A Prospective Study of Costs Associated With the Evaluation of Allergic Reactions to Radiological Contrast Media.

BACKGROUND AND OBJECTIVE: The prevalence of hypersensitivity reactions to radiological contrast media (RCM) is increasing owing to the improved performance of diagnostic and therapeutic tests that require RCMs. Objective: We carried out a year-long real-life observational study to prospectively evaluate patients referred to the allergy department from primary care, the emergency department, and other specialties with suspected moderate-to-severe RCM hypersensitivity reactions. METHODS: To study the costs of evaluating RCM hypersensitivity reactions, we systematically recorded direct and indirect costs. RESULTS: Sixty-nine patients with previous reactions to RCM were evaluated in the allergy department from June 1, 2017, to May 31, 2018.Total direct health care costs were €10 715.84, with a mean (SD) cost per patient of €155.30 (77.08). Specifically, direct non-health care costs reached €1605.42 (mean, €23.27 [41.14]), and indirect costs were €6490.85 (mean, €94.07 [110.61]). In summary, the total cost was €18 812.11, that is, a mean cost of €272.64 (164.77). CONCLUSION: Our study shows that the costs of an elective evaluation of hypersensitivity reactions to RCM are low, thus confirming that correct and safe management of affected patients are cost-effective. Therefore, our efforts should be directed toward ensuring the necessary logistics.

A Comprehensive Prospective Study of the Costs Associated With Evaluation of ß-Lactam Allergy.

BACKGROUND AND OBJECTIVE: Being labeled as allergic to penicillin (unverified ß-lactam allergy) can result in patients receiving broader-spectrum antibiotics than necessary that may be more toxic, less effective, and/or more expensive than alternative options. Objective: We aimed to evaluate the real costs of evaluating ß-lactam allergy. METHODS: We performed a prospective real-life observational study designed to evaluate all adult patients who consulted for suspected ß-lactam allergy over a 1-year period. Direct and indirect costs were systematically recorded. Direct health costs were calculated based on the number of visits and all additional and diagnostic tests performed, direct nonhealth costs based on the number of visits and the distance from their homes to the Allergy Department, and indirect costs based on absenteeism. RESULTS: A total of 296 patients with suspected allergy to ß-lactams were evaluated in our outpatient clinic from June 1, 2017 to May 31, 2018. Total direct health care costs were €28 176.70, with a mean (SD) cost of €95.19 (37.20). Direct nonhealth costs reached €6551.73, that is, €22.13 (40.44) per patient. Indirect health costs reached €20 769.20, with a mean of €70.17 (127.40). In summary, the total cost was €55 497.63, that is, a cost per patient of €187.49 (148.14). CONCLUSIONS: When all possible costs are taken into account, the evaluation of ß-lactam allergy is not expensive and can reduce future expense arising from unnecessary use of more expensive and less effective antibiotics.

Adherence to Anaphylaxis Guidelines: Real-World Data From the Emergency Department of a Tertiary Hospital.

BACKGROUND AND OBJECTIVE: Few studies have evaluated adherence to anaphylaxis guidelines in emergency departments (EDs). Objective: The objective of this study was to evaluate adherence to anaphylaxis guidelines in the ED of a tertiary hospital. METHODS: Medical records of patients attended in the ED of University Hospital of Salamanca, Spain were reviewed. Those patients fulfilling the anaphylaxis criteria proposed by the NIAID/FAAN were selected. RESULTS: During a 1-year period, we identified 89 patients (74 adults and 15 children). The anaphylactic reaction was moderate in 65% of adults, severe in 34%, and very severe in 1%. In children, all reactions were moderate. Fewer than half of the patients (42%) received adrenaline in the ED; this was administered intramuscularly in only 19% of cases. As for the severity of the reaction, 65% of patients with moderate reactions and 42% with severe reactions were not treated with adrenaline. At discharge from the ED, an adrenaline auto-injector was recommended to only 5.6% of patients. Fifty-two percent of patients received a documented allergy referral (57% adults vs 27% children, P=.047), 29% instructions about avoidance of triggers (31% adults vs 20% children, NS), and 51% written instructions for recognition of anaphylaxis warning signs (41% adults vs 100% children, P<.001). CONCLUSIONS: The results of the study show a large discrepancy between recommendations in guidelines and management of anaphylaxis in the ED. Additional training efforts are needed to improve the treatment of patients with anaphylactic reactions.

