Neuralgia lagrimal recurrente desencadenada por procedimientos oftalmológicos / Recurrent lacrimal neuralgia secondary to ophthalmological procedures

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ALBIRA: a small animal PET∕SPECT∕CT imaging system.

PURPOSE: The authors have developed a trimodal PET∕SPECT∕CT scanner for small animal imaging. The gamma ray subsystems are based on monolithic crystals coupled to multianode photomultiplier tubes (MA-PMTs), while computed tomography (CT) comprises a commercially available microfocus x-ray tube and a CsI scintillator 2D pixelated flat panel x-ray detector. In this study the authors will report on the design and performance evaluation of the multimodal system. METHODS: X-ray transmission measurements are performed based on cone-beam geometry. Individual projections were acquired by rotating the x-ray tube and the 2D flat panel detector, thus making possible a transaxial field of view (FOV) of roughly 80 mm in diameter and an axial FOV of 65 mm for the CT system. The single photon emission computed tomography (SPECT) component has a dual head detector geometry mounted on a rotating gantry. The distance between the SPECT module detectors can be varied in order to optimize specific user requirements, including variable FOV. The positron emission tomography (PET) system is made up of eight compact modules forming an octagon with an axial FOV of 40 mm and a transaxial FOV of 80 mm in diameter. The main CT image quality parameters (spatial resolution and uniformity) have been determined. In the case of the SPECT, the tomographic spatial resolution and system sensitivity have been evaluated with a (99m)Tc solution using single-pinhole and multi-pinhole collimators. PET and SPECT images were reconstructed using three-dimensional (3D) maximum likelihood and ordered subset expectation maximization (MLEM and OSEM) algorithms developed by the authors, whereas the CT images were obtained using a 3D based FBP algorithm. RESULTS: CT spatial resolution was 85 µm while a uniformity of 2.7% was obtained for a water filled phantom at 45 kV. The SPECT spatial resolution was better than 0.8 mm measured with a Derenzo-like phantom for a FOV of 20 mm using a 1-mm pinhole aperture collimator. The full width at half-maximum PET radial spatial resolution at the center of the field of view was 1.55 mm. The SPECT system sensitivity for a FOV of 20 mm and 15% energy window was 700 cps∕MBq (7.8 × 10(-2)%) using a multi-pinhole equipped with five apertures 1 mm in diameter, whereas the PET absolute sensitivity was 2% for a 350-650 keV energy window and a 5 ns timing window. Several animal images are also presented. CONCLUSIONS: The new small animal PET∕SPECT∕CT proposed here exhibits high performance, producing high-quality images suitable for studies with small animals. Monolithic design for PET and SPECT scintillator crystals reduces cost and complexity without significant performance degradation.

Expectation maximization (EM) algorithms using polar symmetries for computed tomography (CT) image reconstruction.

We suggest a symmetric-polar pixellation scheme which makes possible a reduction of the computational cost for expectation maximization (EM) iterative algorithms. The proposed symmetric-polar pixellation allows us to deal with 3D images as a whole problem without dividing the 3D problem into 2D slices approach. Performance evaluation of each approach in terms of stability and image quality is presented. Exhaustive comparisons between all approaches were conducted in a 2D based image reconstruction model. From these 2D approaches, that showing the best performances were finally implemented and evaluated in a 3D based image reconstruction model. Comparison to 3D images reconstructed with FBP is also presented. Although the algorithm is presented in the context of computed tomography (CT) image reconstruction, it can be applied to any other tomographic technique as well, due to the fact that the only requirement is a scanning geometry involving measurements of an object under different projection angles. Real data have been acquired with a small animal (CT) scanner to verify the proposed mathematical description of the CT system.

Design and evaluation of the MAMMI dedicated breast PET.

