Tecnologías de la información y la comunicación al servicio de la atención farmacéutica: “Tu farmacéutico de guardia”, una web por y para los pacientes / Information and communication technologies at the service of pharmaceutical care: «Your pharmacist on duty», a website by and for patients

Objetivo: Alineado con la recomendación de la OMS de incorporar a la atención sanitaria diferentes estrategias de salud digital, el objetivo es doble: describir las funcionalidades y recursos de una página web creada para formar e informar a los pacientes y analizar la actividad de la herramienta tras un periodo de funcionamiento de seis años.Material y métodos: Los pasos que se siguieron en la creación de la web fueron: 1) desarrollo del logotipo y sistema de marca; 2) creación de contenidos tanto escritos como audiovisuales y 3) campaña de lanzamiento. Para evaluar su uso se realizó un estudio descriptivo retrospectivo (septiembre 2015 – noviembre 2021) en el que se recogieron los indicadores clave de rendimiento.Resultados: La web se estructuró en 11 grupos de patologías disponiendo de información escrita (179 fichas) y audiovisual (61 videos) sobre medicamentos y un repositorio de temas actuales sobre la salud a modo de noticias (515 reseñas publicadas). Desde su lanzamiento se han registrado un total de 176.530 visitas por 150.004 usuarios diferentes. En noviembre de 2020 se rediseñó la web, optimizándola para móviles con un diseño de marca renovado; hecho que reportó un importante crecimiento de las visitas, siendo el móvil (74,9%) el dispositivo de visualización más utilizado en este último periodo. (AU)

Objectives: To write the functionalities and resources of a web page created to train and inform patients and to analyze the activity of the tool after a six-year operating period. These two objectives are aligned with the WHO recommendation to incorporate different digital health strategies into health care.Material and methods: To create the web page we followed the next steps: 1) development of the logo and brand system; 2) creation of written and audiovisual content and 3) launch campaign. To evaluate the use of the web page, a retrospective descriptive study was carried out (September 2015 – November 2021) and key performance indicators were collected.Results: The website was structured into 11 groups of pathologies, including written information (179 files) and audiovisual information (61 videos) about drugs and a repository of current health topics shown as news (515 published reviews). Since its launch, a total of 176,530 visits have been registered by 150,004 different users. In November 2020 the web was redesigned, optimizing it for mobile devices and with a renewed brand design. This update reported a significant growth in visits, with mobile phones being the most used display (74.9%) in this last period. (AU)

High-dose versus low-dose corticosteroid treatment strategy in patients hospitalised with COVID-19: effect on ICU admission rate / Estrategia de tratamiento corticoide en altas dosis versus bajas dosis en pacientes COVID-19 hospitalizados: efecto en la tasa de ingreso en UCI

Objective: COVID-19 is associated with lung damage and a high mortality rate in hospitalised patients. Corticoids may reduce the evolution to respiratory failure and death. This study aims to assess the effect on the ICU admission rate of a change in corticosteroid treatment strategy, administering low versus high doses. Methods: A retrospective, observational study was designed. Confirmed COVID-19 patients indicated to start treatment with corticosteroids were enrolled. To study the association between the type of corticosteroid used and admission to the ICU, a binary logistic regression model was constructed. This model included variables that could cause confusion or influence the response: gender, age, comorbidities, and analytical data. Results: From 190 admitted patients, 127 were enrolled in the study. In both groups, patients received a minimum of two doses of corticosteroids during admission. 12.4% (12/97) of the patients who received methylprednisolone (high doses) were subsequently admitted to the ICU, compared to 30.0% (9/30) of the patients who received dexamethasone (low doses). In the logistic regression model constructed, the type of corticosteroid (low-dose dexamethasone) (p=0.002), male gender (p=0.023), age over 50 years (p=0.014) and IL-6 level >70 pg/mL (p=0.004) remained as predictive factors for admission to the ICU.Conclusions: In the studied population of patients hospitalised for COVID-19, the use of high-dose methylprednisolone is associated with a lower rate of admission to the ICU than the administration of low-dose dexamethasone. (AU)

