[Factors associated with dissatisfaction with pharmacological treatment in patients with type 2 diabetes mellitus: A cross-sectional study]. / Factores asociados a la insatisfacción con el tratamiento farmacológico en pacientes con diabetes mellitus tipo 2: estudio transversal.

BACKGROUND AND OBJECTIVES: Diabetes is a chronic disease with a high impact on both health and Quality of Life Related to Health (QLRH). To evaluate the satisfaction of treatment in patients with type 2 diabetes mellitus through the Diabetes Treatment Satisfaction Questionnaire (DTSQ) and its relationship with sociodemographic variables, with antidiabetic medication and clinical-analytical variables. MATERIALS AND METHODS: This cross-sectional study was conducted in General University Hospital of San Juan de Alicante between September 2016 and December 2017. Two hundred thirty-two patients diagnosed with type 2 diabetes mellitus at least 1 year before inclusion, treated with antidiabetic medication were included. The Spanish version of the DTSQ scale was used to measure satisfaction with treatment. Factors associated with low satisfaction were analyzed by applying the Chi-square test for qualitative variables and Student-T for quantitative variables. To estimate magnitudes of association, logistic models were adjusted. RESULTS: Two hundred thirty-two patients were included in this study. 21.5% of the patients presented low satisfaction with the treatment. Patients who presented low satisfaction with treatment were associated with medications that could cause hypoglycemia (OR: 2.872 [1.195-6.903]), HbA1c levels higher than 7% (OR: 2.260 [1.005-5.083]) and drugs administered by the route oral (OR: 2.749 [1.233-6.131]). CONCLUSIONS: Patients with type 2 diabetes mellitus who had a lower score on the DTSQ questionnaire were associated with medications that produced hypoglycaemia, and with higher levels of HbA1c higher than 7%, and those who took oral medication.

The Trans Accountability Project: Community Engagement to Address Structural Marginalization and Health Inequities.

BACKGROUND: Black and Latina Transgender women face systemic marginalization and harm, increasing vulnerability to social stress and poor health outcomes. These communities have limited access to resources to mobilize and create paths toward health equity. OBJECTIVES: In this paper we report on the results of a community partnership to engage Black and Latina transgender communities on the South and West Sides of Chicago and establish service priorities for collective empowerment. METHODS: The Trans Accountability Project (TAP), a steering committee of racially diverse transgender and nonbinary representatives from four partner organizations, was established and led the design, recruitment, implementation, and analysis of a community needs assessment. World café and human-centered design methods, guided two community conversations/listening sessions around four activities: the perfect provider, my dream job, safety planning, and a stake-holder reflection. RESULTS: Sixty-three participants completed three activities and envisioned innovations for 1) accessible and holistic gender-affirming health care, 2) autonomous, flexible, and community-focused jobs in the arts, nonprofit/business, and care professions, and 3) safer social interactions and spaces. Ten stakeholders attended to listen and inform their organizational and clinical practices to empower Black and Latina transgender women. CONCLUSIONS: TAP prioritized accountability, connectedness, and centering the voices of Black and Latina transgender women as a starting point to intervene upon structural marginalization. Five insights emerged and have directed TAP's focus toward employment and collective care. Although further structural change remains a priority, TAP represents a mechanism for sharing power, improving communication and collaboration, and increasing transparency across relevant Chicago community-based organizations.

4-Hydroxydibenzyl: a novel metabolite from the human gut microbiota after consuming resveratrol.

Resveratrol (RSV) was known to be metabolised by the gut microbiota to dihydroresveratrol, lunularin (LUNU), and (or) 3,4'-dihydroxy-trans-stilbene (DHST). We describe here for the first time that LUNU can be further dehydroxylated, but only at the 3-position, to yield 4-hydroxydibenzyl, a novel metabolite found in human urine after RSV intake in 41 out of 59 healthy participants. In contrast, DHST was not further dehydroxylated, and thus, 4-hydroxy-trans-stilbene was not detected as a gut microbial metabolite of RSV. Faecal in vitro incubations confirmed the in vivo results.

[Analysis of two health attendance models for the non-hospital emergencies in Gipuzkoa: Retrospective study]. / Análisis de dos modelos asistenciales para la atención de las emergencias extrahospitalarias en Guipúzcoa: Estudio retrospectivo.