PURPOSE: A breast dedicated positron emission tomography (PET) scanner has been developed based on monolithic LYSO crystals coupled to position sensitive photomultiplier tubes (PSPMTs). In this study, we describe the design of the PET system and report on its performance evaluation. METHODS: MAMMI is a breast PET scanner based on monolithic LYSO crystals. It consists of 12 compact modules with a transaxial field of view (FOV) of 170 mm in diameter and 40 mm axial FOV that translates to cover up to 170 mm. The patient lies down in a prone position that facilitates maximum breast elongation. Quantitative performance analysis of the calculated method for the attenuation correction specifically developed for MAMMI, and based on PET image segmentation, has also been conducted in this evaluation. In order to fully determine the MAMMI prototype's performance, we have adapted the measurements suggested for National Electrical Manufacturers Association (NEMA) NU 2-2007 and NU 4-2008 protocol tests, as they are defined for whole-body and small animal PET scanners, respectively. RESULTS: Spatial resolutions of 1.6, 1.8, and 1.9 mm were measured in the axial, radial, and tangential directions, respectively. A scatter fraction of 20.8% was obtained and the maximum NEC was determined to be 25 kcps at 44 MBq. The average sensitivity of the system was observed to be 1% for an energy window of (250 keV-750 keV) and a maximum absolute sensitivity of 1.8% was measured at the FOV center. CONCLUSIONS: The overall performance of the MAMMI reported on this evaluation quantifies its ability to produce high quality PET images. Spatial resolution values below 3 mm were measured in most of the FOV. Only the radial component of spatial resolution exceeds the 3 mm at radial positions larger than 60 mm. This study emphasizes the need for standardized testing methodologies for dedicated breast PET systems similar to NEMA standards for whole-body and small animal PET scanners.

Small animal PET scanner based on monolithic LYSO crystals: performance evaluation.

PURPOSE: The authors have developed a small animal Positron emission tomography (PET) scanner based on monolithic LYSO crystals coupled to multi-anode photomultiplier tubes (MA-PMTs). In this study, the authors report on the design, calibration procedure, and performance evaluation of a PET system that the authors have developed using this innovative nonpixelated detector design. METHODS: The scanner is made up of eight compact modules forming an octagon with an axial field of view (FOV) of 40 mm and a transaxial FOV of 80 mm diameter. In order to fully determine its performance, a recently issued National Electrical Manufacturers Association (NEMA) NU-4 protocol, specifically developed for small animal PET scanners, has been followed. By measuring the width of light distribution collected in the MA-PMT the authors are able to determine depth of interaction (DOI), thus making the proper identification of lines of response (LORs) with large incidence angles possible. PET performances are compared with those obtained with currently commercially available small animal PET scanners. RESULTS: At axial center when the point-like source is located at 5 mm from the radial center, the spatial resolution measured was 1.65, 1.80, and 1.86 mm full width at half maximum (FWHM) for radial, tangential, and axial image profiles, respectively. A system scatter fraction of 7.5% (mouse-like phantom) and 13% (rat-like phantom) was obtained, while the maximum noise equivalent count rate (NECR) was 16.9 kcps at 12.7 MBq (0.37 MBq/ml) for mouse-like phantom and 12.8 kcps at 12.4 MBq (0.042 MBq/ml) for rat-like phantom The peak absolute sensitivity in the center of the FOV is 2% for a 30% peak energy window. Several animal images are also presented. CONCLUSIONS: The overall performance of our small animal PET is comparable to that obtained with much more complex crystal pixelated PET systems. Moreover, the new proposed PET produces high-quality images suitable for studies with small animals.

Desarrollo de un sistema SPECT-pinhole de radio variable con una gammacámara portátil / Development of a variable-radius pinhole SPECT system with a portable gamma camera

Objetivo. Desarrollar un sistema SPECT de animal pequeño utilizando una cámara portátil de bajo coste equipada con colimador de tipo pinhole (con agujero de alfiler), un cristal de centelleo continuo y un tubo fotomultiplicador sensible a la posición. Material y métodos. Se incorporó la gammacámara a un sistema de radio variable que nos permitió optimizar la resolución y la sensibilidad ajustando el radio de rotación al tamaño del objeto. A fin de investigar la capacidad del sistema SPECT para obtener imágenes de animal pequeño se estudió la dependencia de la resolución y los parámetros de calibración con el radio, y se realizaron adquisiciones de maniquí de tamaño pequeño y de ratones. Resultados. Se obtuvieron valores de resolución de 1mm para un radio de 21,4mm hasta 1,4mm para un radio de 37,2mm, justificando el interés en un sistema SPECT de radio variable. Conclusiones. Los resultados de calidad de imagen de los maniquís y animales fueron satisfactorios, confirmando la utilidad del sistema SPECT para realizar estudios de animal pequeño(AU)

