Escala de movilidad ProMover. Un lenguaje unificado para la evaluación de pacientes hospitalizados / ProMover mobility scale. A unified language for the evaluation of hospitalized patients

Resumen La Clasificación Internacional del Funcionamiento (CIF) define la movilidad como la posibilidad de "moverse cambiando la posición o ubicación del cuerpo o moviéndose de un lugar a otro, trans portando, moviendo o manipulando objetos, caminando, corriendo o trepando, y utilizando diversas formas de transporte". La fisioterapia se centra en la evaluación y el tratamiento de los problemas de movimiento. La deter minación del estado de movilidad es un componente central de la evaluación de la salud de los adultos mayores, ya que es un marcador importante de las capacidades físicas y la independencia, y un predictor de morbilidad y mortalidad. Sin embargo, a la fecha no disponemos de escalas que representen el grado de movilidad del paciente con algún tipo de imagen visual que facilite su documentación de forma rápida y fiable por parte de cualquier profesional sanitario que trabaje en el ámbito de la hospitalización. Por estas razones, desarrollamos una escala de movilidad intuitiva basada en iconos que es fácil de administrar en pacientes hospitalizados en diferentes entornos. La escala de movilidad ProMover proporciona a los profesionales de la salud una herramienta unificada para evaluar la movilidad de los pacientes hospitalizados, con el fin de unificar un lenguaje común. Se trata de una herramienta sencilla, práctica, fiable y objetiva y de uso común por todos los profesionales sanitarios.

Abstract. The International Classification of Functionality (CIF) defines mobility as the possibility of "moving by changing the position or location of the body or moving from one place to another, transporting, moving or manipulating objects, walking, running or climbing, and using various forms of transport ". Physical therapy focuses on the assessment and management of movement problems. Determining mobility status is a central component of the health assessment of older adults since it is an important marker of physical abilities and independence, and a predictor of morbidity and mortality. However, to date we did not have scales that represent the degree of mobility of the patient with some type of visual image that facilitates its documentation quickly and reliably by any health professional who works in the field of hospitalization. For these reasons, we developed an intuitive, icon-based mobility scale that is easy to administer in hospitalized patients in different settings. The ProMover mobility scale provides health professionals with a unified tool for evaluating the mobility of hospitalized patients, in order to unify a common language. This is a simple, practical, reliable and objective tool and commonly used by all health professionals.

Recommendations for the diagnosis and management of persons with suspected vaccine-induced immune thrombotic thrombocytopenia (VITT) / Recomendaciones para diagnostico y manejo de personas con trombocitopenia trombotica inmune inducida por vacunas (VITT)

Abstract In recent months, rare cases of thrombosis at unusual sites associated with thrombocytopenia, occurring within a typical risk window (i.e., 4-28 days) after receiving SARS CoV2 vaccines, have been reported. Healthcare professionals should be prepared to detect these cases on time. The Expert Panel of the Knowledge Management and Transfer Network conducted a free search of the related literature. With the available information and the clinical expertise of the working group, we formulated, reviewed, and endorsed recommendations for the timely suspicion, diagnosis (case definitions, the use of initial laboratory and imaging tests, specific tests), and management of these thrombotic conditions. This document is considered a living document that will be updated as new evidence emerges, and recommendations may change over time.

Resumen En meses recientes se han reportado casos raros de trombocitopenia y trombosis en sitios inusuales, que ocurren dentro de una ventana de riesgo típica ( por ejemplo de 4 a 28 días) luego de recibir vacunas de SARS CoV 2. Los profesionales de la salud deben estar preparados para detectar estos casos a tiempo. Un panel de expertos y una red de transferencia de conocimiento realizó una búsqueda libre de literatura seleccionada. Con la información disponible y la experticia clínica del grupo de trabajo revisamos y dimos recomendaciones para la sospecha temprana, el diagnostico (definición de caso, el uso de pruebas de laboratorio especificas y de imágenes diagnósticas) para le manejo de estas condiciones tromboticas. Este documento es considerado un documento vivo que debe ser actualizado a medida que surja nueva evidencia y las recomendaciones vayan cambiando con el tiempo

Impacto de la Iniciativa HEARTS en una institución de salud de segundo nivel en Colombia / Impact of the HEARTS Initiative in a second-level health institution in Colombia / Impacto da iniciativa HEARTS em um estabelecimento de atenção secundária à saúde na Colômbia

RESUMEN Objetivo. Identificar el impacto de la iniciativa HEARTS en los pacientes con hipertensión arterial atendidos en un hospital colombiano. Métodos. Estudio cuasiexperimental, retrospectivo entre 2017 y 2019 con pacientes hipertensos mayores de 18 años, incluidos en la estrategia HEARTS, atendidos en el Hospital Santa Mónica del municipio de Dosquebradas, departamento de Risaralda. La unidad de análisis fue la historia clínica. Se evaluaron las metas de presión arterial (definido en la Iniciativa HEARTS como un paciente con presión arterial sistólica <140 mmHg y <90 mmHg en la presión diastólica) al momento del ingreso al programa HEARTS y un año después. Se incluyeron variables sociodemográficas, farmacológicas, clínicas, metas de presión arterial y cumplimiento de la iniciativa. Se realizaron análisis descriptivos y se aplicó regresión logística binaria (p <0.05). Resultados. Se analizaron 372 pacientes de los cuales 262 eran mujeres (70,4%). La edad media fue de 66,3 ± 12,2 años. En la primera consulta de control se reportaron 285 pacientes (76,6%) que presentaron cifras de tensión arterial en metas, en la segunda consulta este logro fue alcanzado por el 84,1% de los pacientes (n=313 diferencia media: 7,5%, IC95%: 1,8 a 13,1; p=0,005). Después de la implementación de la Iniciativa HEARTS el 77,4% en los pacientes (n=288) continuaron con el manejo inicial. Cumplir las recomendaciones HEARTS aumenta la probabilidad de estar en las metas (p=0,033; OR= 2,688; IC= 1,081 - 6,684). Conclusiones. La implementación de la Iniciativa HEARTS impactó favorablemente las cifras de tensión arterial en pacientes con hipertensión, con beneficios adicionales en variables que disminuyen el riesgo cardiovascular.

