Hemodialysis vascular access flow measurements by the novel DMed NephroFlow® device: A comparative study with Transonic®.

INTRODUCTION: The current Spanish Clinical Guidelines on Vascular Access for Hemodialysis support the need for surveillance and monitoring of vascular access (VA) to avoid complications. Ultrasound dilution (UD) methods are accepted for the evaluation of VA flow and Transonic® has established the gold standard method for the measurement. The DMed NephroFlow (NIPRO®) device, based on UD method has recently been incorporated. We report a comparative study between the classic Transonic® versus the new NephroFlow® device. MATERIAL AND METHODS: For two consecutive months, measurements of VA flow using both referred systems were performed in patients with a native arteriovenous fistula (AVF) or a graft (AVG) on hemodialysis (HD) in our unit. Both studies were undertaken according to the usual recommendations: VA flow of 250 ml/min, ultrafiltration rate without modifications, both needles in the same vein, and always in the first hour of the HD session. RESULTS: Forty-five patients were included: 17 women and 28 men, mean age of 67 ± 12 years. Thirty patients were diabetic. The baseline meantime on HD was 51 ± 39 months (range: 3-163). Type of VA was: 17 patients radio-cephalic AVF, 17 brachiocephalic AVF, 7 brachiobasilic AVF, and 3 with a graft. The mean flow estimated by the Transonic® was 1222 ± 805 ml/min and the estimated flow by the NephroFlow® device was 1252 ± 975 ml/min. Good reliability between Transonic® and NephroFlow® was observed, with a reliability index of Cronbach's Alpha of 0.927 and an Intraclass Correlation Index of 0.928. CONCLUSIONS: The NephroFlow® device seems comparable with the accepted gold standard UD method for estimating VA flow. More studies must be performed to verify these results. However, they should be considered for the surveillance and monitoring of VA flow, in agreement with the Spanish Guidelines.

A Model to Develop Chatbots for Assisting the Teaching and Learning Process.

Recently, in the commercial and entertainment sectors, we have seen increasing interest in incorporating chatbots into websites and apps, in order to assist customers and clients. In the academic area, chatbots are useful to provide some guidance and information about courses, admission processes and procedures, study programs, and scholarly services. However, these virtual assistants have limited mechanisms to suitably help the teaching and learning process, considering that these mechanisms should be advantageous for all the people involved. In this article, we design a model for developing a chatbot that serves as an extra-school tool to carry out academic and administrative tasks and facilitate communication between middle-school students and academic staff (e.g., teachers, social workers, psychologists, and pedagogues). Our approach is designed to help less tech-savvy people by offering them a familiar environment, using a conversational agent to ease and guide their interactions. The proposed model has been validated by implementing a multi-platform chatbot that provides both textual-based and voice-based communications and uses state-of-the-art technology. The chatbot has been tested with the help of students and teachers from a Mexican middle school, and the evaluation results show that our prototype obtained positive usability and user experience endorsements from such end-users.

An Architecture for Collaborative Terrain Sketching with Mobile Devices.

3D terrains used in digital animations and videogames are typically created by several collaborators with a single-user application, which constrains them to update the shared terrain from their PCs, using a turn-taking strategy. Moreover, collaborators have to visualize the terrain through 2D views, confusing novice users when conceiving its shape in 3D. In this article, we describe an architecture for collaborative applications, which allow co-located users to sketch a terrain using their mobile devices concurrently. Two interaction modes are supplied: the standard one and an augmented reality-based mode, which helps collaborators understand the 3D terrain shape. Using the painting with brushesparadigm, users can modify the terrain while visualizing its shape evolution through the camera of their devices. Work coordination is promoted by enriching the 3D space with each collaborator's avatar, which provides awareness information about identity, location, and current action. We implemented a collaborative application from this architecture that was tested by groups of users, who assessed its hedonic and pragmatic qualities in both interaction modes and compared them with the qualities of a similar Web terrain editor. The results showed that the augmented reality mode of our prototype was considered more attractive and usable by the participants.

