La mayoría de edad de la mujer sobre su salud sexual y reproductiva / Women's sexual and reproductive health coming of age

El control de la salud reproductiva no puede considerarse una enfermedad, aunque se halle en el marco de la salud de la mujer, sino que es un método que ayuda a las mujeres y a las parejas a planificar su deseo de tener descendencia y, por lo tanto, no requiere un diagnóstico previo. Asumiendo que la anticoncepción no sea un problema de salud y no precise diagnóstico, la pregunta es si debe seguir precisándose una intervención médica directa para autorizarla. Es posible que dependa del método que quiera usarse, de si tiene efectos secundarios o contraindicaciones que precisen de esa intervención. En este sentido, los extremos podrían ser un preservativo, que no requiere intervención médica alguna, y un DIU, que sí la precisa. Sin embargo, entre ambos extremos podemos encontrar muchos casos que cabe replantearse a qué ámbito pertenecen, aunque sean medicamentos. Esto es lo que ocurre con las píldoras anticonceptivas de sólo gestágenos (POP), que presentan un perfil de seguridad adecuado y no requieren un examen médico previo para su uso. Es por esto que, con vistas de favorecer el empoderamiento de la mujer y una mayor facilidad en el acceso a las medidas de planificación familiar, las sociedades científicas SEFAC (farmacéuticos comunitarios), SEMERGEN y SEMG (médicos de atención primaria) abogan, desde el consenso y la coordinación entre sus profesionales, por la dispensación sin receta médica de estos fármacos, ya que el acceso sin receta a estos anticonceptivos podría reducir los embarazos no deseados al posibilitar la mejora del cumplimiento en la toma de estos medicamentos. (AU)

An internet of things-based intensity and time-resolved fluorescence reader for point-of-care testing.

A miniature internet of things (IoT)-based point-of-care testing (PoCT) fluorescence reader, able to perform both intensity and time-resolved measurements of different fluorescent tags, is presented. This low cost platform has been conceived for performing tests in low-resource and remote settings, displaying versatile performance and yet simple operation. It consists on an external case of 43 × 30 × 42 mm3 (built in a 3D-printer) where all the elements are fixed, including some basic optics (3 lenses and 2 filters), a laser diode and a custom designed Single-Photon Avalanche Diodes (SPADs) camera. Both, the laser and the camera are controlled by a Field Programmable Gate Array (FPGA) with IoT capabilities. The PoCT was validated by detecting Plasmodium antigen in a fluorescent enzyme-linked immunosorbent assay (ELISA) using a fluorescence substrate. The results were compared to those provided in parallel by two commercial fluorescent plate readers. As it will be shown, the PoCT fluorescent readout was more sensitive than its colorimetric counterpart. Furthermore, the PoCT displayed similar signal trends and levels of detection than the bulkier and more expensive commercial fluorescence plate readers. These results demonstrate that the PoCT platform developed could bring the performance of central laboratory assay techniques closer to the end-user level.

A child with resistant Kawasaki disease successfully treated with anakinra: a case report.

BACKGROUND: Kawasaki disease (KD) is an acute self-limited systemic vasculitis of unknown etiology. Intravenous immunoglobulin (IVIG) is an effective treatment and decreases the risk of cardiac complications to less than 5%. In spite of its effectiveness, some children do not respond to this therapy and still develop coronary aneurysms (CAA). The optimal treatment for IVIG non-responsive patients remains controversial although corticoids have been suggested to be an effective treatment in some patients. For those patients still resistant to IVIG and corticoids, interleukin-1 receptor antagonists (IL-1RA) such anakinra could be an alternative. CASE PRESENTATION: We present a 3 year-old Caucasian patient with KD without cardiac complications but with important resistance to treatment. After becoming resistant to IVIG and corticoids, anakinra proved to be an effective treatment. CONCLUSIONS: To our knowledge, this is the first report of the utility of IL-1RA in refractory KD without coronary impairment. The patient fulfilled the classical criteria for KD and, after becoming resistant to first and second line treatments, anakinra proved to be an effective treatment. Further studies are required to determine if this is an effective treatment option for other cases of resistant Kawasaki disease.

Enfermedad de Castleman: dos variantes, dos pacientes / Castleman's disease: two variants, two patients

Introducción: La enfermedad de Castleman (EC) es un trastorno linfoproliferativo poco frecuente, localizada más frecuentemente en mediastino y abdomen. Se describen dos casos de EC de localización mediastínica presentados en nuestro servicio. El primer caso una mujer de 33 años con EC variante plasmocelular asociada a enfermedad de Hodgkin, y el segundo caso, una mujer de 32 años con EC tipo hialinovascular. Discusión: De etiología desconocida, clínicamente se distinguen dos formas de EC: a) la multicéntrica, que afecta a más de un órgano, cursa con síntomas generales y puede estar acompañada de otras afecciones como linfoma, y b) la localizada, más frecuente, que cursa de forma asintomática o con síntomas compresivos por efecto de masa. En estos casos presentados, se puede observar la diferencia en la presentación clínica de esta enfermedad en sus dos variedades. Conclusiones: La EC es una rara enfermedad linfoproliferativa cuyo tratamiento es la resección tumoral y su pronóstico es bueno (AU)

Introduction: Castleman's disease (CD) is an uncommon lymphoproliferative disorder most frequently localized in the mediastinum and abdomen. Two cases of CD with mediastinal localization in our service are described. The first case was found in a 33-year old woman with the plasma cell variant of CD associated to Hodgkin's disease and the second case was found in a 32 year old woman with hyalinevascular type CD. Discussion: CD, of unknown etiology, is clinically distinguished with two forms, multicentric that affects more than one organ and occurs with general symptoms and can be accompanied by other involvements such as lymphoma. The second one is the localized one, which is more frequent and evolves asymptomatically or with compressive symptoms due to mass effect. In these cases presented, the difference in the clinical presentation of this condition in its two variants can be seen. Conclusions: CD is an uncommon lymphoproliferative disease whose treatment is tumor resection and whose prognosis is good (AU)

[Delayed-release drugs or with enteric cover: are they correctly used?]. / Fármacos de liberación retardada o con cubierta entérica: se utilizan correctamente?