BACKGROUND AND OBJECTIVE: Out-of-hospital medical emergency services are defined as a functional organization that performs a set of sequential human and material activities. The objective of this study was to compare the mortality of patients attended by the out-of-hospital medical emergency services in 2 neighboring Spanish regions with different models of healthcare transport assistance for emergency care. MATERIAL AND METHOD: Retrospective observational cohort study, done between June 1, 2007 and December 31, 2008 in 2 regions of Gipuzkoa, Alto Deba (AD) and Bajo Deba (BD). The study variables were age, sex and place of exposure (AD/BD), heart rate, blood pressure, initial reason for the call defined by the European Resuscitation Council, unconsciousness and digestive bleeding. 3452 subjects were analyzed. RESULTS: The risk of in situ mortality in BD was 1.31 times higher than in AD (P=.050), that of hospital mortality in BD was 0.71 times lower than in AD (P=.011) and the risk of mortality at one year between counties and the combined mortality (in situ+hospital) did not contribute significant differences. CONCLUSIONS: Mortality (in situ+in-hospital, and one year aftercare) of patients treated by the out-of-hospital emergency medical services in AD (non-medicalized healthcare transport model) was similar to that of the BD region (mixed healthcare transport model).

HLA-G as a new tumor biomarker: detection of soluble isoforms of HLA-G in the serum and saliva of patients with colorectal cancer.

INTRODUCTION: Recent medical investigations suggest that HLA-G, due to its tolerogenic properties, can be used as a biomarker in the diagnosis, treatment, and prognosis of different neoplasms. This observational prospective pilot study aims at detecting sHLA-G in the serum and saliva of patients diagnosed with colorectal cancer (CRC). For this purpose, we compared the expression of sHLA-G from patients with a control sample from a healthy population. MATERIALS AND METHODS: Using the specific enzyme-linked immunosorbent assay (ELISA) method, the expression of sHLA-G in the serum and saliva samples from patients affected by CRC (n = 20) and in a control sample (n = 10) were analyzed. RESULTS: The data showed that in patients with CRC, salivary sHLA-G values were significantly higher than in the control group (18.84 U/ml versus 6.3 U/ml, p = 0.036). In addition, higher levels of sHLA-G were observed in the saliva of patients with CRC in more advanced stages, compared with patients in early stages (24.2 U/ml vs. 8.1 U/ml, p = 0.019). A significant correlation was observed between the concentration of sHLA-G in the serum and saliva of the analyzed samples (Spearman correlation 0.7, p = 0.004). CONCLUSIONS: This study demonstrates, for the first time, the possibility of detecting sHLA-G in the saliva of patients with CRC, resulting in a less invasive alternative to venipuncture. Likewise, we propose that sHLA-G could be an attractive molecular target based on its significant high levels in advanced stages.

Tomografía computarizada multidetector en el traumatismo facial: informe estructurado y observaciones clave para un abordaje sistemático / Multidetector computed tomography for facial trauma: structured reports and key observations for a systematic approach

Las fracturas faciales, relacionadas frecuentemente con accidentes de tráfico, agresiones, accidentes laborales o caídas, constituyen un considerable número de urgencias en nuestros hospitales y asocian, además, una elevada morbimortalidad. La tomografía computarizada multidetector es la técnica de imagen de elección por su amplia disponibilidad y rapidez, y porque permite tanto la caracterización de las fracturas faciales como de las complicaciones asociadas, incluyendo las de localización craneal. Es, por tanto, fundamental para orientar el manejo clínico y la planificación quirúrgica. En este trabajo se describe la anatomía radiológica de la región facial, destacando la importancia de los contrafuertes o arbotantes faciales, se ilustran los hallazgos característicos en las fracturas faciales, y se indican los puntos clave necesarios para su abordaje estructurado al realizar el correspondiente informe radiológico

Facial fractures, often related to traffic accidents, assault, work-related accidents, or falls, account for a considerable number of emergencies in our hospitals and are associated with high morbidity and mortality. Multidetector computed tomography (MDCT) is the imaging technique of choice in this scenario because it is widely available, fast, and useful for characterizing facial fractures and associated complications, including those located in the head. For all these reasons, MDCT is fundamental in the clinical management of these patients and in planning surgery. This paper describes the radiological anatomy of the facial region, underlining the importance of the facial buttresses, and it indicates the key points necessary for carrying out a structured approach and elaborating the corresponding radiologic report

Multidetector computed tomography for facial trauma: structured reports and key observations for a systematic approach. / Tomografía computarizada multidetector en el traumatismo facial: informe estructurado y observaciones clave para un abordaje sistemático.

