Macular oedema associated with taxanes: A case report and literature review. / Edema macular asociado a taxanos: presentación de un caso y revisión de la literatura.

BACKGROUND AND PURPOSE: Although taxanes are a frequently used group of chemotherapy agents, they can, rarely, lead to macular oedema. The purpose of this article is to review and communicate, in an integrated way, the data of the cases previously reported in the literature, as well as to present a new case. MATERIAL AND METHODS: Narrative review of reports of cases of macular oedema associated with taxanes, and communication of the clinical case of a 73-year-old woman who, after treatment with paclitaxel for metastatic breast cancer, developed macular oedema that disappeared after discontinuing the drug. RESULTS: The review included 57 cases with data from 109 eyes collected in 52 articles. The large majority (76.79%) of the cases were women, and the mean age was 58.75 years. The cancer that most frequently motivated the treatment was breast cancer (60.72%), and 92.5% of cases had metastases. The most frequently associated drug was paclitaxel (52.63%). The median time to symptom development was 4.25 months. At the initial examination, 92.86% of the cases had bilateral oedema and the mean visual acuity was 0.4 (decimal scale). The mean macular thickness was 509.63 microns, and 97.83% of the eyes had no or minimal angiographic findings. In 90.57% of the cases, the treatment with taxanes was interrupted, and some other treatment was used in 43.86% of the cases, with the most widely used being acetazolamide. The outcome was favourable, to a greater or lesser extent, in 96.23% of cases. CONCLUSIONS: Despite being a rare entity, macular oedema associated with the use of taxanes is a disorder that every oncologist and ophthalmologist should be aware of, taking into account the good outcome of the condition that usually occurs when treatment is suspended.

Cuidado perdido de enfermería. Estado del arte para la gestión de los servicios de salud / Missing nursing care. State-of-the-art healthcare service management / Cuidado perdido de enfermagem. Estado da arte para a gestão dos serviços de saúde

Resumen Introducción: El cuidado perdido de enfermería es un fenómeno recientemente explorado que afecta la seguridad de los pacientes, la calidad de la atención y cuestiona la actuación de los profesionales de enfermería. Objetivo: Conocer el Estado del Arte del tema Cuidado perdido en Enfermería a partir de artículos publicados durante el periodo marzo 2012- marzo 2018. Metodología: Se realizó una investigación documental a través del sistema de búsqueda PUBMED, con las siguientes palabras clave: missed nursing care, misscare AND care nurse. Se seleccionaron 47 artículos de investigación en idioma inglés y español. Posterior al análisis de contenido de los artículos, los resultados se agruparon en categorías. Resultados: Se identificaron las siguientes categorías: país donde se realizó la investigación, unidades de atención, tipo de estudio, muestra estudiada, instrumento empleado, marco conceptual, así como los elementos, razones y predictores del cuidado perdido. Conclusiones: El estudio del fenómeno puede ser un insumo para la toma de decisiones en políticas de salud y en el diseño de estrategias e intervenciones que contribuyan a la mejora del cuidado en las instituciones de salud. La revisión del fenómeno y el análisis permitirán a los interesados en el tema, profundizar en el cuidado perdido e identificar la fundamentación teórica, los elementos conceptuales y los resultados encontrados, los cuales serán aportes para la toma de decisiones en los procesos de mejora, la docencia, el cuidado y la investigación.

Abstract Introduction: Missing nursing care is a recently explored phenomenon which has impacts on patient security and quality of attention, and which questions the performance of nursing professionals. Objective: To gain understanding on the phenomenon of missing nursing care from the lens of state-of-the-art care management by reviewing related articles published in the period March 2012 - March 2018. Methodology: A documentary research was carried out in the PUBMED database using the following key terms: missed nursing care, misscare, AND nurse care. 47 research articles written in English or Spanish were selected. From the content analysis, the results were clustered in categories. Results: The following categories were selected: country were the research took place, units of attention, type of study, sample studied, instrument used, conceptual frame, and the elements, reasons, and predictors related to missing nursing care. Conclusions: The study of this phenomenon can bring about bases of orientation to the process of political decision-making, and strengthen the strategies and interventions in the practice, teaching, and research areas which can contribute to provide a better healthcare in institutions.

