[Prospective observational study of the impact of problems accessing treatment such as risk factors for adherence and persistence. Pilot study]. / Estudio observacional prospectivo del impacto de los problemas de acceso al tratamiento como factores de riesgo de la adherencia y persistencia. Estudio piloto.

Introduction: Some preliminary studies that reveal the onset of risk factors not investigated previously in regard to the health system were performed. They can reduce adherence and/or persistence of pharmacological treatments. Knowledge about them can lead to possible solutions. Aim: To estimate the incidence of risk factors in regard to the health system that can reduce adherence/persistence with treatments associated with problems accessing these in the community pharmacy. Method: Transversal, randomized, prospective study in community pharmacies in Asturias and Aragón regions. The primary endpoint was the incidence of new risk factors that means that the prescription is inadequate for its dispensing. Different subgroups were analyzed according to type of risk factor, population and prescription. Results: The typical patient is a vulnerable person according to his age (65.4 years), multipathology and polypharmacy (6.8 drugs). After the evaluation of 138,697 cases of dispensing in 98 community pharmacies a total of 2009 patients were detected with 2221 cases of dispensing with risk factors in terms of adherence and/or persistence (1.6% of the total dispensing). The type of incidence most commonly observed was expiry of the prescription (54.7%; 95%CI=52.6-56.8), followed by no prescription record (18.7%; 95%CI: 17.1-20.3). For its part supply problems stood at 10.2% (95%CI= 10.6%-10.9%). The most compromised therapeutic groups were groups N Nervous System (27.6%), C Cardiovascular System (20.3%) and A Gastrointestinal System (15.3%). Conclusions: The results obtained suggest that the current incidence of risk factors in regard to the health system in terms of adherence and/or persistence may comprise a health problem with a clinical, quality of life and financial impact. As these risk factors are modifiable, a greater capacity for community pharmaceutical action by means of exceptional dispensing to authorize the treatment's continuity would be an acceptable solution.

[Project on exceptional dispensation in the Principality of Asturias]. / Proyecto sobre dispensación excepcional en el Principado de Asturias.

Community pharmacy (CF) is daily confronted with situations that prevent the proper dispensing of medication, putting at risk the continuity of treatment by patients, which causes medication-related problems (DRPs). In this pilot study, carried out in the Principality of Asturias, the aim was to quantify the number of incidents of this type related to those aspects of the prescription that could be easily corrected by the community pharmacist through simple interventions at the time of dispensing. It was carried out in ten pharmacies in this autonomous community during normal opening hours over fifteen working days. The sample included a total of 32,331 containers dispensed. A total of 406 incidences of exceptional dispensing were recorded. The total incidence rate reached 1.26% of the dispensations, which extrapolating to the total number of dispensations made in Asturias during the month of October 2020 would give us a figure of 27,030 total dispensations susceptible to exceptional dispensing.The total incidence rate was lower in urban pharmacies (1.03%) compared to semi-urban and rural pharmacies (1.37% and 1.39%). Most of the cases (59.4 %) involved patients with an individual contribution to the Health System corresponding to 10 % (TSI2) and the mean age of the patient was 60.8 years. Regarding the level of care, 79% of the cases corresponded to Primary Care (PC) prescriptions. The most common type of incidence is "potential interruption due to prescription not active at the time of dispensing (exceeding the 10-day margin)" with an incidence rate of 0.61 % of the dispensations, which would mean a total of 13,181 prescriptions susceptible to exceptional dispensing due to this type of incidence.In terms of economic savings, it was found that 63 of the 406 cases would have necessarily required a medical consultation and 30% of them would have been for active patients. Therefore, the remaining 343 cases, which could be resolved through exceptional dispensing by the community pharmacist, would mean a saving of more than 4,000 consultations and nearly 200,000 euros in direct and indirect costs if the pharmacist were allowed to intervene.

