Registro unicéntrico de ablaciones de taquiarritmias cardíacas en pacientes pediátricos. Seguridad y eficacia / Single-center registry of ablations of arrhythmogenic substrates in pediatric patients. Safety and efficacy

Introducción: Las taquiarritmias en pediatría son uno de las principales motivos cardiológicos de consulta a la guardia. Durante el primer año de vida presentan una significativa morbi-mortalidad, por lo que el tratamiento farmacológico inmediato es fundamental para reducir la misma. Hasta los 3 años existe la posibilidad de curación espontánea en un porcentaje de éstos pacientes. La indicación de procedimientos de ablación durante los primero 4 años de vida se limita a casos refractarios al tratamiento antiarrítmico, dado que cuanto menor peso presenta el paciente, más pequeño es el corazón y más riesgoso es el mismo. Las taquicardias en pacientes con cardiopatía empeora el pronóstico de la misma. A pesar que el tratamiento farmacológico ha permitido el control de la gran mayoría de ellas, en muchos casos se requieren más de una droga antiarrítmica, con mayor exposición a efectos adversos, y en muchos otros se vuelven refractarias. En las últimas 3 décadas se ha desarrollado en forma exponencial el tratamiento de las taquiarritmias por medio de la ablación por radiofrecuencia o por frío (crioablación). Estos procedimientos han permitido obtener la curación de la mayor parte de las taquiarritmias en pediatría. En nuestro trabajo se evaluaron las indicaciones de dichos procedimientos en una población pediátrica, como así también la tasa de éxito, recurrencia, y la morbimortalidad tanto globalmente, como en cada arritmia (AU)

In children, tachyarrhythmias are one of the main reasons for cardiological consultation at the Department of Emergency. In the first year of life, they are associated with significant morbiditymortality and therefore, immediate drug treatment is essential up to 3 years of age. The indication of ablation procedures during the first 4 years of life is limited to patients refractory to antiarrhythmic treatment, since the lower weight of the patient, the smaller the heart and the riskier the intervention. In patients with heart disease, tachycardia worsens the prognosis. Although pharmacological treatment controls the vast majority of tachyarrhythmias, more than one antiarrhythmic drug is often required, leading to greater exposure to adverse effects, and many become refractory. Over the past three decades, treatment of tachyarrhythmias has developed exponentially with the advent of radiofrequency or cold ablation (cryoablation). These procedures have led to the cure of most tachyarrhythmias in children. Our study assessed the indications for these procedures in a pediatric population, as well as the success and recurrence rates, and morbidity both overall and of each arrhythmia episode (AU)

Traducción al castellano y validación de la escala Abbey para la detección del dolor en pacientes no comunicativos / No disponible

Objetivo: El dolor en pacientes no comunicativos es un problema clínico a resolver. En nuestro país, no disponemos de momento, de un método validado al castellano para paliar el problema, por lo que nos propusimos hacerlo validando la escala Abbey. Pacientes y métodos: Incluimos a aquellos pacientes mayores de 60 años, no comunicativos, de ambos sexos, y excluimos a aquellos con un estado febril o con diagnóstico de cáncer, traumatismo cráneo-encefálico, coma neurológico y a todo paciente que podía responder verbalmente a la pregunta de si “tiene usted dolor”, que ingresaron a lo largo de un año en la unidad geriátrica de un hospital general. Al ingreso se aplicaron el MiniMental, la escala Reisburg (Global Deterioration Scale) y la versión española de la escala Abbey, a cada paciente que cumplía los criterios de inclusión. En aquellos pacientes con un dolor potencial, se hizo un seguimiento cada 24 h tras aplicar analgésicos con pauta horaria, según la escalera analgésica de la OMS, hasta la remisión del dolor. Tratamiento estadístico: Propiedades psicométricos de fiabilidad; alfa-cronbach, concordancia interobservador (I:Kappa) e intraobservador (ICC). Propiedades psicométricos de validez; validez predictiva para un punto de corte de tres (curva ROC, especificidad y sensibilidad, I.Youden); validez concordante entre las puntuaciones de la escala y la impresión holística del investigador (coeficiente de correlación de Spearman), y la sensibilidad al cambio (test Wilcoxon). Estudio descriptivo de las variables de la muestra. Resultados: Se recogieron datos de un total de 119 pacientes no verbales de ambos sexos con una edad de 80 ± 0,7 años; el 48% procedía de residencia y un 75% sufría demencia avanzada. El 36% de los pacientes al ingreso tomaban analgésicos. Tras aplicar la escala detectamos 44 pacientes con un dolor potencial que fue resuelto con la pauta analgésica. Los valores para la consistencia interna (α Cronbach = 0,71); concordancia intraobservador (ICC = 0,77) e interobservador (i. kappa = 0,65); sensibilidad al cambio (Z = 5,35); y valor predictivo (curva ROC= 0,94) fueron satisfactorios. La correlación entre la impresión holística del observador y la escala fue altamente significativa (r = 0,78, p < 0,001). Conclusión: A la vista de los aceptables resultados obtenidos proponemos a la escala Abbey en versión al castellano como método fácil, sencillo y confiable para detectar dolor en pacientes españoles no comunicativos (AU)