Facial fractures, often related to traffic accidents, assault, work-related accidents, or falls, account for a considerable number of emergencies in our hospitals and are associated with high morbidity and mortality. Multidetector computed tomography (MDCT) is the imaging technique of choice in this scenario because it is widely available, fast, and useful for characterizing facial fractures and associated complications, including those located in the head. For all these reasons, MDCT is fundamental in the clinical management of these patients and in planning surgery. This paper describes the radiological anatomy of the facial region, underlining the importance of the facial buttresses, and it indicates the key points necessary for carrying out a structured approach and elaborating the corresponding radiologic report.

Herramienta para mejorar la eficiencia en el manejo clínico de pacientes hipertensos / Tools to improve efficiency in the clinical management of hypertensive patients

Objetivo: Crear una herramienta que permita evaluar la eficiencia de la gestión clínica de los pacientes hipertensos en atención primaria. Material y métodos: Se creó un cuestionario dirigido a los centros de atención primaria, con acceso vía Web, para la autoevaluación del manejo de la hipertensión, respecto a 5 áreas de gestión: sistemas de información; pruebas diagnósticas y analíticas; aspectos organizativos; demanda asistencial y consumo de recursos; y programas de atención continuada para profesionales y para pacientes. Previamente, un comité de expertos definió estas preguntas, así como su respuesta ideal o «control», basándose en la literatura científica o, en caso de no haber referencias publicadas, de manera consensuada por dicho comité. Se realizó un análisis descriptivo de los datos y se creó un índice de adherencia de sus resultados con respecto al «control», que oscila entre 0 (ninguna adherencia) y 1 (total adherencia). Resultados: Un total de 35 centros de salud introdujeron sus datos de gestión de pacientes hipertensos en la Web de gestión clínica. Se observó la mayor adherencia en el área «Pruebas diagnósticas y analíticas» (0,69±0,10) y la menor en el área «Programas de formación continuada para pacientes y profesionales» (0,42±0,21). Conclusiones: La eficiencia de la gestión clínica en pacientes hipertensos puede analizarse mediante la herramienta web creada para este fin. Su uso permite realizar una auditoría interna para detectar las áreas que necesitan mejoras y también sirve para hacer evaluaciones comparativas en las distintas áreas de gestión a lo largo del tiempo

Objective: To create a tool to evaluate the efficiency of the clinical management of hypertensive patients in Primary Care. Material and methods: A web-based questionnaire was designed for Primary Care centres to self-evaluate the management of hypertension in five specific areas: information systems, diagnostic and analytical tests, organisational aspects, use of resources, and continuous training programmes for patients and healthcare professionals. A committee of experts previously defined these questions and their ideal responses or "control", based on the scientific literature or, if there were no published references, by consensus of the committee. A descriptive analysis was performed on the data, and an adherence score was created that ranged from 0 (no adherence) to 1 (total adherence). Results: A total of 35 Primary Care centres entered their data into the website for the clinical management of hypertensive patients. The highest adherence to the ideal algorithm was observed in the area "Diagnostic and analytical tests" (0.69±0.10), and the lowest in "Continuous training programmes for patients and professionals" (0.42±0.21). Conclusions: The efficiency of clinical management in hypertensive patients can be analysed using the website tool created for this purpose. Its use allows an internal audit to detect the areas that need improvement, and also serves to make comparative evaluations in the different areas of management over time

Paraganglioma carotídeo maligno. A propósito de un caso / Malignant carotid paraganglioma: a case report

Los tumores del cuerpo carotídeo son neoplasias poco frecuentes, de lento crecimiento, muy destructivos y vascularizados, que tienen un origen neuroectodérmico. Los tumores malignos representan el 5-13% de los casos y presentan un comportamiento agresivo local con infiltración de los ganglios linfáticos adyacentes o metástasis a distancia. Presentamos el caso de un varón de 60 años al que en el estudio por dolor y parestesias en miembro superior se le realiza una resonancia magnética donde se visualiza una gran tumoración en el espacio carotídeo izquierdo, la cual se biopsió obteniendo el diagnóstico histológico de paraganglioma. Al realizar el estudio de extensión se identificó la presencia de metástasis pulmonares y óseas, lo que confirma la malignidad del tumor

