Consumo de medicamentos para el tratamiento de la demencia en la Comunidad Autónoma Vasca durante el periodo 2006-2011 / Dementia drug consumption in the Basque Country between 2006 and 2011

Objetivo: Este estudio evalúa el consumo de medicamentos para el tratamiento cognitivo de la EA y otras demencias en personas mayores de 60 años entre los años 2006 y 2011 en el País Vasco. Métodos: Se realizó un estudio descriptivo retrospectivo. La Dirección de Farmacia del Departamento de Salud del Gobierno Vasco facilitó los datos de prescripción de donepezilo, rivastigmina, galantamina y memantina. Se obtuvieron el número de dosis diarias definidas (DDD) y el número de DDD por 1.000 habitantes/día (DHD). Resultados: El consumo se incrementó un 49,72% durante el periodo 2006-2011, aumento que varió en función del medicamento (donepezilo 13,02%; rivastigmina 93,18%; galantamina 37,79%; memantina 70,40%) y del TTHH (Álava 16,34%; Bizkaia 50,49%; Gipuzkoa 57,37%). El gasto aumentó de 11,5 millones de € en 2006 a 18,1 millones en 2011. Conclusiones: Se observó un aumento en el consumo aunque existen diferencias entre TTHH que pueden deberse a hábitos de prescripción diferentes. El gasto farmacéutico se incrementó paralelamente al aumento en el consumo, ya que el precio de los medicamentos permaneció estable en ese periodo

Objective: We evaluated the consumption of specific medications for treating cognitive symptoms associated with AD and other types of dementia in individuals over 60 years of age between 2006 and 2011 in the Basque Country. Methods: A retrospective descriptive study was conducted. The pharmacy division of the Basque Government Department of Health provided the prescribing data for the following drugs: donepezil, rivastigmine, galantamine, and memantine. The number of defined daily doses (DDDs) and the number of DDDs per 1000 inhabitants/day (DHD) were calculated. Results: Consumption increased by 49.72% between 2006 and 2011. There were marked differences between drugs (13.02% donepezil; 93.18% rivastigmine; 37.79% galantamine; 70.40% memantine) and Basque provinces (16.34% in Áraba; 50.49% in Bizkaia; 57.37% in Gipuzkoa). Likewise, expenditure increased from Euros 11.5 million in 2006 to € 18.1 million in 2011. Conclusions: This study shows increased consumption of these drugs, although there are also marked differences by province which may be due to differences in prescribing habits. Spending for these drugs rose parallel to this increase in consumption; drug prices remained stable throughout the study period

Dementia drug consumption in the Basque Country between 2006 and 2011. / Consumo de medicamentos para el tratamiento de la demencia en la Comunidad Autónoma Vasca durante el periodo 2006-2011.

OBJECTIVE: We evaluated the consumption of specific medications for treating cognitive symptoms associated with AD and other types of dementia in individuals over 60 years of age between 2006 and 2011 in the Basque Country. METHODS: A retrospective descriptive study was conducted. The pharmacy division of the Basque Government Department of Health provided the prescribing data for the following drugs: donepezil, rivastigmine, galantamine, and memantine. The number of defined daily doses (DDDs) and the number of DDDs per 1000 inhabitants/day (DHD) were calculated. RESULTS: Consumption increased by 49.72% between 2006 and 2011. There were marked differences between drugs (13.02% donepezil; 93.18% rivastigmine; 37.79% galantamine; 70.40% memantine) and Basque provinces (16.34% in Áraba; 50.49% in Bizkaia; 57.37% in Gipuzkoa). Likewise, expenditure increased from €11.5 million in 2006 to € 18.1 million in 2011. CONCLUSIONS: This study shows increased consumption of these drugs, although there are also marked differences by province which may be due to differences in prescribing habits. Spending for these drugs rose parallel to this increase in consumption; drug prices remained stable throughout the study period.