Objective: The validation of a pain assessment scale for non communicative Spanish patients: Spanish version of the Abbey scale. Patients and methods: Geriatric unit in the hospital setting included all non-communicative patients over 60 years, with the exclusion of those who had respiratory failure, cerebral coma, severe brain trauma, or taking palliative oncological treatment. Variables: age, sex, carer, reason for admission, diagnosis, treatment, scale scores. Patients were evaluated using the Abbey scale for the detection of pain, Mini-Mental for evaluation of cognitive impairment, and the Global Deterioration Scale. When pain was detected it was treated with round the clock analgesics, and the patient was evaluated at 24 hour intervals, until pain was controlled, scale scores were noted each time. Statistical Analyses: Descriptive study of the variables tested. Psychometric properties: Reliability: Intrarater (ICC- intraclass correlation coefficient), Inter-rater (Kappa) and the internal consistency of the scale was measured using α-Cronbach. Validity: predictive validity was measured using ROC curve analysis, concurrent validity (Spearman) and sensitivity to change (Wilcoxon). Results: Data was collected from 119 non communicative patients; 71 (59.7%) women, mean age 81.62 ± 0.716. Pain was detected in 44 patients (37.8%). Reliability: ICC (intrarater) = 0.77; kappa (inter-rater) = 0.65 and α-cronbach (internal consistency) = 0.71. Validity: concurrent validity with the holistic impression of the examiner Pearson coefficient (r = 0.82, p = 0.001). Predictive Validity (ROC curve analysis) for a cut off score of 3; Specifity 100% and sensitivity 95.6% (Youden´s Index 0.96). Sensitivity to change was of statistical significance Z = 5.35. Conclusions: Although results were moderate, findings show evidence of reliability and validity of the Spanish version of the Abbey scale (AU)

Interacciones medicamentosas en pacientes de un servicio de medicina interna / Drug-drug interactions in patients from an internal medicine service

Objetivo: El objetivo de este ensayo fue poder realizar una primera estimación de las interacciones medicamentosas en un servicio de medicina interna y los factores asociados a su aparición. Método: Se diseñó un estudio prospectivo en 120 pacientes elegidos al azar de un total de 376 ingresos durante un período de 3 meses (febrero-abril de 2007) en un servicio de medicina interna. Las interacciones se recogieron en un protocolo diseñado ad hoc. Resultados: El 43% de pacientes tuvo al menos una interacción potencial no deseable y un 14% de las interacciones se asoció con reacciones adversas. El omeprazol fue el fármaco más implicado en las interacciones farmacocinéticas, al prescribirse conjuntamente con acenocumarol, fenitoína y digoxina. Las asociaciones de antiinflamatorios no esteroideos con diuréticos saluréticos, insulina con bloqueadores beta y aspirina con prednisona fueron las interacciones farmacodinámicas más importantes. El número de interacciones estuvo relacionado con el de prescripciones (p < 0,001), no siendo así para el sexo, edad y comorbilidad. Conclusiones: Las interacciones medicamentosas son un problema clínico importante que requiere una mayor información y atención médicas (AU)

