[Home parenteral nutrition in Spain 2011 and 2012; a report of the home and ambulatory artificial nutrition group NADYA]. / Nutrición Parenteral Domiciliaria en España 2011 y 2012: informe del grupo de nutrición artificial domiciliaria y ambulatoria NADYA.

OBJECTIVE: To report the data of the Home Parenteral Nutrition (HPN) registry of the NADYA-SENPE working group for the years 2011 and 2012. METHODOLOGY: We compiled the data from the on-line registry introduced by reviewers of NADYA group responsible for monitoring of NPD introduced by since January 1, 2011 to december 31, 2012. Included fields were: age, sex, diagnosis and reason for HPN, access path, complications, beginning and end dates, complementary oral or enteral nutrition, activity level, autonomy degree, product and fungible material supply, withdrawal reason and intestinal transplant indication. RESULTS: Year 2010: 184 patients from 29 hospitals , representing a rate of 3.98 patients/million inhabitants/ year 2011, with 186 episodes were recorded NPD . During 2012, 203 patients from 29 hospitals , representing a rate of 4.39 patients/million inhabitants/year 2012 , a total of 211 episodes were recorded NPD . CONCLUSIONS: We observe an increase in registered patients with respect to previous years.Neoplasia remains as the main pathology since 2003. Although NADYA is consolidated registry and has been indispensable source of information relevant to the understanding of the progress of Home Artificial Nutrition in our country, there is ample room for improvement. Especially that refers to the registration of pediatric patients and the registration of complications.

Objetivo: Comunicar los datos del registro de Nutrición Parenteral Domiciliaria (NPD) del grupo de trabajo NADYA-SENPE de los años 2011 y 2012. Material y métodos: Recopilación de los datos del registro "on-line" introducidos por los colaboradores del grupo NADYA responsables del seguimiento de la NPD desde el 1 de enero de 2011 al 31 de diciembre de 2012 dividido por años naturales. Resultados: Año 2010: Se registraron 184 pacientes, procedentes de 29 hospitales, lo que representa una tasa de 3,98 pacientes/millón habitantes/año 2011, con 186 episodios de NPD. Durante el año 2012 se registraron 203 pacientes, procedentes de 29 hospitales, lo que representa una tasa de 4,39 pacientes/millón habitantes/año 2012, con un total de 211 episodios de NPD. Conclusiones: Se observa un aumento progresivo de los pacientes registrados respecto a años anteriores. El principal grupo patológico sigue siendo oncológico ocupando el primer lugar desde 2003. Aunque el registro NADYA es un registro consolidado y ha sido y es fuente imprescindible de información relevante para el conocimiento de los avances de la Nutrición Artificial Domiciliaria en nuestro país, queda un amplio margen para la mejora. En especial lo que hace referencia al registro de pacientes pediátricos y al registro de las complicaciones.

Análisis del valor predictivo positivo de las subcategorías BI-RADS ®4: resultados preliminares en 880 lesiones / Analysis of the positive predictive value of the subcategories of BI-RADS ® 4 lesions: preliminary results in 880 lesions

Objetivos. Las subcategorías BI-RADS®4A/B/C comprenden amplios rangos de valores predictivos positivos (VPP) y no se ha definido su correlación con descriptores específicos. Nuestro objetivo es analizar el VPP de las subcategorías y los descriptores asignados a ellas en lesiones mamográficas y ecográficas. Material y método. Analizamos 880 lesiones confirmadas histológicamente y subclasificadas prospectivamente como BI-RADS®4A/B/C entre 2003-2010. El estudio estadístico incluyó pruebas de significación, tablas de contingencia y estudio de riesgos relativos (RR) sobre 545 lesiones mamográficas y 627 ecográficas. Resultados. Los VPP por subcategoría fueron 8,8%-4A, 18,9%-4B y 58,3%-4C. La correlación entre VPP y lesiones fue la esperada, excepto: VPP 4A>4B en nódulos ecográficos irregulares/márgenes no circunscritos y microcalcificaciones con distribución segmentaria, asignación de BI-RADS®4 a lesiones BI-RADS®3 y consideración de lesiones idénticas en distintas subcategorías. En el estudio por tablas de contingencia, las lesiones mamográficas estuvieron en rangos de 4B/C y las ecográficas en 4B. Los RR fueron significativos en nódulos mamográficos para morfología irregular (RR=3,205) y márgenes espiculados (RR=2,469), y para microcalcificaciones pleomórficas (RR=2,531), amorfas (RR=0,334) y distribución segmentaria (RR=1,895). En la ecografía, los RR fueron significativos en todos los descriptores, con valores mayores de uno en morfología irregular (RR=1,977) y márgenes no circunscritos (RR=2,277). Conclusiones. Nuestros resultados concuerdan con los publicados. Las excepciones encontradas pueden justificarse por aspectos relacionados con la variabilidad y factores no radiológicos con posible influencia en la categorización y VPP. Es necesario elaborar modelos matemáticos que permitan la categorización objetiva e incluyan factores no relacionados con la imagen(AU)

