[Treatment adherence in a hospital emergency service]. / Adhesión al tratamiento en un servicio de urgencias hospitalarias.

OBJECTIVE: Patients do not always follow medical indications. This is a public health problem, with implications in health care and costs. The objective of this study was to calculate the percentage of non-adherence of adults to the treatment prescribed in a Hospital Emergency Service ("HES") and understanding wich factors led to poor adherence so improvements can be established. METHODS: Prospective observational study. Cohort of adults who attended the HES. We collected sociodemographic data, medical history, chronic treatments, diagnosis and treatment at discharge from each individual. We applied Morisky-Green test (tailor made to the HES) to asses secondary non-adherence and multivariate analysis to find a correlation with the factors studied. RESULTS: We established a non-adherence of 36.6% (IC95%=30.0-43.8). Patients with chronic endocrine pathology (RR=11.2; IC95%=2.1-60.8), diagnosed with ophthalmological problems (RR=9.8; IC95%=1.1-89.6) or contusions, sprains or fractures (RR=2.9; IC95%=1.1- 7.8), those who were prescribed antibiotics (RR=5.4; IC95%=2.4-11.9), or those who considered that they had received sufficient explanations (RR=3.5; IC95%=1.0-13.2) were more adherent. Those who received analgesics or anti-inflammatories were less adherent (RR=0.4; IC95%=0.2-0.9). CONCLUSIONS: Our results provide information on adherence in acute pathologies in the emergency department. Diabetes and ophthalmological problems or trauma are predictors of increased adherence. We observe more adherence in people with antibiotic treatments, although 20% did not complete treatment. There is a lack of adherence to analgesic/anti-inflammatory treatments. We consider it is important for professionals to take into account patient´s concerns about the medication. Patients who considered they had received enough explanations on their treatment were more adherent tan others. We believe it would be useful to provide further information about the outcomes of the medication we prescribe using new technologies such as mobile applications so we could increase adherence. Further studies would be needed to asses the benefit of the changes recently introduced (electronic hisory and prescription).

OBJETIVO: Que los pacientes no siempre sigan las indicaciones médicas es un problema de salud pública, que tiene implicaciones sobre los cuidados de salud y el coste de los servicios sanitarios. El objetivo del estudio fue determinar el porcentaje de no adhesión al tratamiento pautado en adultos en un Servicio de Urgencias Hospitalarias (SUH), así como identificar los factores que influyen en ello para instaurar así medidas de mejora. METODOS: Se realizó un estudio observacional prospectivo, mediante una cohorte de personas adultas que acudieron al SUH. De cada persona se recogieron datos sociodemográficos, antecedentes, tratamientos crónicos y diagnóstico y tratamiento al alta. Se evaluaron, por medio de encuesta, la no adhesión primaria y secundaria (test de Morisky-Green adaptado a Urgencias), y se relacionó con los factores recogidos empleando análisis multivariable. RESULTADOS: Se detectó una no adhesión del 36,6% (IC95%=30,0-43,8). Fueron más adherentes las personas con antecedente de enfermedad endocrina (RR=11,2; IC95%=2,1-60,8) y las que al alta fueron diagnosticadas de contusiones, esguinces o fracturas (RR=2,9; IC95%=1,1-7,8), o de algún problema oftalmológico (RR=9,8; IC95%=1,1-89,6). También fueron más adherentes los que al alta recibieron tratamiento antibiótico (RR=5,4; IC95%=2,4-11,9) o recibieron suficientes explicaciones (RR=3,5; IC95%=1,0-13,2). Fueron menos adherentes los pacientes con tratamiento analgésico o antinflamatorio (RR=0,4; IC95%=0,2-0,9). CONCLUSIONES: Los resultados aportan información sobre la adhesión en patologías agudas en Urgencias. El ser diabético y el acudir debido a un problema oftalmológico o traumatológico son predictores de una mayor adhesión. En las personas con tratamiento antibiótico se observa una mayor adhesión, aunque todavía son necesarios esfuerzos para mejorar la situación, ya que un 20% no realizó adecuadamente el tratamiento. Se observa una importante falta de adhesión a los tratamientos con analgésicos o antiinflamatorios. A la vista de nuestros resultados, parece fundamental una buena comunicación. Es necesario sensibilizar a los profesionales para que tengan en cuenta las inquietudes y deseos del paciente acerca de la medicación, así como realizar esfuerzos dirigidos a mejorar la legibilidad del informe de alta y de las prescripciones.