Validación psicométrica de la Escala de gravedad de fatiga en médicos residentes mexicanos / Psychometric validation of the Fatigue Severity Scale in Mexican medical residents

Los médicos residentes están continuamente expuestos a la fatiga, que puede ocasionarles problemas laborales, académicos y personales, por consiguiente, es importante contar con instrumentos confiables y válidos para medirla. Una de las escalas más utilizadas es la Escala de gravedad de fatiga, sin embargo, hay versiones con una y distinto número de reactivos en distintas poblaciones. Por lo que el propósito de este trabajo fue traducir, adaptar de manera culturalmente relevante y comparar las versiones con distinto número de reactivos de la escala, para identificar la más adecuada en médicos residentes mexicanos. Se trabajó con tres grupos diferentes de participantes; el primero para la traducción y adaptación conformado por siete jueces expertos en el idioma, el segundo para la validación psicométrica con 100 médicos residentes y, el tercero, para el análisis factorial confirmatorio y prueba de invarianza por tipo de programa (especialidad y alta especialidad) con 182 médicos residentes. Se probó la distribución, discriminación, confiabilidad y estructura de la escala, en un análisis exploratorio y confirmatorio, quedando una escala final de 6 reactivos con buen ajuste (X2[9] = 9,39, p = 0,40; CFI = 0,99; RMSEA = 0,02), con una confiabilidad = 0,91 e invarianza factorial estricta por tipo de programa de residencia

Resident physicians are continually exposed to fatigue, which can lead to work, academic and personal problems, so it is important to have reliable and valid instruments to measure it. One of the most used is Fatigue Severity Scale, but, there are versions with different number of items in different populations. Therefore, the purpose of this work was to translate, adapt culturally relevant and compare versions with different numbers of items, to identify the most appropriate in Mexican resident physicians. With three different groups of participants; first one for translation by seven expert judges in the language, second for psychometric validation with 100 resident physicians, and third for confirmatory factor analysis and invariance test by type of program (specialty and high specialty) with 182 resident physicians. Distribution, discrimination, reliability and factor structure of the scale were tested in an exploratory and confirmatory analysis, leaving a final scale of 6 items with good fit (X2[9] = 9,39, p = 0,40; CFI = 0,99; RMSEA = 0,02), with a reliability = 0,91 and strict factorial invariance by type of residence program

Ethical aspects involving the use of information technology in new surgical aplications: telesurgery and surgical telementoring / Aspectos éticos relacionados con el uso de información tecnológica en nuevas aplicaciones quirúrgicas: tele-cirugía y tele-tutoría / Aspectos éticos envolvendo o uso de tecnologia da informação em novas aplicações cirúrgicas: telescirurgia e telemonitoria cirúrgica

Abstract: Background: The surgical telementoring is a technology that involves surgical procedures guided by an expert or mentor, performed by other surgeons from a distance, using information and knowledge technologies. This therapeutic innovation has generated new opportunities to improve the surgical attention and the training of the surgeons. However, their ethical implications should be analyzed to clarify their use, to check the patient's safety and eliminate uncertainties. The characteristics of surgical telementoring generate specific challenges and ethical dilemmas that must be identified, analyzed and solved. Results: In this paper the ethical challenges and dilemmas of surgical telementoring identified and analyzed cover multiple aspects such as patient safety, privacy and vulnerability, the surgeon-mentor-patient relationship and informed consent, professional responsibility, cost-effectiveness analysis and Solidarity and social justice regarding the use of healthcare resources, the systematic approach to validation of the proposed new technology and conflicts of interest. For many of these issues solutions are provided, but they are still to be solved. Conclusions: surgical telementoring potentially improves patient healing and surgeon education. It will have a rapid evolution in the next years. This rapid growth should not be anticipated to the solid implantation of ethical guarantees for its use due to the particular characteristics that this technology has in the field of telemedicine.

