[Oral antibiotic request without prescription in community pharmacies. Description of pharmacists' intervention]. / Demanda de antibióticos sin prescripción en la farmacia comunitaria. Descripción de la intervención del farmacéutico.

OBJECTIVES: To quantify the proportion of oral antibiotics requests without prescription in Community Pharmacy (CP) and to analyse it causes. METHOD: Cross-sectional multicentre study carried out in Spanish community pharmacies during 4 weeks, one in each season of the year. Oral J01 antibiotics (Anatomical Therapeutic Chemical classification, ATC) requested for self-medication were analysed. RESULTS: 247 pharmacies and 365 pharmacists participated in the study, 1172 antibiotic requests were recorded. More frequent requests for antibiotic self-medication were: previous treatment for the same symptoms (63.1%), insufficient time for a general practitioner (GP) consultation (12.1%) and patient belief that GP is going to prescribe the antibiotic (4.9%). Higher number of generic medication were requested compared to brand medication (41.1 versus 34.9%). Active ingredients commonly requested were amoxicillin (28.2%), amoxicillin-clavulanic (14.9%) and phosphomycin (21.8%) to treat upper respiratory related infections (35.1%), urinary infections (28.1%) and teeth infections (20.2%). 2406 pharmacists' interventions were carried out: referring to the GP (40.8%), information for correct use of medication (31.3%), non-pharmacological treatment (15.7%), and recommendation of a different medication (6.9%) or a different product (5.3%). CONCLUSIONS: Nowadays higher number of active ingredients than brands are requested when selecting a treatment for an infection, mainly ß-lactams and macrolides. Majority of self-medication tried to treat upper respiratory infections, urinary and teeth infections. Most frequent pharmacists' intervention was referring to the GP to obtain a correct diagnosis and treatment.

[Characteristics of private and irregular prescription for oral antibiotics in Spanish community pharmacies]. / Perfil de las solicitudes de antibióticos en farmacia comunitaria con receta privada y prescripción irregular.

OBJECTIVE: To quantify the proportion of oral antibiotics through private prescription (PP) and irregular prescription (IP) in the Community Pharmacy (CP). MATERIAL AND METHODS: Cross-sectional multicentre study carried out in Spanish community pharmacies over a 4week period, one in each season of the year. An analysis was made of private and irregular prescriptions of oral J01 antibacterials for systemic use (Anatomical Therapeutic Chemical [ATC] classification). The study variables used were prescription and consultation characteristics. RESULTS: A total of 3569 PP (71% followed legislation) and 833 IP were recorded by 365 pharmacists working in 247 CP. PP were prescribed by dentists (43.7%), general practitioners (GP) (26.20%), and paediatricians (10.3%), to treat teeth infections (39.8%), upper respiratory infections (25.6%), lower respiratory infections (10.3%), and urinary infections (7.7%). The most prescribed antibiotics were amoxicillin (27.9%) and amoxicillin-clavulanic (25.2%). IP came from Emergency Departments (32.8%), oral/phone prescriptions (20.4%), and patient demand due to insufficient quantity of antibiotic to complete treatment (10%). Prescriptions came from GP (25.2%), dentists (24.7%), and paediatricians (12%) to treat upper respiratory infections (32.5%), teeth infections (25.8%), urinary infections (14.2%), and lower respiratory infections (10.8%). The most prescribed antibiotics were amoxicillin-clavulanic (27.4%) and amoxicillin (21.6%). Since every patient with IP was referred to the GP, 45.4% of them accepted the recommendations of the pharmacists. CONCLUSIONS: This study obtained PP and IP characteristics, unknown and needed data in Spain for future health policy plans.

Applying data mining techniques to medical time series: an empirical case study in electroencephalography and stabilometry.