Telling children their mother is seriously ill or dying: mapping French people's views.

BACKGROUND: What to tell children when their mother's life is seriously endangered is a largely unstudied issue. METHODS: We had 255 lay persons in France judge the appropriateness of the parents' behaviour in 48 scenarios of parents dealing with this problem. The scenarios comprised according to a four within-subject orthogonal design: child's age (4, 6, 8 or 10 years), severity of disease (lethal or worrisome but curable), child's concern or not about his or her mother's illness and parents' decision about how much to tell (tell nothing, minimize or tell the full truth). RESULTS: Cluster analysis revealed four clusters, labelled 'always tell the truth' (33%), 'tell the truth or minimize' (16%), 'tell nothing or minimize' (22%) and 'depends on child's age and level of concern' (29%). Women and participants who had already faced breaking bad news like this to children were more frequently members of the two 'tell the truth' clusters than other participants. CONCLUSIONS: People who have already experienced a situation of having to tell a child about their mother's bad health tend to think, more than others, that telling the truth is the best policy.

Stability study of sodium colistimethate-loaded lipid nanoparticles.

In the last decades, the encapsulation of antibiotics into nanoparticulate carriers has gained increasing attention for the treatment of infectious diseases. Sodium colistimethate-loaded solid lipid nanoparticles (Colist-SLNs) and nanostructured lipid carriers (Colist-NLCs) were designed aiming to treat the pulmonary infection associated to cystic fibrosis patients. The nanoparticles were freeze-dried using trehalose as cryoprotectant. The stability of both nanoparticles was analysed over one year according to the International Conference of Harmonisation (ICH) guidelines by determining the minimum inhibitory concentration (MIC) against clinically isolated Pseudomonas aeruginosa strains and by studying their physico-chemical characteristics. The results showed that Colist-SLNs lost their antimicrobial activity at the third month; on the contrary, the antibacterial activity of Colist-NLCs was maintained throughout the study within an adequate range (MIC ≤16 µg/mL). In addition, Colist-NLCs exhibited suitable physico-chemical properties at 5 °C and 25 °C/60% relative humidity over one year. Altogether, Colist-NLCs proved to have better stability than Colist-SLNs.

Pulmonary drug delivery: a review on nanocarriers for antibacterial chemotherapy.

As the WHO stated, lower respiratory infections are the third leading cause of death. In addition, it is remarkable that antimicrobial resistance represents a huge threat. Thus, new therapeutic weapons are required. Among the possible alternatives, antibiotic encapsulation in nanoparticles has gained much attention in terms of improved tolerability, activity and ability to combat the resistance mechanisms of bacteria. In this regard, this review article focuses on the latest nanocarrier approaches for inhalatory therapy of antibiotics. First, the technology related to lung disposition will be reviewed. Then, nanocarrier systems will be introduced and the challenges required to perform adequate pulmonary deposition analysed. In the following part, drug delivery systems (DDSs) on the market or in clinical trials are described and, finally, new approaches of nanoparticles that have reached pre-clinical stage are enumerated. Altogether, this review aims at gathering together the novel nanosystems for anti-infectious therapy, underlining the potential of DDSs to improve and optimize currently available antibiotic therapies in the context of lung infections.

Assessing the impact of As-Cd-Pb metal mixture on cell transformation by two-stage Balb/c 3T3 cell assay.

Human beings are exposed to metals as a consequence of various industrial activities, including glass production, agrochemical production, metallurgy and battery manufacture. New data about the possible mechanisms involved in the carcinogenic activity of these metals are constantly being reported. Exposure to complex mixtures of metals is more likely to occur than exposure to a single metal alone. Among these elements, arsenic, cadmium and lead are ubiquitous air and water pollutants that continue to threaten the quality of public health around the world. The aim of the present study was to evaluate the capability of a mixture of 2 µM NaAsO2, 2 µM CdCl2 and 5 µM Pb(C2H3O2)2·3H2O at relevant epidemiological concentrations to induce cell transformation processes. Transforming potential was determined by a murine two-stage Balb/c 3T3 cell assay. Cell viability, reactive oxygen species (ROS), DNA damage, cell cycle analysis, senescence, generation time and metallothionein expression were also evaluated. The results showed that the metal mixture induced morphological cell transformation only when acting as initiator stimuli of the process. A decrease in cell viability was observed at the promotion stage, a time during which ROS increase, especially when a metal mixture was applied as a promoter stimulant. Changes in DNA damage were not observed throughout the assay; however, we observed G1 cell cycle arrest. The metal mixture, acting as a promoter, is capable of inducing senescence, but metals employed as initiators with 12-O-tetradecanoylphorbol-13-acetate as a promoter are capable of causing avoidance of senescence and triggering the transformation potential of the cells.

