Morphological variability and ecological characterization of the Chagas disease vector Triatoma dimidiata (Hemiptera: Reduviidae) in El Salvador.

There are 8 million people with Chagas disease worldwide and in El Salvador approximately 39% of the population is at risk of contracting the disease. One of the principal challenges in mitigating Chagas is evaluating the role of the vector ecology of triatomine species in the transmission of the Trypanosoma cruzi parasite in anthropogenically modified habitats, where new patterns of transmission frequently arise. Field studies of triatomine vector ecology in El Salvador have largely focused on describing parameters that contribute to infestation patterns, which may themselves be rooted in the morphological variability that exists in triatomine populations. The objective of this study was to evaluate the morphology of the vector species Triatoma dimidiata with respect to the characteristics of the ecological landscape the vector inhabits throughout El Salvador. We used image analyses to evaluate T. dimidiata morphological variability and then used Geographic Information Systems to intersect the morphological point-data with map layers containing different environmental characteristics. Our study found that the variation in the size, shape, and coloration of T. dimidiata varied in relation to elevation, Holdridge life zone, soil type and land use. We further characterize the local morphological adaptations of T. dimidiata with respect to the local ecological, biological, and geographical conditions in El Salvador. We suggest that future studies consider a molecular exploration of local T. dimidiata species complex in El Salvador, especially since morphological studies of triatomine species complex have found that variability correlate with the genetic variability of the population.

Calidad percibida por ostomizados en la utilización de un nuevo producto que contiene miel de manuka / Quality perceived by ostomized on the use of a new product containing manuka hone

La calidad es un concepto fundamental en el avance de todo producto sanitario. Objetivo. Evaluar el grado de calidad percibida por los usuarios en una bolsa colectora con miel de Manuka integrada en el protector cutáneo para ostomías. Metodología. Estudio descriptivo transversal comparativo realizado entre diciembre de 2017 y marzo de 2018, en distintos centros españoles. Criterios de selección: ser portador de una ostomía intestinal temporal o permanente, ≥18 años y no haber utilizado el nuevo producto. Se empleó un cuestionario autodiseñado con 16 ítems. Las variables analizadas fueron: tipo de estoma del paciente, cambio de frecuencia de bolsa, manejo del nuevo dispositivo, estado de la piel periestomal, nivel de satisfacción del usuario y necesidad del uso de accesorios complementarios. Resultados. Se incluyeron 31 pacientes. El 58% era portador de una ileostomía. El 71% consideró que la nueva bolsa era mejor o mucho mejor con un filtro más efectivo y una muy buena calidad del apósito (61,3%). Un 25,6% indicó haber reducido el número de cambios precisado. El 87,10% indicó que la bolsa era más fácil de colocar y al 64,5% le resultó más fácil despegarla con menor presencia de residuos (67,7%). Un 25,8% señaló requerir un número menor de accesorios. Conclusiones. La reducción en el número de cambios de bolsas y el mayor nivel de confort se relaciona con la rápida adherencia a la piel y la ventana de inspección. El mayor nivel de satisfacción se relaciona con la buena calidad del apósito y del filtro, la mejor adaptación a la piel y el cuidado de esta

Objective. To evaluate the level of quality perceived by users on a collection bag with Manuka honey integrated into the ostomy skin protector. Methodology. Descriptive transversal study realised between December 2017 and March 2018, in different Spanish centers. Selection criteria: To be a carrier of a temporary or permanent intestinal ostomy, ≥ 18 years old and not to have used the new product. The patients answered a self-designed questionnaire with 16 items. The variables analyzed were: Type of patient stoma, change of bag frequency, use of the new product, peristomal skin condition, level of user satisfaction and need for the use of complementary accessories. Results. 31 patients were included. 58% were carriers of an ileostomy. The 71% considered that the new bag was better or much better with a more effective filter and a very good quality of the dressing (61.3%). A 25.6% indicated that they had reduced the number of changes of the bag. The 87.10% indicated that the bag was easier to place and 64.5% said that it was easier to take off with less presence of waste (67.7%). A 25.8% pointed that the new bag required less accessories. Conclusions. The reduction in the number of bag changes and the higher level of comfort is related to the quick adherence to the skin and the inspection window. The highest level of satisfaction is related to the good quality of the dressing and the filter, the best adaptation to the skin and the care of it