Tumors of the carotid body are uncommon neoplasms that originate in the neuroectoderm. These tumors are slow growing but well vascularized and very destructive. Between 5% and 13% of carotid body tumors are malignant, behaving aggressively at the local level, invading the adjacent lymph nodes, and resulting in remote metastases. We present the case of a 60-year-old man who was examined for pain and paresthesias in his arm. Magnetic resonance imaging showed a large tumor in the left carotid space. Histologic study of a biopsy specimen from the tumor revealed that it was a paraganglioma. Further studies to determine the extent of disease detected metastases in bone and lung, confirming the tumor's malignancy

Re-examining the role of the gut microbiota in the conversion of the lipid-lowering statin monacolin K (lovastatin) into its active ß-hydroxy acid metabolite.

Monacolin K (MK, lovastatin), a naturally occurring statin, only exerts lipid-lowering effects in its active ß-hydroxy acid form (MKA). This activation was thought to be mediated by the gut microbiota (GM). We report here for the first time that the GM does not convert MK into MKA (a spontaneous pH-dependent conversion) but catabolises MKA. The GM might hamper the lipid-lowering effects by degrading the active metabolite MKA.

[Tools to improve efficiency in the clinical management of hypertensive patients]. / Herramienta para mejorar la eficiencia en el manejo clínico de pacientes hipertensos.

OBJECTIVE: To create a tool to evaluate the efficiency of the clinical management of hypertensive patients in Primary Care. MATERIAL AND METHODS: A web-based questionnaire was designed for Primary Care centres to self-evaluate the management of hypertension in five specific areas: information systems, diagnostic and analytical tests, organisational aspects, use of resources, and continuous training programmes for patients and healthcare professionals. A committee of experts previously defined these questions and their ideal responses or "control", based on the scientific literature or, if there were no published references, by consensus of the committee. A descriptive analysis was performed on the data, and an adherence score was created that ranged from 0 (no adherence) to 1 (total adherence). RESULTS: A total of 35 Primary Care centres entered their data into the website for the clinical management of hypertensive patients. The highest adherence to the ideal algorithm was observed in the area "Diagnostic and analytical tests" (0.69±0.10), and the lowest in "Continuous training programmes for patients and professionals" (0.42±0.21). CONCLUSIONS: The efficiency of clinical management in hypertensive patients can be analysed using the website tool created for this purpose. Its use allows an internal audit to detect the areas that need improvement, and also serves to make comparative evaluations in the different areas of management over time.

Malignant carotid paraganglioma: a case report. / Paraganglioma carotídeo maligno. A propósito de un caso.

Tumors of the carotid body are uncommon neoplasms that originate in the neuroectoderm. These tumors are slow growing but well vascularized and very destructive. Between 5% and 13% of carotid body tumors are malignant, behaving aggressively at the local level, invading the adjacent lymph nodes, and resulting in remote metastases. We present the case of a 60-year-old man who was examined for pain and paresthesias in his arm. Magnetic resonance imaging showed a large tumor in the left carotid space. Histologic study of a biopsy specimen from the tumor revealed that it was a paraganglioma. Further studies to determine the extent of disease detected metastases in bone and lung, confirming the tumor's malignancy.

Percepción de los médicos de atención primaria sobre la integración con cardiología mediante programas de continuidad asistencial en prevención secundaria / Perception of Primary Care physicians on the integration with cardiology through continuity of healthcare programs in secondary prevention