ABSTRACT Objective. To identify the impact of the HEARTS initiative on patients with high blood pressure treated in a Colombian hospital. Methods. Quasi-experimental, retrospective study between 2017 and 2019 with hypertensive patients over 18 years of age included in the HEARTS strategy and treated at the Santa Mónica Hospital in the municipality of Dosquebradas, department of Risaralda. The unit of analysis was medical history. Blood pressure targets (defined in the HEARTS initiative as a patient with systolic blood pressure <140 mmHg and diastolic pressure <90 mmHg) were assessed at the time of admission to the HEARTS program and one year later. Sociodemographic, pharmacological, clinical, and blood pressure targets were included, as was compliance with the recommendations of the initiative. Descriptive analysis was performed, and binary logistic regression was applied (p <0.05). Results. A total of 372 patients were studied, of whom 262 were women (70.4%). The mean age was 66.3 ± 12.2 years. In the first consultation, 285 patients (76.6%) presented blood pressure figures within the target range; in the second consultation this was achieved by 84.1% of patients (n=313, mean difference: 7.5%, 95% CI: 1.8 to 13.1; p=0.005). After implementation of the HEARTS initiative, 77.4% of patients (n=288) continued with the initial treatment. Following HEARTS recommendations increases the likelihood of being in the target range (p=0.033; OR= 2,688; CI= 1.081 - 6.684). Conclusions. Implementation of the HEARTS initiative favorably impacted blood pressure figures in patients with hypertension and decreased cardiovascular risk.

RESUMO Objetivo. Identificar o impacto da iniciativa HEARTS nos pacientes com hipertensão arterial atendidos em um hospital colombiano. Métodos. Estudo quase-experimental, retrospectivo entre 2017 e 2019, com pacientes hipertensos maiores de 18 anos incluídos na estratégia HEARTS, atendidos no Hospital Santa Mónica do município de Dosquebradas, departamento de Risaralda. A unidade de análise foi a história clínica. As metas de pressão arterial (definidas na iniciativa HEARTS como pressão arterial sistólica <140 mmHg e pressão diastólica <90 mmHg) foram avaliadas no momento de ingresso no programa HEARTS e um ano depois. Foram incluídas variáveis sociodemográficas, farmacológicas, clínicas, metas de pressão arterial e adesão à iniciativa. Foram realizadas análises descritivas e foi aplicada a regressão logística binária (p<0,05). Resultados. Foram analisados 372 pacientes, dos quais 262 eram mulheres (70,4%). A média de idade foi de 66,3 ± 12,2 anos. Na primeira consulta de controle, 285 pacientes (76,6%) apresentaram valores de pressão arterial dentro das metas; na segunda consulta, as metas haviam sido alcançadas por 84,1% dos pacientes (n=313 diferença média: 7,5%, IC95%: 1,8 a 13,1, p=0,005). Após a implementação da iniciativa HEARTS, 77,4% dos pacientes (n=288) continuaram com o manejo inicial. O cumprimento das recomendações da HEARTS aumenta a probabilidade de estar nas metas (p=0,033; OR= 2,688; IC= 1,081 - 6,684). Conclusões. A implementação da iniciativa HEARTS teve um impacto favorável nos valores da pressão arterial em pacientes com hipertensão e diminuiu o risco cardiovascular.

Trends of vasopressor use in intensive care units in Colombia / Tendencias de consumo de vasopresores en unidades de cuidados intensivos de Colombia

Abstract Introduction Vasopressors are essential in the management of various types of shock. Objective To establish the trend of vasopressors use in the intensive care units (ICU) in a population of patients affiliated with the Colombian Health System, 2010-2017. Methods Observational trial using a population database of patients hospitalized in eleven ICUs in various cities in Colombia. The drugs dispensed to hospitalized patients over 18 years old, from January 2010 until December 2017 were considered. A review and analysis of the vasopressors dispensed per month was conducted, taking into account sociodemographic and pharmacological variables (vasopressor used and daily doses defined per 100/beds/day (DBD). Results 81,348 dispensations of vasopressors, equivalent to 26,414 treatments in 19,186 patients receiving care in 11 hospitals from 7 cities were reviewed. The mean age of patients was 66.3±18.1 years and 52.6 % were males. Of the total number of treatments recorded, 17,658 (66.8 %) were with just one vasopressor. Norepinephrine was the most frequently prescribed drug (75.9 % of the prescriptions dispensed; 60.5 DBD), followed by adrenaline (26.6 %; 41.6 DBD), dopamine (19.4%), dobutamine (16.0 %), vasopressin (8.5 %) and phenylephrine (0.9 %). The use of norepinephrine increased from 2010 to 2017 (+6.19 DBD), whilst the use of other drugs decreased, particularly the use of adrenaline (-60.6 DBD) and dopamine (-10.8 DBD). Conclusions Norepinephrine is the most widely used vasopressor showing a growing trend in terms of its use during the study period, which is supported by evidence in favor of its effectiveness and safety in patients with shock.