Resumen: Antecedentes: El uso de tele-tutoría en cirugía es una tecnología que incluye procedimientos quirúrgicos guiados por un experto o tutor, realizado por otros cirujanos a distancia usando tecnologías de información y conocimiento. Esta innovación terapéutica ha generado nuevas oportunidades para mejorar la práctica de cirugía y la formación de los cirujanos. Sin embargo, deberían de analizarse sus implicaciones éticas para clarificar su uso, comprobar la seguridad del paciente y eliminar incertidumbres. Las características de la tele-tutoría en cirugía generan desafíos específicos y dilemas éticos que deben identificarse, analizarse y resolverse. Resultados: En este artículo se identificaron y analizaron múltiples aspectos en cuanto a desafíos éticos y dilemas de tele-tutoría en cirugía tales como: seguridad del paciente, privacidad y vulnerabilidad, la relación cirujano-tutor-paciente y el consentimiento informado, la responsabilidad profesional, análisis de costo-efectividad, solidaridad y justicia social respecto al uso de recursos en el cuidado de la salud, la aproximación sistemática para la validación de la nueva tecnología propuesta y los conflictos de interés. Para muchos de estos temas se han proporcionado soluciones, pero todavía no han sido resueltas. Conclusiones: La tele-tutoría en cirugía mejora potencialmente la sanación del paciente y la educación del cirujano. Va a tener una rápida evolución en los próximos años. Este rápido crecimiento no debería anticiparse a la implantación sólida de garantías éticas para su uso debido a las características particulares que tiene esta tecnología en el campo de la tele-medicina.

Resumo: Fundo: A cirurgia teleguiada é uma tecnologia que envolve procedimentos cirúrgicos, guiados por um especialista ou mentor, executados por outros cirurgiões à distância, usando tecnologias da informação e do conhecimento. Esta inovação terapêutica tem gerado novas oportunidades para melhorar a atenção cirúrgica e a formação dos cirurgiões. No entanto, suas implicações éticas devem ser analisadas para esclarecer seu uso, para verificar a segurança do paciente e eliminar as incertezas. As características da cirurgia teleguiada geram desafios específicos e dilemas éticos que devem ser identificados, analisados e resolvidos. Resultados: Neste artigo os desafios éticos e dilemas da cirurgia teleguiada identificados e analisados vislumbram vários aspectos como a segurança do paciente, sua privacidade e vulnerabilidade, o relacionamento paciente-cirurgião-mentor e consentimento informado, responsabilidade profissional, análise custo-eficácia e solidariedade e justiça social em relação ao uso dos recursos de saúde, a abordagem sistemática para validação da tecnologia nova proposta e conflitos de interesse. Para muitas destas questões são fornecidas soluções, mas muitas ainda estão para serem resolvidas. Conclusões: a cirurgia teleguiada potencialmente melhora o atendimento do paciente e o ensino do cirurgião. Vai ter uma rápida evolução nos próximos anos. Este rápido crescimento não deve ser antecipado para a implantação contínua de garantias éticas para seu uso devido as características particulares que esta tecnologia tem no campo da telemedicina.

Uso transitorio de sistemas personalizados de dosificación (SPD): más allá de la polimedicación / Transient use of personalized dosing systems (PDS): beyond polypharmacy

Los pacientes diana del Servicio Personalizado de Dosificación (SPD) han sido habitualmente las personas con enfermedades crónicas polimedicadas con dificultades físicas o cognitivas para manejar adecuadamente su medicación. Sin embargo, existen otros grupos susceptible de beneficiarse igualmente de esta herramienta, como son los pacientes sin deficiencias ni dependencias pero que debido a la complejidad de la pauta del tratamiento a administrar pueden aprovechar este servicio de forma puntual. En este caso veremos una paciente habituada a manejar no sólo su medicación sino también la de su marido pero que debido a una pauta cambiante de medicamentos ansiolíticos y antidepresivos prefiere confiar en la farmacia comunitaria para su correcta administración

The target patients of the Personalized Dosing Service (PDS) have usually been people with chronic polymedicated diseases with physical or cognitive difficulties to properly manage their medication. However, there are other groups likely to equally benefit from this tool, such as patients without deficiencies or dependencies but due to the complexity of the treatment regimen to be administered, they can occasionally take advantage of this service. In this case, we will see a patient used to handling not only her own medication but also that of her husband but due to a changing pattern of anxiolytic and antidepressant medications, she prefers to rely on the community pharmacy for proper administration