Objetivo: Conocer la percepción de los médicos de atención primaria (AP) sobre la integración con cardiología (CA) mediante programas de continuidad asistencial. Material y métodos: Estudio transversal y multicéntrico en el que participaron 200 médicos de AP de todo el territorio nacional cumplimentando una encuesta cualitativa para evaluar el grado de integración con CA en prevención secundaria. Los médicos fueron agrupados según el grado de integración entre AP-CA. Resultados: Existe una buena percepción del grado de integración AP-CA, aunque mejor en los centros con mayor integración (74,0% vs. 60,0%; p=0,02) y en general se considera que ha mejorado (92,0% vs. 73,0%; p<0,001). Prácticamente todos los médicos de AP recibían el informe de alta. En la mayoría de los informes se realizaban recomendaciones para el seguimiento cardiológico y en AP, control de factores de riesgo y duración del tratamiento en prevención secundaria, sin diferencias según el grado de integración. El 55,8% de los informes contenían indicaciones sobre cuándo realizar el siguiente control analítico, un 63,6% información sobre el regreso a la vida laboral y un 51,3% sobre la reanudación de la actividad sexual. El papel sigue siendo el medio de comunicación dominante (75 vs. 84%; p=NS). La comunicación entre niveles asistenciales fue mayor en aquellos centros con mayor integración, así como la periodicidad de la comunicación y la satisfacción de los médicos (80,0% vs. 63,0%; p=0,005). Conclusiones: El grado de integración entre AP y CA en general es satisfactorio, pero los centros con mayor integración se benefician de una mayor comunicación y satisfacción

Objective: To determine the perception of Primary Care (PC) physicians on the integration with cardiology (CA) through continuity of healthcare programs. Material and methods: A cross-sectional and multicentre study was conducted, in which a total of 200 PC physicians from all over Spain completed a qualitative survey that evaluated the level of integration with CA in secondary prevention. Physicians were grouped according to the level of PC-CA integration. Results: The integration between CA and PC was good, but it was better in those centres with a higher integration (74.0% vs. 60.0%; p=.02) and in general, physicians considered that integration had improved (92.0% vs. 73.0%; p<.001). Almost all PC physicians received the hospital discharge report. The majority of the hospital discharge reports included recommendations about the CA and PC follow-up, control of risk factors, as well as the duration of secondary prevention treatment, with not significant differences according to the level of integration. In 55.8%, 63.6%, and 51.3% of hospital discharge reports, indications were given on when to perform the follow-up blood analysis, as well as information about returning to working life and sexual activity, respectively. The most common communication method was the paper-based report (75 vs. 84%; p=NS). The communication between healthcare levels was greater in those Primary Care centres with a higher level of integration, as well as periodicity of the communication and the satisfaction of physicians (80.0% vs. 63.0%; p=.005). Conclusions: The level of integration between PC and CA is, in general, satisfactory, but those centres with a higher level of integration benefit more from a greater communication and satisfaction

Prognostic factors and predictive model for in-hospital mortality following hip fractures in the elderly.

PURPOSE: The incidence of hip fractures is increasing within the aging population. Our objective was to identify and quantify the risk factors and develop a predictive model for the in-hospital mortality among hip fracture patients older than 65 years. METHODS: This is a prospective study conducted on 331 hip fracture patients older than 65 years admitted to our hospital from 2011 to 2014. Patients' demographics, prehospitalization residential status, prefracture comorbidity data, anti-aggregant and anticoagulant medication, preoperative hemoglobin value, type of fractures, type of treatments, time to surgery, and complications were recorded. RESULTS: The average age was 83 years, 73% female, and 57% of them sustained a femoral neck fracture. In 62.8% of patients, the number of pre-fracture baseline comorbidities was ≥2. The in-hospital mortality rate was 11.4%. In multivariate analysis, age over 90 years, congestive heart failure, asthma, rheumatologic disease, lung cancer, and not taking antiaggregant medication were independently associated with in-hospital mortality. A formula and risk stratification scoring for predicting the risk for in-hospital mortality was developed. Risk-adjustment model based on these variables had acceptable accuracy for predicting in-hospital mortality (c-statistic 0.77). CONCLUSION: Advanced age, and five prefracture comorbidities have a strong association with in-hospital mortality in a hip fracture patient older than 65 years old. Our predictive model was specifically designed for the old hip fracture population. It has an accuracy similar to other risk models. The specificity, positive predictive value, and negative predictive value are high. In addition, it could discriminate a high risk patient from a low risk patient for in-hospital mortality.

