Actuaciones del farmacéutico sobre la demanda de medicamentos a través del servicio de indicación farmacéutica: INDICA+PRO Implantación (2020-2021) / Pharmacist actions on medicines demand through the pharmaceutical indication service: INDICA+PRO Implementation (2020-2021)

JUSTIFICACIÓN: en España, las especialidades farmacéuticas publicitarias sólo están disponibles a través de la farmacia comunitaria (FC). Desde 2019, Foro de Atención Farmacéutica en Farmacia Comunitaria (Foro AF-FC) incluye la demanda de medicamento para un síntoma menor a través del servicio de indicación farmacéutica (SIF) y lo simboliza como “Deme esto para…”. El estudio INDICA+PRO Implantación tiene como objetivo implantar el SIF protocolizado en la FC española incluyendo ambas vías de entrada al servicio (consulta de síntoma menor y demanda de medicamento para el mismo).OBJETIVOS: describir la demanda de medicamentos para un síntoma menor atendidas por el farmacéutico comunitario a través del SIF.MATERIAL Y MÉTODOS: el estudio realizado utiliza un diseño híbrido de efectividad-implantación tipo 3 durante 14 meses inicialmente. La intervención implantada constaba de: procedimiento general del SIF establecido por Foro AF-FC, protocolos consensuados entre sociedades médicas (Semergen y SemFyC), asociaciones farmacéuticas (SEFAC y MICOF) y universidad (GIAF-UGR) específicos para 31 síntomas menores incluidos en una plataforma digital (SEFAC e_XPERT®) y la formación y el seguimiento de los farmacéuticos. Se consideraron los pacientes que acudían a FC demandando un medicamento para un síntoma menor incluido en el estudio (dermatológico, digestivo, relacionado con el dolor, respiratorio u otro). Todos los pacientes recibían seguimiento 10 días tras la consulta en FC.RESULTADOS: 14083 consultas fueron registradas por 687 farmacéuticos pertenecientes a 518 FC. Mayor número de consultas por síntoma menor (84,6 %, n=11911) que por demanda de un medicamento concreto fueron atendidas a través del SIF (15,4 %, n=2172). Entre aquellos pacientes que demandaron un medicamento, el 7,7 % (n=168) fueron derivados al médico. (AU)

[Vitamin D treatment in childhood: an evidence based discussion]. / Tratamiento con vitamina D en la infancia: discusión de la evidencia.

Vitamin D treatment during childhood has been recommended in those younger than one. Evidence is not available to recommend this treatment in general population. Solar exposure is enough in most infants younger than 1 year, and this should be taken into account. Data showing optimal doses at this stage is not available to date. Our review suggests, solar exposure in Spain appears sufficient.

Capsulitis adhesiva idiopática bilateral de cadera / Bilateral idiopathic adhesive capsulitis of the hip

La capsulitis adhesiva es una condición patológica de etiología desconocida en muchas ocasiones, caracterizada por la presencia de dolor y limitación de la movilidad. Esta alteración se produce con frecuencia en la articulación del hombro (frozen shoulder), aunque puede encontrarse en otras articulaciones. En la cadera es un cuadro infrecuente, normalmente relacionado con traumatismos locales. Presentamos el caso clínico de una mujer de 33 años con una capsulitis adhesiva bilateral e idiopática de caderas ya que no se encontró enfermedad reumatológica, hematológica, endocrina, tumoral o traumática que justificara su aparición. Debido a los problemas diagnósticos que se presentaron, y a pesar de realizar una rehabilitación intensa, posiblemente se planteó una indicación quirúrgica de forma tardía, por lo que se consiguieron unos resultados funcionales muy pobres. Se discute, a partir de la escasa literatura existente, diversos aspectos diagnósticos y terapéuticos de este proceso, comparándolo en ocasiones con la mayor información publicada en el caso del hombro

Adhesive capsulitis is a pathology of unknown ethiology, often characterized by the presence of pain and limited movility. It typically affects the shoulder joint (frozen shoulder), but can also affect other joints. Hip adhesive capsulitis is not very common and is usually associated with local traumatisms. We hereby present the clinical case of a 33 year old female with hip bilateral idiopatic adhesive capsulitis. No sign of illness (reumatological, haematological, endocrine, tumor or traumatism injury) that could cause the development of capsulitis was found. Due to the appearance of some problems during the diagnosis, and despite an intensive rehabilitation treatment, a late chirurgical intervention was carried out, showing poor functional improvement. Based on the sparse literature available, various diagnostical and therapeutical issues are discussed sometimes compared with the more numerous shoulder capsulitis reports

[Medicine in the adolescent]. / Medicina del adolescente.

UNLABELLED: The biologic, cognitive and sociocultural changes that occur during adolescence include a wide range such as to be best treated by internists, but focus in old ages is increasing and younger are being treated by others specialists. We review the data of those adolescents attended in our Hospital and discuss Internal Medicine interest in adolescents. MATERIAL AND METHODS: Epidemiological data, and clinical status of those patients between 15 and 21 years old admitted in our hospital during the period 1996-2002 were analysed. RESULTS: 5894 admissions of adolescent s patients were made in this period. 1326 (23%) where attended in the Internal Medicine Department. 755 (57%) were male. Main causes of admission were infectious diseases, (mostly urinary tract and respiratory infections). Tobacco and alcohol abuse were present in 160 (6%) patients. DISCUSSION: Adolescence marks the transition from childhood to adulthood. Health problems and deaths among adolescents and young adults result from accidents (mostly from motor vehicle), but there are conditions usually matter of our speciality. A significant number of patients are been attended by Paediatrics Department and such a speciality as Adolescence Medicine is mostly integrated by paediatric specialists. We consider as this paper show, these ages ranges are clearly matter of our specialty and best treated by internists, but probably need a better consideration in our training. The opportunity to incorporate more adolescents into practice if realized, could prove challenging for internists.

[Influence of foods on the absorption of antimicrobial agents]. / Influencia de los alimentos en la absorción de los antimicrobianos.

Understanding the interaction between foods and antimicrobial agents is an aspect of therapy which may have an important clinical repercussion, which is why it must not be forgotten. This study reviews the interactions of foods with the anti-microbial agents which occur at the level of absorption, considering the mechanisms involved. The food-drug interaction can cause an increase, a decrease, or a delay in the bio-availability of the anti-microbial agents; foods may have no affect on the absorption of the anti-microbial agents, or they may improve the gastrointestinal tolerance. The Food and Drug Administration's bioequivalency criteria for considering whether or not there is an alteration in absorption have an orientative function, as generally all studies are conducted on healthy volunteers, but in clinical practice one must consider the physiological and pathological condition of the patient. The composition of the diet as well as the volume of liquid administered are other aspects which should be considered, as these may exert a different effect depending on the type of drug. After ingesting fatty foods, there is an increased absorption of albendazole, griseofulvin, itraconazole, and mebendazole. All foods but especially carbohydrates reduce the absorption of isoniazide. Among the anti-HIV drugs, the following must be administered on an empty stomach: didanosine, indinavir zalcitabine , and zidovudine ; lamivudine can be administered either on an empty or on a full stomach, because although food delays the absorption, it does not affect the amount absorbed; the absorption of stavudine is not affected by foods; ritonavir should be administered together with tile meals, and saquinavir must be administered after ingestion of food. It is advisable to administer clarithromycin together with foods, and azythromycin on an empty stomach; the same holds true for perfloxacin and rifabutine as for lamivudine.