Esophageal lesions detected during small bowel capsule endoscopy : incidence, diagnostic and therapeutic impact.

BACKGROUND: Nowadays, capsule endoscopy is the first-line procedure for the visualization of the small bowel. Although it was primarily designed with this goal, it may also identify other segments of the gastrointestinal tract. The aim of the current study is to evaluate the incidence of esophageal abnormalities detected in patients undergoing small bowel capsule endoscopy and its impact on patient management. PATIENTS AND METHODS: This study is a retrospective analysis of data from 2217 consecutive capsule endoscopy procedures performed at a single tertiary-care centre between January 2008 and February 2016. Patient baseline characteristics, esophageal lesions, diagnosis and management before and after capsule endoscopy were recorded and a descriptive analysis was then performed. RESULTS: 2217 patients were finally included in the analysis. 1070 were male (48.2%) and the mean age was 56.1 ± 19.5 years (12-93). Obscure gastrointestinal bleeding (52.3%) and inflammatory bowel disease (18.3%) were the main procedure indications. Esophageal abnormalities were detected in 105 out of 2217 patients (4.7%). The most common lesions detected were peptic esophagitis (58.1%) and esophageal varices (17.1%). This information had a clinical/diagnostic impact of 3.3% and a therapeutic impact of 3.2%. CONCLUSION: Capsule endoscopy detects not only small bowel lesions, but also significant esophageal lesions that may be overlooked during initial gastroscopy. Therefore, all images of the esophagus should be read during small bowel capsule endoscopy, since it could provide relevant information that may result in changes on patient´s management.

[Local immunotherapy]. / Inmunoterapia local.

Specific immunotherapy, together with avoidance of the allergen and symptomatic treatment, forms part of the treatment of allergic pathology. The oldest, best known and most studied form is subcutaneous immunotherapy (SCIT), whose efficacy, both in the short and the long term, has been widely demonstrated in numerous studies. However, in spite of having been shown to be safe, it is not free of adverse effects and must be administered under the supervision of medical personnel. This has encouraged the search for new ways of administration of similar efficacy, with a good safety profile and good adherence on the patient's side. Sublingual immunotherapy (SLIT) is the most relevant of the different alternatives studied. In this alternative the antigen is administered in the form of drops under the tongue. There are different dosages of administration depending on the allergen involved. The optimum treatment dose has still to be determined, at present a wide range of dosages are found in comparison with subcutaneous immunotherapy. Its mechanism of action is little known although immunological changes have been observed in different studies. SLIT has shown a good safety profile with scarce secondary effects, normally of a local character. Similarly, different clinical tests have been carried out in which its efficacy has been shown in the treatment of respiratory allergy both in children and in adults. For this reason, although there are still unresolved data concerning this way of administering the immunotherapy, it has been proposed by the WHO as a valid alternative to SCIT.

[Inhalation techniques in the treatment of asthma]. / Técnicas de inhalación en el tratamiento del asma.

In the pharmacological treatment of asthma, the most suitable way is by inhalation, since this enables us to achieve a greater concentration of medicine in the affected organ than systemic medication, and besides the latter's secondary effects are minimized. The suitable use of inhalers and hence their efficacy depends on very different factors. Some of those of a merely technical kind are as follows: A suitable volume of inhalation. The rhythm of inhalation. The length of the inspiratory apnea following administration of the medicine. The coordination between the inspiration of the aerosol and activation of the device, in the case of the metered dose inhaler (MDI). One of the reasons for the incorrect use of MDI aerosols is the lack of coordination between activation of the device and inspiration. This has led to the design of different devices that avoid the need for this coordination, such as: inhalation chambers and devices for inhaling dry dust. It has also been suggested in the literature that the causes of these mistakes are to be found in the health professionals not knowing, or not suitably teaching the patients how to handle the devices. In spite of being designed to facilitate correct administration, suitable knowledge of the technique of their use by the patient is required.

[Safety of hymenopteran venoms immunotherapy in a cluster schedule. A nursing perspective]. / Seguridad de inmunoterapia con veneno de himenópteros en pauta agrupada. Perspectiva de enfermería.