Prevalencia de recesión gingival y factores asociados a la higiene bucal en estudiantes del postgrado de la Universidad Científica del Sur / Prevalence of gingival recession and the factors associated with oral hygiene in students graduate in the Cientifica del Sur University

OBJETIVO: Determinar la prevalencia de la recesión gingival y los factores asociados a la higiene bucal en estudiantes del postgrado de la UCSUR. Lima 2014.METODOLOGÍA: Se realizó un estudio observacional, descriptivo y transversal en una muestra de 77 alumnos. Los datos se obtuvieron mediante un cuestionario, se tomaron de 3 fotografías intraorales: anterior y laterales (derecha e izquierda), usando separadores y una cámara profesional Canon T3 con lente Sigma de 105 mm y ring flash; se examinaron los cepillos dentales con un uso no menor a un mes, estos fueron observados, fotografiados y clasificados.RESULTADOS: Se utilizó el modelo de análisis de regresión logística múltiple para explicar el comportamiento de la recesión gingival con respecto al género, tipo de cerdas, frecuencia de cepillado, técnica de Bass, presión excesiva, ortodoncia previa, deterioro de cerdas y edad, encontrándose valores para la edad (p=0.02) con un OR=8.292 y el deterioro de las cerdas (p=0.045) con un OR=0.150, que si aportaron significativamente al modelo. Sin embargo, el resto de variables resultaron no tener un aporte, ni ser un factor de riesgo significativo. CONCLUSIONES: La prevalencia de la recesión gingival fue elevada en los alumnos evaluados de Postgrado de la UCSUR, asimismo se encontró asociación entre recesión gingival con el grupo etario igual o mayor a 30 años, con el deterioro de cerdas, con la excesiva presión al cepillado y el tipo de pieza dentaria. (AU)

OBJECTIVE: To determine the prevalence of gingival recession and the associated factors with oral hygiene UCSUR Graduate students.METHODOLOGY: For this purpose an observational, descriptive, cross sectional study was conducted on a sample of 77 students. Data were obtained by questionnaire, took 3 buccal photographs: Anterior and lateral (right and left), using spacers and a professional camera Canon T3 with Sigma 105mm lens and ring flash; toothbrushes were examined with a use not less than one month that were observed, photographed and classified.RESULTS: The model of multiple logistic regression analysis was used to explain the behavior of gingival recession with regard to gender, type of bristle brushing frequency, Bass technique, excessive pressure, after orthodontics, deterioration of bristles and age, finding values for age (p = 0.02) with an OR = 8.292 and the deterioration of the bristles (p = 0.045) with an OR = 0.150, if significantly contribute to the model. However, the other variables were not having a contribution or be a significant risk factor.CONCLUSIONS: The prevalence of gingival recession was higher among students tested Postgraduate UCSUR, association be-tween gingival recession also met with equal or greater than 30 years, with the deterioration of bristles, with excessive brushing pressure and the type of tooth age group: most affected premolars. (AU)

Preoperative evaluation in elective surgery. INAHTA synthesis report.

OBJECTIVES: To collect and summarize information published by INAHTA agencies on the indications, habitual attitudes and practices, and economic and legal implications of preoperative evaluation in elective surgeries. METHOD: The authors appraised the information contained in six papers published between 1989 and 1999 in Sweden, France, Basque Country, the Netherlands, United Kingdom, and Catalonia. The section on indications in preoperative evaluation does not present global conclusions. The sections addressing habitual attitudes and practices among physicians and those addressing economic and legal considerations cover only the similarities among the reports and the main ideas relating to these issues. RESULTS: The conclusions found in the reports about indications in preoperative evaluation are similar or differ slightly, e.g., as regards age limits in patients for whom the tests are recommended. However, more important differences are shown in other areas, especially in reports where consensus methods were used. In some instances, the opinions, attitudes, and customary practices of professionals during the preoperative stage do not concur with the recommendations extracted from the assessment reports and the customary practice of doctors. In relation to economic considerations, a substantial quantity of resources could be liberated if the recommended general clinical practices were followed. From the point of view of civil law, the evidence-based recommendations could be considered as a kind of coded lex artis.

[Peracetic acid: alternative to the sterilization of bronchofibroscopes]. / Acido peracético: alternativa a la esterilización de broncofibroscopios.

The Steris system for cold sterilization with peracetic acid was evaluated by effecting a series of contaminations of a fiberoptic bronchoscope (FB) with specimens of Pseudomonas aeruginosa, Acinetobacter baumanii and Mycobacterium kansasi. The FB was contaminated 24 times, 8 times by each microorganism, using specimens containing more than 10(8) cfu/ml. After fixing the secretions on the FB and washing it with enzyme soap, the BF was sterilized. Specimens were taken for culturing after contamination of the FB, after washing, immediately after sterilization and 1 hour after sterilization. No microorganism growth of any of the samples was detected either immediately after sterilization or one hour later. Microbiological data confirmed contamination of the FB after aspiration and fixation of the inoculate. Chemical and biological tests with B. stearothermophilus spores as specified by the manufacturer were correct in all cases: 24 contaminations and 52 processes of prior training. The efficacy of washing with enzyme soap before sterilization stands out. In 14 of the 24 samples, culture was negative after washing and in 7 the concentration of microorganisms was less than 500 cfu/ml, which confirms the need for appropriate washing before any disinfection or sterilization process is begun. In conclusion, the Steris system based on peracetic acid is an alternative to other systems for cold sterilization or high level disinfection.