Estrategias para aumentar la disponibilidad de órganos destinados a trasplante pulmonar. Enfoque desde Argentina / Strategies to increase the availability of organs destined for lung transplantation. Approach from Argentina

Resumen Ante la escasez de donantes pulmonares, el aumento de los pacientes en lista de espera y el aumento de las muertes en lista de espera existen varias estrategias que buscan resolver estos problemas. Las estrategias de promoción son necesarias, continuas y transver sales a todo el proceso. Las de procuración implican mejora continua en la calidad de atención médica, siendo muy costo-efectivas en nuestro contexto. Las de distribución ya se emplean y han generado mejoras en el acceso al trasplante; deben ser constantemente evaluadas. Las de selección involucran mejoras a expensas de mayores costos a veces con consecuencias negativas, por lo que deben ser evaluadas caso a caso. El uso de EVLP es efectivo, aunque pareciera no ser una intervención costo-efectiva en nuestro medio debiendo emplearse otras estrategias previamente. La utilización de donantes a corazón parado es efectiva aunque requiere de una inversión en el sistema logístico que no parece ser viable por el momento en Argentina.

Abstract Given the shortage of lung donors and the increase in patients and deaths on the waiting lists, there are several strategies that could be carried out. Promotion strategies are necessary, continuous and transversal to the entire process. Strategies that attempt to enhance organ procurement involve continuous improvement in the quality of healthcare, which is highly profitable in our context. Interventions on grafts distribution are already in use and have generated improvements in access to lung transplantation. Laxity in the selection criteria generates higher costs, sometimes with negative consequences, so a case-by-case selection must be applied. Ex vivo lung perfusion is effective, although it does not appear to be a cost-effective intervention in our country, other strategies must be implemented previously. The use of non-heart-beating lung donors requires an investment in a logistics system that nowadays does not seem viable in Argentina.

Monthly Continuous Erythropoietin Receptor Activator Versus Weekly Epoetin-Beta, Similar Hemoglobinization but Different Anisocytosis Degree in Hemodialysis Patients: A Randomized Controlled Trial.

BACKGROUND: The monthly continuous erythropoietin receptor activator (CERA) utilization maintains stable hemoglobin (Hb) after conversion from weekly epoetin-ß (EB); however, how the different pharmacologic properties affect the red blood cell (RBC) size determined by RBC distribution width (RDW) has not been evaluated yet. We assess the potential differences in iron metabolism, plasma erythropoietin (EPO), hepcidin, and soluble α-Klotho (α-Klotho) levels as an emergent hematopoiesis factor. METHODS: Thirty-seven chronic hemodialysis patients were included from January 2010 to November 2011 and randomized (1:1) to continue with EB or to convert to monthly CERA. Primary outcome was the mean change in Hb between groups at months 0, 3 and 6, and the percentage of patients who maintained stable Hb (Hb ± 1 g/dL from baseline level to month 6). Secondary outcomes were the influence on the erythropoietic process and iron metabolism markers. Thirty-one patients completed the study (CERA: n = 15, EB: n = 16). RESULTS: The mean (95% confidence interval (CI)) Hb difference between groups was 0.28 g/dL (-0.36 to 0.93). There was no difference between the percentages of patients with stable Hb levels. In the CERA group RDW values increased progressively (interaction erythropoietin-stimulating agent (ESA) type and time on RDW values, F (1.57, 45.60) = 17.17, P < 0.01, partial η2 = 0.37) and the mean corpuscular volume changed at the different time points, (F (2, 28) = 29.12, P = 0.03, partial η2 = 0.23). During the evaluation period, in the CERA group, EPO was higher, and hepcidin and ferritin decreased significantly. α-Klotho decreased in both groups and correlated negatively with the changes on the RDW and positively with transferrin and serum iron. The number of serious adverse events was higher at the CERA group. CONCLUSIONS: Monthly CERA maintained Hb concentrations; however, it showed a significant effect on RDW, probably due to its impact on the EPO and hepcidin levels. α-Klotho decreased significantly in both groups, and its changes correlated with the changes in iron metabolism. Whether the RDW evolution was associated with the serious adverse events (SAEs) is a feasible hypothesis that needs to be confirmed in large studies.