One of the major challenges in the medical domain today is how to exploit the huge amount of data that this field generates. To do this, approaches are required that are capable of discovering knowledge that is useful for decision making in the medical field. Time series are data types that are common in the medical domain and require specialized analysis techniques and tools, especially if the information of interest to specialists is concentrated within particular time series regions, known as events. This research followed the steps specified by the so-called knowledge discovery in databases (KDD) process to discover knowledge from medical time series derived from stabilometric (396 series) and electroencephalographic (200) patient electronic health records (EHR). The view offered in the paper is based on the experience gathered as part of the VIIP project. Knowledge discovery in medical time series has a number of difficulties and implications that are highlighted by illustrating the application of several techniques that cover the entire KDD process through two case studies. This paper illustrates the application of different knowledge discovery techniques for the purposes of classification within the above domains. The accuracy of this application for the two classes considered in each case is 99.86% and 98.11% for epilepsy diagnosis in the electroencephalography (EEG) domain and 99.4% and 99.1% for early-age sports talent classification in the stabilometry domain. The KDD techniques achieve better results than other traditional neural network-based classification techniques.

Generating reference models for structurally complex data. Application to the stabilometry medical domain.

OBJECTIVES: We present a framework specially designed to deal with structurally complex data, where all individuals have the same structure, as is the case in many medical domains. A structurally complex individual may be composed of any type of single-valued or multivalued attributes, including time series, for example. These attributes are structured according to domain-dependent hierarchies. Our aim is to generate reference models of population groups. These models represent the population archetype and are very useful for supporting such important tasks as diagnosis, detecting fraud, analyzing patient evolution, identifying control groups, etc. METHODS: We have developed a conceptual model to represent structurally complex data hierarchically. Additionally, we have devised a method that uses the similarity tree concept to measure how similar two structurally complex individuals are, plus an outlier detection and filtering method. These methods provide the groundwork for the method that we have designed for generating reference models of a set of structurally complex individuals. A key idea of this method is to use event-based analysis for modeling time series. RESULTS: The proposed framework has been applied to the medical field of stabilometry. To validate the outlier detection method we used 142 individuals, and there was a match between the outlier ratings by the experts and by the system for 139 individuals (97.8%). To validate the reference model generation method, we applied k-fold cross validation (k = 5) with 60 athletes (basketball players and ice-skaters), and the system correctly classified 55 (91.7%). We then added 30 non-athletes as a control group, and the method output the correct result in a very high percentage of cases (96.6%). CONCLUSIONS: We have achieved very satisfactory results for the tests on data from such a complex domain as stabilometry and for the comparison of the reference model generation method with other methods. This supports the validity of this framework.

[Complications of gynaecological surgery]. / Complicaciones de la cirugía ginecológica.

Gynaecological surgery is undergoing a process of constant change and therefore some of its complications as well. The incorporation of endoscopy has added a new dimension, with the rate of complications related to its complexity. Endoscopy has meant a great advance in surgery, and specifically in gynaecology, which benefits from two ways of approaching the genital apparatus: laparoscopy and histeroscopy. These techniques involve risks that are specific to these techniques: the induction of pneumoperitoneum, insertion of trocar, remote coagulation, vascular passage of the glycine employed in uterine relaxation during hysteroscopy, etc. When a patient comes to Accidents and Emergencies in the postoperative phase, or simply suffers a complication during the 24 or 48 hours that they are hospitalised, the doctor who attends her must be acquainted with this course of approach and its possible complications.

Carcinoma sarcomatoide de pulmón / No disponible

El carcinoma sarcomatoide es una neoplasia maligna, poco frecuente,de localización extremadamente rara en pulmón, más frecuenteen varones y en clara relación con el hábito tabáquico.Describimos el caso de un varón de 72 años que presentaba clínicade tos con expectoración hemoptoica, síndrome febril y cuadroconstitucional, en el que se objetivó en la radiografía de tóraxduplicación del tamaño de una lesión quística, ya conocida previamentey con sospecha clínica de quiste hidatídico en lóbulo superiorderecho. Ante la falta de diagnóstico con las pruebas no invasivas,se realizó una toracotomía diagnóstico-terapéutica,estableciéndose el diagnóstico anatomopatológico de carcinomasarcomatoide de pulmón tras la extirpación de la pieza quirúrgica (AU)

Sarcomatoid carcinoma is an infrequent malignant neoplasia,extremely rare in the lung, more frequent in men and with a clearrelationship with the tobacco habit.We describe the case of a 72 year old man who presented a clinicalpicture of cough with haemoptoic expectoration, febrile syndromeand constitutional syndrome, in which chest X-ray examinationshowed a duplication in the size of a previously known cystic lesion,with the clinical suspicion of a hydatid cyst in the right upper lobe.Faced with the lack of a diagnosis with non-invasive tests, a diagnostic-therapeutic thoracotomy was made, establishing the anatomopathologicdiagnosis of sarcomatoid carcinoma of the lung afterthe surgical resection of the lesion (AU)

Evaluación del derrame pleural de origen infeccioso / No disponible

No disponible

[Musculoskeletal hydatidosis: an unusual location]. / Hidatidosis musculoesquelética: una localización atípica.

