Prevalencia de consumo de benzodiacepinas en un grupo de población militar / Prevalence of consumption of benzodiacepines in a group of military population

Antecedentes: Las benzodiacepinas constituyen un grupo de fármacos depresores del Sistema Nervioso Central, usados como ansiolíticos, hipnóticos, relajantes musculares y anticonvulsivantes. El consumo con alcohol o asociación con otras sustancias puede provocar interacciones toxicológicas importantes. Al igual que el consumo prolongado puede provocar alteraciones y generar de-pendencia y tolerancia a estas. Objetivo: Determinar la prevalencia del consumo de Benzodiacepinas y sus análogos en una muestra de población militar atendida en el Laboratorio de la Armada en San Fernando, durante los años 2013, 2014 y 2015. Material y métodos: Se realizó un estudio descriptivo transversal retrospectivo donde se investiga consumo de Benzodiacepinas entre el personal militar atendido en Laboratorio, durante los años 2013, 2014 y 2015. Las variables recogidas fueron el sexo y las benzodiacepinas o análogos consumidos siete días antes de acudir al Laboratorio. Para la identificación de las sustancias se utilizó un listado según la clasificación ATC (Anatomical Therapeutic Chemical Classification System) de la Organización Mundial de la Salud (OMS). Resultados: En 2013, habían utilizado una benzodiacepina o análogo 138 personas (en siete habían consumido dos tipos de benzo-diacepinas). En 2014 se observaron 130 (seis habían consumido dos tipos) y en 2015 se observó 169 (de los cuales trece consignaban dos y en una persona tres tipos benzodiacepinas). En 2013 la prevalencia total fue de 1,8%, siendo las mujeres un 3,4% y hombres un 1,6%. En 2014 la prevalencia total fue 1,9%, siendo las mujeres un 5,2% y los hombres 1,5%. En 2015 la prevalencia total fue de 2,4%, siendo las mujeres un 5,9% y los hombres 2,1%. Las benzodiacepinas más consumidas en 2013 se correspondían con Diazepam (39%),Tetrazepam (17%) y Alprazolam (16%). En 2014 fueron Diazepam (44%), Alprazolam (25%) y Bromazepam (9%). En 2015 fueron Diazepam (44%), Alprazolam (22%) y Bromazepam (13%). Conclusiones: Al igual que en las encuestas nacionales el consumo es superior en mujeres que en hombres. Se observa un aumento progresivo del consumo en ambos grupos a lo largo de los años analizados aunque la prevalencia en nuestro estudio fue menor (AU)

Backgound: Benzodiazepines constitute a depressant drugs group of Central Nervous System, used as anxiolytics, hypnotics, muscle relaxants and anticonvulsants. Consuming alcohol or associating them with other substances can cause significant toxicological interactions. As a prolonged use can cause disturbances and lead into dependence and tolerance to these. Objective: To determine benzodiazepines prevalence and its analogs in a sample of population served in the Navy Laboratory in San Fernando during the years 2013, 2014 and 2015. Material and methods: A descriptive transversal retrospective study. It was made, and was completed with the personal attended during the years 2013-2015. The variables were sex and Benzodiazepines or analogues consumed seven days before. We have used for the identification of substances listed at the ATC (Anatomical Therapeutic Chemical Classification System) classification of WHO. Results: In 2013, 138 had used benzodiazepines or analogue (In seven had consumed two benzodiazepines). In 2014 they had used benzodiazepines 130 (six had consumed two) and 2015 was observed in 169 (of which 13 had consumed two and one had consumed three benzodiazepines).In 2013 the prevalence was of 1,8%, with it was a 3,4% women and 1,6% men.In 2014 the global prevalence was of 1,9%, with it was a 5,2% women and 1,5% men.In 2015 the global prevalence was of 2,4%, with it was a 5,9% women and 2,1% men. Benzodiazepines most consumed in 2013 are Diazepam (39%), Tetrazepam (17%) and Alprazolam (16%). A 44% of Diazepam in 2014, a 25% of Alprazolam and a 9 % of Bromazepam. In 2015 of Diazepam were a 44%, a 22 % of Alprazolam and a 13% of Bromazepam. Conclusions: As in national surveys, consumption is higher in woman than in men. It is also observed a progressive increase in consumption in both groups over the analyzed years, although the prevalence in our study was lower (AU)

Estabilidad de metabolitos del cannabis y cocaína en orina conservada a -20 °C en laboratorio de Armada (San Fernando), durante un periodo de tiempo superior a 1 año / Stability of cannabis metabolites and cocaine in urine preserved at -20ºC in Armada (San Fernando) laboratory over a period of time of more than 1 year