Lay people's and health professionals' views about breaking bad news to children.

BACKGROUND: Bad health news is difficult to communicate, especially when parents must give bad news to their children. METHODS: We had 170 lay persons, 33 nurses and six physicians in Toulouse, France, judge the appropriateness of the parents' behaviour in 64 scenarios of parents dealing with this problem. The scenarios were composed according to a four within-subject orthogonal design: child's age (4, 6, 8 or 10), severity of disease (lethal or worrisome but curable), child's concern or not about his illness and parents' decision about communicating the news (tell nothing, minimize, tell the truth or ask the physician to tell the truth). RESULTS: Cluster analysis revealed four clusters, labelled 'Always Tell the Truth' (33%, including a majority of doctors and nurses), 'Tell Nothing or Minimize' (16%, with an older average age), 'Tell the Truth Except in Cases of Incurable Illness' (22%) and 'Depends on Child's Characteristics' (29%). CONCLUSIONS: Physicians in training and in practice need to be aware that lay people--and likely parents as well--have diverse and complex opinions about when and how parents should give bad health news to their children.

[Adaptation and validation of the MoVac-flu scale on motivation towards the flu vaccine]. / Adaptación y validación de la escala MoVac-flu sobre motivación hacia la vacuna de la gripe.

OBJECTIVE: To translate, adapt and validate the psychometric properties of MoVac-flu scale in order to be used in Spanish. METHOD: The present research was an analytical observational study of cross-cultural adaptation and validation into Spanish of the MoVac-flu scale. It has been carried out between the months of March and July 2022. The sample size was 142 people who were obtained by consecutive sampling. The processes used for the adaptation have been translation, validation by a committee of experts, back-translation and pilot test. For validation, the psychometric properties of reliability, internal consistency, appearance validity, content validity, utility and ceiling-floor effect have been verified. RESULTS: The internal consistency of the MoVac-flu scale in its version translated into Spanish was high, showing a McDonald's ω of 0.914. CONCLUSIONS: The MoVac-flu scale in Spanish allows to measure the degree of motivation towards vaccination against influenza in the adult population.

Mapping French Laypeople's Views Regarding Living Organ Donation.

BACKGROUND: French laypeople's views on living organ donation (LOD) were examined. METHODS: From 2010 to 2014, 327 adults (including 21 nurses) judged the acceptability of LOD in 60 realistic scenarios composed of all combinations of 5 factors: 1. type of organ; 2. whether it could have been obtained from a cadaver; 3. donor-recipient relationship; 4. donor's level of autonomy; 5. financial compensation; and 6. patients' level of responsibility for their illness. In all scenarios, the patients were in need of a kidney or liver transplantation. The ratings were subjected to cluster analysis and analyses of variance. RESULTS: Five qualitatively different positions were found that were termed Free Market (22%), Pragmatism (15%), Altruism (48%), Always Acceptable (7%), and Undetermined (8%). Nurses comprised the majority (90%) of the members of the altruism cluster. Younger and more-educated people were, more frequently than older and less-educated people, members either of the pragmatism or of the free market cluster. CONCLUSIONS: Half of French adults support the altruism model of LOD. A substantial minority, however, mostly young and more educated people, support alternative models allowing the introduction of financial incentives.

Urban vegetation and particle air pollution: Experimental campaigns in a traffic hotspot.

