. / Un paciente con esferocitosis hereditaria y sordera súbita tras esplenectomía.

We report the case of a 29 year-old male with of hereditary spherocytosis, who developed two episodes of sensorineural hearing loss in his right ear after splenectomy due to repetitive hemolytic crisis. We discuss the eventual altiopathogenic mechanism of this audiological disorder.

[Variations of salivary dismutase superoxide in tonsillar infection]. / Variaciones de la superóxido dismutasa salivar en la infección amigdalar.

The antioxidant effect of superoxido dismutase in saliva was measured in children bearing of tonsillar hypertrophy, recidivant tonsillitis or peritonsillar abscess. These levels were compared to those detected on tonsillar tissue obtained from tonsillectomy (p < 0.001). Although salivary SOD concentration in children with tonsillar infection was higher than hypertrophy, there was not a significative correlation to tonsillar value of the enzyme (R2 = 0.2276), so we can not accept a predictive value for salivary SOD of tonsillar suffering and, eventually, of tonsillectomy.

[Oxidative profile of tonsil infection. Study of antioxidant enzymes in tonsil and blood]. / Perfil oxidativo de la infección amigdalar. Estudio de las enzimas antioxidantes en amígdala y sangre.

In order to investigate the effect of oxidative damage due to free radicals on ENT infectious diseases, levels of superoxide dismutase (SOD), glutathione-peroxidase (GPx) and reductase (GRt) and the total antioxidant status (TAS) were measured by spectrophotometry on tonsillar tissue obtained from tonsillectomy in 538 patients, who were divided in three groups according to their surgical indication: tonsillar hypertrophy (n = 235), recurrent tonsillitis (n = 280) or peritonsillar abscess (n = 23). SOD concentration were also measured on adenoid tissue and middle ear exudate in 75 patients from the first two groups. Erythrocyte and tonsillar SOD levels were significantly greater in the abscess group, and lower in the hypertrophic one. These differences were similar for GPx and TAS. For GRt, its level in abscess were lower than in the other two groups in a statistically significant way. There were strong correlations between erythrocyte and tonsillar SOD, tonsillar SOD and GPx, tonsillar SOD and TAS, and tonsillar GPx and TAS. SOD concentrations from adenoid tissue and middle ear exudate did not affect its blood level. So, we can conclude that tonsillar oxidative damage is determined by the frequency or the severity of local infections, and it can be evaluated by measuring the SOD concentration in the tonsillar tissue or in the peripheral blood. So, it can be considered a good marker of tonsillar damage.

[Tonsillar and erythrocyte levels of superoxide dismutase in children with and without recurrent tonsillitis]. / Niveles de superóxido dismutasa amigdalar y eritrocitaria en niños con y sin amigdalitis de repetición.

BACKGROUND AND OBJECTIVES: Oxidative stress secondary to infant tonsillar infection produces the expression of local and systemic antioxidants. Its determination seems to be useful as a marker of tonsillar suffering before tonsillectomy but is currently unknown. The aim of this study was to determine the evolution of this parameter in tonsillectomized children during a long-term follow-up. METHODS: One hundred thirty-six children underwent tonsillectomy, 46 for tonsillar hypertrophy without infection and 90 for recurrent tonsillitis. Superoxide dismutase (SOD) concentrations were measured before tonsillectomy and at 6, 12, 24 and 36 months post-tonsillectomy. RESULTS: Infection provoked significantly higher SOD concentrations than tonsillar hypertrophy in tonsillar tissue (223.06 30.46 vs 156.39 54.05 U/l, p < 0.001) and in blood (1124.91 141.73 vs 1007.19 97.03 U/gr Hb, p < 0.001). There was a strong correlation between tonsillar and erythrocyte concentrations. During the 3-year follow-up, SOD concentrations in blood progressively decreased until stabilizing in all patients. Stabilization was reached at 6 months post-tonsillectomy in the group with tonsillar hypertrophy and at 2 years in the group with infection. Children with recurrent tonsillitis consistently showed higher SOD concentrations in blood throughout the follow-up. CONCLUSIONS: Oxidative damage in tonsillar tissue results from the incidence and severity of focal infections. Tonsillectomy reduces SOD levels but, as a consequence of oxidative stress, these do not return to normal.

[Co-administration of histamine H1 antagonist and oral anticoagulants]. / Empleo simultáneo de antihistamínicos H1 y anticoagulantes orales.