Antecedentes: El consumo de drogas constituye un problema en el medio militar, siendo el cannabis y la cocaína, las drogas ilegales con una mayor prevalencia de consumo. Los laboratorios situados en establecimientos farmacéuticos son los encargados de la realización del análisis preliminar de cribado de muestras, como lo marca la Instrucción Técnica 1/2012 de IGESAN, siendo confirmados los resultados positivos de estos, en el Instituto de Toxicología de la Defensa. Las muestras cuyos resultados sean positivos a drogas de abuso se conservarán durante seis meses (excepto Orden Judicial o expediente disciplinario en curso) a -20 °C, por si se requiere repetir la determinación. Los metabolitos presentes en la orina pueden deteriorarse durante su almacenamiento y conservación, obteniendo resultados distintos si reanalizamos la muestra. Así, es importante para el laboratorio conocer la estabilidad de los metabolitos presentes en dichas muestras. Objetivo: Estudiar la estabilidad de los metabolitos del cannabis y cocaína en orina, después de haber sido conservadas a -20 °C durante más de un ano. Material y métodos: 91 muestras de orina que resultaron positivas (65 a metabolitos del cannabis, 25 a metabolitos de cocaína y 1 a cannabis y cocaína), utilizando el analizador Cobas Integra 400 plusR (método semicuantitativo-cualitativo que usa una técnica inmunológica, con puntos de corte de 50 ng/ml para cannabis y 300 ng/ml para cocaína). Fueron conservadas en tubos de plástico a -20 °C durante mas de un ano. Tras descongelar y agitar suavemente para homogeneizarlas, se reanalizaron con el mismo analizador. Resultados: De los 66 muestras positivas a metabolitos de cannabis se produjo una disminución media respecto a los valores iniciales de -22,89% (rango +43,15 a -73,36). De las 26 muestras positivas a metabolitos de cocaína se produjo una disminución media respecto a los valores iniciales de -4,02% (rango de +7,03 a -49,01). Conclusiones: Observamos que los metabolitos del cannabis presentes en las orinas congeladas durante mas de un ano, disminuyen en mayor medida que los de la cocaina. Resultaron porcentajes similares a los obtenidos por otros autores en el caso de cannabis, aunque no asi en caso de cocaína (AU)

Antecedents: drug consumption constitutes a problem in the military milieu, being cannabis and cocaine the illegal drugs with a highest prevalence of consumption. Laboratories situated in pharmaceutical establishments are responsible for carrying out the preliminary analysis of screening samples, as it is shown by the I.T. 1/2012 of IGESAN, which confirmed the positive results of these in the Toxicology Institute of Defense. Samples whose results are positive to abused drugs would be kept for six months at -20 oC, if required by repeating the test. Metabolites which are present in urine could be deteriorated during storage and conservation, getting different results when the sample is revised. For laboratories it is important to know the stability of the metabolites present in the samples. Objective: to investigate cannabis and cocaine metabolite stabilities in urine, after having been kept at -20 oC for more than a year. Material and methods: 91 urine samples turned out positive (65 to cannabis, 25 to cocaine and 1 to both), using the analyzer Cobas Integra 400 plusR (semiquantitative-qualitative method using an immunological technique, with cutoffs of 50 ng/ml for cannabis and 300 ng/ml for cocaine). They were stored in plastic tubes at -20 °C for more than a year. After defrosting and shaking them softly to homogenize, they were reanalyzed with the same analyzer. Results: for the 66 positive samples of cannabis metabolites the average decrease from initial values was of -22, 89% (range -73.36% to +43.15%).For the 26 positive samples of cocaine metabolites the average decrease from initial values was of -4.02% (range -49.01% to +7.03%). Conclusions: It was reported that cannabis metabolites present in frozen urine for more than a year decreased to a greater extent than those of cocaine. Cannabis percentages were similar to those obtained by other authors, whereas this was not the case of cocaine metabolites (AU)

[Prescription appropriateness: Indication of citicoline in Primary Care]. / Adecuación prescripción-indicación de citicolina en atención primaria.