This work presents the main results of two experimental campaigns carried out in summer and winter seasons in a complex pollution hotspot near a large park, El Retiro, in Madrid (Spain). These campaigns were aimed at understanding the microscale spatio-temporal variation of ambient concentration levels in areas with high pollution values to obtain data to validate models on the effect of urban trees on particulate matter concentrations. Two different measuring approaches have been used. The first one was static, with instruments continuously characterizing the meteorological variables and the particulate matter concentration outside and inside the park. During the summer campaign, the particulate matter concentration was clearly influenced by a Saharan dust outbreak during the period 23 June to 10 July 2016, when most of the particulate matter was in the fraction PM2.5-10. During the winter campaign, the mass concentrations were related to the meteorological conditions and the high atmospheric stability. The second approach was a dynamic case with mobile measurements by portable instruments. During the summer campaign, a DustTrak instrument was used to measure PM10 and PM2.5 in different transects close to and inside the park at different distances from the traffic lane. It was observed a decrease in the concentrations up to 25% at 20 m and 50% at 200 m. High PM10 values were linked to dust resuspension caused by recreational activities and to a Saharan dust outbreak. The highest PM values were measured at the Independencia square, an area with many bus stops and high traffic density. During the winter campaign, three microaethalometers were used for Black Carbon measurement. Both pollutants also showed a reduction in their concentrations when moving towards inside the park. For PM10 and PM2.5, reductions up to 50% were observed, while for BC this reduction was smaller, about 20%.

Knowledge of the risks associated with skin bleaching among Togolese users.

We examined the extent of Togolese users' knowledge of the health risks associated with the regular use of bleaching agents. A massive underestimation of some of the main risks was discovered. The more frequent the use of bleaching agents, the higher the underestimation.

Adaptación y validación de la escala MoVac-flu sobre motivación hacia la vacuna de la gripe / Adaptation and validation of the MoVac-flu scale on motivation towards the flu vaccine

Objetivo: Realizar una traducción, adaptación y validación de las propiedades psicométricas de la escala MoVac-flu para ser utilizada en español. Método: Estudio observacional analítico de adaptación transcultural y validación al español de la escala MoVac-flu. Se llevó a cabo entre los meses de marzo y julio del año 2022. El tamaño muestral fue de 142 personas que se reclutaron mediante muestreo consecutivo. Los procesos utilizados para la adaptación fueron traducción, validación por comité de expertos, retrotraducción y prueba piloto. Para la validación se comprobaron las propiedades psicométricas de fiabilidad, consistencia interna, validez de apariencia, validez de contenido, utilidad y efecto techo-suelo. Resultados. La consistencia interna de la escala MoVac-flu en su versión traducida al español fue alta, con una ω de McDonald de 0,914. Conclusiones: La escala MoVac-flu en español permite medir el grado de motivación ante la vacunación frente a la gripe de la población adulta.(AU)

Objective: To translate, adapt and validate the psychometric properties of MoVac-flu scale in order to be used in Spanish. Method: The present research was an analytical observational study of cross-cultural adaptation and validation into Spanish of the MoVac-flu scale. It has been carried out between the months of March and July 2022. The sample size was 142 people who were obtained by consecutive sampling. The processes used for the adaptation have been translation, validation by a committee of experts, back-translation and pilot test. For validation, the psychometric properties of reliability, internal consistency, appearance validity, content validity, utility and ceiling-floor effect have been verified. Results: The internal consistency of the MoVac-flu scale in its version translated into Spanish was high, showing a McDonald's ω of 0.914. Conclusions: The MoVac-flu scale in Spanish allows to measure the degree of motivation towards vaccination against influenza in the adult population.(AU)

A Prospective Study of Costs Associated With the Evaluation of Allergic Reactions to Radiological Contrast Media

Background: The prevalence of hypersensitivity reactions to radiological contrast media (RCM) is increasing owing to the improved performance of diagnostic and therapeutic tests that require RCMs. Objective: We carried out a year-long real-life observational study to prospectively evaluate patients referred to the allergy department from primary care, the emergency department, and other specialties with suspected moderate-to-severe RCM hypersensitivity reactions. Methods: To study the costs of evaluating RCM hypersensitivity reactions, we systematically recorded direct and indirect costs. Results: Sixty-nine patients with previous reactions to RCM were evaluated in the allergy department from June 1, 2017, to May 31, 2018.Total direct health care costs were €10 715.84, with a mean (SD) cost per patient of €155.30 (77.08). Specifically, direct non–health care costs reached €1605.42 (mean, €23.27 [41.14]), and indirect costs were €6490.85 (mean, €94.07 [110.61]). In summary, the total cost was €18 812.11, that is, a mean cost of €272.64 (164.77). Conclusions: Our study shows that the costs of an elective evaluation of hypersensitivity reactions to RCM are low, thus confirming that correct and safe management of affected patients are cost-effective. Therefore, our efforts should be directed toward ensuring the necessary logistics (AU)