Resumo Introdução: O cuidado perdido de enfermagem é um fenómeno recentemente explorado que afeta a segurança dos pacientes, a qualidade da atenção e questiona a atuação dos profissionais de enfermagem. Objetivo: Conhecer o Estado da Arte do tema Cuidado perdido em Enfermagem a partir de artigos publicados durante o período março 2012- março 2018. Metodologia: Realizou-se uma pesquisa documental a través do sistema de busca PUBMED, com as seguintes palavras chave: missed nursing care, misscare AND care nurse. Escolheram-se 47 artigos de pesquisa em idioma inglês e espanhol. Posterior à análise de conteúdo dos artigos, os resultados agruparam-se em categorias. Resultados: Identificaram-se as seguintes categorias: país onde se realizou a pesquisa, unidades de atenção, tipo de estudo, amostra estudada, instrumento empregado, marco conceitual, assim como os elementos, razões e preditores do cuidado perdido. Conclusões: O estudo do fenómeno pode ser um insumo para a toma de decisões em políticas de saúde e no desenho de estratégias e intervenções que colaborem para a melhora do cuidado nas instituições de saúde. A revisão do fenómeno e a análise permitiram aos interessados no tema, aprofundar no cuidado perdido e identificar a fundamentação teórica, os elementos conceituais e os resultados encontrados, os quais serão contribuições para a tomada de decisões nos processos de melhora, a docência, o cuidado e a pesquisa.

Lymphocyte Transformation Test (LTT) in Allergy to Benznidazole: A Promising Approach.

Benznidazole (Bzn) from the nitroimidazole family and nifurtimox from nitrofurans family, are drugs used as first and second line treatment for acute and chronic phases of Chagas disease (CD). Even though skin reactions are frequent, confirmed allergy to Bzn is rare, and there are few cases reported in the literature. Since CD treatment is very restrained, the possibility of cross-reactivity between members of the same and other pharmacological families highlights the importance of an adequate diagnosis that allows alternative treatments in CD and other diseases. We report a series of 31 patients (69% women) referred to our Allergy unit with suspected hypersensitivity to Bzn, twenty three of them with mild reactions and eight of them with severe reactions. LTT with Bzn was performed in 31 patients and in 8 negative controls. LTT was also performed in 25 and 20 of these patients with nifurtimox and Mtn, respectively. Twenty-one out of thirty-one patients were Bzn prick tested, and all were negative. We obtained 2/19 positive results on patch tests to Bzn. LTT with Bzn was positive in 22/31 patients (Sensitivity 75.9% and specificity 100%). The test was considered positive with a stimulation index ≥2. There was a positive result in 7/25 patients for nifurtimox and in 7/20 patients with Mtn. After negative LTT and skin tests, oral provocation was performed in 4/9 patients, all negative. LTT is a safe test that seems to be more useful than skin tests (prick and patch test), particularly in severe reactions, in confirming delayed hypersensitivity to Bzn and detecting cross reactivity with other imidazoles such as Mtn and reactivity to other drugs like nifurtimox. Tests for these drugs need to be included in the workup of patients with hypersensitivity to Bzn in case they are needed as an alternative treatment for CD or to treat other frequent infectious diseases.

El recien nacido pretermino con tubo endotraqueal. Cuidado seguro en la Unidad Neonatal / Safe care of the preterm newborn with endotracheal tube neonatal intensive care unit

Introducción. Cuidado seguro se defne como causa o consecuencia de las intervenciones de enfermería. La seguridad en el paciente es un tema de interés en los últimos años, no obstante, hablar del recién nacido pretérmino (RNPT) con tubo endotraqueal (TET), es enfrentarse a una población vulnerable por sus características biofsiológicas. La Unidad de Cuidado Intensivo Neonatal (UCIN) representa un medio ambiente complejo, en estos escenarios es de importancia conocer los factores que pueden contribuir al "Cuidado Seguro" evitando un evento adverso(EA)y sus repercusiones para la vida. Objetivo: Describir y dar a conocer aspectos encontrados a nivel mundial sobre el cuidado seguro al RNPT con TET. Desarrollo: Se realizó una búsqueda en distintas bases de datos: Pubmed, Scielo, BVS, LILACS, Elsevier, utilizando (DeCs)/ (MeSH), rescatando artículos nacionales e internacionales, idioma español, inglés y portugués, de 5 años a la fecha, con títulos relacionados al cuidado del neonato. Tres rubros fueron los explorados: posición corporal en el RNPT, cuidado de enfermería omitido, eventos adversos (EAs) en la UCIN. Conclusiones: La función respiratoria del RNPT con TET se optimiza con el factor posición corporal. El cuidado omitido ha sido poco estudiado en el área neonatal. Los EAs que prevalecen son: los relacionados a la terapia de infusión, termorregulación, infecciones asociadas y extubación no programada (ENP). El cuidado seguro debe ser abordado a profundidad a fn de emitir recomendaciones específcas para este grupo vulnerable de la población(AU)