Objective. To develop a small-animal SPECT system using a low cost commercial portable gamma camera equipped with a pinhole collimator, a continuous scintillation crystal and a position-sensitive photomultiplier tube. Material and methods. The gamma camera was attached to a variable radius system, which enabled us to optimize sensitivity and resolution by adjusting the radius of rotation to the size of the object. To investigate the capability of the SPECT system for small animal imaging, the dependence of resolution and calibration parameters on radius was assessed and acquisitions of small phantoms and mice were carried out. Results. Resolution values, ranging from 1.0mm for a radius of 21.4mm and 1.4mm for a radius of 37.2mm were obtained, thereby justifying the interest of a variable radius SPECT system. Conclusions. The image quality of phantoms and animals were satisfactory, thus confirming the usefulness of the system for small animal SPECT imaging(AU)

Development of a variable-radius pinhole SPECT system with a portable gamma camera.

OBJECTIVE: To develop a small-animal SPECT system using a low cost commercial portable gamma camera equipped with a pinhole collimator, a continuous scintillation crystal and a position-sensitive photomultiplier tube. MATERIAL AND METHODS: The gamma camera was attached to a variable radius system, which enabled us to optimize sensitivity and resolution by adjusting the radius of rotation to the size of the object. To investigate the capability of the SPECT system for small animal imaging, the dependence of resolution and calibration parameters on radius was assessed and acquisitions of small phantoms and mice were carried out. RESULTS: Resolution values, ranging from 1.0mm for a radius of 21.4mm and 1.4mm for a radius of 37.2mm were obtained, thereby justifying the interest of a variable radius SPECT system. CONCLUSIONS: The image quality of phantoms and animals were satisfactory, thus confirming the usefulness of the system for small animal SPECT imaging.

Monitoring system for isolated limb perfusion based on a portable gamma camera.

BACKGROUND: The treatment of malignant melanoma or sarcomas on a limb using extremity perfusion with tumour necrosis factor (TNF-alpha) and melphalan can result in a high degree of systemic toxicity if there is any leakage from the isolated blood territory of the limb into the systemic vascular territory. Leakage is currently controlled by using radiotracers and heavy external probes in a procedure that requires continuous manual calculations. The aim of this work was to develop a light, easily transportable system to monitor limb perfusion leakage by controlling systemic blood pool radioactivity with a portable gamma camera adapted for intraoperative use as an external probe, and to initiate its application in the treatment of MM patients. METHODS: A special collimator was built for maximal sensitivity. Software for acquisition and data processing in real time was developed. After testing the adequacy of the system, it was used to monitor limb perfusion leakage in 16 patients with malignant melanoma to be treated with perfusion of TNF-alpha and melphalan. RESULTS: The field of view of the detector system was 13.8 cm, which is appropriate for the monitoring, since the area to be controlled was the precordial zone. The sensitivity of the system was 257 cps/MBq. When the percentage of leakage reaches 10% the associated absolute error is +/-1%. After a mean follow-up period of 12 months, no patients have shown any significant or lasting side-effects. Partial or complete remission of lesions was seen in 9 out of 16 patients (56%) after HILP with TNF-alpha and melphalan. CONCLUSION: The detector system together with specially developed software provides a suitable automatic continuous monitoring system of any leakage that may occur during limb perfusion. This technique has been successfully implemented in patients for whom perfusion with TNF-alpha and melphalan has been indicated.

[Importance of the antimicrobial spectrum and the bacterial resistances in the antibiotic choice for the treatment of pediatric patients with communitary infections]. / Importancia de la cobertura antimicrobiana y de las resistencias bacterianas en la elección de antibióticos en Pediatría.