Manejo de la ferroterapia para enfermería / Use of ferrotherapy for nursing

El hierro es esencial para el mantenimiento de la salud. Su disminución está asociada con una reducción en la calidad de vida y un aumento en el número de hospitalizaciones. La terapia oral es económica y cómoda, pero no siempre bien tolerada, poco efectiva en presencia de ciertas enfermedades y con una adherencia muy pobre. Las nuevas moléculas de hierro intravenoso muestran mayor eficacia y seguridad. Esto ha hecho que se conviertan en la vía de elección cuando se trata de repleciones rápidas y con altos requerimientos, así como en procesos renales o digestivos inflamatorios crónicos. El hierro a altas dosis permite reducir el número de infusiones, preservando los accesos venosos del paciente, además de reducir el coste sanitario

Iron is essential for maintaining health. Its decrease is associated with a reduction in the quality of life and an increase in the number of hospitalizations. Oral therapy is economical and convenient but not always well tolerated, ineffective in the presence of certain diseases and with a high rate of low adherence. New molecular intravenous iron preparations show greater effectiveness and safety. This has made it the route choice when it comes to rapid high demanding repletion, as well as in chronic inflammatory renal or digestive processes. High-dose iron decreases the frequency of hospital visits and preserves venous access by reducing the number of punctures, resulting in lower healthcare costs

Administración de fármacos en el adulto en el ámbito hospitalario / Drug administration in adult hospital inpatients

La seguridad del paciente es una prioridad dentro del ámbito hospitalario. Los nuevos fármacos, la complejidad de los tratamientos o su duración favorecen la aparición de eventos adversos. Las terapias intravenosas son muy frecuentes, pero su aplicación no está exenta de complicaciones debido a la manipulación de los fármacos y catéteres para hacer viable su administración. Por ello, uno de los mayores retos y responsabilidades de la enfermera es la administración de medicamentos y la prevención y detección de posibles efectos adversos, debido a la relevancia de las potenciales lesiones sobre el paciente. El presente artículo revisa los criterios y las buenas prácticas clínicas basadas en la evidencia referentes al manejo de la terapia intravenosa en lo que respecta a aspectos tan importantes como las diferentes formas de administración de medicamentos, las compatibilidades e interacciones farmacológicas y las complicaciones más frecuentes que se pueden presentar

Maintaining patients' safety is a priority within the hospital setting. The appearance of adverse events is encouraged by the use of new drugs, the complexity of treatments and their duration. Intravenous therapies are very frequent; however, their delivery is not exempt from complications, due to the handling techniques necessary for the administration of drugs and catheters. Therefore, one of nursing's major challenges and responsibilities is medication management, together with the prevention and detection of possible adverse effects, due to the relevance that these may have on patients' potential injuries. The present article offers a review on the criteria and evidence-based best clinical practice for intravenous therapy management, regarding important aspects such as: the different ways of drug administration, compatibilities and pharmacological interactions, along with the most common complications that may occur

Complicaciones asociadas al catéter venoso central en pacientes hematológicos / Complications associated to central venous catheters in hematology patients