Objectives. The positive predictive values (PPV) of the subcategories of BI-RADS® 4 lesions (A/B/C) vary widely, and their correlation with specific descriptors has yet to be defined. We aimed to analyze the PPV of the subcategories and of the mammographic and ultrasonographic descriptors assigned to each. Material and methods. We analyzed 880 histologically confirmed lesions prospectively classified as BI-RADS® 4 A/B/C between 2003 and 2010. The statistical analysis included significance tests, contingency tables, and relative risk (RR) ratios, calculated for 545 mammographic lesions and 627 ultrasonographic lesions. Results. The PPV was 8.8% for subcategory 4A, 18.9% for subcategory 4B, and 58.3% for subcategory 4C. The correlation between PPV and lesions was what we expected, with three exceptions: a) the PPV of 4A was greater than that of 4B in nodules that were irregular or had uncircumscribed margins on ultrasonography and in microcalcifications with segmental distribution on mammography, b) BI-RADS® 3 lesions classified as BI-RADS® 4, and c) identical lesions classified in distinct subcategories. In the contingency table analysis, the mammographic lesions were 4B/C and the ultrasonographic lesions were 4B. On mammography, the RR was significant for nodules with irregular shape (RR=3.205) and for those with spiculated margins (RR=2.469), as well as for microcalcifications that were pleomorphic (RR=2.531) or amorphous (RR=0.334), and for those with segmental (RR=1.895). On ultrasonography, the RR were significant for all the descriptors, with values greater than 1 for irregular shape (RR=1.977) and uncircumscribed margins (RR=2.277). Conclusions. Our results corroborate previous reports. The exceptions can be explained by aspects related to variability and nonradiological factors that might influence the classification and PPV. Mathematical models should be developed to enable the objective classification and these should include factors not related to imaging(AU)

[Analysis of the positive predictive value of the subcategories of BI-RADS(®) 4 lesions: preliminary results in 880 lesions]. / Análisis del valor predictivo positivo de las subcategorías BI-RADS(®)4: resultados preliminares en 880 lesiones.

OBJECTIVES: The positive predictive values (PPV) of the subcategories of BI-RADS(®) 4 lesions (A/B/C) vary widely, and their correlation with specific descriptors has yet to be defined. We aimed to analyze the PPV of the subcategories and of the mammographic and ultrasonographic descriptors assigned to each. MATERIAL AND METHODS: We analyzed 880 histologically confirmed lesions prospectively classified as BI-RADS(®) 4 A/B/C between 2003 and 2010. The statistical analysis included significance tests, contingency tables, and relative risk (RR) ratios, calculated for 545 mammographic lesions and 627 ultrasonographic lesions. RESULTS: The PPV was 8.8% for subcategory 4A, 18.9% for subcategory 4B, and 58.3% for subcategory 4C. The correlation between PPV and lesions was what we expected, with three exceptions: a) the PPV of 4A was greater than that of 4B in nodules that were irregular or had uncircumscribed margins on ultrasonography and in microcalcifications with segmental distribution on mammography, b) BI-RADS(®) 3 lesions classified as BI-RADS(®) 4, and c) identical lesions classified in distinct subcategories. In the contingency table analysis, the mammographic lesions were 4B/C and the ultrasonographic lesions were 4B. On mammography, the RR was significant for nodules with irregular shape (RR=3.205) and for those with spiculated margins (RR=2.469), as well as for microcalcifications that were pleomorphic (RR=2.531) or amorphous (RR=0.334), and for those with segmental (RR=1.895). On ultrasonography, the RR were significant for all the descriptors, with values greater than 1 for irregular shape (RR=1.977) and uncircumscribed margins (RR=2.277). CONCLUSIONS: Our results corroborate previous reports. The exceptions can be explained by aspects related to variability and nonradiological factors that might influence the classification and PPV. Mathematical models should be developed to enable the objective classification and these should include factors not related to imaging.