Hydatidosis is a zoonosis with a continuing high prevalence in our environment. The most commonly affected organs are the lungs and the liver, with the musculoskeletal location being considered an unusual one. We comment the case of a patient who presented a series of lesions in his left iliac crest and middle left buttock with spontaneous fistulization to the skin surface. In this case a combined treatment was given; prior to the surgical operation we administered a cycle of albendazol. Following removal of the lesion, the patient was given two further cycles of albendazol in order to minimize the risk of a recurrence of the illness. This patient is currently free of any symptoms relating to this illness.

Evaluation of survival of Staphylococcus aureus and Clostridium botulinum in charqui meats.

Charqui meats were prepared in laboratory conditions in order to carry out experiments to observe the possibility of development of enterotoxigenic Staphylococcus aureus and Clostridium botulinum proteolytic type B spores and their toxins. Results demonstrated that the harsh processing conditions, high salt concentration, relative high temperature, a(w) values, inhibited the growth of both bacteria. Under our experimental conditions, S. aureus would survive throughout the sequence of salting steps i.e. brine followed by rock salting and the sunshine drying step. However, at final a(w) value of 0.70-0.75 would create conditions to inhibit its development. The other experiment revealed that C. botulinum spores germination also was impaired because of these low a(w) values. Under these conditions, charqui meats revealed to be safe products in relation to toxins from both enterotoxigenic S. aureus and C. botulinum.

Seguimiento farmacológico del hipoparatiroidismo durante el embarazo: descripción de un caso / Fharmacologic follow-up of hypoparathyroidism during pregnancy: a case report

Se describe un caso de hipoparatiroidismo adquirido por tiroidectomía y posterior embarazo. La hipocalcemia fue corregida mediante aporte oral de calcio (0,5 g/12 horas); dosis que fue duplicada y suplementada con calcitriol (0,5 µg) en la 31ª semana de embarazo. Con motivo de la cesárea, se determinaron las dosis de calcio vía parenteral considerando una bioequivalencia oral del 38 por ciento, administrándose 765 mg de calcio mediante perfusión intravenosa. Las pérdidas de calcio producidas por la cesárea se corrigieron mediante la administración de Ringer Lactado (90 mg de calcio). El tratamiento del hipoparatiroidismo en el embarazo pretende evitar estados de hipocalcemia que producirían alteraciones fetales o abortos. La terapia combinada de calcio y calcitriol es habitual, si bien las dosis utilizadas deben aumentarse en el tercer trimestre del embarazo y disminuirse tras el parto. Por ello, se recomienda monitorizar el calcio plasmático y conseguir un manejo farmacoterapéutico seguro y eficaz (AU)

Características sociales y clínicas de un grupo de madres infectadas por VIH en Valencia: influencia de la drogadicción parenteral / Social and clinical characteristics of mothers with HIV infection: the influence of intravenous drug addiction