Resumen Introducción Los fármacos vasopresores son fundamentales en el manejo de los diferentes tipos de choque. Objetivo Determinar la tendencia de utilización de fármacos vasopresores en unidades de cuidados intensivos (UCI) en una población de pacientes afiliados al Sistema de Salud de Colombia, 2010-2017. Métodos Estudio observacional, a partir de una base de datos poblacional con pacientes hospitalizados en once UCI de diferentes ciudades de Colombia. Se obtuvieron las dispensaciones de pacientes mayores de 18 años hospitalizados desde enero de 2010 hasta diciembre de 2017. Se hizo revisión y análisis de la dispensación mensual de vasopresores. Se consideraron variables sociodemográficas y farmacológicas (medicamento vasopresor usado y dosis diarias definidas por 100 camas/día [DCD]). Resultados Se revisaron 81.348 dispensaciones de vasopresores, equivalentes a 26.414 terapias en 19.186 pacientes atendidos en 11 hospitales de 7 ciudades, cuya edad promedio fue 66,3±18,1 años y el 52,6 % eran hombres. Del total de terapias registradas, 17.658 (66,8 %) fueron con un solo vasopresor. La norepinefrina fue el más comúnmente prescrito (75,9 % de las dispensaciones; 60,5 DCD), seguido por adrenalina (26,6 %; 41,6 DCD), dopamina (19,4 %), dobutamina (16,0 %), vasopresina (8,5 %) y fenilefrina (0,9 %). El uso de norepinefrina se incrementó de 2010 a 2017 (+6,19 DCD), mientras que el de otros fármacos disminuyó, especialmente adrenalina (-60,6 DCD) y dopamina (-10,8 DCD). Conclusiones La norepinefrina es el fármaco vasopresor más utilizado y el que ha demostrado una tendencia de uso incremental durante el periodo de estudio, lo cual está respaldado por evidencia a favor de su efectividad y seguridad en pacientes con choque.

Estado nutricional y preferencia del sabor dulce en adultos chilenos / Nutritional status and sweet taste preference in Chilean adults

El dramático aumento de la prevalencia e incidencia de la obesidad sugiere que factores ambientales y cambios en el estilo de vida contribuyen de forma importante a su tendencia epidémica. En humanos, se han reportado diferencias interindividuales en los umbrales de detección y preferencia del sabor dulce, lo que podría afectar la ingesta habitual de azúcares, y por ende al estado nutricional. Objetivo: El presente estudio busca determinar la relación entre el estado nutricional y la preferencia al sabor dulce en la comunidad de un establecimiento de educación superior. Método: Muestra fue constituida por estudiantes, funcionarios y docentes, entre 18 y 60 años, pertenecientes a la Universidad Mayor, Sede Temuco. Para determinar preferencia al sabor dulce se empleó prueba organoléptica que mide grado de satisfacción frente a solución dulce, junto a ello se realizaron mediciones de peso y talla para determinar el Índice de Masa Corporal. Resultados: Muestra final comprendió de 319 personas, de las cuales un 30,1% fueron hombres y 69,9% mujeres. No se observaron diferencias significativas en la preferencia hacia las soluciones con mayor concentración de sacarosa según el estado nutricional. Sin embargo, el modelo predictivo desarrollado arrojó que hombres prefieren las soluciones con mayor concentración de azúcar independiente de la edad y estado nutricional. Conclusiones: Es necesario desarrollar nuevos estudios que permitan aclarar si la preferencia al sabor dulce favorece el desarrollo de obesidad y sobrepeso, o si es la composición nutricional de los alimentos procesados o ultraprocesados, lo que está teniendo un mayor impacto negativo en el estado nutricional de la población(AU)

The dramatic increase in the prevalence and incidence of obesity seems to suggest that environmental factors and lifestyle changes are contributing significantly to the epidemic trend of this pathology. In humans, inter-individual differences in the thresholds of preference of sweet taste have been reported, which could affect habitual sugar intake, and therefore the nutritional status. Objective: The present study seeks to determine the relationship between nutritional status and the preference of sweet taste in the population of a higher education establishment. Method: Sample was constituted by students, officials and teachers between 18 and 60 years, belonging to the Universidad Mayor, Temuco. To determine the perception of the sweet taste, an organoleptic test was used that measures the degree of satisfaction with the sweet solution, along with this, weight and height measurements were made to determine the Body Mass Index. Results: Final sample comprised 319 people, of which 30.1% were men and 69.9% women. No significant differences were observed in the preference for solutions with a higher concentration of sucrose according to nutritional status. However, a predictive model developed showed that men prefer the solutions with the highest concentration of sugar regardless of age and nutritional status. Conclusions: It is necessary to develop new studies to clarify whether the preference for sweet taste favors the development of obesity and overweight, or if it is the nutritional composition of processed or ultraprocessed foods, which is having a greater negative impact on the nutritional status of the population.(AU)

Vulvar lesion mimicking vitiligo: A case report.