OBJECTIVE: This study aimed to know the importance of the antimicrobial spectrum and the bacterial resistances for the antibiotic choice in the extrahospitalary pediatric area, at the same time that establish the relationship with others therapeutics parameters. MATERIAL AND METHODS: Cross-sectional, observational study within the MUSA (Improvement of Use of Antimicrobial Agents in Primary Health Care) Project made by personal interview of 210 pediatrician doctors randomly selected with national representation. This target is included in a bigger universe (855 doctors) representative of the most doctors responsible of the antibiotic prescriptions in the extrahospitalary area (sample error of the 3.3% for a 95% confidence interval and maximum response dispersion: p=q=50). The results of the pediatric study were subjected to a comparative analysis with the results of a similar study made ten years ago and with the global results of the general study. The questionnaire used for the interview had two clearly different parts: in the first part, the questions were open with the objective to get spontaneous answers from the participants; the second part had questions with suggested answers. RESULTS: Clinical efficacy is the most spontaneously valued issue by the Spanish pediatricians when it comes to choosing an antimicrobial agent; efficacy is followed by tolerance/safety and posology. Antimicrobial spectrum is mentioned by one out of 4-5 pediatricians that have participated in the study (21.9%), while the bacterial resistances are only mentioned by a 3.8%. In a suggested level, clinical efficacy is still the most valued parameter, being identified by 7 out of 10 interviewed with the bacterial eradication. In this case, the antimicrobial spectrum is the following parameter on significance, appearing as a synonym of "activity against specific microorganisms" in 2 out of 3 cases. In relation to his own evaluation, 3 out of 4 pediatricians say they take "a lot" of the bacterial resistances into consideration, who are mostly understood as "global rate" for 5-6 out of 10 interviewed, whether the resistance showed by the pneumococcal is what worried the most to 4 out of 10 of them. This importance given to the bacterial resistances at the second part of the study contrasts with the low consideration showed when it is compared with other parameters and the valoration is treated in a spontaneous way. In relation to a similar study realized on 1997 (Urano Proyect), we observe that clinical efficacy has replaced tolerance/safety as a parameter to bear in mind, probably as a consequence of more experience and confidence with the most important antimicrobial agents in the antibiotic prescriptions in podiatry. On the other hand, the bacterial resistances still being left out on the pediatricians spontaneous consideration, a fact that is shared with the majority of the collectives participating on the general study. The rest of the parameters stay in a similar way. CONCLUSIONS: Is necessary to emphasize at the importance of bacterial resistances in the antimicrobials rational use on the pediatric patient. As the antimicrobial tolerance profile has been improving in the last ten years, clinical efficacy, understood as "bacterial eradication" has became the most determining parameter when choosing antimicrobial agents.

[Behavior of the primary care physicians in the treatment of community infections]. / Comportamiento de los médicos de Atención Primaria en el tratamiento de las infecciones comunitarias.

This study aimed to evaluate the behavior of the physicians who attend to patients with community infections who are responsible for most of the antibiotic prescriptions made in the community setting. Furthermore, the evolution over the last 10 years in regards to the treatment habits of the most frequent infections in Primary Health Care (PHC) was studied and prescription behaviors were analyzed in relationship to the acquaintance and attitude of the participating physicians. A data collection sheet from 1,411 prescriptions made by 855 physicians from different specialties was used to conduct the study. This represents a statistically significant sample nationwide both from the point of view of the physicians involved in the treatment of infectious diseases in PHC as well as regarding to the prescriptions they have written. The study reveals the amplitude of respiratory and pararespiratory disease with oral antimicrobial agents, particularly beta-lactamics, and the significant advance in the last 10 years in the use of amoxicillin and clavulanic acid as treatment of choice. Treatment duration was somewhat longer while the number of containers prescribed was less than in the previous study. This would be related to the use of more spaced doses of the antimicrobial agents. Furthermore, the study reveals some discrepancies between attitudes and events of the physicians in the approach to certain diagnoses. Key words: Behavior. Primary care physicians. Prescription. Antimicrobials agents.

[Antimicrobial selection criteria evaluation by family doctors and general practitioners]. / Evaluación de los criterios de selección de antimicrobianos por los médicos generales y de familia.