Objetivo: Al principio de conocerse la infección por el virus de la inmunodeficiencia humana (VIH), la causa más importante de su transmisión en las mujeres occidentales fue el consumo de drogas por vía parenteral. El objetivo de nuestro trabajo consistió en describir las principales características sociales y clínicas de un grupo de madres seropositivas, y en analizar su relación potencial con el uso intravenoso de drogas. Métodos: Realizamos un estudio observacional prospectivo con 220 mujeres infectadas por VIH que presentaban la particularidad de haber dado a luz niños con riesgo de infección. Se incluyeron todas las madres reclutadas en la Unidad VIH de un hospital de Valencia que tuviesen definido el diagnóstico de su infección durante el período de estudio comprendido entre el primer caso materno conocido en 1985 y 1993. El análisis de los datos se basó en un análisis univariado. Resultados: La transmisión del virus se produjo por mantener relaciones heterosexuales en un 27,7 por ciento de las mujeres estudiadas, y a través de la drogadicción parenteral en el 69,1 por ciento. Se detectó mayor número de madres que abortaron, con antecedentes penales y abandono domiciliario entre las usuarias de drogas por vía parenteral (UDVP), con odds ratio (OR) de 1,8 (p = 0,087), 8,95 (p = 0,012) y 15 (p = 0,000), al compararlas con las madres no UDVP. Además las UDVP presentaron mayor probabilidad de contraer la infección por hepatitis B o C (OR = 7,06, p = 0,000) y de tener asociados otros hábitos tóxicos como tabaquismo (OR = 6,19, p = 0,000) y alcoholismo (OR = 5,91, p = 0,117).Conclusiones: Muchas de las características analizadas en estas mujeres estaban más relacionadas con el consumo de droga inyectada que con la infección por VIH, tales como la mayor frecuencia de abortos electivos, antecedentes penales, abandono domiciliario, politoxicomanías y antecedentes patológicos como hepatitis B o C (AU)

Quantification of ethanol concentrations in the extracellular fluid of the rat brain: in vivo calibration of microdialysis probes.

Traditional microdialysis techniques provide qualitative data, although quantitative data are often required for pharmacodynamic analyses. This study evaluated a potentially useful in vivo delivery technique to calibrate microdialysis probes for ethanol. We measured in vivo delivery extraction fractions within subjects across 2 days and found no change over time. We tested the effect of diffusion direction on extraction fraction and found that it was higher for ethanol diffusion out of the probe than for diffusion into the probe, both in vitro and in vivo. The in vivo extraction fraction ratio of diffusion(IN) versus diffusion(OUT) was 0.65+/-0.03. Finally, we predicted extracellular brain ethanol concentrations after 1 g/kg ethanol administration using in vivo delivery, "no net flux" dialysis, or in vivo delivery corrected for diffusion direction with the in vivo extraction fraction ratio. Both in vivo delivery and "no net flux" dialysis predicted brain concentrations that were approximately one-third lower than blood concentrations, whereas the corrected in vivo delivery predicted extracellular concentrations very similar to blood concentrations. We conclude that microdialysis calibration methods for ethanol require a measure of extraction fraction for diffusion into the probe. Further studies are needed to establish whether this effect is common to other alcohols.

[Social and clinical characteristics of a group of mothers infected with HIV in Valencia: influence of parenteral drug addiction]. / Características sociales y clínicas de un grupo de madres infectadas por VIH en Valencia: influencia de la drogadicción parenteral.

OBJECTIVE: In the first years after the finding of HIV-infection, the main was for its transmission among western women was the intravenous drug addiction. The objective of our work consisted in evaluating the main social and clinical characteristics of a group of seropositive mothers, and in analyzing their potential relationship with intravenous consumption of drugs. METHOD: We performed an observational prospective study in 220 HIV-infected women who had recently given birth to children with high risk for infection. We included every women at an HIV Unit of a hospital in Valencia who had been diagnosed of HIV infection at any moment between the first mother-child transmission reported in 1985 and 1993. The analysis was based on univariate analysis. RESULTS: The virus transmission was produced by heterosexual relations in a 27.7% of the study women and due to the parenteral drug addiction in 69.1%. We detected more women who had an abortion, with criminal antecedents and parental abandonment among those who were intravenous drug users (IVDU), with OR of 1.8 (p = 0.087), 8.95 (p = 0.012) and 15 (p = 0.000), when compared with those mothers non-IVDU. Besides, IVDU presented a higher probability for getting hepatitis B or C infection and for other toxic habits, as smoking (OR = 6.19, p = 0.000) or alcoholism (OR = 5.91, p = 0.017). CONCLUSION: Many of the analysed characteristics in these women were more related with the consumption of injected drug than with the HIV infection, such as the greater frequency of elective abortions, criminal antecedents, parental abandonment, multiple drug abuse and pathological precedents like hepatitis B or C.