[Understanding Bipolar Disorder: Risk Factors & Protective Measures]. / Factores de Protección en el Trastorno Afectivo Bipolar: Una Revisión Narrativa de la Literatura.

Bipolar Affective Disorder (BD) is a severe mental pathology characterized by recurrent mood episodes that usually cycle between two opposite poles: mania or hypomania and depression. It has a high level of morbidity/mortality (i.e., cardiovascular disease, cognitive impairment, altered functionality, and absenteeism from work) and associated substantial socioeconomic costs. The most dramatic outcome is death by suicide, which occurs in 5% to 15% of patients. Early detection plays a vital role in modifying the natural course of the disease. It is essential to determine the disease's risk and specific protective factors to prevent its occurrence, delay its appearance, and reduce its deterioration effects. Characteristics such as genetic profile, cognitive reserve (partially explained by educational level and premorbid intelligence), chronotype (particularly morning chronotype), personality aspects (including resilience and hyperthymic temperament), the absence of substance use and childhood maltreatment, in addition to an adequate support network, have been associated with a lower impact in the onset and course of the disease. Once present, interventions -both in the early and late stages (i.e., specific pharmacotherapy and psychotherapy, dietary factors, physical activity, and judicious use of antipsychotics)-can play a protective role against the appearance of the disease and the severity of its mood episodes.

Characterization of the phone-calls made to a poison center related to household and cosmetics products exposition in pediatrics. / Caracterización de las consultas realizadas a un Centro de Información Toxicológica por productos de aseo y productos cosméticos en niños.

INTRODUCTION: Household cleaning products and cosmetics are necessary for daily life and widely used by the population. However, their use may not be risk-free, especially when they are not used or stored as recommended. It is important to characterize exposures, as this is useful for developing stra tegies to reduce morbidity, mortality, and health costs associated, especially in the child population. OBJECTIVE: To describe reports associated with household cleaning products and cosmetics exposure in patients under the age of 12, reported to the Poison Information Center of the Catholic University of Chile (CITUC). PATIENTS AND METHOD: Descriptive cross-sectional study of phone calls to CITUC during 2016. The analyzed variables were age, sex, product, caller, caller and incident location, ex posure circumstances, exposure route(s), symptoms, and severity from manual records and from the WHO's electronic record software 'INTOX Data Management System'. RESULTS: 3,415 cases met the inclusion criteria. Children under the age of five represented 91% of the exposures, and 58.5% were male. 99.4% were accidental exposures, and 98.6% occurred at home. Family members (57%) and health personnel (42%) made the calls. 68.3% of the patients had no symptoms after exposure. The four products with the highest incidence were household bleach (27.6%), floor cleaners and polishers (13.1%), dish soap (7.9%), and perfume/cologne (5.8%). The main exposure route was by ingestion (89.4%). CONCLUSIONS: Household cleaning products and cosmetics are common causes of exposures especially in children under the age of five. Although these products have a low morbidity and mortality rate, it is important to educate the population to prevent possible poisonings in the child population.

Prevalence, trends, correlates and treatment of depression in Chile in 2003 to 2010.

PURPOSE: There is a need for recent, nationally representative data on the prevalence of mental disorders in Latin America. We aim to assess the prevalence of depression in Chile and possible changes over time. METHODS: In the Chilean National Health Surveys in 2003 (n = 5469) and 2010 (n = 7212), two nationally representative cross-sectional population surveys, the Composite International Diagnostic Interview, Short Form (CIDI-SF) was applied to establish diagnosis of major depressive episode (MDE) using DSM-IV criteria. Sociodemographic correlates of MDE and time trends were analyzed. RESULTS: The prevalence of MDE was 20.5% (95% CI 18.3-22.7) in 2003 and 18.4% (95% CI 16.5-20.2) in 2010. In 2003, women and persons residing in urban areas had increased risk of depression, whereas in 2010 the risk factors were female sex, younger age and lower education. There were up to 15-fold differences in prevalence between regions. No significant changes in prevalence occurred over the observation period. 21.2% (95% CI 16.6-25.8) of those depressed were currently receiving antidepressant treatment, with large regional variations in access to treatment. CONCLUSIONS: Depressive disorders are a pressing public health concern in Chile, and particularly women, persons with low education, and the poorer regions of the country are affected. Prompt actions are needed to address the burden of depression with sufficient resources for treatment and prevention.