[New therapeutic aspects for the control of risk factors in obesity]. / Nuevos aspectos terapéuticos para el control de los factores de riesgo de la obesidad.

Treatment of obesity continues to rely upon the classical triad of nutritional advise, increase of physical activity and use of drugs. However, in recent years, there have appeared novelties in both therapeutic targets and new molecules. With regard to therapeutic targets of obesity, success does not consist of losing much weight but attaining a moderate yet maintained weight lose (5-10% of initial weight) at the expense of visceral fat. In other words, instead of weight, what is needed is a waist reduction, mainly to improve or prevent obesity-related metabolic and vascular complications. Regarding drugs, a new molecules is about to appear in the international pharmaceutical market: rimonabant. A selective blocker of the endocannabinoid receptor CB1, it has proven to be effective and safe in treating obesity and its comorbidities. Another known agent, orlistat, has proven to be effective in the prevention of the development of type 2 diabetes in obese patients with or without glucose intolerance.

Effect of driving pressure and nebulizer model on aerosol output during intermittent delivery with a dosimeter.

Recent guidelines reinforce the need for a standardized technique during inhalational bronchoprovocation challenge testing. We investigated the effects of nebulizer model and dosimeter driving pressure on nebulizer output using a nebulized saline model. Four nebulizers (Hudson 1720, Salter 8900, Baxter Airlife, and DeVilbiss 644) were evaluated at two driving pressures (20 and 50 pounds per square inch [psi]) via a dosimeter (Salter 700) that delivered a 0.6-sec actuation. Output was determined gravimetrically after 20 actuations of saline at constant respiratory flow and volume. Output per actuation at 20 psi was 2.83 +/- 0.41 mg (mean +/- SD), 4.58 +/- 0.66, 4.75 +/- 0.42, and 4.75 +/- 1.37 for the Hudson, Salter, Baxter, and DeVilbiss, respectively, and 6.75 +/- 0.61 mg, 9.17 +/- 0.88, 9.42 +/- 1.32, and 9.83 +/- 1.75 at 50 psi. The Hudson delivered a lower volume than the other nebulizers (p < 0.0005). At 20 psi, output from the DeVilbiss had greater variability (coefficient of variation = 28.8%) compared to the Baxter (CV = 8.8%; p = 0.045). The output was greater at 50 psi than 20 psi for all models (p < 0.0005). These results demonstrate that, when choosing a nebulizer driven by a dosimeter, it is important to base that selection on published data describing aerosol output under different driving pressures.

Digitomyces, a new genus of hyphomycetes with cheiroid conidia.

The new anamorphic genus Digitomyces, based on Dictyosporium verrucosum, is proposed. It is characterized by micronematous or semimacronematous conidiophores, integrated or discrete, holoblastic, determinate conidiogenous cells, and olivaceous to pale brown, verrucose, cheiroid conidia, with a truncate basal cell and (2-)3 arms. The new taxon is compared with morphologically similar anamorph genera.

Penzigomyces catalonicus, a new species of hyphomycetes from Spain.

Penzigomyces catalonicus sp. nov., collected on dead branches of an unknown tree species in Spain, is described and illustrated. This fungus is characterized by short, dark brown, percurrent conidiophores, usually doliiform conidiogenous cells and ellipsoidal or slightly obclavate, (2-)3-4(-6) euseptate, thin-walled conidia. The new taxon is compared with species from other morphologically similar genera, and a key to the known species of Penzigomyces is provided.

Hyphomycetes from Nigerian rain forests.

