Síndrome de oftalmoplejía dolorosa, más allá del síndrome de Tolosa Hunt. Una serie de casos / Painful ophthalmoplegia syndrome, beyond Tolosa-Hunt syndrome. A case series

El síndrome de oftalmoplejía dolorosa se caracteriza por la presencia de dolor periorbital o pericraneal, que se acompaña de parálisis de los nervios oculomotores. El diagnóstico diferencial es amplio y requiere un estudio riguroso. Se describen 3casos clínicos de pacientes con síndrome de oftalmoplejía dolorosa en los que se requirieron múltiples estudios de extensión para obtener un diagnóstico etiológico. El síndrome de oftalmoplejía dolorosa es un trastorno complejo que tiene múltiples causas, entre las que se incluyen infecciones, procesos inflamatorios y tumorales. Debe considerarse la biopsia en aquellos pacientes en los que los estudios no invasivos no son conclusivos (AU)

Painful ophthalmoplejía syndrome is characterised by the presence of peri-orbital or peri-cranial pain that is accompanied by paralysis of the oculomotor nerves. The differential diagnosis is broad, and requires a rigorous study. Three clinical cases of patients with painful ophthalmoplejía syndrome are described, in which multiple extension studies were required to obtain an aetiological diagnosis. Painful ophthalmoplejía syndrome is a complex disorder that has multiple causes, including infections, inflammatory, and tumour processes. Biopsy should be considered in those cases in which non-invasive studies are inconclusive (AU)

Painful ophthalmoplegia syndrome, beyond Tolosa-Hunt syndrome. A case series.

Painful ophthalmoplegia syndrome is characterised by the presence of peri-orbital or peri-cranial pain that is accompanied by paralysis of the oculomotor nerves. The differential diagnosis is broad, and requires a rigorous study. Three clinical cases of patients with painful ophthalmoplegia syndrome are described, in which multiple extension studies were required to obtain an aetiological diagnosis. Painful ophthalmoplegia syndrome is a complex disorder that has multiple causes, including infections, inflammatory, and tumour processes. Biopsy should be considered in those cases in which non-invasive studies are inconclusive.

Painful ophthalmoplegia syndrome, beyond Tolosa-Hunt syndrome. A case series. / Síndrome de oftalmoplejía dolorosa, más allá del síndrome de Tolosa Hunt. Una serie de casos.

Painful ophthalmoplejía syndrome is characterised by the presence of peri-orbital or peri-cranial pain that is accompanied by paralysis of the oculomotor nerves. The differential diagnosis is broad, and requires a rigorous study. Three clinical cases of patients with painful ophthalmoplejía syndrome are described, in which multiple extension studies were required to obtain an aetiological diagnosis. Painful ophthalmoplejía syndrome is a complex disorder that has multiple causes, including infections, inflammatory, and tumour processes. Biopsy should be considered in those cases in which non-invasive studies are inconclusive.

Factores a considerar en el análisis de la prescripción de antibióticos en pediatría / Antibiotic use in the pediatric population: factors to consider

El objetivo del estudio fue analizar la utilización de antiinfecciosos (excluyendo antivirales y antimicóticos) en las siete áreas de salud de laComunidad Autónoma de Canarias (CCAA), durante el quinquenio 2001-2005, a partir de los datos de facturación de recetas obtenidos delos programas DIGITALIS y pharmaCANARIAS del Servicio Canario de la Salud. Para ello utilizamos el concepto de dosis diaria definida (DDD)como unidad técnica de medida y el de dosis diaria definida/1000 habitantes/día (DHD) como indicador comparativo, de acuerdo con lo recomendadopor la OMS y siguiendo la clasificación ATC. Se trata de un estudio observacional retrospectivo sobre el total de prescripcionesrealizadas por médicos cuyas claves Cias los identifican como pediatras tanto hospitalarios como extrahospitalarios. Los datos demográficosse obtuvieron de las Tarjetas Sanitaria Individuales (TSI) según los cupos asignados a los pediatras de atención primaria de las diferentes áreasde salud de la CCAA. El total de prescripciones en número de envases fue: 277.332 en 2001, 243.702 en 2002, 268.072 en 2003, 210.879en 2004 y 207.347 en 2005. Las especialidades analizadas fueron las de los subgrupos terapéuticos J01 antibióticos sistémicos. También seconsideró la modificación de la clasificación ATC en relación con las fluoroquinolonas. Durante el periodo de estudio, el consumo total de antibióticosen pediatría fue de 1.207.726 envases (646.139 en la provincia de Tenerife y 561.587 en la provincia de Las Palmas), y el importecon cargo al Servicio Canario de la Salud fue de 6.119.679,01 ; en Tenerife y 4.808.654,12 ; en Las Palmas. La acumulación anual de lasDHD varió entre 103,044 en 2001 y 68,168 en 2005, siendo este año el de menor consumo de antibióticos. Se determinó el coste absolutode los cinco años de estudio de todos los principios activos, por provincia y subgrupos terapéuticos de antimicrobianos...(AU)