[PET/CT: Technique, considerations and indications in the oncology study of pediatric patients]. / PET/CT: Técnica, consideraciones e indicaciones en el estudio oncológico de pacientes pediátricos.

Pediatric cancer is the second cause of death in children older than 5 years in our country, after trauma. Positron emission tomography/computed tomography (PET/CT) is a hybrid technique that involves radiation, which has been used for some time in adults and is being progressively imple mented in children. This technique allows morphological and functional assessments of the body with applications in neoplastic and non-neoplastic pathology. Its main role in oncology is in the evaluation and control of lymphomas, sarcomas and neuroblastomas, among others. The quality of the results is determined by a number of rigorous processes to obtain the images. In this article we describe the steps in obtaining the images, the technicalities involved, sources of misinterpretation and what the main current indications that must be known by radiologists and pediatricians are.

[Mental health in Chile and Finland: Challenges and lessons]. / Salud mental en Chile y Finlandia: desafíos y lecciones.

This article analyses and compares the epidemiology of mental disorders and relevant public policies in Chile and Finland. In Chile, a specific mental health law is still lacking. While both countries highlight the role of primary care, Finland places more emphasis on participation and recovery of service users. Comprehensive mental health policies from Finland, such as a successful suicide prevention program, are presented. Both countries have similar prevalence of mental disorders, high alcohol consumption and high suicide rates. In Chile, the percentage of total disease burden due to psychiatric disorders is 13% and in Finland 14%. However, the resources to address these issues are very different. Finland spends 4.5% of its health budget on mental health, while in Chile the percentage is 2.2%. This results in differences in human resources and service provision. Finland has five times more psychiatric outpatient visits, four times more psychiatrists, triple antidepressant use and twice more clinical guidelines for different psychiatric conditions. In conclusion, both countries have similar challenges but differing realities. This may help to identify gaps and potential solutions for public health challenges in Chile. Finland’s experience demonstrates the importance of political will and long-term vision in the construction of mental health policies.

[Radiographic assessment of catheters in a neonatal intensive care unit (NICU)]. / Evaluación radiológica de catéteres en UCI neonatal.

Intravascular catheters are widely used in Neonatal Intensive Care Units. The major types of intravascular access in the newborn are peripheral catheters, venous or arterial umbilical catheters, central venous catheters and peripherally-inserted central venous catheters (PICC). Anomalous positioning of catheters, especially umbilical catheters, is quite frequent as their installation is without imaging guidance. The radiographic assessment of the catheter performed by pediatricians and/or radiologists, who must be able to recognize those poorly positioned as they can cause serious complications, is essential. This article contains a sample of correct and misplaced catheter x-ray often used in a NICU.

[Monitoring polymedicated elderly patients in a health care unit]. / Seguimiento del paciente anciano polimedicado en un área de salud.

OBJECTIVE: Implement a coordinated strategy for the family care unit and the pharmacy division in order to enable revising treatment in polymedicated patients. To this end, we have developed a software tool permitting the patient's primary doctor to have a quick, summarised description of the patient's updated pharmacological treatments, and detect iatrogenic risks and/or dosage adjustments and pharmacotherapy advice. METHODS: In this study, polymedicated patients are defined as those taking 10 or more medications during at least one month. Development phases: Design of a guide form to assist the family doctor in reviewing treatments. Development of a pharmacotherapy report (FTR) as a complementary document to assist the doctor in reviewing treatments. Implementation of a coordinated loop between the family doctor and the pharmacist. Review of work instructions and distribution to involved staff members. RESULTS: The target population of the study consists of 1897 polymedicated patients. We issued 1897 reports, containing the following: 8530 recommendations (10% alerts from regulatory authorities, 31% recommendations regarding high-risk drugs in elderly patients, 7% information on new treatments and 52% recommendations on proper drug use); 399 highly relevant drug interactions; and 5036 recommendations for dose adjustment. These pharmacotherapy reports permit treatment to be revised for nearly 100% of the selected population. CONCLUSION: The development and implementation of software tools for monitoring polymedicated patients enables us to create FTRs that facilitate routine medical reviews of pharmacological treatment in a fairly wide range of patients.