OBJECTIVE: This study has aimed to know the criteria used by the Spanish medical practitioners/family doctors (MP/FD) when choosing an antimicrobial agent in their daily practice and to compare it with that existing one decade ago. MATERIAL AND METHODS: This is an observational, cross-sectional study performed with a structured personal interview to 450 MP/FDs randomly chosen with representativeness on the national level. The field work was made by specialized personnel in the last quarter of the year 2006. A 95.5% confidence interval margin was proposed, with a sample error = 4.7%, for maximum dispersion response (p=q=50). RESULTS: The parameter considered most when choosing an antibiotic treatment (spontaneous response) is clinical efficacy (two out of every three doctors). Clinical efficacy is following by the dosage regime and tolerability/safety, which was the principal parameter expressed ten years ago. Following these are antibacterial spectrum, administration route, price and bacterial resistances. However, they considered that the latter significantly influence clinical efficacy and when they are not relativized with other parameters, the doctors state that they take them into account <>. It seems that the opinion of the patient is usually considered and that the protocol, scientific information and expert's opinions are the principal sources of information considered when prescribing an antimicrobial agent. Amoxicillin/clavulanate is the antibiotic drug of choice in all upper and lower respiratory tract infections. There is overestimation of the bacterial etiology in throat infections and acute bronchitis and S. pyogenes to betalactamic antibiotics. It is concluded that knowledge of the Spanish MP/DF regarding antimicrobial therapy has improved in recent years and that clinical efficacy, related with bacterial eradication and not only with clinical remission, is the factor that should be considered when choosing an antibiotic.

Comportamiento de los médicos de Atención Primaria en el tratamiento de las infecciones comunitarias / Behavior of de Primary Care physicians in the treatment of community infections

El objetivo del estudio fue valorar el comportamientode los médicos que atienden a pacientes con infecciones dela comunidad y son responsables de la mayoría de las prescripcionesantibióticas realizadas en el ámbito extrahospitalario.Al mismo tiempo se estudió la evolución experimentadaen los últimos 10 años en cuanto a los hábitos detratamiento de las infecciones más frecuentes en la AtenciónPrimaria de Salud (APS) y se analizaron las conductasde prescripción en relación al conocimiento y la actitud de losmédicos participantes. El estudio se llevó a cabo medianteuna hoja de recogida de datos procedentes de 1.411 prescripcionesrealizadas por 855 médicos de distintas especialidades,lo que representa una muestra estadísticamente significativaen el ámbito nacional tanto desde el punto devista de los médicos involucrados en el tratamiento de lasenfermedades infecciosas en la APS como de las prescripcionesrealizadas por los mismos. El estudio pone de manifiestola abundancia de la patología respiratoria y pararrespiratoriatratada con antimicrobianos orales, especialmentebetalactámicos, así como el significativo avance en los últimos10 años en la utilización de amoxicilina-ácido clavulánicocomo tratamiento de elección. La duración del tratamientofue algo mayor, mientras que el número de envasesprescritos fue menor que en el estudio anterior, lo que estaríaen relación con la utilización de dosis de antimicrobianosmás espaciadas. Asimismo, el estudio saca a la luz ciertasdiscrepancias entre las actitudes y los comportamientos delos médicos en el abordaje de determinados diagnósticos (AU)

This study aimed to evaluate the behavior of thephysicians who attend to patients with community infectionswho are responsible for most of the antibioticprescriptions made in the community setting. Furthermore,the evolution over the last 10 years in regards tothe treatment habits of the most frequent infections inPrimary Health Care (PHC) was studied and prescriptionbehaviors were analyzed in relationship to the acquaintanceand attitude of the participating physicians. A datacollection sheet from 1,411 prescriptions made by 855 physiciansfrom different specialties was used to conduct thestudy. This represents a statistically significant samplenationwide both from the point of view of the physiciansinvolved in the treatment of infectious diseases in PHCas well as regarding to the prescriptions they have written.The study reveals the amplitude of respiratory and pararespiratorydisease with oral antimicrobial agents, particularlybeta-lactamics, and the significant advance in the last 10years in the use of amoxicillin and clavulanic acid astreatment of choice. Treatment duration was somewhatlonger while the number of containers prescribed wasless than in the previous study. This would be related tothe use of more spaced doses of the antimicrobial agents.Furthermore, the study reveals some discrepancies betweenattitudes and events of the physicians in the approach tocertain diagnoses

[Knowledge and attitude of primary health care doctors in the treatment of community-acquired infections]. / Conocimiento y actitud de los médicos de atención primaria en el tratamiento de las infecciones comunitarias.

