Problemas farmacoterapéuticos asociados a la nutrición parenteral total detectados en el seguimiento farmacoterapéutico y su impacto económico / Drug-therapy problems associated with total parenteral nutrition detected in pharmaceutical care practice and their economic impact

Introducción: La nutrición parenteral total es la administración de los nutrientes requeridos por vía intravenosa. No es un método libre de complicaciones. El químico farmacéutico en el área asistencial por medio del seguimiento farmacoterapéutico puede aportar a la mejora de la terapia nutricional de un paciente con nutrición parenteral total.Objetivo: Detectar los problemas farmacoterapéuticos asociados a la nutrición parenteral total a través del seguimiento farmacoterapéutico en pacientes y los ahorros de las intervenciones farmacéuticas generados en una clínica de tercer nivel en Barranquilla-Colombia.Método: Se realizó un estudio evaluativo, cuasi-experimental, ambiespectivo en 109 pacientes con prescripción de nutrición parenteral total en una clínica de tercer nivel de la ciudad de Barranquilla, durante 6 meses.Resultados: Se detectaron un total de 81 problemas relacionados con los medicamentos durante la fase de estudio, de los cuales el 75,31% fueron del tipo de dosis pauta y/o duración no adecuada. 20 problemas relacionados con los medicamentos se convirtieron en resultados negativos asociados a los medicamentos, de estos, el 55% fueron del tipo inefectividad cuantitativa. Fueron realizadas 81 intervenciones, con un porcentaje de aceptación de 93,83% (76), de las intervenciones aceptadas se lograron resolver 67 problemas, 5 intervenciones no fueron aceptadas y 14 problemas no pudieron ser resueltos debido a distintos factores. En cuanto a los ahorros generados, se alcanzó la cifra de $ 12.751.595 COP en seis meses de desarrollo del estudio.Conclusión: La identificación del perfil del paciente y los riesgos asociados al soporte nutricional ayudarán a generar un impacto económico para la institución y clínico en el paciente teniendo una visión integral de los problemas farmacoterapéuticos asociados. (AU)

Introduction: Total parenteral nutrition is the administration of the nutrients that an individual requires intravenously. It is not a method free of complications. The Pharmacist in care area through pharmacotherapeutic monitoring can contribute to the improvement of the nutritional therapy of a patient with Total parenteral nutrition. Objective: To detect pharmacotherapy problems associated with total parenteral nutrition through pharmacotherapy follow-up in patients and the savings from pharmaceutical interventions generated in a third level clinic in Barranquilla-Colombia.Methodology: It was performed an evaluative study with a quasi-experimental methodological design of ambyespective type, in relation to the time of collection of the data, in 109 patients prescribed with total parenteral nutrition in a third level clinic located in Barranquilla Colombia, in the period between November-December 2018 and January-May 2019.Results: A total of 81 drug related problem were detected during study phase, of which 75,31% were dose type and/or inadequate duration. 20 drug related problem became into negative outcome medications, of these, 55% were quantitative ineffectiveness type. 81 interventions were performed, with an acceptance percentage of 93,83% (76), of these accepted interventions, 67 problems were solved, 5 interventions were not accepted and 14 problems could not be solved due to different factors. Regarding the savings generated, the figure of $12.751.595 COP was reached in six months of study development.Conclusion: The identification of the patient’s profile and the risks associated with nutritional support will help generate an economic impact for the institution and clinician on the patient by having a comprehensive view of the associated pharmacotherapeutic problems. (AU)

Nuevo método para evaluar el Test Subjetivo Vertical / New method for assessing Subjective Visual Vertical Test