Acid phosphatase activity during the interaction of the nematophagous fungus Duddingtonia flagrans with the nematode Panagrellus sp.

The use of Duddingtonia flagrans, a nematode-trapping fungus, has been investigated as a biological control method against free living larvae of gastrointestinal nematodes of livestock animals. This fungus captures and infects the nematode by cuticle penetration, immobilization and digestion of the internal contents. It has been suggested that this sequence of events occurs by a combination of physical and enzymatical activities. This report characterizes the acid phosphatase activity during the interaction of D. flagrans with the free-living nematode Panagrellus sp. The optimum pH for the hydrolysis of the acid phosphatase substrate p-nitrophenyl phosphate was 2.2, 2.8 and 5.4 from D. flagrans alone and 2.2 and 5.4 for Panagrellus sp alone, fungus-nematode interaction in liquid medium and fungus-nematode interaction in solid medium. Different acid phosphatase activity bands were detected by SDS-PAGE. Maximum acid phosphatase activity of the fungus or nematode alone and of the fungus-nematode interaction occurred within 70min of incubation in the presence of the substrate 4-methylumbelliferyl phosphate. The activity of this enzyme was significantly higher for the fungus-nematode interaction when compared to the organisms alone, indicating a synergistic response. Furthermore, structures appeared in the hyphae after 30min, nematodes were observed adhered after 40min and many were captured by the typical fungus traps after 70min of interaction. The participation of acid phosphatase activity and its importance during the interaction of the fungus with the nematode were discussed.

Influence of temperature on the hydrolysis, acidogenesis and methanogenesis in mesophilic anaerobic digestion: parameter identification and modeling application.

The effect of temperature on the kinetic parameters involved in the main reactions of the anaerobic digestion process was studied. Batch tests with starch, glucose and acetic acid as substrates for hydrolysis, acidogenesis and methanogenesis, respectively, were performed in a temperature range between 15 and 45 degrees C. First order kinetics was assumed to determine the hydrolysis rate constant, while Monod and Haldane kinetics were considered for acidogenesis and methanogenesis, respectively. The results obtained showed that the anaerobic process is strongly influenced by temperature, with acidogenesis exerting the highest effect. The Cardinal Temperature Model 1 with an inflection point (CTM1) fitted properly the experimental data in the whole temperature range, except for the maximum degradation rate of acidogenesis. A simple case-study assessing the effect of temperature on an anaerobic CSTR performance indicated that with relatively simple substrates, like starch, the limiting reaction would change depending on temperature. However, when more complex substrates are used (e.g. sewage sludge), the hydrolysis might become more quickly into the limiting step.

Factores de Protección en el Trastorno Afectivo Bipolar: Una Revisión Narrativa de la Literatura / Understanding Bipolar Disorder: Risk Factors & Protective Measures

El Trastorno Afectivo Bipolar es una patología mental grave, de curso cíclico, caracterizada por episodios anímicos recurrentes que habitualmente transcurren entre dos polos opuestos: la manía o hipomanía y la depresión. Cuenta con una elevada morbimortalidad (enfermedad cardiovascular, deterioro cognitivo, alteración de la funcionalidad y ausentismo laboral) y costo socioeconómico asociado, siendo su desenlace más dramático la muerte por suicidio (el cual sucede en 5% a 15% de los pacientes). La detección precoz juega un rol importante en modificar el curso natural de la enfermedad; un elemento fundamental, junto con determinar los factores de riesgo para TAB, consiste en la identificación de factores protectores específicos, de modo que la enfermedad no se presente, y de serlo así, sea más tarde y con menor deterioro. Características tales como el perfil genético, la reserva cognitiva (explicada en parte por el nivel educacional y la inteligencia premórbida), el cronotipo (en particular el cronotipo matutino), aspectos de personalidad (que incluyen la resiliencia y el temperamento hipertímico), la ausencia de consumo de sustancias y maltrato infantil, además de una adecuada red de apoyo, se han asociado con un menor impacto en relación al inicio y curso de la enfermedad. Una vez presente, intervenciones tanto en la etapa temprana como tardía (farmacoterapia y psicoterapias específicas, factores dietéticos, actividad física y uso juicioso de antipsicóticos), pueden jugar un rol protector en relación a la aparición y/o gravedad de los episodios anímicos.