BACKGROUND: Post-inflammatory hypopigmentation (PIH) is an acquired partial or total loss of pigment that occurs as a result of cutaneous inflammation. Clinically, post-inflammatory hypopigmentation is recognized by a discoloration of the skin; however, proper diagnosis requires a skin biopsy. Although post-inflammatory hypopigmentation is similar in appearance to vitiligo, histopathological evaluation highlights the key differences in the presence of melanocytes and melanophages. CASE PRESENTATION: A 28-year-old woman presented with discoloration in the vulvovaginal area. Physical examination was within normal limits; however, a genital exam revealed a large, intensely white discoloration in an hourglass pattern involving the clitoris, labia majora, and perianal area. Pigmentation was observed at the base of the hair follicles, which is not consistent with vitiligo. The patient consented to a skin biopsy, which was performed without complication. The biopsy showed mild chronic vulvitis and pigment incontinence due to post-inflammatory hypopigmentation. The patient was prescribed a high-potency topical steroid and a significant reduction in lesion area was observed at 3-month follow-up. DISCUSSION: Proper diagnosis via clinical examination and skin biopsy is essential in the treatment of pigment deficiencies. In cases of post-inflammatory hypopigmentation, the initial cause of inflammation must first be identified in order to provide an effective treatment regimen. When facing uncommon dermatological conditions such as post-inflammatory hypopigmentation, proper histopathological diagnosis, course of treatment, and follow-up are important in order to achieve patient satisfaction.

Carbon dioxide (CO2) laser ablation treatment of a peri-urethral genital wart: A case report.

BACKGROUND: Visible genital warts are caused by the nearly 100 recognized strains of human papillomavirus (HPV). HPV infections caused by high-risk strains are associated with significant morbidity and mortality rates. Genital warts are diagnosed by visual inspection and treated by three major methods: topical agents, systemic agents, and surgical therapies. CO2 laser ablation is the best treatment option for warts that present as refractory, thick, extensive lesions. CO2 ablation offers benefits such as a painless procedure, increased clearance rate, lesser side-effects and decreased pain. CASE PRESENTATION: An 18-year old patient was referred to the obstetric/gynecology clinic and presented with severe urinary complications. She complained of dysuria, frequency, vaginal irritation, and spraying while voiding. Physical exam was within normal limits; however, genital examination revealed a 3 cm fungating mass corresponding to a large genital wart at the urethral meatus and peri-urethral area. Due to her progressing symptomatology, CO2 laser ablation therapy was advised. DISCUSSION: HPV directly impacts the public health system, affecting 1% of the US population with an estimated 10-20% prevalence rate. Treatment options such as CO2 laser ablation offers complete removal for most patients with limited side-effects. Accurate follow-up is necessary to monitor proper recovery. CONCLUSION: CO2 laser ablation is considered an effective form of therapy in cases where immediate removal is desired and surgical excision is not recommended. CO2 laser ablation provides high clearance rates and minimal instances of recurrence, as well as superior aesthetic outcome.

Recomendaciones para el uso de tromboprofilaxis en pacientes hospitalizados por COVID-19 en la Argentina / Recommendations for the use of thromboprophylaxis in hospitalized patients with COVID-19 in Argentina

Si bien la incidencia es incierta, algunos reportes de caso sugieren que la infección por COVID 19 se asocia con un aumento del riesgo de tromboembolismo venoso. Sugerimos iniciar tromboprofilaxis a todos los pacientes hospitalizados por síntomas asociados con una infección por COVID-19, a menos que esté contraindicado, con enoxaparina 40 mg SC diariamente si el clearance de creatinina es mayor a 30 ml/min.

Although the incidence is uncertain, some case reports suggest that COVID 19 infection is associated with an increased risk of venous thromboembolism. We suggest starting prophylactic anticoagulant therapy for all patients hospitalized with a symptomatic infection with COVID-19, unless contraindicated, with enoxaparin 40 mg SC daily if creatinine clearance is greater than 30 ml/min.

Big data, pharmacoepidemiology and pharmacovigilance / Big data, farmacoepidemiología y farmacovigilancia

Abstract Big data is a term that comprises a group of technological tools capable of processing extremely large heterogeneous data sets, which are continuously collected and are available to be used at any time, and, therefore, constitutes a source of scientific evidence production. In the pharmacoepidemiology field, analyses made using these data sets may result in the development of pharmacological therapies that are more efficient, less expensive, and have a lower occurrence rate of adverse reactions. Likewise, the use of tools such as Text Mining or Machine Learning has led to major advances in pharmacoepidemiology and pharmacovigilance areas, so it is likely that these tools will be increasingly used over time.

Resumen Big data es un término que comprende un grupo de herramientas tecnológicas capaces de procesar conjuntos de datos heterogéneos extremadamente grandes, los cuales se recolectan de manera continua, están disponibles para ser usados y constituyen una fuente de evidencia científica. En el área de la farmacoepidemiología, los análisis generados a partir de estos conjuntos de datos pueden resultar en la obtención de terapias médicas más eficientes, con menor número de reacciones adversas y menos costosas. Asimismo, el uso de herramientas como el Text Mining o el Machine Learning también ha llevado a grandes avances en las áreas de farmacoepidemiología y farmacovigilancia, por lo que es probable que su empleo sea cada vez mayor.