Phaeobotrys gen. nov., based on Phaeodactylium acutisporum, characterized by branched and pigmented conidiophores, and the production of hyaline, appendiculate conidia from denticles on polyblastic conidiogenous cells which usually extend sympodially to form more conidiogenous loci, and Zanclospora stellata sp. nov., recognized by its stellate sterile branches in the distal part of the conidiophore and bacilliform conidia, are described and illustrated from decaying leaf litter from Nigeria. Keys to Phaeobotrys and related genera, and to species of Zanclospora are proposed. Furthermore, a list of hyphomycetes newly reported for Nigeria is provided.

Adhesión al tratamiento en un servicio de urgencias hospitalarias / Treatment adherence in a hospital emergency service

OBJETIVO: Que los pacientes no siempre sigan las indicaciones médicas es un problema de salud pública, que tiene implicaciones sobre los cuidados de salud y el coste de los servicios sanitarios. El objetivo del estudio fue determinar el porcentaje de no adhesión al tratamiento pautado en adultos en un Servicio de Urgencias Hospitalarias (SUH), así como identificar los factores que influyen en ello para instaurar así medidas de mejora. MÉTODOS: Se realizó un estudio observacional prospectivo, mediante una cohorte de personas adultas que acudieron al SUH. De cada persona se recogieron datos sociodemográficos, antecedentes, tratamientos crónicos y diagnóstico y tratamiento al alta. Se evaluaron, por medio de encuesta, la no adhesión primaria y secundaria (test de Morisky-Green adaptado a Urgencias), y se relacionó con los factores recogidos empleando análisis multivariable. RESULTADOS: Se detectó una no adhesión del 36,6% (IC95%=30,0-43,8). Fueron más adherentes las personas con antecedente de enfermedad endocrina (RR=11,2; IC95%=2,1-60,8) y las que al alta fueron diagnosticadas de contusiones, esguinces o fracturas (RR=2,9; IC95%=1,1-7,8), o de algún problema oftalmológico (RR=9,8; IC95%=1,1-89,6). También fueron más adherentes los que al alta recibieron tratamiento antibiótico (RR=5,4; IC95%=2,4-11,9) o recibieron suficientes explicaciones (RR=3,5; IC95%=1,0-13,2). Fueron menos adherentes los pacientes con tratamiento analgésico o antinflamatorio (RR=0,4; IC95%=0,2-0,9). CONCLUSIONES: Los resultados aportan información sobre la adhesión en patologías agudas en Urgencias. El ser diabético y el acudir debido a un problema oftalmológico o traumatológico son predictores de una mayor adhesión. En las personas con tratamiento antibiótico se observa una mayor adhesión, aunque todavía son necesarios esfuerzos para mejorar la situación, ya que un 20% no realizó adecuadamente el tratamiento. Se observa una importante falta de adhesión a los tratamientos con analgésicos o antiinflamatorios. A la vista de nuestros resultados, parece fundamental una buena comunicación. Es necesario sensibilizar a los profesionales para que tengan en cuenta las inquietudes y deseos del paciente acerca de la medicación, así como realizar esfuerzos dirigidos a mejorar la legibilidad del informe de alta y de las prescripciones

OBJECTIVE: Patients do not always follow medical indications. This is a public health problem, with implications in health care and costs. The objective of this study was to calculate the percentage of non-adherence of adults to the treatment prescribed in a Hospital Emergency Service ("HES") and understanding wich factors led to poor adherence so improvements can be established. METHODS: Prospective observational study. Cohort of adults who attended the HES. We collected sociodemographic data, medical history, chronic treatments, diagnosis and treatment at discharge from each individual. We applied Morisky-Green test (tailor made to the HES) to asses secondary non-adherence and multivariate analysis to find a correlation with the factors studied. RESULTS: We established a non-adherence of 36.6% (IC95%=30.0-43.8). Patients with chronic endocrine pathology (RR=11.2; IC95%=2.1-60.8), diagnosed with ophthalmological problems (RR=9.8; IC95%=1.1-89.6) or contusions, sprains or fractures (RR=2.9; IC95%=1.1- 7.8), those who were prescribed antibiotics (RR=5.4; IC95%=2.4-11.9), or those who considered that they had received sufficient explanations (RR=3.5; IC95%=1.0-13.2) were more adherent. Those who received analgesics or anti-inflammatories were less adherent (RR=0.4; IC95%=0.2-0.9). CONCLUSIONS: Our results provide information on adherence in acute pathologies in the emergency department. Diabetes and ophthalmological problems or trauma are predictors of increased adherence. We observe more adherence in people with antibiotic treatments, although 20% did not complete treatment. There is a lack of adherence to analgesic/anti-inflammatory treatments. We consider it is important for professionals to take into account patient's concerns about the medication. Patients who considered they had received enough explanations on their treatment were more adherent tan others. We believe it would be useful to provide further information about the outcomes of the medication we prescribe using new technologies such as mobile applications so we could increase adherence. Further studies would be needed to asses the benefit of the changes recently introduced (electronic hisory and prescription)