BACKGROUND: The inherent seriousness of IgE mediated hypersensitivity to hymenopteran venoms makes it necessary to reach, in the shortest period of time, the maintenance dose in immunotherapy with poisons. The aim of this article is to evaluate the safety of a cluster schedule of subcutaneous hymenopteran venom immunotherapy, which reduces the time needed to reach the maintenance dose from 12 to 3 weeks. MATERIAL AND METHODS: Thirty patients, 24 men and 6 women with an average age of 46.06 years, who had been diagnosed with hypersensitivity to the poison of hymenopterans and for whom immunotherapy had been prescribed participated in the study. The patients received Pharmalgen (ALK Abelló) immunotherapy against hymenopteran venoms, 13 Apis mellífera, 12 Véspula spp, and 5 Polistes spp, with a cluster schedule that consisted of: day 1 (4 microg + 6 microg), day 8 (10 microg + 30 microg) and day 15 (40 microg + 60 microg). The reactions occurring during the starting phase between April 2005 and February 2008 were evaluated. RESULTS: Of the 30 vaccinated patients 2 presented an exaggerated local reaction, there were other non-specific symptoms on two occasions, and another 2 presented systemic reaction. One following administration of the dose of 40 microg presented a grade III systemic reaction, and the other after receiving the dose of 60 microg presented a grade II systemic reaction. Both passed to a conventional model of immunotherapy administration and had new grade III reactions, and were therefore kept on immunotherapy with premedication with oral antihistamines. DISCUSSION: The study confirms that the model employed is safe with a low incidence of adverse reactions, 1.67% presented an exaggerated local reaction, 1.11% had an non-specific reaction and 1.11% a systemic reaction.

Seguridad de inmunoterapia con veneno de himenópteros en pauta agrupada. Perspectiva de enfermería / Safety of hymenopteran venoms immunotherapy in a cluster schedule. A nursing perspective

Fundamento. La gravedad inherente a la hipersensibilidadIgE mediada a veneno de himenópteros impone la necesidadde alcanzar, en el menor plazo de tiempo posible, ladosis de mantenimiento en la inmunoterapia con venenos.El objetivo del presente trabajo es valorar la seguridad deuna pauta agrupada (cluster) de inmunoterapia subcutáneacon veneno de himenópteros, que reduce de 12 a 3 semanasel tiempo necesario para llegar a la dosis de mantenimiento.Material y métodos. El estudio fue realizado en 30 pacientes,24 varones y 6 mujeres con una media de edad de 46,06años, que habían sido diagnosticados de hipersensibilidada veneno de himenópteros y se les había indicado tratamientocon inmunoterapia. Los pacientes recibieron inmunoterapiafrente a veneno de himenópteros Pharmalgen®(ALK Abelló), 13 fueron de Apis mellífera, 12 de Véspula spp,y 5 de Polistes spp, con una pauta agrupada que consistióen: día 1 (4μg + 6μg), día 8 (10μg + 30μg) y día 15 (40μg +60μg). Se valoraron las reacciones ocurridas durante la fasede inicio entre abril de 2005 y febrero de 2008.Resultados. De los 30 pacientes vacunados 2 presentaronreacción local exagerada, otros síntomas inespecíficos endos ocasiones y 2 más reacción sistémica. Uno tras administrarla dosis de 40μg, presentó reacción sistémica grado III,y el otro tras recibir la dosis de 60 μg, presentó una reacciónsistémica grado II. Ambos pasaron a una pauta convencionalde administración de inmunoterapia y tuvieron nuevasreacciones de grado III por lo que se les mantiene la inmunoterapiacon premedicación con antihistamínicos orales.Discusión. El estudio confirma que la pauta utilizada es seguracon una baja incidencia de reacciones adversas, 1,67%presentó reacción local exagerada, 1,11% tuvo reaccióninespecífica y 1,11% reacción sistémica(AU)