Introduction. Safe Care is the cause or consequence of nursing interventions. Patient safety is a topic of interest in recent years, however, to speak of the preterm newborn (RNPT) with endotracheal tube (ETT), is to confront a vulnerable population due to its biophysiological characteristics. Te Neonatal Intensive Care Unit (NICU) represents a complex environment, in these scenarios it is important to know the factors that can contribute to "Safe Care" avoiding an adverse event (AD) and its repercussions for life. Objective: Describe and publicize aspects found around the world on the Safe Care of RNPT with TET. Development: A search was made in different databases: Pubmed, Scielo, VHL, LILACS, Elsevier, using (DeCs) / (MeSH), rescuing national and international articles, Spanish, English and Portuguese, from 5 years to date , with titles related to the care of the newborn. Tree items were explored: body position in the RNPT, nursing care omitted, adverse events (AEs) in the NICU. Conclusions: Te respiratory function of RNPT with TET is optimized with the body position factor. Te omitted care has been little studied in the neonatal area. Te EAs that prevail are: those related to infusion therapy, thermoregulation, associated infections and unscheduled extubation (ENP). Safe Care must be approached in depth in order to issue specifc recommendations for this vulnerable group of the population(AU)

Introdução. Safe Care é a causa ou consequência das intervenções de enfermagem. A segurança do paciente é um tema de interesse nos últimos anos, no entanto, falar do recém-nascido pré-termo (RNPT) com tubo endotraqueal (TET) é confrontar uma população vulnerável devido às suas características biofsiológicas. A Unidade de Terapia Intensiva Neonatal (UTIN) representa um ambiente complexo, nesses cenários é importante conhecer os fatores que podem contribuir para o "Cuidado Seguro" evitando um evento adverso (DA) e suas repercussões para a vida. Objetivo: Descrever e divulgar aspectos encontrado em todo o mundo sobre o Cuidado Seguro do RNPT com o TET. Desenvolvimento: Pesquisa realizada em diferentes bases de dados: Pubmed, Scielo, BVS, LILACS, Elsevier, utilizando (DeCs) / (MeSH), resgatando artigos nacionais e internacionais, espanhol, inglês e português, a partir de 5 anos, com títulos relacionados ao cuidado do recém-nascido. Três itens foram explorados: posição corporal no RNPT, cuidados de enfermagem omitidos, eventos adversos (EAs) na UTIN. Conclusões: A função respiratória do RNPT com TET é otimizada com o fator de posição corporal. O cuidado omitido tem sido pouco estudado na área neonatal. Os EAs que prevalecem são: aqueles relacionados à terapia de infusão, termorregulação, infecções associadas e extubação não programada (ENP). Cuidados Seguros devem ser abordados em profundidade, a fm de emitir recomendações específcas para este grupo vulnerável da população(AU)

Safety and Efficacy of Prolonged Use of Dalbavancin in Bone and Joint Infections.

Dalbavancin is a lipoglycopeptide with potent activity against Gram-positive microorganisms, a long half-life, a favorable safety profile, and a high concentration in bone, which makes it an interesting alternative for treatment of osteoarticular infections. We performed a multicentric retrospective study of all patients with an osteoarticular infection (septic arthritis, spondylodiscitis, osteomyelitis, or orthopedic implant-related infection) treated with at least one dose of dalbavancin between 2016 and 2017 in 30 institutions in Spain. In order to evaluate the response, patients with or without an orthopedic implant were separated. A total of 64 patients were included. Staphylococcus epidermidis and Staphylococcus aureus were the most frequent microorganisms. The reasons for switching to dalbavancin were simplification (53.1%), adverse events (25%), or failure (21.9%). There were 7 adverse events, and no patient had to discontinue dalbavancin. In 45 cases, infection was related to an orthopedic implant. The implant material was retained in 23 cases, including that in 15 (65.2%) patients that were classified as cured and 8 (34.8%) that presented improvement. In 21 cases, the implants were removed, including those in 16 (76.2%) cases that were considered successes, 4 (19%) cases were considered improved, and 1 (4.8%) case that was considered a failure. Among the 19 cases without implants, 14 (73.7%) were considered cured, 3 (15.8%) were considered improved, and 2 (10.5%) were considered failures. The results show that dalbavancin is a well-tolerated antibiotic, even when >2 doses are administered, and is associated with a high cure rate. These are preliminary data with a short follow-up; therefore, it is necessary to gain more experience and, in the future, to establish the most appropriate dose and frequency.

Staphylococcus aureus meningitis in adults: A comparative cohort study of infections caused by meticillin-resistant and meticillin-susceptible strains.

