Psicofármacos y gasto en la prisión de Madrid III (Valdemoro) / Psychoactive drugs and costs in the Madrid III (Valdemoro) prison

El gasto farmacéutico en el medio penitenciario está aumentando exponencialmente y la partida en psicofármacos contribuye especial-mente a este incremento. Con bastante frecuencia estos tratamientos se prescriben buscando utilidades terapéuticas en relación con trastornos de personalidad, dependencias y conductas disfuncionales, que no figuran entre las indicaciones autorizadas (uso compasivo). El presente estudio ha permitido una descripción pormenorizada del uso de psicofármacos en el Centro Penitenciario Madrid III, uno de los centros con menor gasto farmacéutico de la comunidad autónoma. Durante 2 semanas se registraron todas las prescripciones de psicofármacos junto con diversos parámetros que pudiesen resultar condicionantes. Un 20,5% de la población recibía algún psicofármaco; el 76% de los pacientes con tratamiento recibía 1 o 2 medicamentos, un 65% tenía prescritos ansiolíticos, un 38%, antidepresivos, y un 27%, antipsicóticos. El consumo total de psicofármacos ascendió a 9.840 dosis diarias de mantenimiento, un 46% de las cuales correspondía a ansiolíticos, un 17% a antidepresivos y un 14% a antipsicóticos. En 2 semanas, el gasto total sumó 5.379 ¿ y la solicitud y selección de ofertas por la farmacéutica supusieron hasta 611 ¿ de ahorro. Los antipsicóticos acumularon un 72% del gasto (3.857 ¿) y, en general, los nuevos psicofármacos, con un 66% de las prescripciones, supusieron un 98% del coste total. Los resultados del estudio apuntan al médico prescriptor como agente primordial, por encima incluso de variables epidemiológicas de los internos (..) (AU)

Abstract: Annual pharmaceutical expenditures in prisons increases dramatically and the rising costs of psychoactive drugs have especially contributed to this. These drugs are often prescribed in order to find therapeutic uses in the field of personality disorders, addictions, and dysfunctional behaviours that are not included in the authorized indications (compassionate use). This study has enabled a detailed description of the use of psychoactive drugs at the Madrid III prison, a centre with one of the lowest levels of pharmaceutical expenditure in this autonomous community. During a two-week period, all prescriptions of psychoactive drugs were collected and registered along with data of several possible conditioning factors. 20.5% of the population was receiving some kind of psychoactive drug; 76% of those inmates undergoing treatment were receiving one or two substances; 65% were taking anxiolytics, 38% antidepressants and 27% antipsychotics. The total amount of psychoactive drugs consumed was 9,840 defined daily doses, 46% of which were anxiolytics, 17% antidepressants and14% antipsychotics. The total cost of the fortnight’s treatment was euros 5,379 with a saving of € 611 due to requesting and selecting offers carried out by the pharmacist. 72% of the costs were spent on antipsychotics and the newer psychoactive drugs, representing 66% of the prescriptions, accounted for 98% of expenditure. The prescriber was one of the key influential factors over the amount, type and cost of the treatments. There are signs that compassionate use of current antipsychotics and antiepileptics, and newer antidepressants are a main cause of the dramatic increase in the costs, with cost-efficiency not always clearly demonstrated. These results are not an isolated fact restricted only to prisons, as demonstrated by consumption data published by the National Health System in the same year(AU)

[Psychoactive drugs and costs in the Madrid III (Valdemoro) prison]. / Psicofármacos y gasto en la prisión de Madrid III (Valdemoro).