On the occurrence of egg masses of the diamond-shaped squid Thysanoteuthis rhombus Troschel, 1857 in the subtropical eastern Atlantic (Canary Islands). A potential commercial species?

Data on opportunistic sightings of diamond-shaped squid Thysanoteuthis rhombus egg masses in the Canary Islands (Atlantic Ocean) are presented. A total of 16 egg masses of this species were recorded and photographed from 2000 to 2010 around the western islands of the archipelago (El Hierro, Tenerife and La Gomera). These data reveal the existence of an important spawning area for diamond-shaped squid around the Canary Islands, in subtropical east Atlantic waters. We provide preliminary data for the potential development of an artisanal fishery focused on this species, and a discussion on its potential impacts on the marine ecosystem.

Requerimiento de unidad de hemodiálisis en el eje este territorial del estado aragua, venezuela, 2014 / Requirement of hemodialysis unit in shaft this territorial aragua state, venezuela. 2014

Hemodialysis treatment defines a condition of life of chronicity and dependency in their patients, for its critical renal function, which must imperatively be supplemented. The objective of this research was to determine the population of this axis of Aragua State, in need of assistance in a hemodialysis unit. The Aragua State haemodialysis centres, recorded a population of 583 patients care, they were selected 83 chronic renal patients who applied a questionnaire to collect socio-demographic information, the characteristics of the treatment of hemodialysis and about their quality of life. The results demonstrate predominance of aged 55-64 years in 36%, 64% and residents male territorially this shaft 57%. Patients are 6 care centres, with waiting time for entry of 2 months and dialysis of the municipality Marine Unit attends to 34%. Patients at 89.2%, feel undermined their quality of life because of the travel time in the range of 1-2 hours, 41% are transferred by taxi. In its entirety, they claimed a local care center to improve their quality of life. These patients demonstrated involvement and impairment of physical, emotional and economic partner status by remoteness and transfer the service providing institutions.

El tratamiento de hemodiálisis define una condición de vida de cronicidad y dependencia en sus pacientes, por su función renal crítica, que imperativamente debe ser suplida. El objetivo de esta investigación, fue determinar la población del eje este del Estado Aragua, con necesidad de asistencia en una unidad de hemodiálisis. Los centros de atención de hemodiálisis del Estado Aragua, registran la atención de una población de 583 pacientes, de ellos fueron seleccionados 83 pacientes renales crónicos a quienes se les aplico un cuestionario para recabar información socio demográfica, las características del tratamiento de hemodiálisis y sobre su calidad de vida. Los resultados demuestran predominio de edades entre 55-64 años en 36%, sexo masculino en 64% y residentes territorialmente del eje este en 57%. Los pacientes corresponden a 6 centros de atención, con tiempo de espera para ingreso de 2 meses y la unidad de diálisis del Municipio Mariño atiende a 34%. Los pacientes en 89.2%, siente menoscabada su calidad de vida debido al tiempo de traslado en rango de 1-2 horas, 41% se trasladan en taxi. En su totalidad, demandaron un centro de atención más cercano para mejorar su calidad de vida. Estos pacientes manifestaron afectación y deterioro físico, emocional y en su condición socio económica por la lejanía y traslado a las instituciones prestadoras del servicio.

