[Patients with COPD hospitalized due to COVID-19 in Spain: a comparison between the first and second wave]. / Pacientes con EPOC hospitalizados por COVID-19 en España: comparación entre la primera y la segunda ola.

Objective: This work aimed to compare the characteristics, progress, and prognosis of patients with COPD hospitalized due to COVID-19 in Spain in the first wave with those of the second wave. Material and methods: This is an observational study of patients hospitalized in Spain with a diagnosis of COPD included in the SEMI-COVID-19 registry. The medical history, symptoms, analytical and radiological results, treatment, and progress of patients with COPD hospitalized in the first wave (from March to June 2020) versus those hospitalized in the second wave (from July to December 2020) were compared. Factors associated with poor prognosis, defined as all-cause mortality and a composite endpoint that included mortality, high-flow oxygen therapy, mechanical ventilation, and ICU admission, were analyzed. Results: Of the 21,642 patients in the SEMI-COVID-19 Registry, 6.9% were diagnosed with COPD: 1,128 (6.8%) in WAVE1 and 374 (7.7%) in WAVE2 (p = 0.04). WAVE2 patients presented less dry cough, fever and dyspnea, hypoxemia (43% vs 36%, p < 0.05), and radiological condensation (46% vs 31%, p < 0.05) than WAVE1 patients. Mortality was lower in WAVE2 (35% vs 28.6%, p = 0.01). In the total sample, mortality and the composite outcome of poor prognosis were lower among patients who received inhalation therapy. Conclusions: Patients with COPD admitted to the hospital due to COVID-19 in the second wave had less respiratory failure and less radiological involvement as well as a better prognosis. These patients should receive bronchodilator treatment if there is no contraindication for it.

[Impact of days elapsed from the onset of symptoms to hospitalization in COVID-19 in-hospital mortality: Time matters]. / Impacto de los días transcurridos desde el inicio de los síntomas hasta la hospitalización en la mortalidad hospitalaria por COVID-19: el tiempo importa.

Background: COVID-19 shows different clinical and pathophysiological stages over time. Theeffect of days elapsed from the onset of symptoms (DEOS) to hospitalization on COVID-19prognostic factors remains uncertain. We analyzed the impact on mortality of DEOS to hospital-ization and how other independent prognostic factors perform when taking this time elapsedinto account. Methods: This retrospective, nationwide cohort study, included patients with confirmed COVID-19 from February 20th and May 6th, 2020. The data was collected in a standardized online datacapture registry. Univariate and multivariate COX-regression were performed in the generalcohort and the final multivariate model was subjected to a sensitivity analysis in an earlypresenting (EP; < 5 DEOS) and late presenting (LP; ≥5 DEOS) group. Results: 7915 COVID-19 patients were included in the analysis, 2324 in the EP and 5591 in theLP group. DEOS to hospitalization was an independent prognostic factor of in-hospital mortalityin the multivariate Cox regression model along with other 9 variables. Each DEOS incrementaccounted for a 4.3% mortality risk reduction (HR 0.957; 95% CI 0.93---0.98). Regarding variationsin other mortality predictors in the sensitivity analysis, the Charlson Comorbidity Index onlyremained significant in the EP group while D-dimer only remained significant in the LP group. Conclusion: When caring for COVID-19 patients, DEOS to hospitalization should be consideredas their need for early hospitalization confers a higher risk of mortality. Different prognosticfactors vary over time and should be studied within a fixed timeframe of the disease.

Impacto de los días transcurridos desde el inicio de los síntomas hasta la hospitalización en la mortalidad hospitalaria por COVID-19: el tiempo importa / Impact of days elapsed from the onset of symptoms to hospitalization in COVID-19 in-hospital mortality: Time matters