Medicamentos innovadores: hacia un modelo colaborativo / No disponible

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Un congreso para estar más cerca y llegar más lejos / No disponible

El VII Congreso de Farmacéuticos Comunitarios ya está a la vuelta de la esquina. Una impresionante progresión en visitantes, comunicaciones, talleres, stands… avalan su vocación de servir a la profesión desde su primera edición en Tarragona en 2004. Sin embargo, la pregunta que debemos hacernos no es cuántos congresos tiene una profesión sino si los congresos que tiene son una herramienta útil para desarrollarla. -SEFAC, como única sociedad científica y profesional específica de la farmacia comunitaria, aspira a que sus congresos cumplan con los tres objetivos básicos que debe tener un congreso científico: a) Formar a los profesionales a través de la actualización de contenidos, compartir descubrimientos, estimulación de la investigación y, en suma, proporcionarles las mejores herramientas, cognitivas y materiales, para ejercer su labor. b) Movilizarla, planteando desde una autocrítica constructiva qué cambios son precisos introducir para permitir que la profesión pueda continuar sirviendo óptimamente a la sociedad, sin caer en flagelos inútiles ni autocomplacencias estériles. c) Finalmente, servir de interlocutor con la sociedad, mostrando, a través del diálogo en nuestro caso con otras sociedades científicas, asociaciones de pacientes, Administración, medios de comunicación… los avances, retos, debates y compromisos que afronta la profesión (AU)

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Endoscopic treatment of postoperative esophagogastric leaks with fully covered self-expanding metal stents

BACKGROUND: the management of postoperative esophageal leaks is a huge therapeutic challenge. Thanks to the advances in endoscopy, treatment with esophageal stents has been proposed as a valid option. AIMS: the main objective of the study was to evaluate the effectiveness and safety of the use of fully covered esophageal metal stents in the treatment of postoperative esophageal leaks. METHODS: a retrospective observational study was performed in patients with postoperative esophageal leaks, treated with fully covered self-expandable metal stents between June 2011 and May 2018. RESULTS: twenty-five patients were evaluated and 34 stents were placed. The closure of the leak was observed in 21 patients after removal of the stent, with an overall technical success rate of 84 %. The mean time with a stent placed for closure of the fistula was 55.7 ± 27.11 days/patient (mean of 39 ± 24.30 days/stent). The most frequent complication was a partial distal stent migration (7/34 stents), followed by five cases of complete migration into the stomach. CONCLUSIONS: endoscopic treatment with fully covered selfexpandable metal stents seems to be an effective and safe first-line treatment for postoperative esophageal leaks, according to the experience in our center

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Schwannoma gástrico como hallazgo ecográfico casual / Gastric schwannoma presenting as a casual ultrasonographic findings

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Hipertensión portal e ictericia colestásica como forma de presentación de una amiloidosis sistémica / Portal hypertension and cholestatic jaundice as a form of presentation of systemic amyloidosis

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Hemorragia digestiva alta como forma de presentación de hematoma retroperitoneal espontáneo gigante secundario a anticoagulación en una mujer con reordenación del gen JAK2 / Spontaneous retroperitoneal hematoma in a patient under anticoagulant agents presenting as upper gastrointestinal bleeding

Presentamos el caso de una mujer de 44 años de edad con antecedentes de abortos de repetición y síndrome de Budd-Chiari secundario a una mielofibrosis primaria en tratamiento anticoagulante. Consulta por melenas y astenia, presentando anemización progresiva. En una gastroscopia inicial se aprecia una compresión extrínseca a nivel supraampular de segunda porción duodenal, con una úlcera asociada en cara posterior de bulbo y primera rodilla. Posteriormente se diagnostica mediante una tomografía computarizada de un hematoma retroperitoneal espontáneo secundario a anticoagulación. Se trata con drenaje percutáneo y retirada de anticoagulación con buena respuesta inicial. No obstante, presenta complicaciones trombóticas (trombosis subclavia y yugular) y se reintroducen los anticoagulantes con dosis en el límite bajo del rango terapéutico (AU)