The aim of this study was to evaluate the knowledge and attitude of the doctors who attend patients with community-acquired infections and who are responsible for most of the antibiotic prescriptions in primary health care. At the same time, the evolution experienced in the last ten years in relation to the main parameters analyzed was studied. The study was conducted by personal interviews, using a structured questionnaire, administered to 855 doctors of different specialties, who make up a statistically significant nationwide sample. The study showed that in spite of the improvements in the knowledge of the microbiology of infectious diseases and the choice of antimicrobial agents, there are still certain areas that need improvement. These are, above all, in regard to the bacterial resistance problem, underevaluation of the viral etiology of certain respiratory tract infections and the somewhat condescending attitude with "visits by third parties", indulgence prescriptions and therapeutic noncompliance. Efficacy defined not only as clinical remission but also, and essentially, as antibacterial coverage, are the main parameters considered when participating physicians choose an antibiotic.

[Storage of antibiotics in Spanish households]. / Almacenamiento de antibioticos en los hogares espanoles.

This study aimed to determine how many antibiotics were stored in Spanish households, analyzing their origin and characteristics (number, antibiotic type and pharmaceutical form). In addition, some general characteristics of the "home medicine cabinet" were investigated. The study was conducted by telephone interviews with one of the heads of the family in 1,000 randomly chosen Spanish homes, but in accordance with a territorial distribution proportional to the Spanish population and to the urban and rural setting. According to the results obtained, there was at least one antibiotic packet in 37% of Spanish households, mostly corresponding (96.5%) to broad-spectrum semisynthetic penicillin (amoxycillin or clavulanic-amoxycillin). A total of 59.2% of the packets found corresponded to solid oral forms (tablets, capsules, etc.) and 40.4% corresponded to liquid oral forms (syrup, suspension, sachet). The antibiotics were mostly obtained by medical prescription (84.9%), self-medication being the origin in almost 15% of them. There was a member of the family under antibiotic treatment at the time of the study in only 30% of the households that had one or more containers. The financial evaluation of the "leftover" antibiotic doses makes it possible to estimate a cost of about 18 million euros, more than 12 million of which would have been financed by the Health Care Administration. The results show that storing of antibiotics continues to be important in Spain, even though a considerable decrease has been observed in the last 10 years. This could be related to a progressive abandonment of self-medicating attitudes.

Almacenamiento de antibióticos en los hogares españoles / Storage of antibiotics in Spanish households

El objetivo del estudio fue determinar el almacenamiento de antibióticos en los hogares españoles, analizando su origen y características(número, tipo de antibiótico y forma de presentación). Al mismo tiempo se investigaron algunas características generales del botiquín casero.El estudio se llevó a cabo mediante entrevista telefónica con el ama de casa o cabeza de familia en 1000 hogares españoles elegidos de formaaleatoria, pero de acuerdo a una distribución territorial proporcional a la población española y al ámbito urbano y rural. Según los resultadosobtenidos, en el 37% de los hogares españoles existe al menos un envase antibiótico, correspondiente en la gran mayoría de loscasos (96,5%) a una penicilina semisintética de amplio espectro (amoxicilina o amoxicilina-ácido clavulánico). El 59,2% de los envases encontradosfueron de una forma de presentación oral sólida y el 40,4% de una forma oral líquida. El envase procedía en la mayoría de loscasos de la prescripción del médico (84,9%), siendo la automedicación el origen de casi el 15%. Únicamente en el 30% de los hogares enque existía uno o más envases había algún miembro de la familia con tratamiento antibiótico en el momento del estudio. La evaluacióneconómica de las dosis no utilizadas y presentes en los envases antibióticos almacenados permite estimar un gasto cercano a los 18 millonesde euros, de los que más de 12 millones habrían sido financiados por la Administración. Los resultados revelan que el almacenamiento deantibióticos sigue siendo importante en España, a pesar de apreciarse un considerable descenso en los últimos diez años, que podría estarrelacionado con un progresivo abandono de la automedicación