Análisis de las interacciones medicamentosas en población extrahospitalaria mayor de 65 años / Analysis of drug interactions in the extra-hospital population over 65 years-old

Introducción. Con el objetivo de conocer cuál es el porcentaje de pacientes mayores de 65 años polimedicados de forma crónica que pueden estar expuestos a interacciones medicamentosas, hemos realizado un estudio observacional para identificar aquellas en las que sería necesario actuar de forma prioritaria. Métodos. La muestra del estudio la constituyen 1.134 pacientes mayores de 65 años que han acudido a consulta del centro de salud al menos una vez en 2 años. Se ha analizado cuántos tienen más de 5 fármacos pautados durante más de 6 meses y, utilizando el programa informático BOT-plus del Colegio de Farmacéuticos, se han detectado las interacciones medicamentosas posibles en cada uno de los pacientes. El programa permite clasificar la significación clínica de las interacciones, así como su naturaleza y las medidas a tomar. Resultados. La población es fundamentalmente femenina (66,3%), siendo el tramo de edad más representado el de 70 a 79 años (51,4%). En 607(69,6%) pacientes se detectaron interacciones medicamentosas, no existiendo diferencias estadísticamente significativas en función del sexo ni de la edad. Sí se ha demostrado que es mayor el número de interacciones en función del número de fármacos administrados (chi cuadrado=2.151,777, p>0,05). El fármaco que más frecuentemente se ha implicado ha sido el acenocumarol con un 7,5% de casos. En cuanto a la significación clínica el 35,3% pueden considerarse importantes. Conclusiones. El número de interacciones medicamentosas detectadas es muy alto. Pensamos que debe prestarse especial atención a la polimedicación en mayores de 65 años, dada su trascendencia en la atención sanitaria (AU)

Introduction. We performed an observational study in order to know how many patients older than 65 long-term polymedicated patients may be exposed to drug interactions, and to identify those where it might need acting on as a priority. Methods. The study sample included 1134 patients over 65 years of age who came to the health centre clinic at least once in two years. Using the Pharmaceutical College computer program BOT-plus, we analysed how many patients had taken more than 5 drugs for more than 6 months. Each patient was screened for possible drug reactions. The program allows the clinical significance of interactions to be assessed, as well as their nature and measures to take. Results. The population was predominantly female (66.3%), with the age range of 70 to 79 years (51.4%) being the most represented. Drug interactions were detected in 607 (69.6%) patients, although there were no statistically significant differences in interactions based on sex or age. It showed that the number of interactions is associated with the number of drugs taken (chi square=2,151.777, P>.05). The drug that was most frequently involved was acenocoumarol with 7.5% of cases. As regards clinical significance 35.3% could be considered important. Conclusions. We must pay special attention to the polymedicated patients over 65, given its importance in health care (AU)

School-based exercise program improves fitness, body composition and cardiovascular risk profile in overweight/obese children.

We determined the effect of a school-based exercise training (ET) without dietary intervention, on body composition, fitness and cardiovascular risk in overweight/obese children. Subjects were 51 overweight/obese 6.5- to 12.5-year-old children (23 boys, 28 girls; BMI 25.6+/-4.3 kg/m 2 ), of whom 48 completed the program. Participants were enrolled in a 15-week aerobic training (three 60-minute sessions/week). Working heart rate was between 120-185 beats/minute. Participation rate was 87%. BMI, waist circumference, body composition (bioimpedance), aerobic capacity (treadmill), blood pressure, lipids and insulin sensitivity (HOMA) were assessed. Waist circumference (85.9+/-12.4 vs. 80.9+/-10.2 cm), muscle mass (32.4+/-6.2 vs. 33.7+/-6.1 kg), maximal oxygen consumption (37.0+/-3.9 vs. 42.6+/-11.2 ml/kg per minute), systolic blood pressure (113.3+/-11.2 vs. 106.7+/-11.6 mmHg) and LDL cholesterol (2.4+/-0.6 vs. 1.9+/-0.6 mM/l) improved significantly. Number of children with abdominal obesity (29 vs. 20), hypertension (10 vs. 5) and elevated triglyceride (18 vs. 14) also declined significantly over time. We concluded that as a result of high attendance and appropriate training program, cardiovascular fitness and abdominal obesity improved in overweight/obese children along with the improvement in metabolic risk factor profile.