Bipolar Affective Disorder (BD) is a severe mental pathology characterized by recurrent mood episodes that usually cycle between two opposite poles: mania or hypomania and depression. It has a high level of morbidity/mortality (i.e., cardiovascular disease, cognitive impairment, altered functionality, and absenteeism from work) and associated substantial socioeconomic costs. The most dramatic outcome is death by suicide, which occurs in 5% to 15% of patients. Early detection plays a vital role in modifying the natural course of the disease. It is essential to determine the disease's risk and specific protective factors to prevent its occurrence, delay its appearance, and reduce its deterioration effects. Characteristics such as genetic profile, cognitive reserve (partially explained by educational level and premorbid intelligence), chronotype (particularly morning chronotype), personality aspects (including resilience and hyperthymic temperament), the absence of substance use and childhood maltreatment, in addition to an adequate support network, have been associated with a lower impact in the onset and course of the disease. Once present, interventions -both in the early and late stages (i.e., specific pharmacotherapy and psychotherapy, dietary factors, physical activity, and judicious use of antipsychotics)-can play a protective role against the appearance of the disease and the severity of its mood episodes.

Post-testicular changes in the density and distribution of intramembrane particles of stallion sperm surface domains.

Freeze-fracture replicas of stallion spermatozoa, collected from the proximal caput, corpus and cauda epididymides regions, were analyzed by electron microscopy to explore the distribution and density of intramembrane particles (IMP). Conspicuous differences in density and arrangement of the IMP were observed in the different topographical domains of mature and immature spermatozoa. A reduction of IMP, especially remarkable in the post-acrosomal domain, was observed in mature epididymal spermatozoa when compared with samples collected from ductuli efferentes. Some structural species-specific differences were also observed. The significance of these changes has not been determined, but remodeling of membrane components during developmental processes constitutes a fine control mechanism to ensure that key molecules are in the correct membrane position and during an appropriate timeframe to mediate fertilization.

Cloning and characterization of a cowpea seed lipid transfer protein cDNA: expression analysis during seed development and under fungal and cold stresses in seedlings' tissues.

Lipid transfer proteins (LTPs) are antimicrobial peptides (AMPs) involved in the defense of plants against pathogens. Our group has previously characterized and purified a LTP from cowpea (Vigna unguiculata (L.) Walp.) seeds which caused the inhibition of growth of fungal pathogens in vitro. The aim of this work was to obtain the cDNA encoding the cowpea LTP and after cloning, to use the cDNA as a probe for studying its expression profile during the development of cowpea seeds. In this work, the N-terminal sequence of the mature LTP peptide from cowpea was used to produce a degenerated oligonucleotide. This primer allowed the amplification of the LTP cDNA by RT-PCR from mRNA of cowpea seeds. The sequence analysis of the cloned cDNA, named VULTP, showed 494 bp which encoded a polypeptide of 91 amino acids. The deduced peptide presented high homology of similarity to plant LTPs of Vigna radiata var. radiate (94%), Prunus domestica (82%) and Zea mays (72%). The expression profile of the VULTP gene in cowpea was analyzed by Northern blot and revealed that the transcript is not accumulated in adult tissues. Conversely, VULTP mRNA is early and strongly accumulated during seed development. The results obtained to seedling of cowpea demonstrate that the VULTP gene presents differential expression in response to different stress. Further studies will be conducted to try to gain better understanding about the physiological role of this gene in cowpea.

Nuclear status of immature and mature stallion spermatozoa.