Objective: Drug interactions are the cause of serious adverse reactions, the incidence and morbimortality of which are not yet well established. The aim of this study is to carry out an initial estimate of drug interactions in an internal medicine service and to look at any factors associated with their appearance. Method: A prospective study was carried out with 120 patients randomly selected from a total of 376 patients admitted to an internal medicine service over a period of three months (February-April 2007).A protocol was designed on an ad-hoc basis to record the interactions. Results: It was observed that 43% of the patients had at least one potential adverse drug interaction and 14% showed associated adverse interactions. The drug with the highest implications in pharmacokinetic interactions was omeprazole when prescribed with acenocoumarol, phenytoin and digoxin. The most significant pharmacodynamic interactions were with associations between NSAID and saluretic-diuretics, insulin and beta-blockers, and aspirin and prednisone. The number of interactions did relate to the number of prescriptions (p < .001), however this was not the case for gender, age and comorbidity. Conclusions: Drug interaction is a serious clinical problem which requires the availability of more in depth information and medical attention (AU)

[Drug-drug interactions in patients from an internal medicine service]. / Interacciones medicamentosas en pacientes de un servicio de medicina interna.

OBJECTIVE: Drug interactions are the cause of serious adverse reactions, the incidence and morbi-mortality of which are not yet well established. The aim of this study is to carry out an initial estimate of drug interactions in an internal medicine service and to look at any factors associated with their appearance. METHOD: A prospective study was carried out with 120 patients randomly selected from a total of 376 patients admitted to an internal medicine service over a period of three months (February-April 2007). A protocol was designed on an ad-hoc basis to record the interactions. RESULTS: It was observed that 43% of the patients had at least one potential adverse drug interaction and 14% showed associated adverse interactions. The drug with the highest implications in pharmacokinetic interactions was omeprazole when prescribed with acenocoumarol, phenytoin and digoxin. The most significant pharmacodynamic interactions were with associations between NSAID and saluretic-diuretics, insulin and beta-blockers, and aspirin and prednisone. The number of interactions did relate to the number of prescriptions (p < .001), however this was not the case for gender, age and co-morbidity. CONCLUSIONS: Drug interaction is a serious clinical problem which requires the availability of more in depth information and medical attention.

Prescripciones inapropiadas en ancianos institucionalizados / Inappropriate prescriptions in elderly residents of nursing homes

Objetivo: estudiar las prescripciones inapropiadas en ancianos institucionalizados y los factores asociados a éstas. Pacientes y método: estudio epidemiológico prospectivo realizado durante 14 meses en 5 residencias de ancianos de la ciudad de Granada (España) y su área metropolitana; se recogieron los datos relativos a la edad, el sexo, el tipo y número de prescripciones, los diagnósticos, la valoración psicofísica y la presencia de reacciones adversas a los medicamentos de los ancianos. Para las prescripciones inapropiadas se aplicaron los criterios explícitos de Beers, a los que se añadió el zolpidem. Como método estadístico se usó un test logístico de regresión multivariable y se utilizó el paquete estadístico STATA versión 7.0.Resultados: se registraron 2.323 prescripciones, de las que un 19,5 por ciento eran inapropiadas; entre ellas destacaron las benzodiacepinas, zolpidem, vasodilatadores cerebrales, nootrópicos, mezclas de antipsicóticos y ansiolíticos, flebotónicos y antibióticos sistémicos. Hubo un mayor riesgo de incidencia de prescripciones inapropiadas relativas a los sistemas cardiocirculatorio y nervioso y del aparato digestivo, así como en las mujeres. No hallamos que la edad, el número de prescripciones o de diagnósticos, el deterioro psicofísico de los ancianos y la presencia de reacciones adversas a medicamentos se comportaran como factores de riesgo. Conclusiones: en los ancianos de las residencias observamos una elevada proporción de prescripciones inapropiadas de fármacos cardiovasculares, del aparato digestivo y del sistema nervioso central; también en mujeres y en el caso de que el médico prescriptor no fuera el habitual. Destacamos el interés de estos estudios en geriatría (AU)

Reacciones adversas a medicamentos de pronóstico grave en ancianos institucionalizados / Adverse drug reactions with poor prognosis in institutionalized elderly