Antecedentes La COVID-19 muestra diferentes fases clínicas y fisiopatológicas a lo largo del tiempo. El efecto de los días transcurridos desde el comienzo de los síntomas (DTCS) hasta la hospitalización sobre los factores pronósticos de la COVID-19 sigue siendo incierto. Analizamos el impacto en la mortalidad de los DTCS hasta la hospitalización y cómo se comportan otros factores pronósticos independientes al tener en cuenta dicho tiempo transcurrido. Métodos En este estudio de cohortes nacional retrospectivo se incluyó a pacientes con COVID-19 confirmada entre el 20 de febrero y el 6 de mayo de 2020. Los datos se recopilaron en un registro normalizado de captura de datos en línea. Se realizó una regresión de Cox uni y multifactorial en la cohorte general y el modelo multifactorial final se sometió a un análisis de sensibilidad en un grupo de presentación precoz (PP) < 5 DTCS y otro de presentación tardía (PT) ≥ 5 DTCS). Resultados En el análisis se incluyó a 7.915 pacientes con COVID-19, 2.324 en el grupo de PP y 5.591 en el de PT. Los DTCS hasta la hospitalización fueron un factor pronóstico independiente de mortalidad intrahospitalaria en el modelo de regresión de Cox multifactorial junto con otras nueve variables. Cada incremento en un DTCS supuso una reducción del riesgo de mortalidad del 4,3% (RRI = 0,957; IC 95%, 0,93-0,98). En cuanto a las variaciones de otros factores predictivos de la mortalidad en el análisis de sensibilidad, únicamente el índice de comorbilidad de Charlson siguió siendo significativo en el grupo de PP, mientras que únicamente el dímero D lo siguió siendo en el grupo de PT. Conclusiones Al atender a pacientes con COVID-19 hay que tener en cuenta los DTCS hasta la hospitalización porque la necesidad de hospitalización precoz confiere un mayor riesgo de mortalidad. Los diferentes factores pronósticos varían con el tiempo y deberían estudiarse dentro de un marco temporal fijo de la enfermedad (AU)

Background COVID-19 shows different clinical and pathophysiological stages over time. Theeffect of days elapsed from the onset of symptoms (DEOS) to hospitalization on COVID-19prognostic factors remains uncertain. We analyzed the impact on mortality of DEOS to hospital-ization and how other independent prognostic factors perform when taking this time elapsedinto account. Methods This retrospective, nationwide cohort study, included patients with confirmed COVID-19 from February 20th and May 6th, 2020. The data was collected in a standardized online datacapture registry. Univariate and multivariate COX-regression were performed in the generalcohort and the final multivariate model was subjected to a sensitivity analysis in an earlypresenting (EP; <5 DEOS) and late presenting (LP; ≥5 DEOS) group. Results 7915 COVID-19 patients were included in the analysis, 2324 in the EP and 5591 in theLP group. DEOS to hospitalization was an independent prognostic factor of in-hospital mortalityin the multivariate Cox regression model along with other 9 variables. Each DEOS incrementaccounted for a 4.3% mortality risk reduction (HR 0.957; 95% CI 0.93---0.98). Regarding variationsin other mortality predictors in the sensitivity analysis, the Charlson Comorbidity Index onlyremained significant in the EP group while D-dimer only remained significant in the LP group. Conclusion When caring for COVID-19 patients, DEOS to hospitalization should be consideredas their need for early hospitalization confers a higher risk of mortality. Different prognosticfactors vary over time and should be studied within a fixed timeframe of the disease (AU)

Pacientes con EPOC hospitalizados por COVID-19 en España: comparación entre la primera y la segunda ola / Patients with COPD hospitalized due to COVID-19 in Spain: a comparison between the first and second wave

Objetivo Comparar las características, evolución y pronóstico de los pacientes con enfermedad pulmonar obstructiva crónica (EPOC) hospitalizados por COVID-19 en España en la primera ola con los de la segunda ola. Material y métodos Estudio observacional de los pacientes hospitalizados en territorio español con diagnóstico de EPOC incluidos en el registro SEMI-COVID-19. Se compararon los antecedentes, la clínica, los resultados analíticos y radiológicos, el tratamiento y la evolución de los pacientes con EPOC hospitalizados en la primera ola (desde marzo hasta junio del 2020 [OLA1]) frente a los que fueron ingresados en la segunda ola (desde julio hasta diciembre del 2020 [OLA2]). Se analizaron los factores de mal pronóstico, definidos como mortalidad por todas las causas y un evento combinado que incluía mortalidad, oxigenoterapia con alto flujo, ventilación mecánica e ingreso en la unidad de cuidados intensivos (UCI). Resultado De 21.642 pacientes del registro SEMI-COVID-19, están diagnosticados de EPOC 6,9%, 1.128 (6,8%) en la OLA1 y 374 (7,7%) en la OLA2 (p = 0,04). Los pacientes de la OLA2 presentan menos tos seca, fiebre y disnea, hipoxemia (43 vs. 36%, p < 0,05) y condensación radiológica (46 vs. 31%, p < 0,05) que los de la OLA1. La mortalidad es menor en la OLA2 (35 vs. 28,6%, p = 0,01). En el global de pacientes la mortalidad y la variable combinada de mal pronóstico fue menor entre aquellos que recibieron tratamiento inhalador. Conclusiones Los pacientes con EPOC con ingreso hospitalario por COVID-19 en la segunda ola presentan menos insuficiencia respiratoria y menor afectación radiológica, con mejor pronóstico. Estos deben recibir tratamiento broncodilatador si no hay contraindicación para el mismo (AU)