Antecedentes: La prevalencia de reacciones de hipersensibilidad a los medios de contraste radiológico (MCR) está aumentando debido al incremento en la realización de pruebas diagnósticas y terapéuticas que requieren MCR. Objetivo: Hemos realizado un estudio observacional de un año de duración para evaluar prospectivamente a los pacientes remitidos al Servicio de Alergología con sospecha de reacciones moderadas a graves por hipersensibilidad a MCR.Métodos: Para estudiar los costes de la evaluación de la hipersensibilidad a MCR, se registraron sistemáticamente los costes directos e indirectos. Resultados: Se evaluaron 69 pacientes con reacciones previas a MCR remitidos al Servicio de Alergología desde el 1 de junio de 2017 hasta el 31 de mayo de 2018. Los costes sanitarios directos totales fueron de 10.715,84 €, con un coste medio por paciente de 155,30 € ± 77,08. En concreto, los costes directos no sanitarios alcanzaron los 1.605,42 € (media 23,27 € ± 41,14 €) y los costes indirectos fueron de6.490,85 € (media 94,07 € ± 110,61 €). En resumen, el coste total fue de 18.812,11 €, lo que supone un coste medio de 272,64 ± 164,77 €. Conclusiones: Nuestro estudio refleja que los costes de una evaluación electiva de hipersensibilidad a MCR son bajos. Este hecho reafirma que el manejo correcto y seguro de estos pacientes podría ser rentable, por lo que nuestros esfuerzos deben estar dirigidos a implementar la logística necesaria (AU)

[Treatment of retinal angiomatous proliferation (RAP). A retrospective study]. / Tratamiento de la proliferación angiomatosa retiniana (RAP). Estudio retrospectivo.

PURPOSE: To assess the follow-up and response to treatment in patients with RAP. METHODS: A retrospective follow-up study of patients with RAP diagnosed between March 2002 and August 2005. Baseline and subsequent angiograms and optical coherence tomography results were reviewed and RAP classified according to the 3 stages described by Yannuzzi. The changes observed and the best visual acuity were assessed separately for each of the 4 different treatments used: Transpupillary thermotherapy (TTT), Photodynamic therapy (PDT), combined treatment with PDT and Intravitreal triamcinolone (IVT), and combined treatment with PDT, IVT and direct laser photocoagulation of the vascular intraretinal lesion (DLPh.). RESULTS: Fifteen eyes of 14 patients with RAP were studied (mean age, 77.5 years). The mean follow-up was 15.9 months and the mean number of treatments was 2.5. The final visual acuity was worse in 7 (46.7%), stable in 7 (46.7%) and better in 1 (6.6%). Visual acuity improvement, in regard to the treatment used, was: TTT group: 2 out of 14 (14.2%): PDT group: 1 out of 5 (20%); PDT + IVT group: 2 out of 5 (40%) and DLPh. + PDT + IVT group: 3 out of 5 (60%). CONCLUSIONS: The final prognosis for RAP, in terms of visual acuity, was generally poor. However the best treatment was the combined treatment with DLPh + PDT + IVT, while the worst was TTT.

[Nasal T lymphoma]. / Linfoma T nasal.

Nasal T lymphoma constitute a type of lymphoproliferative very infrequent symdrome. One of the fondamental problems it presents to bring a high probability of survival obtain a precocious diagnose. It is due that it originates inespecific histologic lesions, and to its clinic. Only the close cooperation between the otorhinolaryngologist and the anatomopathologist can arrive to obtain a very speedy diagnose and in that way the possibility of a correct treatment, because newly treatments appear, to which this type of disease every day better respond. We present the cases of nasal T lymphomas diagnosticated in the ORL Service of the Toledo area during 15 years, their symptomotology, treatment, evolution and survival. Besides a up to date bibliographic revision on this controversial syndrome.

[Parotid tuberculosis simulating neoplasia. Presentation of a case and review of literature]. / Tuberculosis parotídea, simulando neoplasia. Presentación de un caso y revisión de la literatura.

A case ofparotid tuberculosis (PTB) that during its clinical presentation complementary proofs, exploration and realised treatment made suspect as first possibility a parotid tumor is presented. After an histologic study, it could be proved that the real problem of the patient was that she had suffered a parotid tuberculosis. An exposition of the case is made with the different technics that must be realised facing a patient of these caracteristics, before thinking in surgery, although secure, but with its mortal risks in these times where the incidence of tuberculosis is increasing in the first world.