Objetivo: Estudiar las reacciones adversas a medicamentos (RAM) de pronóstico grave en ancianos institucionalizados. Metodología: Se realizó un estudio epidemiológico prospectivo durante 12 meses recogiendo, de historias clínicas elegidas al azar de ancianos institucionalizados en 5 residencias de Granada y su área metropolitana, información relativa a edad, sexo, número y tipo de medicamentos, diagnóstico y grado de validez fisicopsíquica de los ancianos, RAM con el fármaco imputado y su pronóstico. Como pruebas estadísticas se usaron la de Wilcoxon para variables numéricas y la de Fisher para las cualitativas, y se empleó para el análisis el paquete estadístico STATA versión 7.0.Resultados: En las 400 historias clínicas consultadas se detectaron 75 RAM, de las que un 33 por ciento fueron graves. Los fármacos más implicados fueron los antiinflamatorios no esteroideos (AINE), antidiabéticos y digoxina. Cuatro ancianos requirieron hospitalización por causa de una RAM grave consistente en dos intoxicaciones digitálicas y dos hemorragias digestivas por AINE.No hallamos diferencias estadísticamente significativas entre RAM graves y edad, sexo, número de diagnósticos o grado de validez fisicopsíquica de los ancianos; en cambio, sí hallamos una débil asociación con el número de medicamentos (p = 0,061). El 88 por ciento de las RAM graves fueron del tipo A, dependientes de la dosis y previsibles. Conclusiones: Los ancianos institucionalizados sufren RAM graves en una elevada proporción por AINE, antidiabéticos y digoxina, y en su mayoría son evitables. Destacamos el interés de este tipo de trabajos (AU)

[Factors associated with the occurrence of adverse reactions to drugs in patients who went to the emergency service of a general hospital: a case-control study]. / Factores asociados con la presentación de reacciones adversas a medicamentos en pacientes que acuden al servicio de urgencia de un hospital general: estudio de casos y controles.

OBJECTIVE: To describe adverse reactions to medicine (ARM) and analyse the factors associated with their presenting in patients attending a general hospital's emergency service. DESIGN: Case-control epidemiological study. SETTING: Emergency service of the San Cecilio University Hospital in Granada. PATIENTS: 654 patients over 15, men and women, who attended the emergency service between October and December 1997. 354 of them had an ARM (cases) and 300 did not (controls). MEASUREMENTS AND RESULTS: 60% of the cases were women, with an average age of 53 +/- 20. 68% of the ARM were type-A (expected). The most affected organs and systems were: digestive tract (41.8%) and skin (31.6%). Drug groups most associated with presentation of ARM were hypnosedatives and salicylates used as analgesics--antithermic drugs (28.2%), and beta-lactams and macrolides (22.6%). Most ARM were classified as probable (52%) and moderate (62%). Family practitioners were the main prescribers (49%) of medicines. 13% of patients were admitted to hospital because of a serious ARM and two people died (0.5%). According to the odds ratio, treatment with cytostatics, psychiatric drugs, NSAIDs, amoxycillin, digoxin, ACEIs and calcium antagonists, being a woman, self-medication, being under 65 and history of ARM were all associated with the presence of an ARM in our patients (cases). CONCLUSIONS: The type of medicine, being a woman, history of ARM, self-medication, and presenting digestive and dermatological symptoms were factors strongly linked to an ARM in patients attending the emergency service.

Factores asociados con la presentación de reacciones adversas a medicamentos en pacientes que acuden al servicio de urgencia de un hospital general: estudio de casos y controles / Factors linked to adverse reactions to medicine in patients who attended a general hospital´s emergency service: case-control study