Objective This work aimed to compare the characteristics, progress, and prognosis of patients with COPD hospitalized due to COVID-19 in Spain in the first wave with those of the second wave. Material and methods This is an observational study of patients hospitalized in Spain with a diagnosis of COPD included in the SEMI-COVID-19 registry. The medical history, symptoms, analytical and radiological results, treatment, and progress of patients with COPD hospitalized in the first wave (from March to June 2020) versus those hospitalized in the second wave (from July to December 2020) were compared. Factors associated with poor prognosis, defined as all-cause mortality and a composite endpoint that included mortality, high-flow oxygen therapy, mechanical ventilation, and ICU admission, were analyzed. Results Of the 21,642 patients in the SEMI-COVID-19 Registry, 6.9% were diagnosed with COPD: 1,128 (6.8%) in WAVE1 and 374 (7.7%) in WAVE2 (p = 0.04). WAVE2 patients presented less dry cough, fever and dyspnea, hypoxemia (43% vs 36%, p < 0.05), and radiological condensation (46% vs 31%, p < 0.05) than WAVE1 patients. Mortality was lower in WAVE2 (35% vs 28.6%, p = 0.01). In the total sample, mortality and the composite outcome of poor prognosis were lower among patients who received inhalation therapy. Conclusions Patients with COPD admitted to the hospital due to COVID-19 in the second wave had less respiratory failure and less radiological involvement as well as a better prognosis. These patients should receive bronchodilator treatment if there is no contraindication for it (AU)

Patients with COPD hospitalized due to COVID-19 in Spain: a comparison between the first and second wave.

OBJECTIVE: This work aimed to compare the characteristics, progress, and prognosis of patients with COPD hospitalized due to COVID-19 in Spain in the first wave with those of the second wave. MATERIAL AND METHODS: This is an observational study of patients hospitalized in Spain with a diagnosis of COPD included in the SEMI-COVID-19 registry. The medical history, symptoms, analytical and radiological results, treatment, and progress of patients with COPD hospitalized in the first wave (from March to June 2020) versus those hospitalized in the second wave (from July to December 2020) were compared. Factors associated with poor prognosis, defined as all-cause mortality and a composite endpoint that included mortality, high-flow oxygen therapy, mechanical ventilation, and ICU admission, were analyzed. RESULTS: Of the 21,642 patients in the SEMI-COVID-19 Registry, 6.9% were diagnosed with COPD: 1128 (6.8%) in WAVE1 and 374 (7.7%) in WAVE2 (p = 0.04). WAVE2 patients presented less dry cough, fever and dyspnea, hypoxemia (43% vs 36%, p < 0.05), and radiological condensation (46% vs 31%, p < 0.05) than WAVE1 patients. Mortality was lower in WAVE2 (35% vs 28.6%, p = 0.01). In the total sample, mortality and the composite outcome of poor prognosis were lower among patients who received inhalation therapy. CONCLUSIONS: Patients with COPD admitted to the hospital due to COVID-19 in the second wave had less respiratory failure and less radiological involvement as well as a better prognosis. These patients should receive bronchodilator treatment if there is no contraindication for it.

Impact of days elapsed from the onset of symptoms to hospitalization in COVID-19 in-hospital mortality: time matters.