Beneficios de una unidad de mediana estancia en la rehabilitación de adultos mayores dependientes / Benefits of a subacute care unit in the rehabilitation of frail dependent older adults

Las Unidades de Mediana Estancia (UME) se definen como un recurso institucional con camas de hospitalización para pacientes ancianos, en donde ‒una vez superada la fase aguda de la enfermedad‒ sea posible efectuar un tratamiento a medio plazo, con recursos rehabilitadores, atención médica y cuidados de enfermería, todo ello con el propósito de conseguir la recuperación funcional y la reinserción en la comunidad. El objetivo de este trabajo fue efectuar un estudio cuasi experimental con propio individuo control antes-después con el fin de describir las características basales de los pacientes ingresados en la UME con objetivos de rehabilitación, así como su ganancia funcional luego de la intervención, medida como la diferencia entre el índice de Barthel al alta (valor final) y al ingreso en la UME (valor basal). Para ello se incluyeron 122 personas y se obtuvo como principal resultado una ganancia funcional positiva de 40 puntos y un parámetro de eficacia (ganancia funcional/días de internación) de 1,18. Los resultados obtenidos se consideran, de acuerdo con la literatura, como efectivos y eficaces. (AU)

Subacute Care Units are defined as an institutional resource with hospital beds where once a patient overcomes the acute phase of a disease, it is possible for him to undergo a rehabilitation treatment with the objective of achieving functional recovery and reintegration into the community. The purpose of this paper was to carry out a quasi-experimental before and after study where the subjects serve as their own controls, in order to describe the baseline characteristics of the patients admitted to the subacute care unit with rehabilitation objectives, as well as their functional gain after the intervention, measured as the difference between the Barthel index at discharge (final value) and admission to the EMU (baseline value). For this, 122 people were included, obtaining as main results a positive functional gain of 40 points (p <0.001) and an efficiency parameter (functional gain / days of hospitalization) of 1.18, considering the results obtained according to the literature as effective and efficient. (AU)

[Updated recommendations for venous thromboembolic prophylaxis in Argentina]. / Recomendaciones actualizadas para profilaxis de la enfermedad tromboembólica venosa en Argentina.

Venous thromboembolic disease (VTE) in hospitalized adults has high morbidity and mortality, is the origin of chronic complications and increased cost for the health system. Since the publication of recommendations for thromboprophylaxis in hospitalized patients in 2013, new alternatives and strategies have emerged, which motivated us to update our recommendations. Although there are different consensus and clinical practice guidelines, adherence to them is suboptimal. The different therapeutic alternatives for hospitalized adult patients (non-surgical, surgical non-orthopedic, with and without cancer, orthopedic an d pregnant) have been updated, paying particular attention to the drugs available in Argentina.

La enfermedad tromboembólica venosa (ETV) en adultos hospitalizados posee elevada morbimortalidad, es origen de complicaciones crónicas y determina incrementos de costos para el sistema de salud. Desde la publicación de recomendaciones de tromboprofilaxis en pacientes internados en 2013, han surgido nuevas alternativas y estrategias, que nos motivaron a actualizar nuestras recomendaciones. A pesar de que existen diferentes consensos y guías de práctica clínica la adherencia a las mismas es subóptima. Se han actualizado las diferentes alternativas terapéuticas para los adultos hospitalizados (clínicos no quirúrgicos, quirúrgicos no ortopédicos, con y sin cáncer, ortopédicos y embarazadas), poniendo particular atención en los fármacos disponibles en Argentina.

Recomendaciones actualizadas para profilaxis de la enfermedad tromboembólica venosa en Argentina / Updated recommendations for venous thromboembolic prophylaxis in Argentina

La enfermedad tromboembólica venosa (ETV) en adultos hospitalizados posee elevada morbimortalidad, es origen de complicaciones crónicas y determina incrementos de costos para el sistema de salud. Desde la publicación de recomendaciones de tromboprofilaxis en pacientes internados en 2013, han surgido nuevas alternativas y estrategias, que nos motivaron a actualizar nuestras recomendaciones. A pesar de que existen diferentes consensos y guías de práctica clínica la adherencia a las mismas es subóptima. Se han actualizado las diferentes alternativas terapéuticas para los adultos hospitalizados (clínicos no quirúrgicos, quirúrgicos no ortopédicos, con y sin cáncer, ortopédicos y embarazadas), poniendo particular atención en los fármacos disponibles en Argentina.

Venous thromboembolic disease (VTE) in hospitalized adults has high morbidity and mortality, is the origin of chronic complications and increased cost for the health system. Since the publication of recommendations for thromboprophylaxis in hospitalized patients in 2013, new alternatives and strategies have emerged, which motivated us to update our recommendations. Although there are different consensus and clinical practice guidelines, adherence to them is suboptimal. The different therapeutic alternatives for hospitalized adult patients (non-surgical, surgical non-orthopedic, with and without cancer, orthopedic an d pregnant) have been updated, paying particular attention to the drugs available in Argentina.

Umbilical Myiasis by Cochliomyia hominivorax in an Infant in Colombia.