Microvascular angina in systemic hypertension: diagnosis and treatment with enalapril.

The causes of hypertensive microvascular ischemia are reviewed along with diagnostic factors. Stress/rest thallium-201 scintigraphy is shown to have a predictive value of 78% for a diagnosis of microvascular disease in hypertensive patients with exertional angina and left ventricular hypertrophy. Lack of isotope uptake at peak stress correlates well with the decrease in coronary flow reserve in ischemic segments, which is 2-3 times lower than in normal subjects. Treatment with enalapril produces regression of left ventricular hypertrophy, normalization of thallium-201 uptake, and an increase in exercise capacity in patients with microvascular angina.

Microvascular angina pectoris in hypertensive patients with left ventricular hypertrophy and diagnostic value of exercise thallium-201 scintigraphy.

In a series of 120 hypertensive patients, 60 were found to have echocardiographic left ventricular (LV) hypertrophy (Devereux's method). Of these, 18 (30%) had typical stress-induced angina and underwent coronary angiography, which showed that 11 (61%) had normal coronary arteries, and 7 (39%) (p < 0.05) had coronary stenosis of the epicardial arteries. Stress-rest thallium-201 scintigraphy (Burow's quantitative method) yielded abnormal results in 21 of the 60 patients with LV hypertrophy. Five of 30 (17%) were asymptomatic, 14 of 18 (78%) had angina, and 2 of 12 (17%) had dyspnea on exertion. In 5 normal patients used as a control group, coronary flow reserve after administration of papaverine (10 coronary arteries) was 6.25 +/- 1.4 versus 3.7 +/- 0.8 in 10 thallium-negative, asymptomatic hypertensive patients with LV hypertrophy (p < 0.001). The mean coronary flow reserve of 21 patients with abnormal thallium-201 results was 2.71 +/- 0.96 (p < 0.01 compared with the group with normal thallium-201 findings) and 2.5 +/- 0.6 in the segments with lowest uptake (p < 0.05 compared with normal segments in these same patients). Thus, stress-induced angina pectoris in hypertensive patients with LV hypertrophy was due to small-vessel disease in over half of our patients (62%).

[Two-dimensional color-Doppler in the diagnosis of left ventricle-right atrium shunts]. / Doppler bidimensional en color en el diagnóstico de los cortocircuitos ventrículo izquierdo-aurícula derecha.

Left ventricular to right atrial shunts, known as Gerbode's defects, are a kind of uncommon atrioventricular defect, the diagnostic of which had been always based on hemodynamic and angiographic findings. Although, at the present, this diagnosis can be done easily by color Doppler echocardiography, there are few references in the literature. We show 4 patients in whom the diagnosis was made by this technique, pointing out the aspects to keep in mind in order to avoid erroneous interpretations. The diagnostic criteria were: systolic turbulence and high velocity jet without pulmonary hypertension or right ventricular out flow stenosis.

[A study of arteriosclerotic disease and of ischemic cardiopathy in particular and the associated risk factors in the Autonomous Basque Community. The Euzkadi project]. / Estudio de la enfermedad arteriosclerosa y cardiopatía isquémica en particular y factores de riesgo asociados en la Comunidad Autónoma Vasca. Proyecto Euzkadi.

The aim of the Euzkadi Project was to know the prevalence rate of cardiovascular disease and the high risk factors (hypertension, hypercholesterolemia and cigarette smoking) in the Basque Country to carry out an intervention trials to reduce these factors if we have collaboration of the Public Health Service. We have studied a sample of 4,800 men, 25-64 years old, randomly selected (1,600 men in each province), the examination was done by cardiologist using the cardiovascular questionnaire by Blackburn and Rose, the cholesterol was tested in WHO Collaborating Lipid Reference Center (Prague) and the electrocardiogram was studied by Minnesota Code. The rate of Atherosclerotic disease was 69%, coronary heart disease 49% (12% angina típica, 9% angina atípica and 28% myocardial infarction), stroke 7%, and peripheral vascular disease 13%. The rate of silent myocardial infarction was 31%. The rate of hypertension was 24%, hypercholesterolemia 14% and cigarette smoking 40%.