OBJECTIVES: To estimate the prevalence of the correct use of a group of oral drugs, which must keep the integrity of their pharmaceutical pattern at the moment of taking them, by the population who uses them. DESIGN: A transversal and descriptive study based on observation, by means of a questionnaire, which evaluated how the interviewees used the drugs. SETTING: Twenty-eight communal chemists. PARTICIPANTS: Patients who came up to the chemist to get drugs included in the study. MEASURES AND RESULTS: 612 questionnaires were evaluated. It was detected that the 7% (95% CI, 5.1-9.2) of the interviewees chewed or grinded the delayed release drugs or with enteric cover, and the 72% (95% CI, 68.7-75.8) made at least one mistake when using these drugs. The most frequent errors were related to the conservation and the intake of the drug related to the food. No relation between the reading of the patient information leaflet and the correct use of these drugs has been observed. CONCLUSIONS: Due to the high percentage of interviewees who use drugs incorrectly, we believe that every health professional should provide the drug users with oral and written information on how to handle such drugs, specifically emphasizing how to use them and where to keep them.

Fármacos de liberación retardada o con cubierta entérica: ¿se utilizan correctamente? / Delayed-Release Drugs or With Enteric Cover: Are They Correctly Used?

Objetivo. Estimar la prevalencia de la correcta utilización de un grupo de medicamentos de administración oral que deben conservar la integridad de su forma farmacéutica en el momento de su utilización. Diseño. Estudio observacional transversal descriptivo realizado mediante cuestionario. Emplazamiento. Un total de 28 farmacias comunitarias de la provincia de Tarragona. Participantes. Personas que acudían a la farmacia a adquirir algún medicamento de los seleccionados en el estudio. Mediciones y resultados. Se evaluaron 612 cuestionarios. Los resultados indican que el 7% (intervalo de confianza [IC] del 95%, 5,1-9,2) de los entrevistados mastica o tritura los medicamentos de liberación retardada o con cobertura entérica, y el 72% (IC del 95%, 68,7-75,8) comete al menos un error al utilizar estos medicamentos. Los errores cometidos con más frecuencia han sido los referentes a la conservación del fármaco y la toma de los medicamentos respecto a los alimentos. No se ha observado ninguna relación entre la lectura del prospecto y la correcta utilización de estos medicamentos. Conclusiones. Debido al elevado porcentaje de entrevistados que utiliza la medicación de manera incorrecta, creemos que los profesionales de la salud deberían facilitar a los usuarios del medicamento información verbal y escrita sobre cómo manejarlos, y remarcar específicamente los aspectos relacionados con su utilización y conservación (AU)

Objectives. To estimate the prevalence of the correct use of a group of oral drugs, which must keep the integrity of their pharmaceutical pattern at the moment of taking them, by the population who uses them. Design. A transversal and descriptive study based on observation, by means of a questionnaire, which evaluated how the interviewees used the drugs. Setting. Twenty-eight communal chemists. Participants. Patients who came up to the chemist to get drugs included in the study. Measures and results. 612 questionnaires were evaluated. It was detected that the 7% (95% CI, 5.1-9.2) of the interviewees chewed or grinded the delayed release drugs or with enteric cover, and the 72% (95% CI, 68.7-75.8) made at least one mistake when using these drugs. The most frequent errors were related to the conservation and the intake of the drug related to the food. No relation between the reading of the patient information leaflet and the correct use of these drugs has been observed. Conclusions. Due to the high percentage of interviewees who use drugs incorrectly, we believe that every health professional should provide the drug users with oral and written information on how to handle such drugs, specifically emphasizing how to use them and where to keep them (AU)

Transference and countertransference in the analysis of a child with autistic nuclei.

The author stresses the importance of using the countertransference when working with autistic and borderline children, in whom severe disorders of cognitive and emotional development have not permitted the establishment of an internal three-dimensional space whereby emotions can be contained, meaning can be assigned to those emotions and symbols can be formed. She argues that the transference will arise gradually in response to the analyst's countertransference. Great importance is attached to the setting in both its material and psychic aspects, the stability of the former being essential because of the patient's two-dimensional mode of functioning, in which he lacks any representation of space and time. After a review of the theoretical background to the treatment of autistic children with particular reference to the work of Houzel and Tustin and a brief discussion of general aspects of the transference in the light of the views of Freud, Klein and Bion, the author turns to the clinical material proper, presenting vignettes from a number of sessions in the analysis of an autistic boy. These show how she utilises her own emotions, sensations and associations to gain information about the patient's state and, by assigning meaning to these manifestations and communicating it to him, to impart motion to his frozen internal world. The author reports that, after several years of analysis, the patient has introjected a stable object that will lead to healthier development and a sense of security.