The aim of this retrospective study was to analyze the use of antibiotics in pediatrics in the Canary Islands during the period 2001-2005. Weused the defined daily dose (DDD) as a technical unit of measurement as well as the DDD/1000 habitants/day (DHD), following the ATC classificationsystem. The demographic data were obtained from individual patient health cards assigned to the primary care pediatricians. Duringthe period 2001-2005, the total number of prescriptions for antibióticos in pediatrics was 1,207,726 at a cost of 6,119,679 Euros to theCanarian Health Service in Tenerife and 4,808,654 Euros in Las Palmas. The annual number of DHD in the Canary Islands decreased from103,044 in 2001 to 68,168 in 2005. The cost for 1000 inhabitants/day (CHD) was 27,686 Euros and 19,183 Euros in Tenerife and Las Palmas,respectively. In analyzing the therapeutic classes of antibiotics, we found that the consumption of broad-spectrum penicillins (amoxicillin) inTenerife decreased, while in Las Palmas it remained stable. There was also a significant decrease in the use of tetracyclines in both provinces.The DHD of beta-lactamase inhibitors was more significantly reduced in Tenerife than in LPA. The consumption of cephalosporins, mainly cefixime,was high in Tenerife, while in Las Palmas the second-generation cephalosporins (cefuroxime and cefaclor) were widely consumed. Theuse of macrolide antibiotics gradually decreased. Interestingly, there were 7,939 prescriptions for fluoroquinolones (mainly ciprofloxacin) inTenerife and 4,846 in Las Palmas (mainly norfloxacin and ciprofloxacin). There were differences in the prescribing practices between Tenerifeand Gran Canaria that don't coincide with changes in the microbiological spectrum. Prescribing practices in Las Palmas are based on scientificdata, probably because of the continuing education courses on antibiotherapy that began in 2003(AU)

Máxima evidencia y de mejor calidad en mataanálisis de Bifosfonatos para el tratamiento de la osteoporosis en mujeres posmenopáusicas / Maximum evidence and better quality in meta-analysis of Bisphosphonates for treatment of osteoporosis in postmenopausal women

Introducción. Se han realizado numerosos metaanálisis de bifosfonatos para el tratamiento de la osteoporosis, pero no se ha realizado una revisión sistemática de todos ellos. Objetivo. Recoger y analizar los metaanálisis publicados con el objeto de conocer cuántos hay, con qué bifosfonatos, su calidad metodológica y conclusiones. Metodología. Se realizaron búsquedas en MEDLINE, EMBASE y Cochrane para los últimos 10 años restringiéndose por idioma. Se incluyeron 13 estudios de metaanálisis en los que se evaluaba la eficacia en la reducción de fractura vertebral (FV), no vertebral (FNV) o de cadera en alendronato y risedronato y FV y FNV para etidronato. Se obtuvo un metaanálisis de bifosfonatos combinados. Se evaluaron los datos resumidos de cada estudio y su calidad metodológica. Resultados. Risedronato y alendronato han demostrado ser eficaces en la reducción de FV y FNV. Ninguno ha demostrado superioridad de eficacia, sólo un metaanálisis de alendronato obtuvo dicho resultado, pero utilizando datos no adecuados. En la reducción de fracturas de cadera los metaanálisis muestran a ambos eficaces, aunque risedronato es el único bifosfonato que lo ha demostrado a través de un ensayo clínico diseñado para ello. Conclusiones. Existe un no despreciable número de metaanálisis de bifosfonatos de calidad metodológica aceptable. Aunque no todos se han realizado con máxima calidad, usando datos individuales de pacientes, la mayor parte de ellos son metodológicamente correctos habiéndose obtenido resultados similares entre ellos, siempre que se han realizado análisis por intención de tratar y se han incluido todos los estudios relevantes