Aspectos clave en el mantenimiento de la diuresis residual en pauta de hemodiálisis incremental. Experiencia de diez años / Key aspects in maintaining residual diuresis in an incremental haemodialysis schedule. Experience of ten years

INTRODUCCIÓN: La hemodiálisis incremental o progresiva es una modalidad de inicio de hemodiálisis, basada en la diuresis residual y adaptada a las necesidades del paciente, poco extendida pese a sus potenciales beneficios. Para su correcto seguimiento es necesario establecer unas pautas específicas en cada sesión de hemodiálisis, que deben ser conocidas por el personal que atiende a estos pacientes de forma regular. OBJETIVO: analizar la evolución de los pacientes que han iniciado tratamiento renal sustitutivo con hemodiálisis incremental. MATERIAL Y MÉTODO: Estudio observacional retrospectivo de pacientes incidentes en tratamiento renal sustitutivo mediante hemodiálisis incremental en nuestro centro en los últimos 10 años. Comparación de resultados basales y a los 12 meses de seguimiento. RESULTADOS: En este periodo de tiempo se han incluido 49 pacientes en técnica de hemodiálisis incremental. Aunque la diuresis residual desciende en el primer año de 2030±600 ml/día a 1300±500 (p < 0,05), ésta se mantiene por encima de un litro en la mayoría de los casos. El aclaramiento de urea también desciende de 5,7±1,6 ml/min a 3,4±1,6 ml/min al año (p < 0,05). CONCLUSIONES: Iniciar tratamiento renal sustitutivo con hemodiálisis incremental puede mantener más tiempo la diuresis residual, para eso es clave el conocimiento de la técnica y su correcto manejo durante las sesiones de diálisis

INTRODUCTION: Incremental or progressive haemodialysis is a modality for starting haemodialysis, based on residual diuresis and adapted to the needs of the patient, and not very widespread despite the potential benefits. For correct follow-up, it is necessary to establish specific guidelines in each haemodialysis session, which must be known by the staff who treat these patients regularly. AIM: To analyse the evolution of patients who start renal replacement therapy with incremental haemodialysis. MATERIAL AND METHOD: Retrospective observational study of incident patients on renal replacement therapy using incremental haemodialysis in our centre in the last 10 years. Comparison of baseline and 12-month follow-up results was carried out. RESULTS: In the study period, 49 patients with incremental haemodialysis were included. Although the residual diuresis falls in the first year from 2030±600 ml/day to 1300±500 (p < 0.05), in most cases, it remains above one litre. Urea clearance also decreases from 5.7±1.6 ml/min to 3.4±1.6 ml/min per year (p < 0.05). CONCLUSIONS: Starting renal replacement therapy with incremental haemodialysis can keep residual diuresis longer. Knowledge of the technique and correct handling during dialysis sessions are key

Analyses of Programmed Cell Death Protein 1 in High Immunologic-Risk Transplant Patients.

Kidney transplant (KT) is the first therapeutic option for most patients with chronic renal failure that requires renal function replacement. The main complication associated with renal graft loss is immune rejection. The T regulatory pathways play a key role in this process, and abnormalities in some of these molecules could participate in the graft rejection. In this paper, our group performed an exploratory analysis of the behavior of the coinducible molecules (CD28, CTLA-4, ICOS, PD-1) in patients with KT rejection and control KT patients without rejection. The Mann-Whitney U test, used for 2 groups, showed significant differences (P = .0005), indicating that PD-1 is underexpressed in patients with allograft rejection. No differences were found in CD28+, regulatory T cells (T reg), CTLA-4, and ICOS, so we are proposing that PD-1 is a key player in the immunotolerance phenomenon and its underexpression participates in the rejection process. More research needs to be performed on this topic.