Myasis is the infestation by fly larvae (Diptera) in live vertebrates including humans. Myasis has been reported most commonly in tropical and subtropical areas around the world with poor sanitation and presence of cattle. Neonatal umbilical myiasis is an important cause of death in bovines and produces major economic losses in the livestock industry. However, its presentation in humans is rare, with a few cases reported worldwide. Moreover, umbilical myasis can be life-treating due to the risk of larvae migration to deeper tissues of the abdomen, omphalitis, and sepsis. We describe the case of a 7-day-old infant admitted to the hospital due to umbilical cord myiasis. In total, 55 larvae were removed from the wound and identified as Cochliomyia hominivorax. The patient recovered satisfactorily after treatment with ivermectin and amoxicillin. A literature search was performed in Pubmed, Medline, Lilacs and Google Scholar, with 64 cases of myasis by C. hominivorax being reviewed. Oral cavity, wounds, scalp and natural orifices are the main affected anatomical areas. Risk factors include the extremes of age, male sex, poor hygiene, alcohol and drug use, cancer, and mental disability. Programs for human myiasis prevention and surveillance are needed in neotropical areas where living conditions make it difficult to implement control strategies.

Ileocecal endometriosis: diagnosis and management.

OBJECTIVE: Ileocecal endometriosis is rare. Symptoms range from no symptoms, cramps, vomiting, to acute intestinal obstruction. Our objective was to review our cases, clarify, and resume its most appropriate management focusing on the factors to determine diagnosis. This is a retrospective study by revision of medical charts of all ileal endometriosis cases of our unit from 2006 to 2014. CASE REPORT: Seven cases were found; three (43%) had previous endometriosis laparoscopic diagnosis, four (57%) had partial bowel obstruction episodes, three (43%) had chronic pelvic pain, and one developed acute intestinal obstruction in postoperative ileostomy closure. In three (43%), the diagnosis was made with magnetic resonance imaging (MRI) and double contrast barium enema, in one (14%) only with MRI, and the other three (43%) during surgery. All patients underwent resection of the ileum and evolved favorably. CONCLUSION: Variability in symptoms hinders diagnosis. The gold standard for diagnosis is MRI, but clinical suspicion optimizes imaging test diagnosis. Segmental resection should be indicated in the majority of the cases.

Medication errors in outpatient care in Colombia, 2005-2013 / Errores de medicación en pacientes atendidos en servicios ambulatorios de Colombia, 2005-2013

Introduction: Medication errors outside the hospital have been poorly studied despite representing an important threat to patient safety. Objective: To describe the characteristics of medication errors in outpatient dispensing pharmacists reported in a pharmaco-surveillance system between 2005 and 2013 in Colombia. Materials and methods: We conducted a descriptive study by reviewing and categorizing medication error reports from outpatient pharmacy services to a national medication dispensing company between January, 2005 and September, 2013. Variables considered included: process involved (administration, dispensing, prescription and transcription), wrong drug, time delay for the report, error type, cause and severity. The analysis was conducted in the SPSS ® software, version 22.0. Results: A total of 14,873 medication errors were reviewed, of which 67.2% in fact occurred, 15.5% reached the patient and 0.7% caused harm. Administration (OR=93.61, CI 95%: 48.510-180.655, p<0.001), dispensing (OR=21.58, CI 95%: 16.139-28.870, p<0.001), transcription errors (OR=5.64; CI 95%: 3.488-9.142, p<0.001), medicines for sensory organs (OR=2.04, CI 95%: 1.519-2.756, p<0.001), anti-infective drugs for systemic use (OR=1.99, CI 95%: 1.574-2.525, p<0.001), confusion generated with the name of the drug (OR=1.28, CI 95%: 1.051-1.560, p=0.014), and trouble interpreting prescriptions (OR=1.32, CI 95%: 1.037-1.702, p=0.025) increased the risk for error reaching the patient. Conclusions: It is necessary to develop surveillance systems for medication errors in ambulatory care, focusing on the prescription, transcription and dispensation processes. Special strategies are needed for the prevention of medication errors related to anti-infective drugs.

Introducción. Los errores de medicación en la atención ambulatoria se han estudiado poco, a pesar de que representan una amenaza importante para la seguridad del paciente. Objetivo. Describir las características de los errores de medicación en atención ambulatoria reportados por un sistema de farmacovigilancia de Colombia entre el 2005 y el 2013. Materiales y métodos. Se hizo un estudio descriptivo en el cual se recopilaron, revisaron y categorizaron los reportes de errores de medicación de pacientes atendidos en un servicio farmacéutico ambulatorio a cargo de una empresa nacional de dispensación de medicamentos, entre enero de 2005 y septiembre de 2013. Se consideraron variables que involucraban el proceso (administración, dispensación, prescripción y transcripción), el medicamento, el tiempo para elaborar el reporte, el tipo de error, su causa y su gravedad. El análisis se hizo con el programa SPSS ® , versión 22.0. Resultados. Se recopilaron 14.873 errores de medicación, de los cuales 67,2 % realmente ocurrió, 15,5 % afectó al paciente y 0,7 % causó daño. Los errores de administración (p<0,001; OR=93,614; IC 95% 48,510-180,655), de dispensación (p<0,001; OR=21,585; IC 95% 16,139-28,870), de transcripción (p<0,001; OR=5,647; IC 95% 3,488-9,142), los relacionados con medicamentos para los órganos de los sentidos (p<0,001; OR=2,046; IC 95% 1,519-2,756), y con los medicamentos de uso sistémico contra infecciones (p<0,001; OR=1,993; IC 95% 1,574-2,525), la confusión en el nombre del fármaco (p=0,014; OR=1,281; IC 95% 1,051-1,560) y los problemas en la interpretación de las prescripciones (p=0,025; OR=1,328; IC 95% 1,037-1,702), aumentaron el riesgo de que el error afectara al paciente. Discusión. Es necesario establecer sistemas de vigilancia específicos para errores de medicación en los servicios ambulatorios, que hagan énfasis en los procesos de prescripción, transcripción y dispensación. Se requieren estrategias específicas para la prevención de los errores de medicación relacionados con antibióticos.