Indications for oral anticoagulation and antihistamine H1 antagonists therapies are increasingly. So, it is easy to find individuals who need both treatments. The unknowledgement about possible interferences of antihistamines over acenocumarin often makes to avoid them at the same time. A review on a population receiving anticoagulation on a Therapeutic Center allowed us to verify disorders secondary to the association of antihistamines into their therapeutic scheme. Loratadine, ebastine and cetirizine show similar records of interaction into acenocumarin pharmacokinetics, probably due to a liver enzymatic induction on the anticoagulant drug, producing a decrease on INR values in which anticoagulation is measured. This could make necessary to increase temporally acenocumarin dose. During coadministration no thromboembolic event nor bleeding were registered.

[Pathophysiological rationale for the use of piracetam in sudden deafness]. / Argumentación fisiopatológica al empleo de piracetam en la sordera brusca.

To determine if blood viscosity disorders affect the clinical course of idiopathic sudden deafness, we studied the usefulness of the rheoactive agent piracetam and prednisolone compared with steroid/vasodilator therapy. The piracetam group (n = 17) showed clinical improvement in 82.3% and a mean hearing gain in 54.1%, compared with 68.7% and 49.3%, respectively, for the group without piracetam (n = 6). In both groups, clinical severity correlated with increased whole blood viscosity and erythrocyte aggregability and filterability rates. On the seventh day after onset, all the viscosity parameters had returned to normal in the piracetam group, but the non-piracetam group still showed no improvement in whole blood viscosity and erythrocyte filterability. Piracetam seemed to be effective in this sensorineural deafness, probably as a result of its effect on the viscoelastic properties of blood. Measurement of these properties seven days after beginning therapy provides information about long-term potential for hearing recovery.

[Lipoperoxidation in otorrhea of the middle ear as a marker of infection. Clinical application]. / Lipoperoxidación en otorreas del oído medio como marcador de infección. Aplicación clínica.

If the generation of free oxygen radicals is a pathophysiological finding in middle-ear infections, as has been reported, demonstration of the oxidative consequences of free radicals in middle-ear exudates may be a quick, simple, objective and accessible test for quantifying the degree of mucosal injury. Therefore, samples of the discharge fluid from cases of acute otitis media (n = 17), cholesteatoma (n = 17), chronic discharge in the absence of cholesteatoma (n = 10), and secretory otitis media (n = 15) were tested using an enzymatic colorimetric assay for lipid peroxide levels due to superoxide and hydroxyl radicals during infection. Lipid peroxide levels in acute otitis media, cholesteatoma, and chronic discharge without cholesteatoma ranged from 575 to 650 nmol/mg of exudate, and was 67 nmol/mg in secretory otitis media, which were statistically significant findings. Infectious otitis media showed findings secondary to increased oxidative metabolism, but not secretory otitis media. Measurement of this oxidative metabolism could serve to monitor the evolution of episodes, as well as to detect relapse or reinfection, and to evaluate response to new therapeutic options for suppurative otitis, such as topical antioxidants.

[Detection tonsillar pathology by superoxide dismutase levels. Comparative study of surgical indications for tonsillectomy]. / Detección de patología amigdalar mediante los niveles de superóxido dismutasa. Estudio comparativo por indicaciones quirúrgicas de amigdalectomía.

If oxygen-derived free radicals are considered the definitive cause of tonsillar damage after infection, it seems reasonable that scavenger antioxidants levels could be used as a detector of tissue impairment. So, superoxide dismutase (SOD) amounts were measured in palatine tonsils and peripheral blood on subjects bearing of hypertrophy without infection (H, n = 83), recurrent tonsillitis (RA, n = 75), and peritonsillar abscess (PA, n = 12). SOD levels in both tonsillar cultures supernatants and peripheral blood erythrocytes were detected progressively increased in groups with H, RA and PA, which were statistically significative (ANOVA-test; p < 0.001). A significative correlation between tissue and blood was observed for all the groups. We can conclude that SOD concentration in palatine tonsils and/or peripheral blood increases proportionally to infections incidence, which allows detecting patients with functional damage, and recommending objectively tonsillectomy or at least monitoring clinical response for a therapy. Practical use and results obtained from comparison to tonsil biopsies are discussed.

[Our experience in the management of peritonsillar phlegmon and abscess in children]. / Conducta ante el flemón y el absceso periamigdalinos en la infancia desde nuestra experiencia.