Objetivo: La COVID-19 está asociada a daño pulmonar y alta tasa de mortalidad en pacientes ingresados. Los corticoides pueden reducir la progresión a insuficiencia respiratoria y muerte. El objetivo del presente estudio es evaluar el efecto sobre la tasa de ingreso en UCI tras el cambio de estrategia en el tratamiento con corticoides, administración de bajas dosis frente a altas dosis. Métodos: Se diseñó un estudio retrospectivo observacional en el que se seleccionaron pacientes COVID-19 confirmado con indicación de inicio de tratamiento con corticoides. Para estudiar la asociación entre el tipo de corticoide utilizado y el ingreso en UCI, se construyó un modelo de regresión logística binaria en el que se incluyeron variables que podrían causar confusión o influir en la respuesta: sexo, edad, comorbilidades y datos analíticos. Resultados: De 190 pacientes ingresados, 127 se incluyeron en el estudio. En ambos grupos los pacientes recibieron un mínimo de dos dosis de corticoides durante el ingreso. El 12,4% (12/97) de los pacientes que recibieron metilprednisolona (altas dosis) ingresaron posteriormente en UCI, frente al 30,0% (9/30) de los pacientes que recibieron dexametasona (bajas dosis). En el modelo de regresión logística construido permanecieron como factores predictivos de ingreso en UCI el tipo de corticoide (dexametasona a bajas dosis) (p=0,002), el sexo masculino (p=0,023), edad superior a 50 años (p=0,014) y nivel de IL-6 >70 pg/mL (p=0,004).Conclusiones: En la población estudiada de pacientes hospitalizados por COVID-19, el uso de metilprednisolona a altas dosis se asocia a una menor tasa de ingreso en UCI que dexametasona a bajas dosis. (AU)

Absorción sistémica de un jarabe de vancomicina oral para el tratamiento de la infección por Clostridium difficile / Systemic absorption of an oral vancomycin syrup for the treatment of Clostridium difficile infection

La infección por Clostridium difficile (ICD) ha aumentado su incidencia en los últimos años, convirtiéndose en una de las infecciones más comunes adquiridas en el ámbito hospitalario, causando una diarrea infecciosa que está fuertemente asociada al uso de antibióticos. En la actualidad, los antibióticos para su tratamiento son la vancomicina oral y fidaxomicina, siendo la vancomicina oral la más coste-efectiva para el Sistema Nacional de Salud.Se describe el caso de una paciente pluripatológica sometida a dos sesiones de hemodiálisis semanales, que es diagnosticada de ICD evolucionada a colitis pseudomembranosa confirmada por endoscopía. Se inició tratamiento para la ICD con una fórmula magistral de vancomicina oral a una dosis de 250 mg cada 6 horas. La terapia con vancomicina oral no fue efectiva ni segura en la paciente, produciéndose una absorción sistémica significativa de vancomicina llegando a concentraciones plasmáticas de 15,57 mcg/mL. Fueron necesarios 8 días para completar la eliminación de la vancomicina, durante los cuales la paciente se sometió a 4 sesiones de hemodiálisis.El caso descrito pone de manifiesto la necesidad de monitorizar las concentraciones plasmáticas de vancomicina durante el tratamiento de ICD, especialmente en pacientes con elevadas dosis de fármaco, con insuficiencia renal y afectación de la integridad del tracto gastrointestinal. (AU)

Clostridium difficile infection (CDI) has increased its incidence in recent years, becoming one of the most common infections acquired in the hospital setting, causing an infectious diarrhea that is strongly associated with the use of antibiotics. Currently, the antibiotics used for this treatment are oral vancomycin and fidaxomycin, being oral vancomycin the most cost-effective for the National Health System.We describe the case of a pluripatological patient who underwent two weekly hemodialysis sessions, which is diagnosed as having developed CDI to pseudomembranous colitis confirmed by endoscopy. Treatment for CDI was initiated with a master formula of oral vancomycin at a dose of 250 mg every 6 hours. Oral vancomycin therapy was not effective and safe in the patient, resulting in significant systemic absorption of vancomycin reaching plasma vancomycin concentrations of 15.57 mcg/mL. It took 8 days to complete the elimination of vancomycin, during which the patient underwent 4 hemodialysis sessions.The described case highlights the need to monitor vancomycin plasma concentrations during the treatment of CDI, especially in patients with high doses of drug, with renal insufficiency and impairment of the integrity of the gastrointestinal tract. (AU)

Conciliación de la medicación al ingreso y al alta hospitalaria en un servicio de cirugía ortopédica y traumatología / Medication reconciliation at hospital admission and discharge in an orthopedic surgery and traumatology department