Introducción: La prueba Visual Subjetiva Vertical (SVV por sus siglas en inglés) corresponde a una prueba de bajo costo y complejidad que permite el estudio de la función vestibular "estática". En el año 2009 se valida la Prueba del Balde con igual confianza, sensibilidad y especificidad, que la prueba de domo. Sin embargo, diversos factores impresionan disminuir su precisión. Objetivo: Proponer un nuevo método utilizando un programa computacional y una interfaz pantalla-paciente, que permita disminuir la influencia de variables y aumentar la precisión de la evaluación. Material y método: En 43 voluntarios sin historia de patología vestibular y en 32 pacientes con patología vestibular se compararon los resultados de la aplicación de SVV en dos modalidades: prueba del balde tradicionalyuna prueba computarizada propuesta en el presente artículo. Resultados: En nuestro estudio el SVV con balde muestra 57% de sensibilidad y 90% de especificidad, mientras el SVV digital tiene 74% de sensibilidad y 93% de especificidad, el cual también presentó significativamente una menor desviación estándar. Conclusión: En suma, el SVV computarizado arroja un resultado más preciso que SVV con balde, con mejor utilidad clínica al tener mayor de discriminación con mejores perfiles de sensibilidad/especificidad.

Background: Subjective Visual Vertical Test (SVV) is a low-cost and simple evaluation that allows the physician to study the static vestibular function of a patient. In 2009 the Bucket Test was validated as a high confidence, sensitivity and specificity comparable to the hemispheric dome testing device. Although, its result can be affected by multiple variables. Aim: To propose a new method to evaluate SVV using a computer software interface, that allows a reduction ofvariables therefore increasing its precision. Material and method: In a sample of 43 volunteers with no previous history of vestibular pathologies and 32 patients with diagnosed vestibular pathologies we compared the results of 2 different modules of SVV testing: a traditional bucket test and a computerized test proposed in the present article. Results: Bucket test SVV for this research showed a sensitivity of 57% and a specificity of 90%, meanwhile Computerized SVV had a sensitivity of 74% and a specificity of 93%, which also presented a significant smaller standard deviation. Conclusion: In summary, digital SVV testing grants more accurate result in comparison to the Bucket Test, with a better clinical performance due to an improved discriminatory capacity with better Sensitivity/Specificity profiles.

Hacia un nuevo VIII par: alternativas de baja complejidad / Towards a new vestibular assessment: low complexity alternatives

Introducción: El examen funcional del VIII par, mediante la prueba calórica permite conocer la función del canal semicircular horizontal, dejando de lado la evaluación de otras estructuras como el complejo utrículo-sacular. Objetivo: Evaluar el rendimiento diagnóstico de pruebas vestibulares de bajo costo y complejidad cefálico para suplir esta falencia. Material y método: En 34 pacientes con indicación de estudio funcional de VIII par se realizaron, además de las pruebas tradicionales, el test visual subjetivo vertical mediante prueba del balde, la prueba de impulso cefálico a ojo desnudo, y la aplicación del cuestionario de sintomatología "Dizziness Handicap Inventory". Resultados: Considerando el VIII par clásico como patrón de oro, se encuentra evidencia objetiva de patología en 50% de la muestra. Con la incorporación de los nuevos exámenes esta cifra aumenta a 85%. Se realizó análisis de discrepancia sobre pacientes con resultados normales en el estudio tradicional, pero anormal según los nuevos exámenes. El 100% de dicho grupo presenta una puntuación patológica en el cuestionario de síntomas. Más aún, los valores de desviación de verticalidad correlacionaron fuertemente con la puntuación de sintomatología (r =0,79; p =0,002). Conclusiones: El análisis de discrepancia sugiere que los nuevos exámenes son confiables en identificar patología en el estudio. Incluir en el estudio tradicional del VIII par pruebas de baja complejidad y corta duración (menos de 5 minutos en su conjunto) podría aumentar el rendimiento diagnóstico del estudio del equilibrio en hasta 35%.

Introduction: Traditionally, the assessment of vestibular function is based on the caloric test. This procedure assesses mainly the horizontal semicircular canal function, leaving other vestibular structures aside, such as the utricule-saccule complex. Aim: To assess the diagnostic performance low complexity tests to compensate for these issues. Material and methods: 34 patients with indication for vestibular assessment were recruited. In addition to traditional testing (caloric test and postural provocation maneuvers), the mentioned Subjective Visual Vertical and Head Impulse tests were applied alongside the Dizziness Handicap Inventory for vestibular symptoms. Results: Considering caloric testing and Dix-Hallpike maneuvers as gold standard, 50% of the sample presented an objective cause of their symptomatology. When including the new test, this value increases to 85%. A discrepancy analysis was conducted on the group with normal traditional tests and abnormal new tests. 100% of this group showed symptoms score above pathological levels. Furthermore, there was a strong relationship between deviation on the Visual Vertical test and symptomatology (r =0,79; p =0,002). Conclusion: The discrepancy analysis suggests that the new tests are reliable in determining pathology on this study. It these test are included to traditional testing, diagnostic performance may increase up to 35%.