We present the case of a 44-year-old woman with past history of repeated miscarriage and Budd-Chiari syndrome secondary to primary myelofibrosis. Because of this she was under treatment with oral anticoagulant agents. The patient was admitted in hospital as she presented with gastrointestinal bleeding (melena), asthenia and progressive anemia. In an initial upper endoscopy an extrinsic duodenal compression associated with an ulcer on the posterior face of the first portion of duodenum and upper duodenal knee was observed. In the following days a huge spontaneous retroperitoneal hematoma due to anticoagulation was diagnosed by computed tomography. This was treated with a percutaneous drainage and withdrawal of the antithrombotic drugs. The evolution of the patient was initially satisfactory but she suffered subclavian and jugular vein thrombosis, and reintroduction of anticoagulant agents at the lowest therapeutic doses was required (AU)

Aneurisma gastroduodenal presentado como masa pancreática / Gastroduodenal artery aneurysm presenting as a pancreatic mass

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Desarrollo y validación psicométrica de la Escala de Privacidad en la Vivienda / Construction and Psychometric Validation of the Dwelling's Privacy Scale

El propósito de este estudio fue generar un instrumento que permita medir la privacidad en las viviendas urbanas de México de manera confiable y válida. Para lo cual se construyó una escala conformada por 20 reactivos con cinco opciones de respuesta; para realizar su validación psicométrica se aplicó a 200 habitantes de la Ciudad de México, de entre los 14 y 75 años de edad, 110 mujeres y 90 hombres con diferentes ocupaciones y grados de escolaridad. Se llevaron a cabo análisis para conocer el poder discriminativo de los reactivos; la confiabilidad y la estructura factorial válida para la población de la Ciudad de México. La escala final estuvo constituida por 11 reactivos, organizados en tres factores Control de Acceso a la Información, Control de Acceso a la Persona e Intimidad.

The main objective of this research was to generate a reliable and valid scale that assessed dwelling privacy in Mexico City's population. A scale was developed specifically for this purpose. The scale included 20 items with five options for answers (Never, few times, sometimes, frequently and always). The scale was applied to a sample of 200 Mexico City's inhabitants in order to obtain its psychometrical validation. The distribution of the participants was as follow: age between 14 to 75; 110 women and 90 men: diverse occupations and school levels. A proper analysis took place in order to learn about the items discriminative power, reliability and valid factorial structure. The final scale was conformed by 11 items organized by three factors as follow: 1) Information Access Control, 2) Person Access Control and 3) Intimacy it explains 68% of variance and has a reliability of Cronbach Alpha =0.89. Afterwards a Confirmatory Factor Analysis was conducted to verify if the structure obtained from the Principal Component Analysis was correct, and a good fit was achieved (df=39, x2= 48.07, p=.151; CFI= .987; RMSEA= .032).

Chest computed tomography findings in severe influenza pneumonia occurring in neutropenic cancer patients

OBJECTIVE: To describe the chest computed tomography findings for severe influenza H1N1 infection in a series of hospitalized neutropenic cancer patients. METHODS: We performed a retrospective systematic analysis of chest computed tomography scans for eight hospitalized patients with fever, neutropenia, and confirmed diagnoses of influenza H1N1. The clinical data had been prospectively collected. RESULTS: Six of eight patients (75%) developed respiratory failure and required intensive care. Prolonged H1N1 shedding was observed in the three mechanically ventilated patients, and overall hospital mortality in our series was 25%. The most frequent computed tomography findings were ground-glass opacity (all patients), consolidation (7/8 cases), and airspace nodules (6/8 cases) that were frequently moderate or severe. Other parenchymal findings were not common. Five patients had features of pneumonia, two had computed tomography findings compatible with bronchitis and/or bronchiolitis, and one had tomographic signs of chronicity. CONCLUSION: In this series of neutropenic patients with severe influenza H1N1 infection, chest computed tomography demonstrated mainly moderate or severe parenchymatous disease, but bronchiolitis was not a common feature. These findings associated with febrile neutropenia should elicit a diagnosis of severe viral infection.