Zigomicosis y síndrome hemofagocítico en un paciente inmunocompetente: informe de caso / Zygomycosis and hemophagocytic lymphohistiocytosis in an immunocompetent patient: a case report

Introducción: la zigomicosis es una infección fúngica poco frecuente, con alta tasa de mortalidad y de mal pronóstico. Afecta principalmente a pacientes inmunocomprometidos. La asociación con el síndrome hemofagocítico es extremadamente inusual, más aún en pacientes inmunocompetentes, con pocos ejemplos registrados en la literatura. Caso clínico: se presenta el caso de un paciente masculino inmunocompetente de 40 años con diagnóstico de mucormicosis y síndrome hemofagocítico que evoluciona desfavorablemente, con fallo multiorgánico, a pesar de los esfuerzos médicos. Conclusión: la asociación de mucormicosis con síndrome hemofagocítico en un paciente inmunocompetente es extremadamente rara; existen pocos casos informados en Latinoamérica. Debemos tener presente esta asociación, ya que requiere un tratamiento agresivo y soporte vital avanzado. (AU)

Introduction: zygomycosis is a rare fungal infection that carries with high mortality rates. This poor prognosis, rapidly progressive infection mainly affects immunocompromised patients. The association with hemophagocytic lymphohistiocytosis is extremely unusual, even more in immunocompetent patients, with few cases reported. Case: we present the case of an immunocompetent male patient who was diagnosed with zygomycosis and hemophagocytic lymphohistiocytosis. Despite medical efforts he developed multiorganic failure. Conclusion: the association of mucormycosis with hemophagocytic lymphohistiocytosis in an immunocompetent patient is exceptional with few cases reported in Latin America. We must always suspect this association considering they require aggressive treatment and advanced life support. (AU)

Re-racialization of Addiction and the Redistribution of Blame in the White Opioid Epidemic.

New York City has the largest number of opioid dependent people of U.S. cities, and within New York, Whites have the highest rate of prescription opioid and heroin overdose deaths. The rise of opioid abuse among Whites has resulted in popular narratives of victimization by prescribers, framing of addiction as a biological disease, and the promise of pharmaceutical treatments that differ from the criminalizing narratives that have historically described urban Latino and black narcotic use. Through an analysis of popular media press and interviews with opioid prescribers and community pharmacists in Staten Island-the epicenter of opioid overdose in New York City and the most suburban and white of its boroughs-we found that narratives of white opioid users disrupted notions of the addict as "other," producing alternative logics of blame that focus on prescribers and the encroachment of dealers from outside of white neighborhoods.

Are you better off? Perceptions of social mobility and satisfaction with care among Latina immigrants in the U.S.

Although the reasons for immigrating to the U.S. vary by Latino groups, many Latinos cite economic or political motivations for their migration. Once in the United States, Latino immigrants may face many challenges, including discrimination and blocked opportunities for social mobility, and difficulties in obtaining health services and quality health care. The purpose of this study was to explore how changes in social mobility from the country of origin to the U.S. may relate to Latina women's health care interactions. We examined whether self-reported social mobility among 419 Latina women immigrants is associated with satisfaction with health care. We also examined the association among social mobility and self-rated health, quality of care, and medical mistrust. Upward social mobility was associated with greater number of years lived in the U.S., and downward social mobility was associated with more years of education. Those who reported no changes in social class (stable social mobility) were older and were the most satisfied with their medical care. Multiple regression analyses indicated that downward social mobility was associated with less satisfaction with care when controlling for demographic covariates, quality of care, and medical mistrust. Results suggest that perceived social mobility may differentially predict Latina immigrants' satisfaction with the health care system, including their trust in U.S. medical institutions. We conclude that perceived social mobility is an important element in exploring the experiences of immigrant Latinas with health care in the United States.