Estudio de percepción del clima organizacional de las empresas tecnificadas de ganadería de leche de la provincia del Tundama, Boyacá (Colombia) / Perception study of the organizational climate of the technified milk cattle companies of the Tundama province, Boyaca (Colombia)

RESUMEN El objetivo de esta investigación fue caracterizar el clima organizacional de las empresas tecnificadas de ganadería de leche de la provincia del Tundama en el departamento de Boyacá (Colombia), con el propósito de contribuir a generar estrategias de gestión de recursos humanos que favorezcan el ambiente laboral en las fincas productoras de leche de la región. El estudio incluyó fincas dedicadas a producción especializada de leche agremiadas a la Federación de Ganaderos de Boyacá (FABEGAN), con manejo de registros, sistemas de manejo de praderas, doble ordeño, venta formal de leche, buenas prácticas ganaderas y un promedio diario de producción por vaca igual o superior a 12 litros. Se siguió una metodología exploratoria, tecnológica psicométrica, con análisis descriptivo de datos y enfoque mixto. Se construyó un instrumento y se validó mediante prueba piloto, una prueba psicométrica por panel de expertos. El coeficiente alfa de Cronbach fue de 0,9044395 y el Chi cuadrado de Pearson fue de 787,14 con 220 grados de libertad y una probabilidad < 2,2-16, lo que evidenció un alto grado de asociación entre las variables. El análisis de correspondencia simple permitió establecer la afinidad del clima organizacional en las fincas por cada una de las 6 opciones de respuesta planteadas en escala de Likert. Se realizó Clústerización de las fincas por cada dimensión del clima organizacional; se generaron dos clúster, esperando que uno de ellos agrupe a las fincas que tienen el comportamiento más cercano al ideal y el otro, el más lejano. Finalmente, se propusieron estrategias que contribuyan a mejorar el clima organizacional de las empresas ganaderas boyacenses.

ABSTRACT The aim of this study was to characterize the organizational climate in technologically advanced dairy cattle farms of the province of Tundama in the department of Boyaca (Colombia), in order to contribute to the generation of human resources management strategies that favor the working environment in the farms. The study included milk producing farms affiliated to the Boyacá Cattle Federation (FABEGAN), that had record management, grassland management systems, double milking, formal sale of milk, good livestock practices and an average daily milk production equal to or greater than 12 liters per cow per day. An exploratory, psychometric technological methodology was followed, with descriptive data analysis and a mixed approach. An instrument was built and validated by means of a pilot test, a psychometric test by an expert panel. Cronbach's alpha coefficient was 0.9044395 and Pearson's Chi square was 787.14 with 220 degrees of freedom and a probability < 2.2-16, indicating a high degree of association between the variables. The simple correspondence analysis allowed to establish the affinity of the organizational climate in the farms for each of the 6 response options proposed on a Likert scale. Clustering of the farms was carried out for each dimension of the organizational climate, generating two clusters, hoping that one of the groups the farms have the behavior closest to the ideal and the other, farther from the ideal. Finally, strategies were proposed aimed at improving the organizational climate of Boyacá cattle companies.

[Perception of Primary Care physicians on the integration with cardiology through continuity of healthcare programs in secondary prevention]. / Percepción de los médicos de atención primaria sobre la integración con cardiología mediante programas de continuidad asistencial en prevención secundaria.

OBJECTIVE: To determine the perception of Primary Care (PC) physicians on the integration with cardiology (CA) through continuity of healthcare programs. MATERIAL AND METHODS: A cross-sectional and multicentre study was conducted, in which a total of 200 PC physicians from all over Spain completed a qualitative survey that evaluated the level of integration with CA in secondary prevention. Physicians were grouped according to the level of PC-CA integration. RESULTS: The integration between CA and PC was good, but it was better in those centres with a higher integration (74.0% vs. 60.0%; p=.02) and in general, physicians considered that integration had improved (92.0% vs. 73.0%; p<.001). Almost all PC physicians received the hospital discharge report. The majority of the hospital discharge reports included recommendations about the CA and PC follow-up, control of risk factors, as well as the duration of secondary prevention treatment, with not significant differences according to the level of integration. In 55.8%, 63.6%, and 51.3% of hospital discharge reports, indications were given on when to perform the follow-up blood analysis, as well as information about returning to working life and sexual activity, respectively. The most common communication method was the paper-based report (75 vs. 84%; p=NS). The communication between healthcare levels was greater in those Primary Care centres with a higher level of integration, as well as periodicity of the communication and the satisfaction of physicians (80.0% vs. 63.0%; p=.005). CONCLUSIONS: The level of integration between PC and CA is, in general, satisfactory, but those centres with a higher level of integration benefit more from a greater communication and satisfaction.