'The highly packed chromatin of mature spermatozoa results from replacement of somatic-like histones by highly basic arginine- and cysteine-rich protamines during spermatogenesis, with additional conformational changes in chromatin structure during epididymal transit. The objective of the present study was to compare the nuclear characteristics of immature and mature epididymal stallion spermatozoa, using a variety of experimental approaches. Resistance to in vitro decondensation of chromatin, following exposure to SDS-DTT and alkaline thioglycolate, increased significantly in mature spermatozoa. Evaluation of the thiol-disulfide status (monobromobimane labeling) demonstrated that immature cells obtained from ductulli efferentes contained mostly thiol groups, whereas these groups were oxidized in mature cells collected from the cauda epididymidis. Based on atomic absorption spectrophotometry, maturation of stallion spermatozoa was accompanied by a 60% reduction in the Zn(2+) content of sperm cells, concomitant with increased concentrations of this ion in epididymal fluid. Furthermore, the degree of disulfide bonding was inversely correlated with susceptibility of chromatin to acid denaturation (SCSA). Collectively, these data were consistent with the hypothesis that maturation of stallion spermatozoa involves oxidation of sulphydryl groups to form intra- and intermolecular disulfide links between adjacent protamines, with loss of zinc as an integral feature. These changes endow mechanical and chemical resistance to the nucleus, ensuring efficient transmission of the paternal genome at fertilization.

Regional differentiation of the blood-epididymis barrier in stallion (Equus caballus).

The occurrence, localization and ultrastructural characteristics of a blood-tissue barrier throughout the stallion proximal seminal excurrent duct system were studied by the exclusion of electron-dense tracers and freeze-fracture techniques. Striking differences were observed in the distribution of lanthanum tracer and in the geometrical organization of the zonulae occludentes along the ductus efferentes, epididymides and vas deferens. The zonulae occludentes domain, the principal structural component of the blood-epididymis barrier, differed in permeability, width and strand numbers along the ductus. The flow of tracer was not impeded by the vascular endothelium, the peritubular myoid layer or other surface membrane specialization. The tight junctions of the ductuli efferentes are poorly developed but unlike those of rats, guinea pigs or man they are not associated with gap junctions. The result of the tracer experiments and the low number of tight junctional strands in the ductuli efferentes suggests that the barrier of the ductuli efferentes corresponds to the 'leaky type'. In the epididymis the zonulae occludentes are well developed throughout the duct. The greatest number of strands, especially in the cauda epididymidis regions, correlates well with a decreased junctional permeability in this area. Another evidence for the existence of the stallion blood-epididymis barrier are the differences in the proteins electrophoretic profiles between blood plasma as compared with the fluid inside the seminal ductus. This junctional complexes contribute to create a highly defined luminal fluid microenvironment that ensures the sperm maturation and survival.

Cytochemical and electrophoretic study of the stallion epididymal glycoproteins.

It has been suggested that proteins produced in specific regions of the epididymis, mostly androgen dependent glycoproteins, are involved in the sperm maturation process. In the present work, the glycoconjugated distribution pattern and the electrophoretic characteristics of the stallion epididymal proteins were examined using lectin probes. The identification in the luminal fluid of some new proteins, probably synthesized and secreted by the epididymis, is an important initial step to investigate their interaction with the stallion sperm membrane. The binding of FITC-lectins (ConA, WGA, LPA, UEA, RCA, HPA) confirmed the presence of macromolecules containing carbohydrate residues in the epithelial cells with a distribution and relative density that was dependent on the epididymal region analyzed. The epithelium displayed affinity for more than one lectin, indicating diversity in the exposed sugar residues. The electrophoretic pattern of proteins obtained from ductus efferentes, corpus and cauda epididymis differed not only from those of the homologous blood serum, but also among the different epididymal regions. The most prominent bands correspond to 66, 55, 45 and 14 kDa proteins, present in different relative concentrations, in the three analyzed regions. A major band of 36 kDa was observed in the cauda epididymis region. The relative concentrations of protein bands of Mw 45, 36, 32, 20 and 18 kDa were significantly increased towards the distal regions of the ductus. The proteins of Mw 66, 55 and 14 kDa showed a relative higher concentration in the efferent ducts, decreasing to 25-30% in the cauda epididymal regions. The Mw 70, 66, 55, 45, 36, 32, 29, 23, 21, 18 and 14 kDa protein bands gave positive PAS reaction indicating that it corresponds to glycoproteins. Mannose residues were detected in the 70, 66, 55, 45, 36 and 32 kDa proteins. WGA-FITC binds to protein bands of Mw 70, 55, 45, 36, 32, 29, 25 and 24 kDa, suggesting the presence of N-linked glycoproteins. However, based on the resistance to the neuraminidase treatment, we suggest that the stallion epididymis contains both O- and N-glycoconjugates, probably in the N-acetyl O-diacetyl form. Although sperm maturation is an androgen-dependent process, no striking differences were detected in the SDS-PAGE obtained from animals in breeding and non-breeding seasons.