BACKGROUND: COVID-19 shows different clinical and pathophysiological stages over time. The effect of days elapsed from the onset of symptoms (DEOS) to hospitalization on COVID-19 prognostic factors remains uncertain. We analyzed the impact on mortality of DEOS to hospitalization and how other independent prognostic factors perform when taking this time elapsed into account. METHODS: This retrospective, nationwide cohort study, included patients with confirmed COVID-19 from February 20th and May 6th, 2020. The data was collected in a standardized online data capture registry. Univariate and multivariate COX-regression were performed in the general cohort and the final multivariate model was subjected to a sensitivity analysis in an early presenting (EP; <5 DEOS) and late presenting (LP; ≥5 DEOS) group. RESULTS: 7915 COVID-19 patients were included in the analysis, 2324 in the EP and 5591 in the LP group. DEOS to hospitalization was an independent prognostic factor of in-hospital mortality in the multivariate Cox regression model along with other 9 variables. Each DEOS increment accounted for a 4.3% mortality risk reduction (HR 0.957; 95% CI 0.93-0.98). Regarding variations in other mortality predictors in the sensitivity analysis, the Charlson Comorbidity Index only remained significant in the EP group while D-dimer only remained significant in the LP group. CONCLUSION: When caring for COVID-19 patients, DEOS to hospitalization should be considered as their need for early hospitalization confers a higher risk of mortality. Different prognostic factors vary over time and should be studied within a fixed timeframe of the disease.

Autologous Platelet-Rich Plasma in the Treatment of Perianal Fistula in Crohn's Disease.

AIM: To assess clinical healing in patients with perianal Crohn's disease with local intrafistular injection of autologous platelet-rich plasma. METHOD: The pilot study was conducted at a single centre between January 2013 and December 2015. Autologous platelet-rich plasma was prepared in platelet-rich and platelet-poor fractions for local intrafistular injection in patients with proven, established perianal Crohn's disease. Patients were permitted biological therapies, and the Perianal Crohn's Disease Activity Index was recorded. Patients were followed for 48 weeks for clinical signs of healing (complete, partial or non-healing), monitoring fistula drainage, closure and epithelialization. RESULTS: The study included 29 patients (19 males; mean age 38 ± 12.8 years) with four exclusions in the operating room because surgery was not indicated and four lost to follow-up. Five adverse events were recorded, with two requiring the drainage of abscess collections. Of the 21 patients assessable at 24 weeks, there was complete healing, partial healing and non-healing in 7 (33.3%), 8 (38.1%) and 6 (28.6%) patients, respectively. By 48 weeks, there was complete healing, partial healing and non-healing in 6 (40%), 6 (40%) and 3 (20%) patients, respectively, with a reduction in the number of visible external fistula openings at both time points (P = 0.021). By the end of the study, there was a higher trend of healing if biological therapies were continued (85.7% with biologics vs. 75% without, P = 0.527), but there were no statistically significant differences and no differences in the Perianal Crohn's Disease Activity Index. CONCLUSION: Autologous platelet-rich plasma is safe in patients with perianal Crohn's disease, with an acceptable healing rate over a medium-term follow-up, particularly if biological therapies are used concomitantly.

Bi-species imposex monitoring in Galicia (NW Spain) shows contrasting achievement of the OSPAR Ecological Quality Objective for TBT.

Imposex is decreasing worldwide after the total ban on tributyltin (TBT) from antifouling paints. In order to assess improvement in the NE Atlantic, the OSPAR Convention designed an Ecological Quality Objective (EcoQO) based on the VDSI (vas deferens sequence index, an agreed measure of imposex) in the rock snail Nucella lapillus; wherever this is not available, the mud snail Nassarius reticulatus was proposed as a proxy. We determined VDSI in Galician populations of rock (n≥34) and mud (n≥18) snails at regular intervals from pre-ban times until 2009 and 2011, respectively. While imposex in the former started decreasing in 2006 and by 2009 the EcoQO had been met in the area, VDSI in the latter was not significantly reduced until 2011 and values contradict such an achievement. This suggests that the OSPAR imposex bi-species scheme may not be of direct application in the current post-ban scenario.

Temporal association between the influenza virus and respiratory syncytial virus (RSV): RSV as a predictor of seasonal influenza.

