[Utility of the AGREE tool for the development and evaluation of clinical protocols: From theory to clinical practice]. / Utilidad del instrumento AGREE para la elaboración y la evaluación de protocolos clínicos: de la teoría a la práctica clínica.

INTRODUCTION AND OBJECTIVE: Clinical protocols are tools for the delivery of optimal and quality healthcare. However, there are often shortcomings in the quality of their design that invalidate their implementation. The aim of this study is to describe a systematic evaluation of clinical protocols, to analyse their quality in order to enable their implementation. MATERIALS AND METHODS: Descriptive study that included the clinical protocols assessed by the Committee of Reviewers of Clinical Practice Recommendations and Health Technologies of a tertiary hospital during 11years of its existence between 2013 and 2023. The AGREE instrument was used to assess the quality of the protocols received, calculating standardised scores by item and domain, and categorising them into: a)excellent (90-100%), b)good (70-89%), c)improvable (50-69%), d)very improvable (30-49%), e)deficient (10-29%), and f)very deficient: 0-9%. RESULTS: Of the 59 documents received by the Commission, 32 were subsidised for AGREE evaluation. The highest scoring domain was «Scope and objective¼, with excellent scores for 29 protocols; the remaining domains had scores ranging from 58.5%-100% for «Rigour in elaboration¼ and 0-100% for «Independence¼. By items, scores ranged from 85.7-100% for «Target users of the protocol are clearly defined¼ to 0-100% for the items «Potential costs of implementing recommendations¼ and «Conflict of interest¼. Of the 32 protocols, 9 were highly recommended, 22 were recommended with modifications/conditions and one was not recommended. CONCLUSIONS: The AGREE tool makes it possible to systematize both the drafting of clinical protocols by the authors and their evaluation by the Clinical Practice Recommendations and Health Technologies Review Committee. This makes it possible to have applicable and quality protocols in our hospital, which results in an improvement in the quality of healthcare.

[Pneumonitis associated to methotrexate]. / Neumonitis secundaria a metotrexate.

Methotrexate (MTX) is a folic acid antagonist that inhibits cellular reproduction. MTX has been shown to be an effective anti-inflammatory agent. Acute interstitial pneumonitis is the main pulmonary side effect during MTX treatment. We report a case of MTX pneumonitis in a 56-year old woman with autoimmune thrombocytopenia who presented with subacute nonproductive cough, dyspnea at rest, fever, and malaise. Chest roentgenogram demonstrated bilateral diffuse interstitial and alveolar infiltration. Infectious diseases were ruled out and methotrexate-induced pneumonitis was suspected. MTX was discontinued and methylprednisolone was prescribed. Patient improved progressively. After eight weeks, radiologic abnormalities and symptoms had disappeared.

[Arterial hypertension and lipid metabolism]. / Hipertensión arterial y metabolismo lipídico.

The frequent connection between essential hypertension and lipid metabolism alterations has led doctors to look for possible pathogenic links between them. Common genetic factors as well as exogenous factors, like diet, have been described. The pathogenic mechanisms through which genetic or exogenic causes work, would be changes in cellular functions. This would be especially so in the case of membrane transporters and insulin resistance which may be a consequence, or a cause, of high blood pressure, but which give rise to lipid metabolism alterations. It is advisable to follow dietetic hygiene measures to combat hypertension and dyslipemic disorders, such as: weight loss, reduction of saturated fats fibre intake reduction of salt and alcoholic drinks, abstaining from tobacco and doing regular aerobic exercise. We will choose the drugs whose structure and doses will not alter lipid levels and will increase insulin sensitivity.