INTRODUCTION: The economic situation has made it necessary to optimize resources by adjusting the pharmaceutical expenditure. Citicoline was (2011) the 10th drug by rank of billed amount. Its approved indications are stroke (acute and sub-acute) and head injury, but not cognitive decline associated with age, the presumed indication for most of its use. OBJECTIVES: To assess the conditions of use of citicoline in the Health Area of Tenerife, in order to detect deviations from the indications of use as stipulated in the prescribing information sheet and the pattern of prescription, with emphasis on the analysis of its use in dementia where currently it has no indication or evidence to support it. METHOD: Cross-sectional study of prescription-indication. A 680 patient sample, segmented by reference hospital (error±5%; CI: 0.95%; P=0.5) was taken from the 4036 patients with a prescription of citicoline billed during august-october 2011 (obtained from the prescription database program, Farmacanarias). RESULTS: We found that 123 patients (18.1%) had an appropriate indication. By including the prescription regimen, 28 patients (4.1%) had adequate indication and dose levels, and in only 2 patients (0.2%) an appropriate indication, dosage and duration were found. CONCLUSIONS: "The correct prescription-indication" of citicoline is inappropiate in almost all patients studied. Impact actions are needed in order to optimize prescription, improve patient safety by reducing potential interactions, and the occurrence of adverse effects, and improve efficiency by promoting savings.

Morgagni-Larrey parasternal diaphragmatic hernia in the adult.

With a prevalence of 0.3-0.5/1000 births, congenital diaphragmatic hernia (CDH) remains a serious, poorly understood abnormality with a high mortality rate that cannot always be effectively managed. Its reported frequency in Spain is 0.69%00 with a yearly decreasing trend of 0.10%00 during the period 1980-2006. Up to 5% of cases are incidentally identified in adults undergoing studies for other reasons.We report the case of a 74-year-old woman with vomiting for three months due to parasternal diaphragmatic hernia of Morgagni-Larrey (retrochondrosternal, retrocostoxyphoid, retrosternal, subcostal, substernal or subcostosternal hernia), which allowed us to report an update on this condition in the adult, and on thoracoabdominal diaphragm morphogenesis. It is in the embryology of the diaphragm where an explanation may be found for some morphological changes and clinical manifestations, even though a number of uncertainties remain. We also analyze the extent of controversy persisting on some aspects of surgical treatment (access routes, mesh use, hernial sac reduction). Overall, minimally invasive techniques predominate. We consider laparoscopy the approach of choice for adult patients with parasternal hernia eligible for surgery.

Hernia diafragmática paraesternal de Morgagni-Larrey en adulto / Morgagni-Larrey parasternal diaphragmatic hernia in the adult

Con una prevalencia de 0,3-0,5/1.000 nacimientos, la hernia diafragmática congénita (HDC) sigue siendo una anomalía grave, no bien entendida, alta mortalidad y tratamiento no siempre efectivo. En España se ha informado de una frecuencia del 0,69%oo con una tendencia decreciente en el periodo 1980-2006 del 0,10%oo por año. No obstante, hasta un 5% se diagnostican en adultos durante la realización de un reconocimiento por otra causa. Presentamos un cuadro de vómitos de tres meses de evolución en una mujer de 74 años por hernia diafragmática paraesternal de Morgagni-Larrey (retrocondroesternal, retrocostoxifoidea, retroesternal, subcostal, subesternal o subcostoesternal), que nos ha permitido realizar una actualización de esta patología en adultos y de la morfogénesis del diafragma toracoabdominal. Es en la embriología del diafragma donde encontramos explicación de algunas de sus alteraciones morfológicas y características clínicas, si bien persisten aspectos confusos de la misma. También analizamos el grado de controversia que persiste en algunos aspectos de su tratamiento quirúrgico (vías de acceso, uso o no de mallas y reducción o no del saco herniario). Por lo general priman las técnicas mínimamente invasivas. Consideramos el abordaje laparoscópico como de elección en pacientes adultos con hernia paraesternal candidatos a la cirugía(AU)

With a prevalence of 0.3-0.5/1000 births, congenital diaphragmatic hernia (CDH) remains a serious, poorly understood abnormality with a high mortality rate that cannot always be effectively managed. Its reported frequency in Spain is 0.69%oo with a yearly decreasing trend of 0.10%oo during the period 1980-2006. Up to 5% of cases are incidentally identified in adults undergoing studies for other reasons. We report the case of a 74-year-old woman with vomiting for three months due to parasternal diaphragmatic hernia of Morgagni-Larrey (retrochondrosternal, retrocostoxyphoid, retrosternal, subcostal, substernal or subcostosternal hernia), which allowed us to report an update on this condition in the adult, and on thoracoabdominal diaphragm morphogenesis. It is in the embryology of the diaphragm where an explanation may be found for some morphological changes and clinical manifestations, even though a number of uncertainties remain. We also analyze the extent of controversy persisting on some aspects of surgical treatment (access routes, mesh use, hernial sac reduction). Overall, minimally invasive techniques predominate. We consider laparoscopy the approach of choice for adult patients with parasternal hernia eligible for surgery(AU)

A young woman with first-trimester metrorrhagia, fever and skin lesions.