Epidemiologists agree that there is a prevailing seasonality in the presentation of epidemic waves of respiratory syncytial virus (RSV) infections and influenza. The aim of this study is to quantify the potential relationship between the activity of RSV, with respect to the influenza virus, in order to use the RSV seasonal curve as a predictor of the evolution of an influenza virus epidemic wave. Two statistical tools, logistic regression and time series, are used for predicting the evolution of influenza. Both logistic models and time series of influenza consider RSV information from previous weeks. Data consist of influenza and confirmed RSV cases reported in Comunitat Valenciana (Spain) during the period from week 40 (2010) to week 8 (2014). Binomial logistic regression models used to predict the two states of influenza wave, basal or peak, result in a rate of correct classification higher than 92% with the validation set. When a finer three-states categorization is established, basal, increasing peak and decreasing peak, the multinomial logistic model performs well in 88% of cases of the validation set. The ARMAX model fits well for influenza waves and shows good performance for short-term forecasts up to 3 weeks. The seasonal evolution of influenza virus can be predicted a minimum of 4 weeks in advance using logistic models based on RSV. It would be necessary to study more inter-pandemic seasons to establish a stronger relationship between the epidemic waves of both viruses.

Prescripciones potencialmente inapropiadas en el tratamiento ambulatorio de pacientes ancianos / Potentially inappropriate prescriptions in the ambulatory treatment of elderly patients

Introducción: Objetivo: conocer el porcentaje de prescripciones potencialmente inapropiadas según los criterios STOPP/START en los tratamientos ambulatorios de los pacientes mayores de 65 años que ingresan en una unidad de medicina interna, e identificar los errores de prescripción más frecuentes. Material y métodos: Estudio observacional prospectivo realizado entre octubre y diciembre de 2012. Variables registradas: edad, sexo, índice de comorbilidad de Charlson, motivo de ingreso y tratamiento farmacológico ambulatorio. Resultados: Se recogieron los datos de 131 pacientes (edad media 80,2 años; 58,8% varones, mediana del índice de comorbilidad de Charlson 2; media de medicamentos por paciente: 8,6). Principales motivos de ingreso: descompensación de insuficiencia cardiaca, infección respiratoria, exacerbación de EPOC, infección del tracto urinario, neumonía y síndrome constitucional. Se detectaron 121 prescripciones potencialmente inapropiadas en 73 pacientes (55,7%). Los criterios STOPP más frecuentes fueron las duplicidades terapéuticas. Los criterios START más frecuentes fueron la omisión de estatinas y antiagregantes plaquetarios en la prevención primaria del riesgo cardiovascular en pacientes con diabetes mellitus y al menos un factor de riesgo cardiovascular. Conclusiones: El porcentaje de pacientes con prescripciones inapropiadas encontrado es similar al obtenido en estudios semejantes. Más de la mitad de los pacientes ancianos presentaron al menos una prescripción inapropiada. Esto hace necesario una búsqueda conjunta de errores por exceso y por defecto en la prescripción de fármacos, con el fin de realizar una evaluación más completa de la práctica de prescripción e intentar conseguir la optimización de la terapéutica de los pacientes mayores, especialmente los más frágiles (AU)

Introduction: The aim of this study was to establish the percentage of potentially inappropriate prescriptions, according to STOPP/START criteria, in the ambulatory treatments of patients over65 years admitted to an internal medicine unit, and to identify the most common prescription errors. Material and methods: A prospective, observational study was performed between October and December 2012. The variable recorded were, age, gender, Charlson comorbidity index, reason for hospitalisation and pharmacological ambulatory treatment. Results: Data from 131 patients were collected (Mean age: 80.2 years; 58.8% male, mean Charlson comorbidity index: 2; mean number of medications per patient: 8.6). Main reasons for hospitalisation: decompensated heart failure, respiratory infection, exacerbated COPD, urinary tract infection, pneumonia, and unintended weight loss. There were 121 potentially inappropriate prescriptions detected in 73 patients (55.7%). The most common STOPP criteria were therapeutic duplicities. The most common START criteria were the omission of statins and antiplatelets in primary prevention for cardiovascular risk in patients with diabetes mellitus and at least one cardiovascular risk factor. Conclusions: The percentage of patients with inappropriate prescriptions was similar to those obtained in similar studies. Over 50% of elderly patients had at least one inappropriate prescription. This warrants a joint search for errors by excess and by default in the prescription of medications, with the aim of performing a more complete evaluation of prescription practice and to achieve optimization of therapy in elderly patients, especially the most fragile (AU)

[Potentially inappropriate prescriptions in the ambulatory treatment of elderly patients]. / Prescripciones potencialmente inapropiadas en el tratamiento ambulatorio de pacientes ancianos.