BACKGROUND: Staphylococcus aureus meningitis is an uncommon nosocomial infection usually associated with neurosurgical procedures, but spontaneous infections may occasionally appear. AIMS: To compare the features of meningitis caused by meticillin-resistant (MRSA) and meticillin-susceptible (MSSA) S. aureus and examine the prognostic factors for mortality, including MRSA infection and combined antimicrobial therapy. METHODS: Retrospective cohort study of 350 adults with S. aureus meningitis admitted to 11 hospitals in Spain (1981-2015). Logistic regression and propensity score matching were used to analyse prognostic factors. RESULTS: There were 118 patients (34%) with MRSA and 232 (66%) with MSSA. Postoperative infection (91% vs 73%) and nosocomial acquisition (93% vs 74%) were significantly more frequent in MRSA than in MSSA meningitis (P < 0.001). Combined therapy was given to 118 (34%) patients. Overall 30-day mortality rate was 23%. On multivariate analysis, mortality was associated with severe sepsis or shock (odds ratio (OR) 9.9, 95% confidence interval (CI) 4.5-22.0, P < 0.001), spontaneous meningitis (OR 4.2, 95% CI 1.9-9.1, P < 0.001), McCabe-Jackson score rapidly or ultimately fatal (OR 2.8, 95% CI 1.4-5.4, P = 0.002), MRSA infection (OR 2.6, 95% CI 1.3-5.3, P = 0.006), and coma (OR 2.6, 95% CI 1.1-6.1, P < 0.029). In postoperative cases, mortality was related to retention of cerebrospinal devices (OR 7.9, 95% CI 3.1-20.3, P < 0.001). CONCLUSIONS: Clinical and epidemiological differences between MRSA and MSSA meningitis may be explained by the different pathogenesis of postoperative and spontaneous infection. In addition to the severity of meningitis and underlying diseases, MRSA infection was associated with increased mortality. Combined antimicrobial therapy was not associated with increased survival.

Asthma Exacerbations in the Pediatric Emergency Department at a Tertiary Hospital: Association With Environmental Factors.

INTRODUCTION: Children with asthma experience recurrent respiratory symptoms and exacerbations due to multiple environmental factors. The aim of this study was to describe the prevalence and triggers of asthma exacerbations and their management in a cohort of pediatric patients attended in an emergency department (ED). METHODS: We performed an observational, retrospective, single-center study in the pediatric ED of Hospital Universitario La Paz, Madrid, Spain in 2015. Children with asthma exacerbations attending the ED were included after a thorough search using our institutional computer database. Pollen and atmospheric mold spore counts and pollution data were collected for that period from official websites. Multiple logistic regression was used to assess the association between daily pollution (NO2, PM10, ozone, pollen, and molds) and admissions to the ED because of asthma. RESULTS: During 2015, a total of 50 619 patients were attended in the ED of our hospital. Of these, 2609 (5%) were diagnosed with asthma exacerbation/bronchospasm. The patient had to be admitted to hospital in 21.7% of cases. The main triggers of asthma exacerbations were respiratory infection in 1841 cases (70.6%). A significant correlation was found between grass pollen counts and ED admissions (P<.0001). A positive correlation was also found between ED admissions and NO2 0.58 (95%CI, 0.02-0.87) and PM10 0.75 (95%CI, 0.31-0.93) (P<.05). CONCLUSION: Environmental factors such as grass pollen counts and pollution (NO2 and PM10) are associated with a higher frequency of admission to the ED.

Evaluation of an Online Educational Program for Parents and Caregivers of Children With Food Allergies.

BACKGROUND AND OBJECTIVE: The increasing prevalence of food allergy affects both patients and their families. Objective: The aim of this study was to evaluate the impact of an online educational program designed for parents and caregivers of children with food allergies. The program was developed by a multidisciplinary group comprising health care professionals, researchers, and expert patients under the participatory medicine model. MATERIAL AND METHODS: Participants took a 2-week online educational program covering major topics in food allergy management. General knowledge about the disease, symptoms, treatment, and topics relevant to families' daily lives were evaluated. The contents included educational videos, online forums, and live video chats. A pretest/posttest questionnaire survey was used to evaluate the impact of the program. RESULTS: A total of 207 participants enrolled in the educational program, which was completed by 130 (62.8%). Knowledge acquisition improved significantly following participation in the program in 15 out of 30 items (50%), reaching P<.001 for 8 items (26.7%). Of the 207 participants who started the program, 139 (67.1%) visited online forums, and 27.5% attended video chats. Average overall satisfaction with the educational program was 8.78 (on a scale of 0 to 10). CONCLUSIONS: The results obtained show that parents improved their knowledge in all areas of food allergy. The high level of satisfaction among participants suggests that digital learning tools are effective and motivational, enabling patients to acquire appropriate knowledge and thus increasing their quality of life.