High prevalence of risk factors in elderly patients using drugs associated with acquired torsades de pointes chronically in Colombia.

AIMS: Medication is one of the main causes of long QT syndrome (LQTS) and torsades de pointes (TdP), and the older adult population is at particularly high risk. The aim of the present study was to describe the prescription patterns of drugs with a risk of TdP in the Colombian older adult population. METHODS: Patients older than 65 years who received medication with a risk of TdP during three consecutive months were selected. The medication was obtained and classified according to the QT Drug List from Crediblemeds.org. The data were analysed using SPSS-22. RESULTS: A total of 55 932 patients were chronically receiving QT-prolonging drugs; 61.9% (n = 34 ,632) were women and the mean age of the sample was 75.6 years. Drugs with a conditional risk were consumed by 95.2% of patients, 5.3% received drugs with a known risk and 2.9% received drugs with a possible risk. Two or more QT-prolonging drugs were consumed by 10.3% of the patients (n = 5786). Most of the sample (96.8%, n = 54 170) had at least one additional risk factor for LQTS, with a mean of 3.1 ± 0.9 risk factors. Patients receiving QT-prolonging drugs for psychiatric and neurological disease were at a higher risk of major polypharmacy [odds ratio (OR) 3.0; 95% confidence interval (CI) 2.80, 3.22) and of receiving high doses of QT-prolonging drugs (OR 3.8; 95% CI 3.52, 4.05). CONCLUSIONS: The widespread use of medication that causes TdP and the high prevalence of additional risks in the older adult population raise the need for accurate prediction of risk and constant patient monitoring. Patients taking psychiatric drugs are at a higher risk of TdP.

Trastornos de la conducta alimentaria en adolescentes de colegios públicos de Pereira / Eating disordder among adolescents in public schools from Pereira

Los trastornos de la conducta alimentaria (TCA) son la tercera enfermedad crónica más prevalente en adolescentes, por lo que se consideran un problema de salud pública.Objetivo: Determinar la prevalencia de trastornos de la conducta alimentariaen estudiantes de media académica de colegios públicos de la zona urbana dela ciudad de Pereira Métodos: Se realizó un estudio descriptivo con muestreo aleatorio mediante distribución proporcional entre los colegios públicos de la zona urbana de Pereira agrupados por sectores según su ubicación. Se aplicó la Encuesta de Comportamiento Alimentario (ECA).Resultados: Se encuestaron 382 estudiantes, 58,9% hombres. La ECA fue positiva en el 24,3% de los encuestados. Según el Índice de Masa Corporal el 9,7% de la población se encontraba en rangos de delgadez, 5,8% sobrepeso y 1,6% obesidad. Se encontró relación (p<0,05) entre el género femenino y la ECA positiva (RM=3,83), realización de dietas (RM=1,55), alteración de la auto imagen (RM=1,79), uso de laxantes (RM=2,58) e inducción del vómito (RM=4,41). El 33,4% reportó tener con alguna frecuencia episodios de consumo de grandes cantidades de alimentos acompañados de sensación de culpa.Discusión: Existen alteraciones comportamentales relacionadas con trastornos de la conducta alimentaria en esta población, por lo que es necesariogenerar programas de prevención y promoción de los TCA enfocados paraadolescentes...

Development, differentiation, and vascular components of subcutaneous and intrahepatic Hepa129 tumors in a mouse model of hepatocellular carcinoma.

Tumor models in mice offer opportunities for understanding tumor formation and development of therapeutic treatments for hepatocellular carcinoma. In this study, subcutaneous or intra-hepatic Hepa129 tumors were established in C3H mice. Tumor growth was determined by daily measurements of subcutaneous tumors and post-mortem studies of subcutaneous and intrahepatic tumors. Administration of Edu was used to determine cell generation dates of tumor cells. Immunohistochemistry with antibodies directed at CD31 or CD34, and intravenous injection of labeled tomato lectin revealed tumor vasculature. Tissue sections also were processed for immunohistochemistry using a panel of antibodies to proteoglycans. Comparison of Edu labeled cells with immunoreactivity allowed determination of development and differentiation of tumor cells after cell generation. Subcutaneous and intrahepatic tumors displayed similar growth over 3 weeks. Immunohistochemistry showed strong labeling for glypican-3, 9BA12, and chondroitin sulfate of tumors in both loci, while normal liver was negative. Tumor regions containing Edu labeled cells did not show significant immunohistochemical labeling for the tumor markers until 2-3 days after Edu treatment; overlap of Edu labeled cells and immunohistochemically labeled tumor regions appeared to reach a maximum at 5 days after Edu treatment. Ectopic subcutaneous tumors displayed vascular ingrowth as the tumor cells expressed immunocytochemical markers; subcutaneous tumors displayed significantly more vascular elements than did intrahepatic tumors.