Annual pharmaceutical expenditures in prisons increases dramatically and the rising costs of psychoactive drugs have especially contributed to this. These drugs are often prescribed in order to find therapeutic uses in the field of personality disorders, addictions, and dysfunctional behaviours that are not included in the authorized indications (compassionate use). This study has enabled a detailed description of the use of psychoactive drugs at the Madrid III prison, a centre with one of the lowest levels of pharmaceutical expenditure in this autonomous community. During a two-week period, all prescriptions of psychoactive drugs were collected and registered along with data of several possible conditioning factors. 20.5% of the population was receiving some kind of psychoactive drug; 76% of those inmates undergoing treatment were receiving one or two substances; 65% were taking anxiolytics, 38% antidepressants and 27% antipsychotics. The total amount of psychoactive drugs consumed was 9,840 defined daily doses, 46% of which were anxiolytics, 17% antidepressants and 14% antipsychotics. The total cost of the fortnight's treatment was euros 5,379 with a saving of euro 611 due to requesting and selecting offers carried out by the pharmacist. 72% of the costs were spent on anti-psychotics and the newer psychoactive drugs, representing 66% of the prescriptions, accounted for 98% of expenditure. The prescriber was one of the key influential factors over the amount, type and cost of the treatments. There are signs that compassionate use of current antipsychotics and antiepileptics, and newer antidepressants are a main cause of the dramatic increase in the costs, with cost-efficiency not always clearly demonstrated. These results are not an isolated fact restricted only to prisons, as demonstrated by consumption data published by the National Health System in the same year.

[The use of psychotropic drugs in prison (CP Madrid III)]. / Uso de Psicofármacos en prisión (CP Madrid III).

The use of psychotropic drugs in primary care has exponentially increased and prisons are no exception. These drugs are often prescribed in order to find therapeutic uses in the fields of personality disorders, addictions, and dysfunctional behaviours that have not been accepted as indications (compassive use). This study enabled us to make a detailed description of the use of psychiatric drugs at the Madrid III prison, a centre with one of the lowest levels of pharmaceutical expenditure in the region. For a two-week period, all prescriptions of psychotropic drugs were collected and registered along with data of several possible conditioning factors. 20.5% of the population was receiving some kind of psychiatric drug; 76% of those inmates undergoing treatment were receiving one or two psychotropic drugs; 65% were taking sedatives, 38% antidepressants and 27% antipsychotic medication. The total amount of psychotropics consumed was 9,840 DDDs, 46% of which were sedatives, 17% of those being antidepressants and the other 14% antipsychotics. The total cost of the fortnight's treatment was 5,379 euros, 72% of which was spent on antipsychotic medication. There are signs that compassive use of the latest generation of antipsychotics and antiepileptics, and the newer antidepressants are a main cause of the dramatic increase in cost, and cost efficiency has not always been clearly demonstrated. One of the key influencing factors on amount, type and cost of treatment was the prescriptor. An unexpected result was that of finding no relationship between age, nationality, grade or other individual variables and prescription of different kind of medication, with the exception of benzodiazepines.

Uso de Psicofármacos en prisión (CP Madrid III) / Theuse of psychotropic drugs in prison ()CP Madrid III)

El uso de psicofármacos en el entorno de atención primaria está aumentando exponencialmente y el medio penitenciario no constituye una excepción a esta tendencia. Con alguna frecuencia estos tratamientos se prescriben buscando utilidades terapéuticas en relación con trastornos de personalidad, dependencias y conductas disfuncionales que no han sido aceptadas como indicaciones (uso compasivo). El presente estudio ha permitido una descripción pormenorizada del uso de psicofármacos en el Centro Penitenciario (CP) Madrid III, uno de los centros con menor gasto farmacéutico de la Comunidad Autónoma. Durante dos semanas se registraron todas las prescripciones de psicofármacos junto con diversos parámetros que pudiesen resultar condicionantes. Un 23,46% de la población recibía algún tipo de psicofármaco; el 76% de los internos a tratamiento recibía uno o dos psicofármacos, un 65% tenía prescritos ansiolíticos, un 38% antidepresivos y un 27% antipsicóticos. El consumo total de psicofármacos ascendió a 9.840 Dosis Diarias de Mantenimiento, un 46% de las cuales correspondían con ansiolíticos, un 17% con antidepresivos y un 14% con antipsicóticos. En dos semanas, el gasto total sumó 5.379 euros y los antipsicóticos acumularon un 72% del coste (3.857 euros). Hay indicios de que el uso compasivo de nuevos antipsicóticos y antiepilépticos supone un porcentaje sustancial del incremento del gasto con dudosa utilidad. Los resultados del estudio apuntan al médico prescriptor como agente primordial en relación con qué, cuánto y con qué coste se prescribe. Al contrario de lo que cabía esperar, no se encontró asociación entre variables como la edad, nacionalidad, grado o tipo de condena de los internos y la prescripción de los distintos subgrupos de psicofármacos con la excepción de las benzodiacepinas