Objetivo. Describir las reacciones adversas a medicamentos (RAM) y analizar los factores que se asociaron con su presentación en pacientes que acuden al servicio de urgencia de un hospital general. Diseño. Estudio epidemiológico de casos controles. Emplazamiento. Servicio de urgencia del Hospital Universitario San Cecilio de Granada. Pacientes. Un total de 654 pacientes, de ambos sexos y mayores de 15 años, de los que 354 presentaban una RAM (casos) y otros 300 no tenían RAM (controles), que acudieron al servicio de urgencia entre octubre y diciembre de 1997. Mediciones y resultados. Un 60 por ciento de los casos fueron mujeres, con una edad media de 53 ñ 20 años; el 68 por ciento de las RAM fueron del tipo A (esperadas). Los órganos y sistemas más afectados fueron: tubo digestivo (41,8 por ciento) y piel (31,6 por ciento). Los grupos farmacológicos más implicados en la presentación de RAM fueron los hipnosedantes y los salicilatos usados como analgésicos-antitérmicos (28,2 por ciento) y los betalactámicos y macrólidos (22,6 por ciento). La mayoría de las RAM fueron catalogadas como probables (52 por ciento) y moderadas (62 por ciento). El médico de familia fue el mayor prescriptor (49 por ciento) de fármacos. Por una RAM grave se hospitalizó un 13 por ciento de los pacientes y se registraron 2 muertes (0,5 por ciento). Según la odds ratio, el tratamiento con citostáticos, psicofármacos, AINE, amoxicilina, digoxina, IECA, antagonistas del calcio, el género femenino, la automedicación, la edad menor de 65 años y la historia previa de RAM se asociaron con la presencia de una RAM en nuestros pacientes (casos). Conclusiones. El tipo de fármaco, el género femenino, la historia previa de RAM, la automedicación y presentar una sintomatología digestiva y dermatológica fueron factores fuertemente asociados con una RAM en pacientes que acudieron al servicio de urgencia (AU)

[A long-term pharmacoepidemiological study on drug dispensing by the pharmacy office in rural primary care. The influence of age and sex]. / Estudio farmacoepidemiológico a largo plazo sobre dispensación de fármacos por la oficina de farmacia en AP rural. Influencia de edad y sexo.

OBJECTIVES: To obtain data on the use of medicaments dispensed through pharmacies in primary rural care. DESIGN: Long-term descriptive observational study. SETTING: Nivar and Güevejar municipalities, Sanitary Health District in north Granada (Spain). There were 2.7% losses. PATIENTS: A randomised sample of 589 inhabitants, 18 years o more, included in the census of two villages. MEASUREMENTS AND MAIN RESULTS: The number of visits to the pharmacy, number of medicaments dispensed, prescribing physician and adverse effects to medicaments were recorded and compared between age groups, and between men and women. Prescriptions accounted for 75% of all medicaments, and 67.4% of the prescriptions were written by the primary care physician. Greater numbers of prescriptions were written for elderly persons and women than for younger person and men. Adverse reactions occurred in 3.3% of all subjects. Most reactions were mild (93.6%), and the greatest number of reactions were caused by nonsteroid antiinflammatory agents. CONCLUSIONS: Age and female sex influence the consumption of medicaments. Long-term studies of dispensation patterns in pharmacies can represent a useful method.

Prevalence of mental disorders among children in Valencia, Spain.

A 2-stage survey was carried out to establish the point-prevalence of mental disorders and help-seeking behaviour in children aged 8, 11 and 15 living in the city of Valencia. Global prevalence rates, rates by age and rates by sex, as well as rates of specific diagnosis according to DSM-III-R criteria are described. Help-seeking behaviour was found to be related to an interaction between internalizing and externalizing symptoms and sex.

Postoperative decline in plasma aspirin-esterase and cholinesterase activity in surgical patients.

We studied preoperative and postoperative plasma hydrolysis of aspirin and plasma cholinesterase activity in surgical patients. Postoperative aspirin esterase and cholinesterase activities fell sharply (119 +/- 32 micrograms ml h-1 and 3746 +/- 1068 U l-1 respectively; P < 0.01) in comparison to basal preoperative values (157 +/- 33 micrograms ml h-1 and 4620 +/- 940 U l-1 respectively, P < 0.01). We suggest that alterations in plasma esterase during the postoperative period may be related to the metabolic response to anesthesia- and surgery-induced stress.

[Differential aspects of drug prescriptions in elderly people living in the northeast area of Granada: study of 366 individuals]. / Aspectos diferenciales sobre la prescripción de fármacos en ancianos residentes de la zona nordeste de Granada: estudio sobre 366 individuos.