Patrones de prescripción de broncodilatadores y corticoides inhalados en pacientes adultos de Colombia / Prescription patterns of bronchodilators and inhaled corticosteroids in adults of Colombia

Introducción: las enfermedades pulmonares obstructivas son frecuentes en pacientes mayores de 40 años y son causa de alta morbimortalidad a nivel mundial. En el presente estudio se describen los patrones de prescripción de medicamentos para su tratamiento en pacientes de Colombia. Material y métodos: estudio descriptivo observacional con pacientes, mayores de 40 años de ambos sexos, afiliados al Sistema General de Seguridad Social en Salud, en tratamiento continuo con broncodilatadores y/o corticoides inhalados entre septiembre y diciembre del año 2013, seleccionados a partir de una base de datos de dispensación de 6.5 millones de personas. Se recolectaron variables sociodemográficas, farmacológicas (fármacos con sus dosis diarias definidas), medicamentos concomitantes y clínicas (comorbilidades). Análisis mediante SPSS 22. Resultados: se incluyeron 6856 pacientes con una edad promedio de 73.8 ± 11.3 años, 54%fueron mujeres. Del total de pacientes 17.2% recibían monoterapia y 82.8% terapia combinada. El 74.3% de sujetos recibía β2-adrenérgicos, la mayoría (81.5%) de corta duración (BDCA), mientras que 33.3% de larga acción (BDLA). El 73.1% recibía anticolinérgicos distribuidos entre ipratropio (87.1%) y tiotropio (16.9%) y 71.7% recibía corticoides inhalados. Los medicamentos prescritos concomitantemente con mayor frecuencia fueron antihipertensivos (68.9%), antiulcerosos (56.1%) e hipolipemiantes (46.2%). Tener entre 40 y 55 o más de 80 años, recibir alguna medicación concomitante, utilizar corticoides inhalados, emplear monoterapia broncodilatadora y ser tratado en Bogotá y Cali, se asociaron de manera estadísticamente significativa con menor riesgo de recibir BDLA. Conclusiones: predomina la prescripción de BDCA, pese al limitado beneficio clínico reportado. La mayoría de broncodilatadores se emplean a dosis superiores a las recomendadas. Se considera necesario establecer estrategias educativas que mejoren los hábitos de prescripción. (Acta Med Colomb 2015; 40: 218-226).

Introduction: obstructive lung diseases are common in patients older than 40 years and cause high morbidity and mortality worldwide. The patterns of drugs prescription for its treatment in Colombian patients are described in this study. Methods: descriptive observational study with patients over 40 years of both sexes, members of the General System of Social Security in Health, in continuous treatment with bronchodilators and / or inhaled steroids between September and December 2013, selected from a dispensing database of 6.5 million people. Sociodemographic and pharmacological variables (drugs with defined daily doses), concomitant medications and co-morbidities were collected. Analysis using SPSS 22. Results: A total of 6856 patients were included with a mean age of 73.8±11.3 years, 54% were women. Of the total of patients, 17.2% received monotherapy and 82.8% combined therapy. 74.3% of subjects received β2-adrenergics, most (81.5%) short-acting bronchodilators, while33.3% long acting bronchodilators. 73.1% received anticholinergics distributed between ipratropium (87.1%) and tiotropium (16.9%) and 71.7% received inhaled steroids. The medications that were most often concomitantly prescribed, were antihypertensive (68.9%), antiulcerants (56.1%) and lipid lowering drugs (46.2%). To be between 40 and 55 or over 80 years, receive any concomitant medication, inhaled corticosteroid use, bronchodilator monotherapy use and being treated in Bogota and Cali, was statistically significantly associated with lower risk of receiving long-acting bronchodilators. Conclusions: the prescription of short-acting bronchodilators predominate despite the limited clinical benefit reported. Most bronchodilators are used at higher than recommended doses. It is necessary to establish educational strategies to improve prescribing habits. (Acta Med Colomb 2015; 40: 218-226).

Use of labeled tomato lectin for imaging vasculature structures.

Intravascular injections of fluorescent or biotinylated tomato lectin were tested to study labeling of vascular elements in laboratory mice. Injections of Lycopersicon esculentum agglutinin (tomato lectin) (50-100 µg/100 µl) were made intravascularly, through the tail vein, through a cannula implanted in the jugular vein, or directly into the left ventricle of the heart. Tissues cut for thin 10- to 12-µm cryostat sections, or thick 50- to 100-µm vibratome sections, were examined using fluorescence microscopy. Tissue labeled by biotinylated lectin was examined by bright field microscopy or electron microscopy after tissue processing for biotin. Intravascular injections of tomato lectin led to labeling of vascular structures in a variety of tissues, including brain, kidney, liver, intestine, spleen, skin, skeletal and cardiac muscle, and experimental tumors. Analyses of fluorescence in serum indicated the lectin was cleared from circulating blood within 2 min. Capillary labeling was apparent in tissues collected from animals within 1 min of intravascular injections, remained robust for about 1 h, and then declined markedly until difficult to detect 12 h after injection. Light microscopic images suggest the lectin bound to the endothelial cells that form capillaries and endothelial cells that line some larger vessels. Electron microscopic studies confirmed the labeling of luminal surfaces of endothelial cells. Vascular labeling by tomato lectin is compatible with a variety of other morphological labeling techniques, including histochemistry and immunocytochemistry, and thus appears to be a sensitive and useful method to reveal vascular patterns in relationship to other aspects of parenchymal development, structure, and function.