INTRODUCTION: The aim of this study was to establish the percentage of potentially inappropriate prescriptions, according to STOPP/START criteria, in the ambulatory treatments of patients over 65 years admitted to an internal medicine unit, and to identify the most common prescription errors. MATERIAL AND METHODS: A prospective, observational study was performed between October and December 2012. The variable recorded were,age, gender, Charlson comorbidity index, reason for hospitalisation and pharmacological ambulatory treatment. RESULTS: Data from 131 patients were collected (Mean age: 80.2 years; 58.8% male, mean Charlson comorbidity index: 2; mean number of medications per patient: 8.6). Main reasons for hospitalisation: decompensated heart failure, respiratory infection, exacerbated COPD, urinary tract infection, pneumonia, and unintended weight loss. There were 121 potentially inappropriate prescriptions detected in 73 patients (55.7%). The most common STOPP criteria were therapeutic duplicities. The most common START criteria were the omission of statins and antiplatelets in primary prevention for cardiovascular risk in patients with diabetes mellitus and at least one cardiovascular risk factor. CONCLUSIONS: The percentage of patients with inappropriate prescriptions was similar to those obtained in similar studies. Over 50% of elderly patients had at least one inappropriate prescription. This warrants a joint search for errors by excess and by default in the prescription of medications, with the aim of performing a more complete evaluation of prescription practice and to achieve optimization of therapy in elderly patients, especially the most fragile.

Seguridad del paciente

La seguridad del paciente es un factor esencial de la calidad asistencial y desde la publicación del informe \"Errar es humano\" es objeto de atención general. Las estrategias de mejora han estimulado el desarrollo de modelos que permiten un mejor conocimiento de los efectos adversos ligados a la asistencia sanitaria. Los sistemas de comunicación de efectos adversos generan información que permitirá adoptar medidas que incrementen la calidad asistencial. Los efectos adversos más comunes son los relacionados con el uso de medicamentos y con frecuencia son evitables. Para disminuirlos, detectarlos y mitigarlos cuando se producen, se pueden emplear estrategias dirigidas a reducir la complejidad, optimizar la información y la automatización de procesos. Aunque el progreso sea lento los cambios se están acelerando especialmente en la implantación de sistemas de prescripción electrónica y difusión de prácticas seguras.

Toxina botulínica A (Dysport ®) asociada a rehabilitación, en pacientes con dolor miofascial cervical o dorsal primario: un estudio piloto multicéntrico aleatorizado / Botulinum toxin type A associated to rehabilitation in patients with primary myofascial pain of cervical or dorsal localization: a randomized multicenter pilot study

Introducción. Se postula que la toxina botulínica A (TBA) es eficaz en el tratamiento del síndrome de dolor miofascial (SDM), pero estudios previos muestran resultados contradictorios. Nuestro objetivo es evaluar la eficacia y la seguridad de una dosis única de TBA (Dysport®) en el SDM primario de localización cervicodorsal. Material y métodos. Estudio piloto multicéntrico, aleatorizado, a doble ciego, paralelo y controlado con placebo. Se aleatorizó a los participantes (n=24, pauta 1:1) para recibir una dosis intramuscular de Dysport® (dosis máxima, 500 U) o de placebo, con seguimiento durante 12 semanas. Se midieron la intensidad del dolor mediante escala visual analógica (EVA) y los umbrales de dolor a la presión mediante algometría. A todos ellos se les indicó estiramientos musculares. Resultados. Los pacientes tratados con placebo mostraron una disminución inicial de la intensidad del dolor seguida de un aumento gradual, mientras que los que recibieron Dysport® mostraron una mejoría más lenta, pero más continua. Después de 12 semanas, las reducciones medias de las puntuaciones EVA fueron del 26 y el 44,6% respectivamente; la reducción en los pacientes a quienes se trataba con Dysport® fue clínicamente relevante, aunque la diferencia entre grupos no fue estadísticamente significativa. A las 12 semanas, el umbral de dolor a la presión había aumentado en ambos grupos (el 36% con placebo y el 58% con Dysport®; p = 0,748 entre tratamientos). Se apreciaron tendencias similares en todos los puntos gatillo. El tratamiento con Dysport® se toleró bien. Conclusiones. Estos resultados indican que Dysport® es beneficioso en el tratamiento del SDM cervicodorsal(AU)