OBJECTIVE: Our objective was to evaluate the possible causes of the increased incidence of peritonsillar abscess in children during recent years, since up until now this condition has been unusual in children. PATIENTS AND METHODS: A retrospective study of all cases diagnosed in the Emergency Room between 1983 and 1998 detected nine children admitted to the hospital with painful swallowing, high fever and trismus. All of them underwent fine needle aspiration and transcutaneous ultrasound. RESULTS: The mean age was 9.8 years. Eight children suffered previous pharyngo-tonsillar infection, although emergency assistance was only confirmed in four cases. Six children were treated with macrolides, two with amoxicillin and one with cefuroxime. Exploration always diagnosed peritonsillar infection and needle aspiration detected an abscess in six cases. Ultrasound did not provide new information. In cases with abscess, drainage was performed and in three patients under general anesthesia. Bacteriologic cultures showed a lack of correlation between the isolates from the tonsillar surface and from pus from the abscess or tonsillar core. In the latter two there was a preponderance of Haemophilus influenzae and anaerobes. All children received intravenous antibiotic therapy and delayed tonsillectomy was done. There were no complications. CONCLUSIONS: Infant cases of peritonsillar abscess are increasing and there is no clear relationship with acute tonsillar infections, but probably with the use of inadequate antibiotics.

[The nonserological diagnostic approach to infectious mononucleosis in an emergency service]. / Aproximación diagnóstica no serológica a la mononucleosis infecciosa desde el Servicio de Urgencias.

Patients with infectious mononucleosis often are seen in Emergency Services because the infection may produce tonsillitis resistant to antibiotic therapy. However, the diagnosis of choice is specific serology, which usually takes days or weeks before results become available. Detection of lymphocytosis in peripheral blood, heterophilic antibodies, and the characteristic mononuclear cells by means of specialized blood counters, together with the clinical signs, have improved the quality of diagnosis in emergency services (93% sensitivity and 97.2% specificity). We found that simple identification by optical microscopy of the lymphomonocytes typical of infectious mononucleosis in a drop of peripheral blood, together with the clinical findings, have a better diagnostic sensitivity (96. 5%) and specificity (99.1%) than any other method available in emergency services.

[The measurement of superoxide dismutase levels in recurrent tonsillitis. Its practical use]. / Medida de los niveles de superóxido dismutasa en la amigdalitis de repetición. Utilidad práctica.

Superoxide radicals generated in the palatal tonsils by recurrent local infections cause an organic response consistent in synthesis of superoxide dismutase. Tonsillar concentrations of this enzyme correlate with the incidence of tonsillitis. Moreover, superoxide dismutase levels in erythrocytes rise in children proportional to tonsillar concentration in a statistically significant way (y = 0.2356x - 64.918; R2 = 0.9266). The similarities in local and systemic changes in recurrent tonsillitis suggest that the determination of superoxide dismutase in peripheral blood could be a good screening method for determining who should undergo tonsillectomy.

[Eosinophils in nasal secretion. Technique and clinical utility]. / El eosinófilo de la secreción nasal. Técnica y utilidad clínica.

The microscopic study of nasal secretions to identify eosinophils is a classic test in the diagnosis of allergic rhinitis. Modern immunologic diagnostic alternatives have reduced the frequency of its practice, but the information that it provides, although complementary, is quick, inexpensive and specific. Panoptic stains easily detect eosinophils, although the absence of these cells does not rule out any diagnosis.

[Clinical response of gabapentin for glossopharyngeal neuralgia]. / Respuesta clínica a la gabapentina en la neuralgia del glosofaríngeo.

INTRODUCTION: The analgesic effect of the antiepileptic drug gabapentin makes it useful as an alternative for neuropathic pain. Its structural resemblance to other GABAergic antiepileptic drugs does not explain its mechanism of action, which seems not to depend on the activation of GABA receptor. Glossopharyngeal neuralgia is a rare entity which presents paroxystic crisis of pain, often with unknown etiology and poor response to treatment. CLINICAL CASES: Nine patients bearing of IX root neuralgia resistant to other therapies and ages ranged from 43 to 71 years old are being treated with gabapentin at doses between 800 and 3,600 mg daily in a period of time between two and sixteen months. Four cases in which magnetic resonance detected a compression of the nerve by posterior inferior cerebellar artery were submitted to a decompression surgery, but it was not effective. Gabapentin, alone or in association to carbamazepine, reduced the frequency and severity of crisis in seven patients, but in those with vascular compression the response was poorer. CONCLUSION: Gabapentin can be considered as an useful option for the management of glossopharyngeal neuralgic crisis, associated or not to other agents, for a short and long time, because of its good tolerance and lack of interactions.