Inflammatory bowel disease commonly affects women with child-bearing potential, and clinical activity extent is most relevant at the time of conception. Below, we report on the case of a 19-year-old woman who was admitted for first-trimester metrorrhagia and fever, with various extraintestinal manifestations, mainly including erythema nodosum and episcleritis during the course of disease. The differential diagnosis of these manifestations led to the diagnosis of Crohn's disease, which involved the whole colon.

Mujer joven con metrorragia del primer trimestre, fiebre y lesiones cutáneas / Clinicopathological Conference A young woman with first-trimester metrorrhagia, fever and skin lesions

La enfermedad inflamatoria intestinal afecta frecuentemente a mujeres en edad fértil, siendo fundamental el grado de actividad clínica en el momento de la concepción. A continuación se presenta el caso de una mujer de 19 años que ingresa por metrorragia del primer trimestre y fiebre; destacando durante su evolución la aparición de diferentes manifestaciones extraintestinales, fundamentalmente eritema nodoso y epiescleritis. A través del diagnóstico diferencial de estas manifestaciones se llegó al diagnóstico de una enfermedad de Crohn que afectaba a todo el colon

Seasonal variability in 7Be depositional fluxes at Granada, Spain.

Measurement of 7Be depositional fluxes at Granada, Spain (37 degrees 10'50''N-3 degrees 35'44''W, altitude 670 m) in the period 1995 through 1998 indicates substantial variations between the four seasons and also between corresponding seasons in different years, ranging from 23.6 to 242 Bq m(-2) per season. A strongly positive correlation with precipitation is shown, which explains about 70% of the variations in the 7Be depositional fluxes over the 16 seasons studied. The depositional 7Be flux is on the average highest in the fall and lowest in the summer. The study shows that precipitation primarily controls the 7Be depositional flux and plays a dominant role in the removal of 7Be from the troposphere. The average annual 7Be depositional flux at Granada amounts to 469+145 Bq m(-2).

Coordinación de formación de becarios de la red temática de investigación cooperativa (RETIC) en primeros episodios psicóticos en niños y adolescentes. Resultados preliminares / Coordination of scholars' formation of the thematic net of cooperative investigation (RE TIC) in the first psychotic episodes in children and teenagers. Preliminary results

El objetivo de este trabajo es evaluar el impacto en la formación de becarios de la designación de un responsable de formación de becarios en una RETIC. Las misiones del responsable de formación son: coordinación y organización de actividades, propuesta de cursos y búsqueda de financiación, fomento del desarrollo de actividades en la red y los centros, facilitación de medios de comunicación efectivos entre de becarios (página web, listas de distribución) y portavoz de los mismos. En cuanto al método, se recogen las horas de formación en la RETlC durante el 2003 y a partir de la designación del coordinador en enero de 2004. El promedio de horas semanales de formación en 2003 fue 2,4. De éstas 1,1 corresponden a formación global de la red para todos los becarios y 1,3 a la formación específica de cada centro. En 2004, el total fue de 5 horas semanales (2,8 de formación global de la red y 2,2 de formación específica de los centros) aunque hay diferencias entre centros. Se observa un aumento de 2,4 a 5 horas de promedio semanal de formación teniendo en cuenta el cómputo total de la formación de la red como de los centros tras designar un responsable de formación de becarios (AU)

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Seasonal 7Be concentrations in near-surface air of Granada (Spain) in the period 1993-2001.

Near-surface air samples for assessment of seasonal 7Be levels were taken weekly at Granada, Spain, (37 degrees 10'50"N-3 degrees 35'44"W, altitude 670 m) in the period 1993-2001. The 7Be levels measured reflect strong seasonal trends. Concentrations during autumn and/or winter showed a minimum (ca. 1.5 mBq/m3), and in each year a fallout maximum was found in summer (ca. 7.6 mBq/m3). Multiple regression of 7Be concentrations with temperature and rainfall, and with sunspot number explained about 71% of the variance in the 7Be data. The data reveal strong variations in the mean annual 7Be concentrations due to variations in the flux of cosmic galactic primary radiation caused by the 11-year sunspot cycle. A difference of a factor of 2.6 was found between the highest level (5.8 mBq/m3) obtained in 1996 (beginning of the solar cycle 23) and the lowest (2.6 mBq/m3) obtained in 2000 (maximum of the solar cycle 23).

[Brucella hepatic abscess. Report of a case and review of the literature]. / Absceso hepático por Brucella. Descripción de un caso y revision de la literatura.