Introduction. It is postulated that botulinum toxin type A (BTA) is effective in the treatment of the myofascial pain syndrome (MPS). However, previous studies have shown contradictory results. Our objective has been to evaluate the efficacy and safety of a single dose of BTA (Dysport®) in primary MPS of cervical-dorsal localization. Material and methods. A multicenter, randomized, double blind, parallel and placebo-controlled pilot study was performed. The participants (n=24, 1:1 regime) were randomized to receive an intramuscular dose of Dysport® (maximum dose: 500 U) or placebo, with follow-up for 12 weeks. Pain intensity using the visual analogue scale (VAS) and pressure pain threshold with the algometry were measured. All of the participants were told to perform muscle stretchings. Results. The patients treated with placebo showed an initial decrease in pain intensity followed by a gradual increase of it while those who received Dysport® show a slower, but more continued improvement. After 12 weeks, the mean reductions on the VAS were 26% and 44.6%, respectively. The reduction in the patients who were treated with Dysport® was clinically relevant, although the difference between groups was not statistically significant. At 12 weeks, the pressure pain threshold had increased in both groups (36% placebo and 58% Dysport®; P=.748 between treatments). Similar tendencies were seen in all the trigger points. Treatment with Dysport® was well tolerated. Conclusions. These results suggest that Dysport® is beneficial in the treatment of cervical-dorsal MPS(AU)

Osteopetrosis del adulto. Conceptos actuales / Osteopetrosis of the adult. Current concepts

Se presentan cuatro casos de osteopetrosis del adulto, entidad poco frecuente, recogidos en nuestro hospital desde 1985 hasta 2005. Se revisa la patogenia y se actualizan conceptos y clasificación. Las manifestaciones clínicas se corresponden con otras publicaciones en las que la edad al diagnóstico es muy variable y el primer síntoma oscila desde dolor óseo a un hallazgo tras una fractura. Se revisan las mutaciones genéticas clásicas de todos los tipos, actualizando conceptos. Se introduce la propuesta de retirada de la osteopetrosis tipo I del adulto, ya que su patogenia parece un defecto intrínseco osteoblástico(AU)

We presents four cases of adult osteopetrosis, a very rare disease, compiled from our hospital from 1985 to 2005. Revising the pathogenesis and updating the current concept and classification. The clinical manifestations correspond with other publications where the age at diagnosis is highly variable and the first symptom oscillate from bone pain to a fracture. Presents the classic genetic mutations of all types updating concepts. Introducing the propose withdrawal of adult osteoporosis type I, because the pathogenesis seemed a intrinsic osteoblastic defect(AU)

[Drug-related interventions made through a computerized prescription order entry system in an Internal Medicine unit]. / Intervenciones farmacoterapéuticas realizadas mediante un programa de prescripción electrónica en una unidad de medicina interna.

INTRODUCTION: The objective of this article is to describe the drug-related interventions made in the prescriptions with a computerized order entry system and to determine their frequency and clinical relevance in order to propose improvement actions. MATERIAL AND METHOD: Observational descriptive study. Drug-related interventions made in the inpatient's prescriptions of an Internal Medicine unit from January to May of 2007 were analyzed and recorded. The frequency of the intervention causes and of the drugs involved was determined.The clinical significance and impact of the recommendations were also determined. RESULTS: A total of 441 interventions were recorded, 0.73 per patient. The most frequent was the proposal of intravenous to oral conversion (45%), mainly with acetaminophen (63%) and protons pump inhibitors (24%). This was followed by replacement of drugs not included in the guide (15% of interventions), mainly involving cardiovascular and central nervous system drugs (23% each one). Educational actions proposed included a campaign to promote intravenous to oral conversion and a program involving therapeutic equivalent replacement. The most clinically significant interventions were due to dosage errors, therapeutic duplicities, off label medications and adverse events. A proposal was made to include a new module in the medical order entry system that alerts on the established maximum doses for each drug, and new protocols for the treatment of certain conditions. Sixty percent of the interventions achieved an improvement in efficiency. DISCUSSION: We conclude that drug therapy intervention analysis can identify items that can be improved, set educational actions for physicians and new protocols for certain conditions. Innovative actions can be introduced into the medical order entry system in order to improve drug safety.