Metodología y técnicas. Ecografía del muslo normal / No disponible

La ecografía músculo-esquelética es la que estudia los elementos del aparato locomotor, y entre ellos el muslo, utilizando una sonda lineal de alta frecuencia (7,5 Mhz-10Mh) y realizando cortes transversales y longitudinales con ecografía comparativa del lado contralateral y durante movimientos de contracción-relajación del miembro inferior. Las principales “indicaciones” son las lesiones musculares, tendinosas, ligamentosas, bursa y cápsula sinovial, y en general la patología deportiva, laboral, traumatológica, reumatológica y pericial para la valoración del daño corporal. El muslo está formado por tres compartimentos: anterior, posterior e interno. Pero previo al estudio ecográfico del músculo debemos realizar el estudio ecográfico de los distintos tejidos blandos adyacentes y asociadas a él: la piel, la grasa subcutánea, el hueso y periostio, la cápsula articular, el cartílago hialino, el tendón, las bolsas serosas o bursas y sinovial, la vaina sinovial y el músculo

Introduction to the musculoskeletal ultrasonography: it is the ultrasonography that is used to study the element of the locomotor apparatus, using the high frequency linear sound (7.5 Mhz-10 Mh) and making cross-sectional and longitudinal cuts with comparative ultrasonography of the contralateral side and during Contraction-Relaxation movements of the lower limb. The main indications are for muscle, tendon, ligament, synovial bursa and capsule injuries and in general in sports-related, work, tramatology, and rheumatology conditions and expert evaluation of body injury. The muscle is formed by three compartments: anterior, posterior and internal. However, prior to the ultrasonographic study of the muscle, we should perform the ultrasonographic study of the different adjacent and associated soft tissues: skin, subcutaneous fat, bone and periostium, articular capsule, hyaline cartilage, tendon, serous or bursa and synovial sac, synovial sheath and muscle

Programa institucional para la optimización de la farmacoterapia en los hospitales de una red sanitaria: análisis comparativo de utilización de medicamentos / A multi-center programme to optimize drug therapy in a health system organization: a comparative analysis of medicines usage

Objetivo: Con este estudio se ha pretendido: a) recabar información homogénea, útil para el análisis comparativo; b) efectuar un análisis comparativo con especial incidencia en los costes, y c) transmitir los resultados obtenidos a los distintos hospitales y Comunidades Autónomas con el fin de proporcionar un instrumento de autoevaluación para la gestión de la farmacoterapia. Métodos: La información se ha elaborado a partir de bases de datos disponibles previa homogeneización, y ajuste. Resultados: Los resultados muestran una gran disparidad de costes y consumos, en todos los parámetros estudiados, en los distintos hospitales, incluso en los del mismo grupo, aunque estas diferencias disminuyen al incorporar la complejidad de los procesos tratados. Conclusiones: Los informes obtenidos y remitidos a los centros se han revelado muy útiles en la detección de las tendencias adversas y de las oportunidades de mejora más relevantes (AU)

Análisis y evaluación del coste de farmacia en los hospitales del Insalud: año 1998 / Analysis and evaluation of pharmacy expense by Insalud hospitals in 1998

El objetivo de este estudio es analizar y evaluar el consumo y coste de los productos farmacéuticos y hemoderivados durante el año 1998 en los hospitales gestionados por el Insular. Se han utilizado los datos de gestión analítica y contabilidad presupuestaria correspondientes a 77 hospitales con el fin de obtener el gasto de farmacia desglosado por partidas presupuestarias, el coste en las diferentes áreas de producción y el coste en el área de hospitalización relacionado con la actividad y la complejidad de cada hospital. En este último caso se han utilizado como indicadores el número de altas y la producción de unidades de complejidad hospitalaria. El mayor porcentaje del gasto se imputa a la partida presupuestaria correspondiente a los productos farmacéuticos (67,8 por ciento). Para el conjunto de los hospitales la proporción del coste total que se asigna al área de ambulantes (43,2 por ciento) es similar al asignado a hospitalización (47,6 por ciento). El mayor grado de complejidad de los hospitales se refleja en un mayor coste de farmacia por UCH. La máxima precisión en la realización de la gestión analítica en los hospitales es fundamental para la obtención de información que sea de utilidad en la toma de decisiones dentro de la gestión global del hospital (AU)

Exercise-physiological approach in the analysis of blood glucose curves.

The effect of a single bout of oral glucose administration on the blood glucose level during three hours of observation was studied at rest in 6 physical education students and in 6 elite walkers with different physical condition. The influence of the physical condition on the observed data was also investigated. The evaluation of the glucose tolerance test (OGTT) was first built on a mathematical model and it was developed by a new method. The point of the brand-new method is the interrelationship between the relative percentage differences of blood glucose values, which is analysed as a function of time. The data of the new method better reflect the alterations of blood glucose regulation after oral administration of glucose. The new method contributes to the more accurate analysis of OGTT curves for beside estimation of the absolute values, it considers the relative differences, thus a thorough examination of the glucose metabolism can be carried out. It opens new potentialities in the analysis of the individual, absorptive, hormonal and fitness-dependent effects of different carbohydrates that are used abundantly by athletes.