Unidad Nefrológica de Atención Continuada. Experiencia de un Hospital Universitario / Nephrological Unit for Continued Care. Experience of a University Hospital

Introducción: Los hospitales de día suponen una alternativa asistencial a la hospitalización convencional mejorando la eficacia de la asistencia sanitaria. Desde nuestro punto de vista, la nefrología se beneficiaria de esta modalidad de atención, ya que el paciente con enfermedad renal crónica tiene unas necesidades concretas de cuidado que conllevan al profesional de enfermería a generar una atención integral e individualizada. Por este motivo surge en nuestro servicio la creación de la Unidad Nefrológica de Atención Continuada. Objetivo: Presentar nuestra experiencia en la implantación y desarrollo de la Unidad Nefrológica de Atención Continuada en el Hospital Universitario del Henares. Material y Método: Estudio descriptivo retrospectivo de la actividad realizada en la Unidad Nefrológica de Atención Continuada entre enero-junio de 2017. Desarrollo y puesta en marcha de las distintas funciones y competencias profesionales. Resultados: En este periodo se asistieron a un total de 874 pacientes, con una media de 145,6 visitas/mes. De todas estas visitas, se atendieron 474 pacientes en programa de Diálisis Peritoneal (55% del volumen total), 149 pacientes con enfermedad renal crónica (16%), 245 pacientes con enfermedad renal crónica avanzada (18%) y 11 pacientes en tratamiento conservador (1%). Se realizaron diferentes técnicas, bien programadas en la agenda electrónica o a demanda. Conclusiones: La implantación de la Unidad Nefrológica de Atención Continuada, de forma estructurada y planificada, es una alternativa válida y necesaria en nuestro sistema sanitario. Permite aseguramos un abordaje integral de los pacientes renales y alcanzar una continuidad de cuidados con menor coste sanitario

Introduction: The daytime hospitals are an alternative to conventional hospitalization and improve the effectiveness of healthcare. From our point of view, nephrology is a specialty that should be able to benefit from this type of care, because chronic kidney disease (CKD) patients have specific care needs that lead to the nursing professional to generate comprehensive and individualized care. For this reason, the creation of the Nephrological Unit for Continued Care (NUCA) arises in our service. Aim: To present our experience in the implantation and development of a NUCA in the University Hospital of Henares. Material and Method: Retrospective descriptive study of the activity carried out at NUCA between January 1, 2017 and June 30, 2017. Development and implementation of different functions and professional competencies. Results: In this period, a total of 804 patients were attended, with an average of 145.6 visits per month. Of all these visits, 474 patients undergoing Peritoneal Dialysis (55% of total volume), 149 patients with CKD (16%), 245 patients with advanced CKD (18%) and 11 patients in conservative treatment (1%). Different techniques were carried out, either programmed by electronic agenda or by demand. Conclusions: The implantation of the NUCA, in a structured and planned way, is a valid and necessary alternative in our health system. It allows to ensure an integral approach to renal patients and achieve a continuity of care with lower healthcare costs

At the Expense of a Life: Race, Class, and the Meaning of Buprenorphine in Pharmaceuticalized "Care".

BACKGROUND/OBJECTIVE: Office-based buprenorphine maintenance has been legalized and promoted as a treatment approach that not only expands access to care, but also reduces the stigma of addiction treatment by placing it in a mainstream clinical setting. At the same time, there are differences in buprenorphine treatment utilization by race, ethnicity, and socioeconomic status. METHODS: This article draws on qualitative data from interviews with 77 diverse patients receiving buprenorphine in a primary care clinic and two outpatient substance dependence clinics to examine differences in patients' experiences of stigma in relation their need for psychosocial supports and services. RESULTS: Management of stigma and perception of social needs varied significantly by ethnicity, race and SES, with white educated patients best able to capitalize on the medical focus and confidentiality of office-based buprenorphine, given that they have other sources of support outside of the clinic, and Black or Latino/a low income patients experiencing office-based buprenorphine treatment as isolating. CONCLUSION: Drawing on Agamben's theory of "bare life," and on the theory of intersectionality, the article argues that without attention to the multiple oppressions and survival needs of addiction patients who are further stigmatized by race and class, buprenorphine treatment can become a form of clinical abandonment.