Effect of dietary oils, cholesterol and antioxidant vitamin supplementation on liver microsomal fluidity and xenobiotic-metabolizing enzymes in rats.

This study was undertaken to compare the effects of four oils: corn (C), olive (O), hazelnut (H) or fish (F), and the intake of two supplements: cholesterol, 1% (Ch) or dl-alpha-tocopherol acetate, 500 mg/kg, and beta-carotene, 30 mg/kg (V), on liver microsomal fluidity, cyt P450 content and aniline hydroxylase (AH), aminopyrine-N-dimethylase (AND) and UDP-glucuronyltransferase (UDP-GT) activities. Male Sprague-Dawley rats (n = 6/group) were fed semipurified diets containing 15% oil, without or with Ch or V, for 20 days. Dietary intake and feed efficiency were lower in rats fed F. Relative liver weight was higher in animals fed F, similar in O and H, and lower in the group fed C. The intake of V increased feed intake in C+V group and decreased the relative liver weight of F+V group, which also decreased with the intake of F+Ch. Ch intake increased the relative liver weight in all groups consuming vegetable oils. Cyt P450 content was higher in rats fed F. Decreased cyt P450 content was observed in C+Ch and F+Ch groups, while it augmented in H+Ch group. Mixture V increased cyt P450 in rats fed C+V, F+V and O+V. The highest membrane fluidity was observed in rats fed F. Fluidity was also higher in group H versus O or C. The intake of Ch decreased microsomal fluidity in all groups, while V induced an increase in microsomal fluidity in group O+V. Rats fed F exhibited higher enzyme activities. AND activity increased with V only in rats fed H+V, while AH activity increased with V intake in groups F+V and O+V. In the C+V group, fluidity was not affected by V, while the cyt P450 content and UDP-GT activity increased. The O+V group exhibited lower UDP-GT activity and higher fluidity and cyt P450 content. The activity of AH decreased in groups F+Ch and C+Ch. UDP-GT activity was higher in rats fed F. It diminished after the intake of Ch in H+Ch and F+Ch. These results indicate that although AH and AND act in the same microsomal metabolic pathway, their localization into the membrane may be determinant of their activity and the response to dietary lipids. It is shown that F intake exerts the most significant effects upon liver microsomal properties, e.g. higher fluidity, cyt P450 content and enzymatic activities, an effect that prevails over the intake of the supplements tested.

[Incidence of congenital cytomegalovirus infection in newborn infants of different socioeconomic strata]. / Incidencia de infección congénita por citomegalovirus en recién nacidos de distinta condición socioeconómica.

Cytomegalovirus is the main agent of congenital viral infections. The aim of this study was to compare the incidence of congenital cytomegalovirus infections of two groups of newborns of differing socioeconomic status. Cytomegalovirus was isolated from urine or oropharingeal secretions in 218 children born in a private clinic and 471 born in a public hospital. Positive viral isolates were confirmed with indirect immunofluorescence using monoclonal antibodies. Infection was detected in 12 children (1.82%), four coming from the private clinic (1.86%) and 8 coming from the public hospital (1.81%). Ninety two percent of infected children were asymptomatic. Urine and oropharingeal secretion samples had the same yield for viral isolation. It is concluded that the incidence of congenital cytomegalovirus infection is similar to that described in developed countries.

[Kawasaki's disease]. / Enfermedad de Kawasaki.

We described a case of Kawasaki's disease in a chilean girl, one year and 5 months old of age, who presented the oral characteristics, cutaneous and systemic manifestation of the condition, that is not very common for the dentist but that it is necessary to know due to the heart complications and the mortality associated with the disease, and it is necessary that the dentist recognize early this condition.