Objetivo: Evaluar los resultados de un programa de conciliación e información de medicación al alta hospitalaria en un servicio de cirugía ortopédica y traumatología. Material y método: Se incluyeron los pacientes ingresados durante 2008 con mayor complejidad en su tratamiento domiciliario. Este se registró y se confirmó, mediante una entrevista con el paciente, la adherencia a éste, así como problemas relacionados con la medicación (PRM). A partir de la epicrisis, se concilió la medicación prescrita con el tratamiento ambulatorio y se resolvieron las discrepancias con el facultativo encargado. Por último, se entregó al paciente el listado completo de su medicación a partir del episodio asistencial y recomendaciones sobre su tratamiento, con la explicación verbal de este. Realizamos una encuesta de satisfacción a los traumatólogos para conocer el conocimiento del programa y su valoración. Resultados: Se seleccionaron 243 pacientes; en 102 (42%) se detectaron PRM. Las principales discrepancias se encontraron en fármacos antitrombóticos (25%) y analgésicos y antiinflamatorios (21%). Las discrepancias más frecuentes fueron la duplicidad terapéutica (53%) y las interacciones (27%). Los PRM se clasificaron según su gravedad: el 65% no habría causado daño al paciente y un 35% requeriría monitorización. Resultados: En cuanto a la encuesta de satisfacción, la valoración global del programa fue «muy buena» para el 100% de los facultativos. Discusión: La conciliación de medicación se ha mostrado como una estrategia útil para aumentar la seguridad de nuestros pacientes, en el marco de un sistema de reducción de riesgos para la salud y mejora de la calidad asistencial (AU)

Purpose: To evaluate the results of a medication reconciliation and drug information program at discharge in an orthopedic surgery and traumatology department. Materials and methods: Patients with more complexity in their home treatment, admitted in this facility during 2008 were included in the study. Preadmission regimens were recorded and the patents were asked about medication-related problems (PRM) and drug adherence. On the day of discharge, prescribed medication was reconciled with the outpatient treatment, resolving discrepancies with the prescribers. Finally, the patients were given a complete list of their medications after the care episode and recommendations on their treatment with oral explanation. We conducted a survey of the physicians to ask about their reconciliation program knowledge and their assessment.Results243 patients were selected, in whom 102 (42%) PRMs were detected. The major discrepancies were found in antithrombotic drugs (25%) and analgesics and anti-inflammatory drugs (21%). The most frequent were: therapeutic duplication (53%) and interactions (27%). The PRMs were classified according to their severity: 65% would not have caused harm to the patient and 35% would require monitoring. Results: Regarding the survey, the overall evaluation of the program was "very good" for 100% of the physicians. Discussion: Medication reconciliation has proved to be a useful strategy for improving the safety of our patients as part of a system to reduce health risks and improving quality of care (AU)

[Variable response to the biological inhibition of platelets by abciximab in patients subjected to percutaneous coronary angioplasty]. / Respuesta variable a la inhibición biológica de las plaquetas por abciximab en pacientes sometidos a revascularización coronaria percutánea.

INTRODUCTION AND OBJECTIVES: Abciximab has been shown to reduce the risk of thrombotic complications during coronary angioplasty, however there are still many aspects to be resolved. The aim of this study was to investigate the various biological effects of abciximab on platelets during coronary angioplasty. METHODS: The degree of platelet inhibition (with 5 and 20 mol/l concentrations of ADP), occlusion time (measurement of platelet haemostatic capacity, PFA-100), and the platelet activation markers were determined in 15 patients who underwent basal coronary angioplasty and abciximab treatment. Determinations were obtained before, 15 minutes after procedure initiation, at procedure termination, and 24 hours after procedure termination. RESULTS: More than 80% platelet aggregation inhibition was observed in 13 patients during the procedure, but after 24 hours (p < 0.05) was only detected in two. The occlusion time during the procedure was > 300 sec. in 13 patients, 6 of whom evolved to normal values after 24 hours (p < 0.05). A high correlation (p = 0.02) was found between these two parameters during the intervention, but not after 24 hours. No platelet inhibition or occlusion time changes were observed in 2 patients during the study. The expression of p-selectin increased significantly during the procedure (p < 0.05). CONCLUSIONS: The variability of platelet function inhibition and existence of circulating activation during coronary angioplasty following the administration of abciximab support the use of early analytical controls with the objective of modifying guidelines for use in order to optimize its effect or to combine it with other antithrombotic agents.

[Clinical and prognostic heterogeneity in Aicardi's syndrome: a description of two cases]. / Heterogeneidad clínica y pronóstica en el síndrome de Aicardi: a propósito de dos casos.