[Radioguided breast surgery. Evolution of the use of minimal-invasive technologies and current situation]. / Cirugía mamaria radioguiada. Evolución del uso de técnicas miniinvasivas y situación actual.

The increase in the detection of occult lesions has led to the development of new localisation methods using radiopharmaceutical products. The use of these products allows us to perform a "thrifty" (less-aggressive) surgical excision and, to simultaneously carry out the biopsy of the sentinel node in cases of breast cancer. On making a search for the most up to date references on this particular topic, we found many articles on radioguided surgery by many leading international work groups. These articles clearly show the advantages of the radioguided surgery method, its effectiveness and attractiveness to surgeons who are very much involved in the search for excellence in their daily work. We also contribute our experience as a functional group, with 413 interventions on occult lesions performed using the radioguided method (ROLL). In 229 cases out of these 413, we found a malignancy (75%); in all these 229 cases it was possible to perform the intervention simultaneously with the biopsy of the sentinel node (SNOLL), during the same surgical act. However the interest created by the new procedure, it is essential to keep a critical but innovative and reflexive mind on this issue, in order to accurately analyze the results obtained by each group. We must remember that these types of methods involve several clinical specialties and, therefore, each one will have to contribute with the highest efficiency.

The hyphomycete genus Piricauda, with the description of a new species.

The genus Piricauda comprises eight species characterized by monotretic conidiogenous cells and micronematous arched conidiophores: P. cochinensis, P. cubensis, P. longispora, P. mexicana, P. paraguayensis, P. pseudarthriae, P. taiwanensis, and P. vulcanensis sp. nov. P. caribensis is transferred to Acrodictys. Species usually colonize dead petioles and rachides of palms in tropical and subtropical areas, but can also be found on branches and leaves of different trees. The species are illustrated and briefly described, and a key to them is provided.

Influence of portal hypertension and its early decompression by TIPS placement on the outcome of variceal bleeding.

Increased portal pressure during variceal bleeding may have an influence on the treatment failure rate, as well as on short- and long-term survival. However, the usefulness of hepatic hemodynamic measurement during the acute episode has not been prospectively validated, and no information exists about the outcome of hemodynamically defined high-risk patients treated with early portal decompression. Hepatic venous pressure gradient (HVPG) measurement was made within the first 24 hours after admission of 116 consecutive patients with cirrhosis with acute variceal bleeding treated with a single session of sclerotherapy injection during urgent endoscopy. Sixty-four patients had an HVPG less than 20 mm Hg (low-risk [LR] group), and 52 patients had an HVPG greater than or equal to 20 mm Hg (high-risk [HR] group). HR patients were randomly allocated into those receiving transjugular intrahepatic portosystemic shunt (TIPS; HR-TIPS group, n = 26) within the first 24 hours after admission and those not receiving TIPS (HR-non-TIPS group). The HR-non-TIPS group had more treatment failures (50% vs. 12%, P =.0001), transfusional requirements (3.7 +/- 2.7 vs. 2.2 +/- 2.3, P =.002), need for intensive care (16% vs. 3%, P <.05), and worse actuarial probability of survival than the LR group. Early TIPS placement reduced treatment failure (12%, P =.003), in-hospital and 1-year mortality (11% and 31%, respectively; P <.05). In conclusion, increased portal pressure estimated by early HVPG measurement is a main determinant of treatment failure and survival in variceal bleeding, and early TIPS placement reduces treatment failure and mortality in high risk patients defined by hemodynamic criteria.