Hepatic involvement in infections caused by Brucella organisms is common but the production of liver abscess is exceptional. Therefore, the most appropriate therapeutic approach is unclear. The use of antibiotics can be effective but in some cases abscess drainage is required. We report here a case of brucellar hepatic abscess and a review of fourteen cases reported in the literature. An emphasis is laid on the clinical, laboratory and radiological findings, treatment, and patient evolution. On the basis of the reported cases a therapeutic approach is proposed.

Absceso hepático por Brucella. Descripción de un caso y revisión de la literatura / Brucella hepatic abscess. A case report and literature review

La afectación hepática en las infecciones por Brucella es frecuente, pero la aparición de un absceso hepático es excepcional, por lo que no está claro cuál es la aproximación terapéutica inicial más apropiada. La antibioterapia puede ser eficaz, pero en algunos casos es necesario el drenaje del absceso.Describimos un caso de absceso hepático por Brucella y una revisión de 14 casos recogidos de la literatura, en especial la forma de presentación clínica, las anomalías bioquímicas y radiológicas, los tratamientos empleados y la evolución de los pacientes. Se propone una aproximación terapéutica farmacológica basada en los casos publicados (AU)

Systemic amyloidosis and ovarian carcinoma.

A case of ovarian carcinoma and systemic amyloidosis in a 64 year old woman with nephrotic syndrome is reported. Immunohistochemical study of renal and rectal biopsy specimens revealed the presence of amyloidosis AA antigens, consistent with secondary amyloidosis. The absence of chronic inflammatory or infectious disease suggested the presence of a neoplasm. The gynaecological sonogram showed a solid mass located behind the uterus. Laparotomy confirmed a poorly differentiated ovarian carcinoma. The association of systemic amyloidosis and ovarian carcinoma has not to our knowledge been described previously.

[Polymicrobial endocarditis: presentation of 3 cases]. / Endocarditis polimicrobiana: presentación de tres casos.

We present three cases of polymicrobian endocarditis (PE), two of them in parenterally drug addicts (PDA) and the other one in a central catheter carrier. In all these three cases, the form of clinical presentation was similar to the monomicrobian endocarditis and the valve affected was the tricuspid one, as it occurs in most of the described PE. PE must be suspect in PDA or central catheter carriers if a rare germ is isolated (commensal of skin, oropharynx or gastrointestinal tract) or if there is a poor response to the antibiotic treatment, as it is the case in the patients described here.

[Coxsackie B4 and cytomegalovirus in patients with insulin-dependent diabetes]. / Coxsackie B4 y citomegalovirus en pacientes con diabetes insulín dependiente.

The purpose of this work is to analyze the potential relationship between infection by Coxsackie and cytomegalovirus and the appearance of insulin-dependent diabetes (IDD). We have assessed complement fixing (CF) antibodies against both viruses in 22 samples of serum from other individuals, among which 11 were patients with a recent diagnosis of IDD--less than 3 months of evolution--(GP) and the remainder 11, supposed healthy individuals with similar age, sex and socioeconomic level (GC). In addition, the presence of anti-pancreatic islets antibodies (ICA) was assessed in 22 serum samples using the indirect immunofluorescence reaction. We have not observed any relationship between the presence of Coxsackie B or CMV antibodies and the appearance of IDD, since although the seroprevalence against CMV was higher in GP than in GC, such difference was not statistically significant. With respect to ICAs, they were only present in the GP samples as expected. Given the small size of the sample, this results are not conclusive and larger series need to be studied.

[Prevalence of the Epstein-Barr virus among different populations in the central area]. / Prevalencia del virus de Epstein-Barr en diferentes poblaciones de la zona centro.

In order to estimate the seroprevalence of the Epstein-Barr virus in the centre area, a serological study is carried out using the indirect immunofluorescence technique on 759 supposed healthy people, from both sexes and with ages between 6 months and 50 years, 565 from which were living in urban areas (Madrid and Guadalajara city) and 194 in rural areas (Arganda del Rey, Madrid) and Chiloeches (Guadalajara). Global seroprevalence was of 81% in Madrid city, 90% in Guadalajara city and 85% in both rural populations. Comparing groups of the same age, we have not found any statistically significant differences between the urban (86%) and the rural (85%) areas. Neither we have found any relation between seropositivity and sex (74.7% for women and 81% for men). On the other hand, we observed that in our study group, seroprevalence was related to socioeconomic status--the higher the antibody percentages, the lower the socioeconomic status, both in the rural and in the urban areas (p less than 0.001)-- and age antibody percentages increased with age, with p less than 0.025 for urban areas and p less than 0.05 for rural areas.