Señales intracelulares que intervienen en el control de la glucosa / Intracellular signals intervening in glucose control

El evento inicial para el control de la glucosa principia con la unión de la insulina a su receptor. Como resultado de esta interacción, las cadenas a y b sufren cambios conformacionales y autofosforilación en la parte carboxilo terminal de la cadena b. Sólo en estas condiciones es posible que el sustrato del receptor de la insulina (IRS) se adose a la cadena b para fosforilarse. La activación del IRS permite que la PI 3-cinasa inicie otra serie de activaciones y asociaciones de proteínas que rodean a las vesículas que contienen a los transportadores de glucosa (GLUT). En la translocación del GLUT participan proteínas que se asocian a las vesículas y proteínas asociadas en la cara interna de la membrana plasmática. Lo anterior implica no solamente asociación, sino también movilización, participación de la red del citoesqueleto y fusión de las membranas. En el metabolismo de la glucosa participan enzimas que convierten la glucosa en energía o la almacenan en forma de glucógeno. En la diabetes tipo 2, enfermedad caracterizada por la falta de control de la glucosa y resistencia a la acción de la insulina, se presentan alteraciones múltiples como disminución en la expresión del receptor de la insulina en la membrana celular, disminución generalizada en la actividad de las fosfotirosinas y activación de las serinas del IRS-1 que disminuyen la señal. Aun cuando conocemos muchas de las funciones de las proteínas involucradas para el control de la glucosa, todavía no entendemos en términos moleculares el significado de la resistencia a la insulina en los pacientes con diabetes tipo 2.

Determinants of mortality in oncology patients colonized or infected with Staphylococcus aureus

As infeccoes causadas por Staphylococcus aureus resistentes a oxacilina (ORSA) sao causas importantes de morbidade e mortalidade. O objetivo do estudo foi identificar os principais fatores associados a mortalidade em pacientes colonizados ou infectados por Staphylococcus aureus em um hospital de cancer. Foi realizado um estudo do tipo caso-controle emparelhado envolvendo todos os pacientes colonizados ou infectados por ORSA (casos) internados no Hospital do Cancer do Rio de Janeiro durante o periodo de 01/01/1992 a 31/12/1994...

Epidemiology of bloodstream infections at a Cancer Center

CONTEXT: Cancer patients are at unusually high risk for developing bloodstream infections (BSI), which are a major cause of in-hospital morbidity and mortality. OBJECTIVE: To describe the epidemiological characteristics and the etiology of BSI in cancer patients. DESIGN: Descriptive study. SETTING: Terciary Oncology Care Center. PARTICIPANTS: During a 24-month period all hospitalized patients with clinically significant BSI were evaluated in relation to several clinical and demographic factors. RESULTS: The study enrolled 435 episodes of BSI (349 patients). The majority of the episodes occurred among non-neutropenic patients (58.6 percent) and in those younger than 40 years (58.2 percent). There was a higher occurrence of unimicrobial infections (74.9 percent), nosocomial episodes (68.3 percent) and of those of undetermined origin (52.8 percent). Central venous catheters (CVC) were present in 63.2 percent of the episodes. Overall, the commonest isolates from blood in patients with hematology diseases and solid tumors were staphylococci (32 percent and 34.7 percent, respectively). There were 70 episodes of fungemia with a predominance of Candida albicans organisms (50.6 percent). Fungi were identified in 52.5 percent of persistent BSI and in 91.4 percent of patients with CVC. Gram-negative bacilli prompted the CVC removal in 45.5 percent of the episodes. Oxacillin resistance was detected in 26.3 percent of Staphylococcus aureus isolates and in 61.8 percent of coagulase-negative Staphylococcus. Vancomycin-resistant enterococci were not observed. Initial empirical antimicrobial therapy was considered appropriate in 60.5 percent of the cases. CONCLUSION: The identification of the microbiology profile of BSI and the recognition of possible risk factors in high-risk cancer patients may help in planning and conducting more effective infection control and preventive measures, and may also allow further analytical studies for reducing severe infectious complications in such groups of patients