OBJETIVO: Conocer la incidencia de complicaciones asociadas a los catéteres venosos centrales (tunelizados, reservorios y PICC), en pacientes con patología oncohematológica, ingresados en Unidades de Hematología o Trasplantes de Progenitores Hematopoyéticos, en dos hospitales terciarios. METODOLOGÍA: Se desarrolló un estudio descriptivo transversal donde se recogieron datos sociodemográficos, clínicos, complicaciones y seguimiento del protocolo de cuidados. A cada catéter se le asignó un número de identificación correlativo. Se recogió información de 366 catéteres: 185 en el Hospital Universitario Ramón y Cajal (HURYC): 80 tunelizados, 40 reservorios y 65 PICC; 181 en el Hospital Universitario Gregorio Marañón (HUGM): 101 tunelizados y 80 reservorios. RESULTADOS: Las principales complicaciones en los tunelizados fueron las infecciones (13,7% en el HURYC vs.6,8% en el HUGM; p < 0,001) y las oclusiones (al menos una vez 3,8% vs.21,8%). En los reservorios se confirmaron un 5% de infecciones en el HURYC frente a 1,2% en el HUGM; se ocluyeron al menos una vez un 10% en el HUGM. No se detectaron otras complicaciones significativas. Respecto a los PICC solo se recogió información en el HURYC, donde las complicaciones fueron: flebitis 10,8%; trombosis 7,7%; infección o sospecha 4,6%; oclusión al menos una vez 7,7%. CONCLUSIONES: La diferencia entre hospitales respecto a la infección y oclusión, puede asociarse a las distintas pautas de cuidados. Destaca la alta incidencia de flebitis y trombosis en PICC

OBJECTIVE: To discover the incidence of central venous catheters (tunnelled, subcutaneous and PICC) in patients with onco-hematological conditions, hospitalized in the Hematology or Transplantations of Hematopoietic Stem Cells Units, in two tertiary care hospitals. METHODOLOGY: A cross-sectional, descriptive study form was developed in order to gather sociodemographic, clinical data as well as complications and follow-up of the care protocol. Each catheter was assigned a correlative identification number. Information was collected on 366 catheters: 185 in the University Hospital Ramón y Cajal (HURYC), 80 tunnelled, 40 subcutaneous venous access and 65 PICC, and 181 in the University Hospital Gregorio Marañón (HUGM), 101 tunnelled and 80 subcutaneous venous access. Findings: Major complications in the tunnellized were infections (13.7% in HURYC vs.6.8% in HUGM - p < 0 .001) and occlusions (at least once in 3.8% vs.21.8%). In subcutaneous venous access, infections were confirmed in 5% in HURYC vs.1.2% in HUGM. There were occlusions at least once in 10% in HUGM and no other significant complications were detected. Regarding PICC, information was only collected in HURYC, where complications were phlebitis 10.8%, thrombosis 7.7%, confirmed or suspected infection 4.6%, occlusion at least once 7.7%. CONCLUSIONS: Differences between hospitals with regard to major complications, infection and occlusion may be related to different care protocol. We need to stress the high incidence of phlebitis and thrombosis in PICC catheters, compared with data of lower incidence of other papers

[Complications associated to central venous catheters in hematology patients]. / Complicaciones asociadas al catéter venoso central en pacientes hematológicos.

OBJECTIVE: To discover the incidence of central venous catheters (tunnelled, subcutaneous and PICC) in patients with onco-hematological conditions, hospitalized in the Hematology or Transplantations of Hematopoietic Stem Cells Units, in two tertiary care hospitals. METHODOLOGY: A cross-sectional, descriptive study form was developed in order to gather sociodemographic, clinical data as well as complications and follow-up of the care protocol. Each catheter was assigned a correlative identification number. Information was collected on 366 catheters: 185 in the University Hospital Ramón y Cajal (HURYC), 80 tunnelled, 40 subcutaneous venous access and 65 PICC, and 181 in the University Hospital Gregorio Marañón (HUGM), 101 tunnelled and 80 subcutaneous venous access. FINDINGS: Major complications in the tunnellized were infections (13.7% in HURYC vs. 6.8% in HUGM - p<0.001) and occlusions (at least once in 3.8% vs. 21.8%). In subcutaneous venous access, infections were confirmed in 5% in HURYC vs. 1.2% in HUGM. There were occlusions at least once in 10% in HUGM and no other significant complications were detected. Regarding PICC, information was only collected in HURYC, where complications were phlebitis 10.8%, thrombosis 7.7%, confirmed or suspected infection 4.6%, occlusion at least once 7.7%. CONCLUSIONS: Differences between hospitals with regard to major complications, infection and occlusion may be related to different care protocol. We need to stress the high incidence of phlebitis and thrombosis in PICC catheters, compared with data of lower incidence of other papers.