Cirugía mamaria radioguiada. Evolución del uso de técnicas miniinvasivas y situación actual / Radioguided breast surgery. Evolution of the use of minimal-invasive technologies and current situation

El aumento en la detección de lesiones no palpables de mama ha permitido el desarrollo de métodos de localización mediante el uso de radiofármacos que nos permiten una óptima cirugía de extirpación “ahorradora” y, simultáneamente, la biopsia del ganglio centinela en los casos de cáncer mamario. Revisamos la bibliografía actual acerca del tema y se aprecia una eclosión de artículos sobre cirugía radioguiada en numerosos y destacados grupos de trabajo mundiales que reflejan la bondad del método, así como su eficacia y atractivo para unos cirujanos que apuestan cada vez más por la excelencia en su labor diaria. Aportamos también nuestra experiencia como grupo funcional que se extiende a 413 intervenciones sobre lesiones no palpables realizadas de forma radioguiada (ROLL) y en 229 casos de afección maligna (75%) ha sido posible simultanear con la biopsia del ganglio centinela (SNOLL). El interés que ha despertado la técnica no debe estar exento de un espíritu crítico pero innovador y reflexivo para poder analizar de forma correcta los resultados obtenidos por cada grupo, conscientes de que estamos ante métodos en que intervienen varias especialidades y cada una deberá aportar la máxima eficiencia (AU)

The increase in the detection of occult lesions has led to the development of new localisation methods using radiopharmaceutical products. The use of these products allows us to perform a “thrifty” (less-aggressive) surgical excision and, to simultaneously carry out the biopsy of the sentinel node in cases of breast cancer. On making a search for the most up to date references on this particular topic, we found many articles on radioguided surgery by many leading international work groups. These articles clearly show the advantages of the radioguided surgery method, its effectiveness and attractiveness to surgeons who are very much involved in the search for excellence in their daily work. We also contribute our experience as a functional group, with 413 interventions on occult lesions performed using the radioguided method (ROLL). In 229 cases out of these 413, we found a malignancy (75%); in all these 229 cases it was possible to perform the intervention simultaneously with the biopsy of the sentinel node (SNOLL), during the same surgical act. However the interest created by the new procedure, it is essential to keep a critical but innovative and reflexive mind on this issue, in order to accurately analyze the results obtained by each group. We must remember that these types of methods involve several clinical specialties and, therefore, each one will have to contribute with the highest efficiency

Nuevos aspectos terapéuticos para el control de los factores de riesgo de la obesidad / New therapeutic aspects for the control of risk factors in obesity

El tratamiento de la obesidad sigue basándose en el trípode clásico formado por el consejo nutricional, el aumento de la actividad física y la utilización de fármacos. Sin embargo, en los últimos años se han producido novedades tanto en lo referente a los objetivos del tratamiento como en la aparición de nuevas moléculas. Con respecto a los objetivos del tratamiento de la obesidad, su éxito no radica en adelgazar mucho, sino en conseguir una pérdida de peso moderada (un 5-10% del peso inicial) pero mantenida y a expensas de la grasa visceral. Es decir, más que peso, lo que interesa es reducir cintura para, sobre todo, mejorar o prevenir las complicaciones metabólicas y vasculares de la obesidad. En lo referente a los fármacos, una nueva molécula está a punto de aparecer en el mercado farmacéutico internacional: rimonabant. Es un bloqueador selectivo del receptor endocannabinoide CB1, que ha demostrado su eficacia y seguridad para tratar la obesidad y sus comorbilidades. Otro fármaco, ya conocido, el orlistat, se ha mostrado eficaz en la prevención de la aparición de diabetes mellitus tipo 2 en pacientes obesos con o sin intolerancia a la glucosa

Treatment of obesity continues to rely upon the classical triad of nutritional advise, increase of physical activity and use of drugs. However, in recent years, there have appeared novelties in both therapeutic targets and new molecules. With regard to therapeutic targets of obesity, success does not consist of losing much weight but attaining a moderate yet maintained weight lose (5-10% of initial weight) at the expense of visceral fat. In other words, instead of weight, what is needed is a waist reduction, mainly to improve or prevent obesity-related metabolic and vascular complications. Regarding drugs, a new molecules is about to appear in the international pharmaceutical market: rimonabant. A selective blocker of the endocannabinoid receptor CB1, it has proven to be effective and safe in treating obesity and its comorbidities. Another known agent, orlistat, has proven to be effective in the prevention of the development of type 2 diabetes in obese patients with or without glucose intolerance