Changes in the plasma membrane proteins of stallion spermatozoa during maturation in the epididymis.

The present paper reports modifications in the electrophoretic and cytochemical characteristics of mature and immature stallion spermatozoa. Some sperm surface glycoproteins (36, 32, 29, 21, 20, 18 kDa) detected in cauda epididymidis spermatozoa, were either absent or present in a very low relative concentration in immature sperm cells. A major 14 kDa protein band, observed in sperm extracts obtained from ductus efferentes, progressively decreased along the epididymal ductus. The nature and distribution of carbohydrate residues on the sperm membrane, during epididymal maturation, was also studied by use of lectin probes. Some protein bands bound concanavalin A while others, as the 36, 32 and 20 kDa proteins, exhibited higher affinity for WGA lectin. The distribution and relative density of mannose-, galactose-, N-acetylglucosamine-, N-acetylgalactosamine-, fucose- and sialic acid-containing macromolecules showed a characteristic pattern depending on the sperm membrane domain and on its origin. Some sperm surface domains displayed affinity for more than one lectin, indicating a diversity in their exposed carbohydrate residues, whereas others bound only one or no lectin. The passage of spermatozoa through the epididymidis was accompanied by changes in the accessibility or abundance of lectin ligands. Some lectins (UEA, WGA, LPA) gave stronger reaction in mature spermatozoa, while others (RCA, WFH, PNA) stained better immature spermatozoa. This remodeling of sperm surface molecules is probably a consequence of interactions between spermatozoa and the epididymal secretions, and may reflect addition or adsorption of new molecules, space configurations changes or biochemical modifications of pre-existing compounds. Our results suggest that the distribution and density of terminal oligosaccharidic residues on the sperm plasma membrane have species-specific characteristics. These post testicular developmental changes may be of significance in the overall understanding of the stallion fertility.

[Psychotherapy of bipolar disorder]. / Psicoterapia de le enfermedad bipolar.

Nowadays, it exists evidence that Bipolar Disorder have a less favourable forecast that it was thought. However, there are drugs that prevent recurrences and they dominate therapeutic management. Psychosocial disturbs that are caused by that Disorder make necessary psycotherapeutic interventions. That article includes a description of three psychotherapies (Group Psychotherapy, Family Psychotherapy and Interpersonal Psychotherapy) addressed to this group of patients.

Thiol-disulfide proteins of stallion epididymal spermatozoa.

Thiol groups of cysteine residues represent redox centers involved in multiple biological functions. It has been postulated that changes in the redox status of mammalian epididymal spermatozoa contribute to the sperm maturation process. The present work shows the thiol-disulfide protein profile of stallion epididymal spermatozoa achieved by two-dimension electrophoresis and MALDI-TOF/TOF mass spectrometry of proteins labeled with a thiol-reactive fluorescent tag, monobromobimane. Our results have shown the formation of disulfide bonds in several sperm protein fractions during the epididymal maturation process. The majority of the oxidized thiol sperm proteins identified correspond to structural molecules of the flagellum (as the outer dense fiber-1 protein - ODF1), followed by glycolytic enzymes (as glyceraldehyde-3-phosphate dehydrogenase spermatogenic), antioxidant protectors (as glutathione S-transferase and phospholipid hydroperoxide glutathione peroxidase - PHGPx). The magnitude of the thiol oxidation differs between proteins, and was more drastic in polypeptides with molecular weights of up to 33kDa, identified as ODF1 and PHGPx. A kinase anchor protein, a voltage-dependent anion channel protein and a zona pellucida-binding protein were also found in the polypeptide samples that contained oxidized SH groups. These proteins may be modified or controlled by the mechanisms involved in the cysteine-redox changes, corroborating the belief that a correct degree of protein oxidation is required for the stabilization of sperm structure, protection against oxidative damage, induction of progressive sperm motility and fertilization.