Merging Outpatient Addiction and Opioid-Maintenance Programs During A Disaster: Lessons From Hurricane Sandy.

OBJECTIVE: After Hurricane Sandy flooded Bellevue Hospital in New York City, its opiate maintenance patients were displaced and Bellevue's outpatient program was temporarily merged with the program at Metropolitan Hospital for continuation of care. The merger forced Metropolitan to accommodate a program twice as large as its own and required special staff coordination and adjustments in clinical care. METHODS: Physicians, clinicians, and administrators from both institutions participated in interviews regarding the merger. RESULTS: Issues that emerged in the interviews fell into 4 major themes: (1) organization and meshing of professional cultures, (2) regulation, (3) communication, and (4) accommodations. CONCLUSIONS: Despite these barriers, data collected after the merger showed high retention rates and low rates of positive urine toxicology results. (Disaster Med Public Health Preparedness. 2017;11:531-537).

Integrating Buprenorphine Into an Opioid Treatment Program: Tailoring Care for Patients With Opioid Use Disorders.

OBJECTIVES: This report identifies the institutional barriers to, and benefits of, buprenorphine maintenance treatment (BMT) integration in an established hospital-based opioid treatment program (OTP). METHODS: This case study presents the authors' experiences at the clinic, hospital, and corporation levels during efforts to integrate BMT into a hospital-based OTP in New York City and a descriptive quantitative analysis of the characteristics of hospital outpatients treated with buprenorphine from 2006 to 2013 (N=735). RESULTS: Integration of BMT into an OTP offered patients the flexibility to transition between intensive structured care and primary care or outpatient psychiatry according to need. Main barriers encountered were regulations, clinical logistics of dispensing medications, internal cost and reimbursement issues, and professional and cultural resistance. CONCLUSIONS: Buprenorphine integration offers a model for other OTPs to facilitate partnerships among primary care and mental health clinics to better serve diverse patients with varying clinical needs and with varying levels of social support.

Shifting blame: Buprenorphine prescribers, addiction treatment, and prescription monitoring in middle-class America.

Growing nonmedical prescription opioid analgesic use among suburban and rural Whites has changed the public's perception of the nature of opioid addiction, and of appropriate interventions. Opioid addiction has been recast as a biological disorder in which patients are victims of their neurotransmitters and opioid prescribers are irresponsible purveyors of dangerous substances requiring controls. This framing has led to a different set of policy responses than the "War on Drugs" that has focused on heroin trade in poor urban communities; in response to prescription opioid addiction, prescription drug monitoring programs and tamper-resistant opioid formulations have arisen as primary interventions in place of law enforcement. Through the analysis of preliminary findings from interviews with physicians who are certified to manage opioid addiction with the opioid pharmaceutical buprenorphine, we argue that an increase in prescriber monitoring has shifted the focus from addicted people to prescribers as a threat, paradoxically driving users to illicit markets and constricting their access to pharmaceutical treatment for opioid addiction. Prescriber monitoring is also altering clinical cultures of care, as general physicians respond to heightened surveillance and the psychosocial complexities of treating addiction with either rejection of opioid dependent patients, or with resourceful attempts to create support systems for their treatment where none exists.

Awareness and Attitudes Toward Intranasal Naloxone Rescue for Opioid Overdose Prevention.