Background. The inherent seriousness of IgE mediated hypersensitivityto hymenopteran venoms makes it necessary toreach, in the shortest period of time, the maintenance dosein immunotherapy with poisons. The aim of this article is toevaluate the safety of a cluster schedule of subcutaneous Hymenopteranvenoms immunotherapy, which reduces the timeneeded to reach the maintenance dose from 12 to 3 weeks.Material and methods. Thirty patients, 24 men and 6 womenwith an average age of 46.06 years, who had beendiagnosed with hypersensitivity to the poison of hymenopteransand for whom immunotherapy had been prescribedparticipated in the study. The patients received Pharmalgen® (ALK Abelló) immunotherapy against hymenopteranvenoms, 13 Apis mellífera, 12 Véspula spp, and 5 Polistes spp,with a cluster schedule that consisted of: day 1 (4μg + 6μg),day 8 (10μg + 30μg) and day 15 (40μg + 60μg). The reactionsoccurring during the starting phase between April 2005 andFebruary 2008 were evaluated.Results. Of the 30 vaccinated patients 2 presented an exaggeratedlocal reaction, there were other non-specific symptomson two occasions, and another 2 presented systemicreaction. One following administration of the dose of 40μgpresented a grade III systemic reaction, and the other afterreceiving the dose of 60μg presented a grade II systemicreaction. Both passed to a conventional model of immunotherapyadministration and had new grade III reactions, andwere therefore kept on immunotherapy with premedicationwith oral antihistamines.Discussion. The study confirms that the model employedis safe with a low incidence of adverse reactions, 1.67%presented an exaggerated local reaction, 1.11% had an nonspecificreaction and 1.11% a systemic reaction(AU)

Técnicas de inhalación en el tratamiento del asma / Inhalation techniques in the treatment of asthma

En el tratamiento farmacológico del asma, la vía más adecuada es la inhalatoria, ya que nos permite alcanzar una mayor concentración de medicamento en el órgano de choque que la medicación sistémica, y además se minimizan los efectos secundarios de esta última. El uso adecuado de los inhaladores y con ello su eficacia depende de muy diversos factores. Entre los de índole meramente técnica, algunos de ellos son: - Un adecuado volumen de inhalación.- El ritmo de inhalación.- La duración de la apnea inspiratoria tras la administración del medicamento.- La coordinación entre la inspiración del aerosol y la activación del dispositivo, en el caso del MDI. Uno de los motivos de uso incorrecto de los aerosoles MDI es la falta de coordinación entre la activación del dispositivo y la inspiración. Ello ha motivado el diseño de diferentes dispositivos que obvien la necesidad de esta coordinación como son: las cámaras inhalatorias y los dispositivos para inhalar polvo seco. También se sugiere en la literatura que las causas de estos errores son motivados porque los profesionales sanitarios no conocen o no enseñan adecuadamente el manejo de los dispositivos a los pacientes. A pesar de estar diseñados para facilitar la correcta administración, exigen un conocimiento adecuado de la técnica de uso por parte del paciente (AU)

Inmunoterapia local / Local immunotherapy

La inmunoterapia específica, junto con la evitación del alergeno y el tratamiento sintomático, forma parte del tratamiento de la patología alérgica. La modalidad más antigua, más conocida y mejor estudiada es la inmunoterapia subcutánea (ITSC), cuya eficacia tanto a corto como a largo plazo, ha sido ampliamente demostrada en numerosos estudios. Sin embargo, a pesar de haberse demostrado segura, no está exenta de efectos adversos y precisa ser administrada bajo supervisión de personal médico. Esto ha animado a buscar nuevas vías de administración de eficacia similar, con un buen perfil de seguridad, y de buena cumplimentación por parte del paciente. De las distintas alternativas estudiadas la más relevante es la inmunoterapia sublingual (ITSL). En ésta, se administra el antígeno en forma de gotas debajo de la lengua. Existen diferentes pautas de administración en función del alergeno implicado. La dosis óptima de tratamiento está aún sin determinar, hallándose en este momento en un rango amplio de dosis respecto a la inmunoterapia subcutánea. Su mecanismo de acción es poco conocido aunque en diversos estudios se han observado cambios inmunológicos. La ITSL ha mostrado un buen perfil de seguridad con escasos efectos secundarios, habitualmente de carácter local. Asimismo se han realizado distintos ensayos clínicos en los que se ha demostrado su eficacia en el tratamiento de la alergia respiratoria tanto en niños como en adultos. Por ello, aunque aún existen datos sin resolver respecto a esta vía de administración de inmunoterapia, ha sido propuesta por la OMS como una alternativa válida a la ITSC (AU)