[Prevalence of potentially inappropriate medication in hospitalized elderly patients by using explicit criteria]. / Prevalencia de medicación potencialmente inapropiada en pacientes ancianos hospitalizados utilizando criterios explícitos.

INTRODUCTION: Potentially inappropriate medication (PIM) prescribing in older adults is quite prevalent and is associated with an increased risk for adverse drug events, morbidity, and utilization of health care resources. The aim of this study was to determine the prevalence and type of PIM in polypharmacy elderly patients on admission and discharge and the factors associated with their prescription. Just as the applicability of various explicit criteria selected from the literature and adapted to our area. METHODS: We performed a cross-sectional study for 12 months (March 2010-February 2011) on 179 polypharmacy elderly patients admitted to an Internal Medicine Department. We created a list of 50 PIM using a Delphi approach based on previous published criteria (Beers, Stopp, BMC and Priscus). Through patient interviews, review of medical records and discharge reconciliation report, we identified the prevalence of PIM in the patients. We also analyzed the relationship between different factors and the prescription of PIM. RESULTS: The prevalence of patients with PIM on admission and discharge were 71% and 48%, respectively. Out of the 50 selected PIM, 27 and 26 were detected on admission and discharge, respectively (55.5% and 57.69% included on STOPP criteria). We detected two factors associated with PIM prescription at discharge: severe-total dependence (OR = 1.8) and prescription of more than 11 drugs (OR = 2). CONCLUSIONS: PIM prevalence in our population is very high (70%), especially at hospital admission. These findings support the need for measures aimed at improving the quality of prescriptions, especially on dependent patients with polypharmacy.

INTRODUCCIÓN: En personas mayores la prescripción de medicamentos potencialmente inapropiados (PIM) es muy elevada y se asocia con mayor riesgo de eventos adversos, morbilidad y utilización de recursos sanitarios. El objetivo del presente estudio es conocer la prevalencia y tipo de PIM en pacientes ancianos polimedicados al ingreso y alta hospitalaria, los factores asociados a su prescripción y la aplicabilidad de distintos criterios explícitos seleccionados de la bibliografía y adaptados a nuestro ámbito. MÉTODO: Se realiza estudio observacional transversal durante 12 meses (marzo 2010-febrero 2011), sobre 179 pacientes ancianos polimedicados, ingresados en un servicio de Medicina Interna. Como herramienta para detectar la prescripción inadecuada se seleccionaron 50 PIM a partir de la bibliografía (criterios Beers, Stopp, BMC y Priscus) utilizando una técnica Delphi. A través de entrevista con el paciente, revisión de historias clínicas e informe de conciliación se identificaron los PIM previamente seleccionados. Posteriormente se analizó la relación entre distintos factores y la prescripción de PIM. RESULTADOS: La prevalencia de pacientes con PIM al ingreso fue de 71% y al alta de 48%. De 50 PIM seleccionados, sólo se detectaron 27 y 26 tipos (55,5% y 57,69% criterios STOPP) al ingreso y al alta respectivamente. Los factores asociados a la prescripción de PIM al alta fueron: dependencia severa-total (OR = 1,8; IC 95% 1,0-3,4) y nº de medicamentos mayor de 11 (OR = 2; IC 95% 1,1-3,7). CONCLUSIONES: La prevalencia de PIM en nuestra población es muy elevada (70%) especialmente al ingreso hospitalario, estos resultados apoyan la necesidad de adoptar medidas enfocadas a mejorar la calidad de la prescripción prioritariamente en pacientes dependientes y polimedicados.