INTRODUCTION: Aicardi's syndrome is characterized by infantile spasms, agenesis of the corpus callosum and ocular lesions. Clinically it presents as severe mental retardation, severe limitation of motor development and of language, with a prognosis of survival for only a few months or years. We present two new cases of this uncommon syndrome and describe the heterogeneity of its clinical and prognostic severity. CLINICAL CASES: Case 1. A ten-month old patient had flexion spasms of the limbs at the age of 4 months, bilateral corioretinal lesions and generalized hypoplasia of the corpus callosum. During the clinical course of the disorder, the epileptic crises were controlled, there was mental retardation, the head was held steady and the baby could sit. Case 2. A nine year old patient had had flexion spasms when aged 2 months, had bilateral retinal lesions and generalized hypoplasia of the corpus callosum. During his clinical course the epileptic crises were controlled, there was severe mental retardation, the patient could pay attention and collaborate, articulate single words, walk on his own and manipulate objects. CONCLUSION: Aicardi's syndrome should be considered to be a syndrome in which the clinical findings and prognosis are heterogeneous, as seen from new cases with less clinical and functional limitation than the patients first described.

Molecular genetic analysis of a compound heterozygote for the glycoprotein (GP) IIb gene associated with Glanzmann's thrombasthenia: disruption of the 674-687 disulfide bridge in GPIIb prevents surface exposure of GPIIb-IIIa complexes.

This work was aimed at elucidating the molecular genetic lesion(s) responsible for the thrombasthenic phenotype of a patient whose low platelet content of glycoprotein (GP) IIb-IIIa indicated that it was a case of type II Glanzmann's thrombasthenia (GT). The parents did not admit consanguinity and showed a reduced platelet content of GPIIb-IIIa. Polymerase chain reaction (PCR)-single-stranded conformational polymorphism analysis of genomic DNA showed no mutations in the patient's GPIIIa and two novel mutations in the GPIIb gene: one of them was a heterozygous splice junction mutation, a C-->A transversion, at position +2 of the exon 5-intron 5 boundary [IVS5(+2)C-->A] inherited from the father. The predicted effect of this mutation, insertion of intron 5 (76 bp) into the GPIIb-mRNA, was confirmed by reverse transcription-PCR analysis of platelet mRNA. The almost complete absence of this mutated form of GPIIb-mRNA suggests that it is very unstable. Virtually all of the proband's GPIIb-mRNA was accounted for by the allele inherited from the mother showing a T2113-->C transition that changes Cys674-->Arg674 disrupting the 674-687 intramolecular disulfide bridge. The proband showed a platelet accumulation of proGPIIb and minute amounts of GPIIb and GPIIIa. Moreover, transfection and immunoprecipitation analysis demonstrated that [Arg674]GPIIb is capable of forming a heterodimer complex with GPIIIa, but the rate of subunit maturation and the surface exposure of GPIIb-IIIa are strongly reduced. Thus, the intramolecular 674-687 disulfide bridge in GPIIb is essential for the normal processing of GPIIb-IIIa complexes. The additive effect of these two GPIIb mutations provides the molecular basis for the thrombasthenic phenotype of the proband.

Measurement of the peritoneal platelet activity through the effluent betathromboglobulin levels in CAPD patients.

Platelet activity is closely related to endothelium and could release factors able to influence capillary wall and surrounding tissues. BTG is a protein included in platelet vesicles and a measure of its activation. Some alterations of peritoneum could be partially related to platelet activity. BTG peritoneal transport from blood is weight limited (36000) and consequently, high levels in effluent should represent local production. The aim of this study has been to characterize peritoneal effluent BTG.12 patients, on CAPD 27 +/- 15 mon., 5 diabetics were studied. Previous peritonitis was 0.3 +/- 0.4 e/year. Determinations performed: Plasma (P) (BTG, T. protein, albumin, platelet count, Hcto and Fibrinogen) and Effluent (EF) (BTG, T. protein, Fibrinopeptide A, FDP, Fibrinolytic act., Fibrinogen, Plasminogen and Mitogenic induced capacity on Swiss 3T3 mice fibroblasts). To evaluate peritoneal function we used mass transfer coefficients (MTC) and net UF.R.:BTG levels: P 118 +/- 14 EF 34 +/- 14 ng/ml P/EF (%) 31 +/- 13 (6-54%). Regression analysis: P BTG did not show significant relationship with any of the studied parameters. EF BTG showed direct significant correlation (p less than 0.05) with Creatinine-MTC (r: 0.81) and EF Fibrinogen (0.68) and in the limit of significance with EF T. prot (0.57) and EF Mitogenicity (0.62). P/EF BTF showed significant correlation with creatinine-MTC (0.77). The analysis of these values grouping patients showed: diabetes has no influence on BTG values, hypertensive patients show higher P/EF BTG values than normotensive (39 +/- 9 vs 23 +/- 11%, p less than 0.05) and no influences of peritonitis or CAPD period were found.(ABSTRACT TRUNCATED AT 250 WORDS)