The use of psychotropic drugs in primary care has exponentially increased and prisons are no exception. These drugs are often prescribed in order to find therapeutic uses in the fields of personality disorders, addictions, and dysfunctional behaviours that have not been accepted as indications (compassive use). This study enabled us to make a detailed description of the use of psychiatric drugs at the Madrid III prison, a centre with one of the lowest levels of pharmaceutical expenditure in the region. For a two-week period, all prescriptions of psychotropic drugs were collected and registered along with data of several possible conditioning factors. 20.5% of the population was receiving some kind of psychiatric drug; 76% of those inmates undergoing treatment were receiving one or two psychotropic drugs; 65% were taking sedatives, 38% antidepressants and 27% antipsychotic medication. The total amount of psychotropics consumed was 9,840 DDDs, 46% of which were sedatives, 17% of those being antidepressants and the other 14% antipsychotics. The total cost of the fortnight’s treatment was 5,379 euros, 72% of which was spent on antipsychotic medication. There are signs that compassive use of the latest generation of antipsychotics and antiepileptics, and the newer antidepressants are a main cause of the dramatic increase in cost, and cost efficiency has not always been clearly demonstrated. One of the key influencing factors on amount, type and cost of treatment was the prescriptor. An unexpected result was that of finding no relationship between age, nationality, grade or other individual variables and prescription of different kind of medication, with the exception of benzodiazepines

Mpg1, a fission yeast protein required for proper septum structure, is involved in cell cycle progression through cell-size checkpoint.

Using a yeast two-hybrid screen we isolated a gene from Schizosaccharomyces pombe which corresponds to the previously uncharacterized ORF SPCC1906.01. We have designated this gene as mpg1, based on the putative function of its product as a mannose-1-phosphatase guanyltransferase. Mpg1 shows strong similarity to other GDP-mannose-1-phosphate guanyltransferases involved in the maintenance of cell wall integrity and/or glycosylation. This homology, together with the protein's localization pattern demonstrated in this work, strongly suggests that Mpg1 is involved in cell wall and septum synthesis. Moreover, cells lacking Mpg1 present a defect in glycosylation, are more sensitive to Lyticase, and show an aberrant septum structure from the start of its deposition, indicating that the Mpg1 function is necessary for the correct assembly of the septum. Interestingly, lack of Mpg1 clearly affects cell cycle progression: mpg1 null mutants arrest as septated and bi-nucleated 4C cells, without an actomyosin ring. Wee1 is required for the G2/M arrest induced in the absence of Mpg1, since the blockade is circumvented when Wee1 is inactivated. Wee1 is part of a cell-size checkpoint that prevents entry into mitosis before cells reach a critical size. The results presented in this work demonstrate that the G2/M arrest induced in the absence of Mpg1 is mediated by this cell size checkpoint, since oversized mutant cells enter mitosis. The mpg1 loss-of-function mutant, therefore, provides a good model in which to study how cells coordinate cell growth and cell division.

[Synovial chondromatosis: review of 25 monoarticular cases]. / Condromatosis sinovial: revisión de 25 casos monoarticulares.

We report 25 patients (20 female) aged 34 to 74 years old, with monoarticular synovial chondromatosis. Affected joints were the knee in 25 cases, the ankle in one case and the elbow in one case. Chronic articular pain was the main symptom, followed by swelling, limitation in motion range, free palpable bodies and symptomatic popliteal cysts. X ray examination showed free calcified osteochondroid bodies in 48% of patients and secondary osteoarthritis in 36%. Bone scintiscan showed an increased focal uptake. All pathological samples had chondroid or osteochondroid nodules; 64% had small blood vessels, thickened with concentric collagen laminae and 20% had isolated chondrocytes. Malignant degeneration was not observed. Surgical or artroscopic synovectomy was the procedure of choice in 20 knees. In the affected elbow and ankle, extraction of free bodies was the sole procedure. No recurrences were observed. It is concluded that synovial chondromatosis must be considered in the differential diagnosis of chronic articular pain and monoarthritis.