Los cultivos de leche humana 5 años después de la primera propuesta de protocolo (II): contribución a una reducción del uso de medicamentos durante la lactancia / Human milk cultures five years after the first protocol proposal (II): Contribution to a reduction in the use of drugs during lactation

La mastitis es un problema relativamente común durante la lactancia, pero la ausencia de pruebas específicas conduce a numerosos errores tanto en el diagnóstico como en el tratamiento. Por tanto, los cultivos de leche parecen una herramienta fundamental para conocer la epidemiología real de esta infección, realizar un diagnóstico correcto e instaurar el mejor tratamiento posible. En esta segunda parte se describen seis casos prácticos que ponen de manifiesto la utilidad de los cultivos de leche para un correcto diagnóstico y tratamiento de los problemas que aparecen durante la lactancia, así como su contribución a una reducción del uso de medicamentos durante esta etapa (AU)

Mastitis is a relatively common problem during lactation but the absence of specific tests frequently leads to errors both in the diagnosis and in the treatment. Consequently, milk cultures seem a key tool in order to know the actual epidemiology of this infec-tion, to get a correct diagnosis, and to prescribe the best treatment. In this part, six practical cases showing the usefulness of milk cultures for a correct diagnosis and treatment of problems arising during lactation are described. They reveal the contribution of milk cultures in reducing the use of unnecessary drugs during lactation (AU)

Los cultivos de leche humana 5 años después de la primera propuesta de protocolo (I): una herramienta útil para la salud pública / Human milk cultures five years after the first protocol proposal (I): a useful tool for Public Health

La mastitis es un problema relativamente común durante la lactancia, pero la ausencia de pruebas específicas conduce a numerosos errores, tanto en el diagnóstico como en el tratamiento. Por tanto, los cultivos de leche representan una herramienta fundamental para conocer la epidemiología real de esta infección, realizar un diagnóstico correcto e instaurar el mejor tratamiento posible, evitando la excesiva medicalización, a menudo ineficaz, que suelen padecer las mujeres afectadas. Un artículo publicado en Acta Pediátrica Española hace 5 años ha sido la base de la sección 4 «Mastitis: diagnóstico microbiológico» del reciente protocolo número 54 («Diagnóstico microbiológico de la infección bacteriana asociada al parto y al puerperio») de la Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. El objetivo de este artículo es responder a las dudas y controversias que, inevitablemente, suelen rodear a cualquier protocolo novedoso (AU)

Mastitis is a relatively common problem during the lactation period but the absence of specific tests frequently leads to errors both in the diagnosis and in the treatment. Consequently, milk cultures are a key tool in order to know the actual epidemiology of this infection, to get a correct diagnosis, and to prescribe the best treatment, thus reducing the excessive medicalization, often inefficient, that women with this condition usually receive. A paper published in Acta Pediátrica Española five years ago provided the basis for section 4 «Mastitis: microbiological diagnosis» of the protocol 54 («Microbiological diagnosis of bacterial infection associated to delivery and puerperium») recently published by the Spanish Society for Infectious Diseases and Clinical Microbiology (SEIMC). The objective of this article is providing answers to the doubts and controversial issues that unavoidably surround any novel protocol in any biomedical field (AU)

Ganciclovir Dosing Strategies and Development of Cytomegalovirus Resistance in a Kidney Transplant Recipient: A Case Report.

In renal transplant recipients, delayed graft function and accompanying renal impairment may lead to therapeutic underexposure of valganciclovir. We describe a case of a cytomegalovirus (CMV)-seronegative kidney transplant recipient from a CMV-seropositive donor, whose course was complicated during valganciclovir prophylaxis by CMV disease, ultimately progressing to ganciclovir, foscarnet, and cidofovir resistance. Assessments and adjustments for renal dysfunction, according to both Cockgroft-Gault and Modification of Diet in Renal Disease study equations, are described. Therapy was complicated by outpatient parenteral therapy with pump-administered antiviral therapy, which may have led to drug underexposure and the fostering of antiviral resistance. Suppression was ultimately achieved in conjunction with reduction in immunosuppressive therapy, CMV immunoglobulin, and initiation of leflunomide. At-risk recipients may benefit from 24 hour creatinine clearance assessments, direct creatinine clearance measurement, or therapeutic drug monitoring. Optimal dosing strategies in recipients with impaired kidney function remain undefined, with limited pharmacokinetic data to date.