Opioid overdose prevention is a pressing public health concern and intranasal naloxone rescue kits are a useful tool in preventing fatal overdose. We evaluated the attitudes, knowledge, and experiences of patients and providers related to overdose and naloxone rescue. Over a six month period, patients and providers within a large community hospital in Staten Island were recruited to complete tailored questionnaires for their respective groupings. 100 patients and 101 providers completed questionnaires between August, 2014 and January, 2015. Patient participants were primarily Caucasian males with a mean age of 37.7 years, of which 65% accurately identified naloxone for opioid overdose, but only 21% knew more specific clinical features. 68% of patients had previously witnessed a drug overdose. Notably, 58% of patients anticipated their behavior would change if provided access to an intranasal naloxone rescue kit, of which 83% predicted an increase in opioid use. Prior overdose was significantly correlated with anticipating no change in subsequent opioid use pattern (p=0.02). 99% of patients reported that their rapport with their health-care provider would be enhanced if offered an intranasal naloxone rescue kit. As for providers, 24% had completed naloxone rescue kit training, and 96% were able to properly identify its clinical application. 50% of providers felt naloxone access would decrease the likelihood of an overdose occurring, and 58% felt it would not contribute to high-risk behavior. Among providers, completion of naloxone training was correlated with increased awareness of where to access kits for patients (p<0.001). This study suggests that patients and providers have distinct beliefs and attitudes toward overdose prevention. Patient-Provider discussion of overdose prevention enhances patients' rapport with providers. However, access to an intranasal naloxone rescue kit may make some patients more vulnerable to high-risk behavior. Future research efforts examining provider and patient beliefs and practices are needed to help develop and implement effective hospital-based opioid overdose prevention strategies.

Evaluación de la administración de carboximaltosa férrica intravenosa en la consulta de enfermedad renal crónica avanzada, para el control de la anemia / Evaluation of the intravenous administration of iron carboxymaltose for controlling anemia in advanced chronic kidney disease

La carboximaltosa férrica es una formulación de hierro endovenosa segura y de fácil dosificación, se puede administrar hasta 1 gramo iv en una sola sesión y permite ahorro de tiempo de los pacientes y de enfermería. Presentamos los resultados de su administración en una consulta de enfermedad renal crónica, analizando sus resultados y la repercusión en la carga de trabajo del personal de enfermería. Material y Métodos: Se analizaron todos los pacientes en seguimiento de la consulta de enfermedad renal crónica en nuestro centro desde Ene-11 hasta Dic-14 que recibieron carboximaltosa férrica iv. Se registraron sus datos basales y los resultados clínicos y analíticos a los seis meses. Resultados: Fueron identificados 85 pacientes en ese periodo. Edad media de 72±12 años, con un filtrado glomerular estimado basal de 28±11ml/min y a los seis meses de 30±11 (p:n.s). La hemoglobina basal y a los seis meses fueron de 10±4 y 11±3 g/dl respectivamente (p:<0,001). El hematocrito basal y final fueron: 34±4 vs 39±6 % (p:<0,001). Los niveles de ferritina e índice de saturación de transferrina basales vs seis meses fueron respectivamente: 88±97 vs 308±327 ng/ml (p:<0,001) y 11,2±6 vs 22,3±11 (p:<0,001). Dado que el tiempo medio de administración de cualquier formulación de hierro endovenoso es de 30 minutos, la estimación en base al número de administraciones es de un ahorro de 85 y 170 horas en estos 4 años si se compara con formulaciones que requieren de tres a cinco sesiones respectivamente. A su vez el número de punciones se ha reducido, sin observarse complicaciones asociadas. Conclusiones: La carboximaltosa férrica es segura y eficaz mostrando una recuperación de los niveles de hemoglobina y de los depósitos de hierro. Su facilidad de administración ha permitido ahorros sustanciales de tiempo. Esto junto a sus escasos efectos secundarios la hacen idónea para la administración ambulatoria (AU)