[Radiation synovectomy with yttrium 90 and rhenium 186 in rheumatoid arthritis, long term follow-up and effects on synovial membrane]. / Sinovectomía radioactiva con yttrium 90 y rhenium 186, en artritis reumatoidea, seguimiento a largo plazo y efecto en la membrana sinovial.

Despite the progress in the treatment of rheumatoid arthritis (RA), many patients continue to suffer from persistent and painful synovitis. We assessed the clinical results of 64 intraarticular injections of Yttrium 90 in the knee and 56 injections of Rhenium 186 in the wrist in 71 patients with RA, older than 40 years, without relief of synovitis after six months of systemic or local treatment and with a radiological stage I or II of their joints. We obtained good results in 75% of knees and 100 of wrists during a follow up period of 8 to 60 months. A repeated histological examination of the synovial membrane of 14 joints in which good results were obtained disclosed a reduction in inflammation and transitory synovial cell hyperplasia that ended in a dense fibrosis. It is concluded that radiation synovectomy continues to be an effective therapy for selected patients with RA and synovitis. The observed histopathological changes may aid the interpretation of magnetic resonance imaging of the treated joints.

[Diagnostic evaluation of cervix uteri infections associated with infection caused by human papilloma virus]. / Evaluación diagnóstica de infecciones de cuello uterino asociadas a infección por virus papiloma humano.

The objective of this study, is to demonstrate the presence of human virus papilloma proteins (HPV) in cervix biopsies, diagnosed histologically as virus infected. In 52.9% of the cases (20 biopsies) the relation between HPV and histological study was found.

Meningitis purulenta / Purulent meningitis in infants and children

Se estudian las características clínicas y de laboratorio de 190 pacientes egresados con diagnóstico de meningitis bacteriana: 57 eran menores de 1 año de edad; 126 tenían entre 12 y 23 meses, 18,9% de 2 a 5 años y 16,8% eran mayores de 5 años y del total 73,1% eran eutróficos. En primavera, otoño e invierno se concentró el mayor número de casos. Los principales síntomas y signos al ingreso fueron fiebre, síndrome meníngeo y vómitos. La cefalea fue frecuente en niños mayores; 33,1% de los enfermos recibió tratamiento antibiótico antes de la hospitalización; 45,2% de los casos ingresó luego de 4 o mas días de evolución de la enfermedad. La positividad de cultivos del LCR fue de 57,8%; los agentes mas frecuentemente aislados son N. Meningitidis, St. Pneumoniae y Haemophillus Influenzae. La mortalidad global promedio fue de 8,42% y se relacionó con la edad y el agente etiológico. Al momento del alta se pesquisó 22,4% de secuelas

Hipotiroidismo congénito atireótico: diagnóstico tardío / Congenital athyreotic hypothyroidism: late diagnosis

Se estudiaron 16 hipotiroidismos atireóticos controlados en el hospital Exequiel González Cortés en los últimos 10 años. Se pudo establecer que en el período de recién nacido se presentaron los siguientes síntomas y signos: llanto ronco 68,75% constipación 62,50%, hipoactividad 56,25% y dificultad para alimentarse e ictericia prolongada 50% de los casos. Lo anterior permitiría un programa de rastreo dirigido a recién nacidos con estos síntomas o signos mejorando la eficiencia del procedimiento y bajando su costo. Efectivamente al igual que en otros países la derivación de estos pacientes a centros especializados es tardía, debido a una valoración inadecuada de síntomas y signos que sin ser específicos, se presentan en la evolución de esta enfermedad siendo los principales encontrados por nosotros: talla baja valorado sólo en 25% de los casos, macroglosia en el 42%, hipactividad en el 40%, piel seca y fascie tosca en el 22% y hernia umbilical persistente no fue valorado en el diagnóstico de hipotiroidismo a pesar de estar presente en 9 casos