BACKGROUND: The geriatric population consumes greater numbers of medicines than other age groups. We compared drug prescription and consumption in elderly persons residing in a nursing home or living in their own home. METHODS: We studied 366 elderly men and women (older than 65 years) who lived either in nursing homes or in their own home. The variables recorded were the most frequent diseases, number and types of drugs prescribed per person, and adverse reactions of the most frequently prescribed drugs. RESULTS: The most common diseases recorded among subjects living at home were arterial hypertension and rheumatic diseases; among those in nursing homes, the most common ailment was dementia. Subjects in nursing homes were prescribed more different drugs (2.8 +/- 1/person) than individuals living on their own (1.8 +/- 1/person). The percentage of adverse reactions was highest in ambulatory patients (64%) and in patients taking benzodiazepines (56%). A large proportion of all prescriptions (74.5%) were for solid galenic forms. CONCLUSIONS: We draw attention to the greater consumption of drugs by elderly persons residing in nursing homes, as well as the prescription of benzodiazepines and analgesic-antiinflammatory drugs within old age.

The influence of family expressed emotion on the course of schizophrenia in a sample of Spanish patients. A two-year follow-up study.

A sample of 60 Spanish schizophrenic patients was studied to ascertain the relationship between their relatives' expressed emotion (EE) and relapse at follow-up. The relatives' EE and patients' relapse were operationalised following Leff & Vaughn's criteria. At nine months a significant association was not found between the relatives' EE and relapse, but this association became significant on reclassifying the relatives' EE scores after decreasing to four points the cut-off point for critical comments. At 24 months no association was found between EE and relapse. There was a tendency for patients who interrupted their medication or who did not work to relapse more frequently, particularly among the high-EE group.

[Emotional expressiveness and development of schizophrenia: a reply to the work of Vaughn]. / Expresividad emocional y evolución de la esquizofrenia: una réplica al trabajo de Vaughn.

The influence of family climate in the course of schizophrenia has been empirically established. However research has been so far limited to the Anglo-American culture and there are reasons to think that straight forward extrapolation to own our culture may not be totally justified. Consecqently a replication of Vaughn's (Vaughn et al, 1984) has been carried out with a sample of 60 schizophrenic patients in Valencia. Relapse rate was not predicted by EE status or by any EE scale-score according to British original criteria. As the cut-off point was changed from six or more critical remarks to four or more, then the relapse rate was significantly different between high and low EE groups. The study confirms the link between EE-status and relapse rates over nine months but is also underlines the need to take into account cultural differences when it comes to establish cut-off scores.

[Levels of blood theophylline in patients with acute bronchospasm]. / Tasas de teofilinemia en pacientes con un broncoespasmo agudo.

Plasma theophylline levels (mcg/ml) of 93 patients with a bronchopulmonary disease (asthma and chronic obstructive lung disease) who were on theophylline (normal or retarded) treatment, were determined on admission at the emergency ward because of acute bronchospasm. Our results show that theophylline blood levels were subtherapeutical in patients treated either with normal (2.1 +/- 0.8 mcg/ml) or retarded theophylline (9.6 +/- 1.3 mcg/ml). This was probably due to insufficient dosing and/or poor patient compliance. The necessity of monitoring this type of treatment is once again evident.

Probable pseudocholinesterase induction by valproic acid, carbamazepine and phenytoin leading to increased serum aspirin-esterase activity in epileptics.

The present findings show clearly that valproic acid, carbamazepine and phenytoin are each capable of significantly raising serum aspirin-esterase activity in epileptics being treated with these drugs (between p less than 0.01 and p less than 0.05). The data suggest that these antiepileptic drugs may well act as enzymatic-inducing agents upon plasma cholinesterase (or pseudocholinesterase) in epileptic patients.

Serum aspirin-esterase activity in epileptic patients receiving treatment with phenobarbital, phenytoin, carbamazepine and valproic acid.

Serum aspirin-esterase activity was studied in a group of epileptic patients under treatment with phenobarbital, phenytoin, carbamazepine and valproic acid, and a group of healthy controls. Serum rates of hydrolytic activity as well as serum esterase activity were found to be higher in epileptics (p less than 0.001) than in controls. The findings suggest that the above-mentioned antiepileptic drugs may induce plasma esterase activity, thus leading to increases in serum hydrolytic activity in epileptic subjects. On the other hand, no sex or albumin-related differences were observed in serum aspirin-esterase activity in the groups investigated.