Introduction. Many meta-analyses of bisphosphonates for the treatment of osteoporosis have been made. However. no systematic review of them has been performed. Objective. Collect and analyze the meta-analyses published in order to know how many there are, with what bisphosphonates, their methodological quality and conclusions. Methodology. Searches were made in MEDLINE, EMBASE and Cochrane for the last 10 years, restricting them by language. Thirteen meta-analysis studies were included, in which efficacy in the reduction of vertebral fracture (VF), non-vertebral fracture (NVF) or hip fracture for alendronate and risedronate and VF and NVF for etidronate was evaluated. A meta-analysis of combined bisphosphonates was obtained. The data summarized from each study and their methodological quality were evaluated. Results. Risedronate and alendronate have been demonstrated to be effective in the reduction of VF and NVF. None have demonstrated superiority of efficacy and only one meta-analysis of alendronate obtained these results, but using inadequate data. In the reduction of hip fractures, the meta-analyses showed that both were effective, although risedronate is the only bisphosphonate that has demonstrated this through a clinical trial design for such purpose. Conclusions. There is an important number of meta-analyses for bisphosphonates with acceptable methodological quality. Although not all of them have been conducted with a maximum quality, using individual data patients, most of them are methodologically correct. They have obtained similar results among them as long as intention to treat analysis had been conducted and all the relevant studies have been included

[Antibiotic use in the pediatric population: factors to consider]. / Factores a considerar en el análisis de la prescripción de antibióticos en pediatría.

The aim of this retrospective study was to analyze the use of antibiotics in pediatrics in the Canary Islands during the period 2001-2005. We used the defined daily dose (DDD) as a technical unit of measurement as well as the DDD/1000 habitants/day (DHD), following the ATC classification system. The demographic data were obtained from individual patient health cards assigned to the primary care pediatricians. During the period 2001-2005, the total number of prescriptions for antibiotics in pediatrics was 1,207,726 at a cost of 6,119,679 Euros to the Canarian Health Service in Tenerife and 4,808,654 Euros in Las Palmas. The annual number of DHD in the Canary Islands decreased from 103,044 in 2001 to 68,168 in 2005. The cost for 1000 inhabitants/day (CHD) was 27,686 Euros and 19,183 Euros in Tenerife and Las Palmas, respectively. In analyzing the therapeutic classes of antibiotics, we found that the consumption of broad-spectrum penicillins (amoxicillin) in Tenerife decreased, while in Las Palmas it remained stable. There was also a significant decrease in the use of tetracyclines in both provinces. The DHD of beta-lactamase inhibitors was more significantly reduced in Tenerife than in LPA. The consumption of cephalosporins, mainly cefixime, was high in Tenerife, while in Las Palmas the second-generation cephalosporins (cefuroxime and cefaclor) were widely consumed. The use of macrolide antibiotics gradually decreased. Interestingly, there were 7,939 prescriptions for fluoroquinolones (mainly ciprofloxacin) in Tenerife and 4,846 in Las Palmas (mainly norfloxacin and ciprofloxacin). There were differences in the prescribing practices between Tenerife and Gran Canaria that don't coincide with changes in the microbiological spectrum. Prescribing practices in Las Palmas are based on scientific data, probably because of the continuing education courses on antibiotherapy that began in 2003.

Liquid chromatography-electrospray ionisation mass spectrometry for the determination of nine selected benzodiazepines in human plasma and oral fluid.

A new simple and rapid liquid chromatographic-mass spectrometric technique was designed for the determination of nine benzodiazepines in plasma and oral fluid. Benzodiazepines were extracted from alkalinised spiked and clinical plasma and oral fluid samples using a single step, liquid-liquid extraction procedure with diethyl ether. The chromatographic separation was performed with a Xterra RP18, 5 microm (150 x 2.1 mm i.d.) reversed-phase column using deuterated analogues of the analytes as internal standard. The recovery ranged from 70.3 to 86.9% for plasma and 63.9 to 77.2% for oral fluid. The limits of detection ranged from 0.5 to 1 ng/ml in plasma and 0.1 to 0.2 ng/ml for oral fluid. The method was validated for all the compounds, including linearity and the main precision parameters. The procedure, showed to be sensitive and specific, was applied to real plasma and oral fluid samples. The method is especially useful to analyse saliva samples from drivers undergoing roadside drug controls.

Sumisión química: Antecedente, situación actual, y perspectivas. Protocolos de actuación para estudios multicéntricos / No disponible

No disponible

Neumonía varicelosa con nódulos pulmonares múltiples / Varicellar pneumonia with multiple lung nodules

No disponible