Evaluation of an online educational program for parents and caregivers of children with food allergies

Background: The increasing prevalence of food allergy affects both patients and their families. Objective: The aim of this study was to evaluate the impact of an online educational program designed for parents and caregivers of children with food allergies. The program was developed by a multidisciplinary group comprising health care professionals, researchers, and expert patients under the participatory medicine model. Material and Methods: Participants took a 2-week online educational program covering major topics in food allergy management. General knowledge about the disease, symptoms, treatment, and topics relevant to families’ daily lives were evaluated. The contents included educational videos, online forums, and live video chats. A pretest/posttest questionnaire survey was used to evaluate the impact of the program. Results: A total of 207 participants enrolled in the educational program, which was completed by 130 (62.8%). Knowledge acquisition improved significantly following participation in the program in 15 out of 30 items (50%), reaching P<.001 for 8 items (26.7%). Of the 207 participants who started the program, 139 (67.1%) visited online forums, and 27.5% attended video chats. Average overall satisfaction with the educational program was 8.78 (on a scale of 0 to 10). Conclusions: The results obtained show that parents improved their knowledge in all areas of food allergy. The high level of satisfaction among participants suggests that digital learning tools are effective and motivational, enabling patients to acquire appropriate knowledge and thus increasing their quality of life (AU)

Introducción: El aumento de la prevalencia de la alergia alimentaria afecta no solo a los pacientes, sino también a sus familias. Objetivo: Evaluar el impacto de un programa educativo online, diseñado para padres y cuidadores de niños con alergia alimentaria. El programa fue desarrollado por un grupo multidisciplinario de profesionales sanitarios, investigadores y pacientes expertos, bajo el modelo de la medicina participativa. Material y métodos: Los participantes tomaron parte en un programa educativo online de dos semanas que cubría los principales temas relacionados con la alergia a alimentos. Se evaluó el conocimiento general acerca de la enfermedad y aspectos relevantes para la vida diaria de la familia. Los contenidos incluyeron: videos educativos, foros online y videoconferencias en directo. Para evaluar el impacto del programa se utilizó un cuestionario pre y post-intervención. Resultados: Un total de 207 participantes se inscribieron en el programa. De éstos 130 (62,8%) lo completaron. En 15 (50%) de los 30 aspectos evaluados se observó mejoría en el conocimiento previo, alcanzando una significación de <0,001 en 8 ítems (26,7%). De los 207 participantes que iniciaron el programa, 139 (67,1%) visitaron los foros online y 27,5% asistieron a las videoconferencias. La satisfacción media con el programa fue de 8,78 (escala 0 a 10). Conclusión: Los resultados demuestran la mejoría del conocimiento de los padres en los temas incluidos en el programa. La alta satisfacción obtenida sugiere que las herramientas de aprendizaje digital son eficaces y motivadoras para adquirir conocimientos y habilidades que permitan mejorar la calidad de vida (AU)

Environmental assessment of potential toxic trace element contents in the inundated floodplain area of Tablas de Daimiel wetland (Spain).

Contamination of aquatic systems with potentially toxic trace elements (PTEs) is a major problem throughout the world. The National Park Tablas de Daimiel (NPTD) is considered to make up one of the two most important wetlands in the Biosphere Reserve called "Wet Spot." Since PTEs are good indicator of the prevailing environmental conditions and possible contamination, soil samples collected from 43 sites were analyzed in order to investigate the levels and its distribution of these elements, in the inundated floodplain area of the NPTD wetland. In addition, some physicochemical parameters such as pH, electrical conductivity and organic matter were measured. The total concentrations of 32 trace elements were determined by X-ray fluorescence. The results show that there was accumulation of lead (Pb), tin (Sn), selenium (Se), antimony (Sb), copper (Cu), vanadium (V), nickel (Ni), zinc (Zn), arsenic (As), strontium (Sr) and zirconium (Zr)-in some cases at high concentrations. The interpolated maps showed that the distributions of some of these elements and in some cases the trend in spatial variability are pronounced and decrease from the inlet to the outlet. The values for some elements are higher than the reference values, which is consistent with contamination (some values are higher by a factor of more than 10 compared to the reference). In the case of iodine (I), the levels at some sample points are significantly more than ten times the reference; Se appears in the range from 1.0 to 9.8 mg/kg, with an average value of 3.1 mg/kg, and these can be considered as seleniferous soils. The concentrations found are consistent with the introduction in the wetland of pollution by human activities, such as agricultural non-point sources, uncontrolled fertilization over many years, treatment with urban wastewater and other possible sources.