Ferric carboxymaltose is a safe and easy dosage of intravenous iron formulation; it can be administered intravenously up to 1 gram in a single session and allows time savings of patients and nursing. We present the results of his administration in a unit of chronic kidney disease, analyzing the results and the impact on the workload of the nursing staff. Materials and methods: All patients followed in the chronic kidney disease unit at our center from January 2011 to December 2014 and who received intravenous iron carboxymaltose were analyzed. Their baseline data and clinical and laboratory results at six months were recorded. Results: 85 patients were identified during this period. Mean age of 72 ± 12 years, with a baseline estimated glomerular filtration rate of 28 ± 11 ml / min and at six months of 30 ± 11 (p >0.05). Baseline and at six months hemoglobin levels were 10 ± 4 and 11 ± 3 g / dl, respectively (p <0.001). The basal and final hematocrit were: 34 ± 4 vs 39 ± 6% (p <0.001). Baseline ferritin levels and transferrin saturation index versus levels at six months were respectively: 88 ± 97 vs 308 ± 327 ng / ml (p <0.001) and 11.2 ± 6 vs 11 ± 22.3 (p <0.001 ). Since the average administration time by any formulation of intravenous iron is 30 minutes, the estimate based on the number of administrations is a saving of 85 and 170 hours on these four years when compared with formulations that require three to five respectively sessions. In turn, the number of punctures has been reduced without associated complications observed. Conclusion: Carboxymaltose iron is safe and effective showing a recovery of hemoglobin levels and iron deposits. Its ease of administration has allowed substantial time savings. This, together with its few side effects makes it ideal for outpatient administration (AU)

Buprenorphine Maintenance for Opioid Dependence in Public Sector Healthcare: Benefits and Barriers.

BACKGROUND: Since its U.S. FDA approval in 2002, buprenorphine has been available for maintenance treatment of opiate dependence in primary care physicians' offices. Though buprenorphine was intended to facilitate access to treatment, disparities in utilization have emerged; while buprenorphine treatment is widely used in private care setting, public healthcare integration of buprenorphine lags behind. RESULTS: Through a review of the literature, we found that U.S. disparities are partly due to a shortage of certified prescribers, concern of patient diversion, as well as economic and institutional barriers. Disparity of buprenorphine treatment dissemination is concerning since buprenorphine treatment has specific characteristics that are especially suited for low-income patient population in public sector healthcare such as flexible dosing schedules, ease of concurrently treating co-morbidities such as HIV and hepatitis C, positive patient attitudes towards treatment, and the potential of reducing addiction treatment stigma. CONCLUSION: As the gap between buprenorphine treatment in public sector settings and private sector settings persists in the U.S., current research suggests ways to facilitate its dissemination.

Aspectos clinicoepidemiológicos de la desnutrición proteicoenergética en menores de 10 años / Clinical and epidemiological aspects of the protein-energy malnutrition in children younger than 10 years

Se efectuó un estudio descriptivo, longitudinal y prospectivo de 32 niños menores de 10 años, pertenecientes al Policlínico Universitario Josué País García de Santiago de Cuba, desde el 1ro de junio del 2012 hasta el 31 de mayo del 2013, con vistas a caracterizar algunos aspectos clinicoepidemiológicos de la desnutrición proteicoenergética en los afectados. Entre las variables analizadas figuraron: edad, sexo, antecedentes patológicos personales y condiciones clínicas asociadas, evaluación nutricional, así como clasificación de la desnutrición. En la serie primaron el sexo masculino, el grupo etario de 1-3 años, la desnutrición mixta, aguda y moderada, el bajo peso al nacer como antecedentes patológico personal más frecuente y la anemia carencial como condición clínica asociada(AU)

A descriptive, longitudinal and prospective study of 32 children under 10 years of age, belonging to Josué País García University Polyclinic in Santiago de Cuba was carried out from June 1st, 2012 to May 31st, 2013, with the aim of characterizing some clinical and epidemiological aspects of the protein energy malnutrition in those affected. Among the analyzed variables there were: age, sex, personal pathological history and associated clinical conditions, nutritional evaluation, as well as classification of malnutrition. Male sex, the age group 1-3 years, mixed, acute and moderate malnutrition, low birth weight as the most frequent pathological personnal record and nutritional anemia as clinical associated condition prevailed in the series(AU)