This study aimed to determine how many antibiotics were stored in Spanish households, analyzing their origin and characteristics (number,antibiotic type and pharmaceutical form). In addition, some general characteristics of the “home medicine cabinet” were investigated. Thestudy was conducted by telephone interviews with one of the heads of the family in 1,000 randomly chosen Spanish homes, but in accordancewith a territorial distribution proportional to the Spanish population and to the urban and rural setting. According to the resultsobtained, there was at least one antibiotic packet in 37% of Spanish households, mostly corresponding (96.5%) to broad-spectrum semisyntheticpenicillin (amoxycillin or clavulanic-amoxycillin). A total of 59.2% of the packets found corresponded to solid oral forms (tablets,capsules, etc.) and 40.4% corresponded to liquid oral forms (syrup, suspension, sachet). The antibiotics were mostly obtained by medicalprescription (84.9%), self-medication being the origin in almost 15% of them. There was a member of the family under antibiotic treatmentat the time of the study in only 30% of the households that had one or more containers. The financial evaluation of the “leftover” antibioticdoses makes it possible to estimate a cost of about 18 million euros, more than 12 million of which would have been financed by the HealthCare Administration. The results show that storing of antibiotics continues to be important in Spain, even though a considerable decreasehas been observed in the last 10 years. This could be related to a progressive abandonment of self-medicating attitudes

Influencia de fármacos inhibidores de bombas de iones en la acumulación de ofloxacino y grepafloxacino en el interior de los leucocitos polimorfonucleares humanos / Influence of ion pump-inhibiting drugs on the accumulation of ofloxacin and grepafloxacin in human polymorphonuclear leukocytes

En este estudio se ha comprobado la influencia de tres fármacos inhibidores de diferentes bombas de iones (digoxina, omeprazol y verapamilo) sobre la acumulación de ofloxacino y grepafloxacino en el interior de los leucocitos polimorfonucleares humanos. Se establecieron dos condiciones de ensayo: preincubando las células con el fármaco antes de añadir la quinolona, y añadiendo simultáneamente ambos fármacos al medio. El I/E máximo de ofloxacino es diferente según la condición de ensayo: 7,69ñ0,88, 5,64ñ1,91 y 3,56ñ1,04 para el ensayo sin preincubación y preincubando las células durante 30 y 60 minutos a 37 ºC, respectivamente. De igual forma, los máximos para grepafloxacino fueron 61,27ñ3,04, 32,18ñ3,25 y 22,52ñ3,86. La digoxina no modifica significativamente la acumulación de las quinolonas en el interior de los PMN, aunque induce un aumento de los I/E respecto al control. El omeprazol reduce, en general, la acumulación de ambas quinolonas. Con ofloxacino se reducen significativamente los I/E cuando ambos fármacos se añaden simultáneamente al medio; sin embargo, con grepafloxacino es necesaria una incubación previa de 60 minutos para obtener diferencias. El verapamilo produce un aumento significativo del I/E de ambas quinolonas cuando las células se preincuban con dicho fármaco a 10 veces la concentración plasmática. (AU)

Actividad in vitro de posaconazol frente a levaduras aisladas en hemocultivo / In vitro activity of posaconazole against yeasts isolated in blood cultures

Se ha valorado la actividad in vitro de posaconazol comparándola con la de fluconazol en especies de levaduras aisladas en hemocultivo, así como el factor tiempo de incubación para la detección de resistencias a estos azoles. Se estudiaron un total de 112 levaduras: 32 Candida albicans, 33 C. parapsilosis, 17 C. tropicalis, 8 C. glabrata, 8 C. guilliermondii, 3 C. famata, 2 C. lusitaniae, 1 C. lipolytica, 1 C. inconspicua, 1 C. lambica, 3 Saccharomyces cerevisiae,1 Blastoschizomyces capitatus, 1 Geotricum spp. y 1 Pichia omheri. La CMI se determinó mediante el método de microdilución M27-A descrito por el NCCLS para Candida spp. y Cryptococcus neoformans. Las especies más sensibles a posaconazol fueron C. parapsilosis (CMI90 0,016 mg/l), C. glabrata (CMI90 0,5 mg/l), C. guilliermondii (CMI90 0,12 mg/l) y el grupo de Candida spp. (CMI90 0,25 mg/l). Sin embargo, este azol no mejora la actividad de fluconazol frente a C. tropicalis (CMI90 8 mg/l) y C. albicans (CMI90 8 mg/l). El tiempo de lectura influyó a la hora de detectar resistencias, ya que a las 48 horas el número de cepas resistentes fue mayor que a las 24 horas, en el caso de C. albicans y C. tropicalis; el resto de las especies estudiadas fueron igual de sensibles en los dos tiempos de lectura. (AU)