[Drug-to-drug interactions and pharmaceutical advice]. / Interacciones medicamento-medicamento y asesoramiento farmacéutico.

OBJECTIVE: To describe suspects of drug interactions in primary health care. DESIGN: Descriptive and transversal study during 1 month. SETTING: Urban health center, primary care, Madrid (Spain). PATIENTS AND OTHER PARTICIPANTS: Patients were treated simultaneously with more than 1 drug (145), 2 general practitioners (GP) and 1 pharmacist. INTERVENTIONS: GP registered in a sheet-form data from diagnostic and pharmacological treatments. The pharmacist checked the sheet-forms to detect drug interactions, and later assessed to the GP about it. The proposals were classified in 3 ways: no change in treatment; to modify or stop the current treatment, and to monitor plasmatic level or clinical parameters. MEASUREMENTS AND MAIN RESULTS: 333 drug interactions were detected in 145 patients. The 67.5% of interactions produced by 7 groups of drugs: theophylines, diuretics, antacids, benzodiacepines, betablockers, NSAID's and ACE's. GP accepted 74% of pharmacist's proposals (recommendations). CONCLUSIONS: Seven types of drugs were involved in the main interactions in primary care. The drug interactions increased as more drugs takes a patient in an accelerated trend. Older than 55 were the most affected. GP accepted 3/4 of the recommended pharmacist proposals.

Cardiac changes in rheumatoid arthritis.

We reviewed the autopsy material of 169 patients with rheumatoid arthritis (RA) and studied the cardiac changes is these patients. Systemic vasculitis was observed in 26 cases (15.38%) among 169 patients with RA. In 17 cases (10%) we found vasculitis of the subepicardial and/or intramural coronary vessels. Coronary arteritis or arteriolotis has led to multifocal small, and/or large myocardial infarctions in 10 cases (5.9%) and was the cause of progressive cardiac insufficiency, the direct cause of death. Multifocal circumscribed myocardial infarction reported in rheumatoid disease. In 8 cases rheumatoid nodules were found in the myocardium, 3 of them related to vasculitis. We suggest that rheumatoid nodules are the most severe form of necrotizing granulomatous vasculitis. Pathognomic nodular rheumatoid pericarditis was seen in 3 cases and diffuse rheumatoid pericarditis in another case. Pathognomic nodular valvulitis was found in 7 cases. Rheumatoid nodules localized to the epi-, myo-, or endocardium were observed on 9 patients. Generalized secondary amyloidosis was observed in 32 (18.93%) of the 169 patients with RA. Secondary amyloidosis was prevalent in the heart in 29 of 32 cases (relative frequency: 90.62%).

The effect of completed nutrition on the athletes' performance.

The performance capacity, some somatical parameters, the cardiorespiratory system and the anaerobic exertion of 92 athletes were studied in the function of nutrition. The traditional alimentation was completed partly by a complete food and partly by a protein-rich food. In every case in double-blind arrangements placebo was also used. The treatments lasted one month each. Between the effective and placebo treatments one months interval was kept. The complete food contained 40-60 KJ/body mass kg; the protein completion was 0.5-0.7 g protein/body mass kg. On the effect of both treatments the performance improved in more than the half of the examined persons. The increase of lean body mass could be observed mainly after protein treatment. The relative aerobic power increased significantly only after complete food treatment. The work-heart-rate did not change significantly on the effect of the treatments. The data indicate that the traditional alimentation neither qualitatively nor quantitatively can be considered optimal in more than the half of the examined athletes.

Some metabolical aspects of physical exercise under laboratory and field conditions.

Parameters of exercise physiology were studied in nearly 300 subjects to resolve whether these indices were equally suitable under laboratory and field conditions to assess the level of physical fitness and optimum work load. Respiratory gas exchange, heart rate and exercise acidosis parameters were studied. The inference drawn on the basis of the obtained data has been that both the mode and the intensity of the imposed exercise exert significant influence on the variation of physiological parameters. During running either on the treadmill or in the field test, blood lactate levels were comparable, but performances related to these concentrations were not the same. When different modes of exercise were employed, also lactate levels differed between the laboratory and field studies. The performance of patients under or after exercise rehabilitation following acute myocardial infarction by using instrumental monitoring in the laboratory was found to excel that attained during rehabilitation exercise training. Any change in the level of physical fitness can only be reliably followed when physiological parameters are obtained with the same mode of exercise and intensity under the same environmental conditions. Modern training planning of sports and exercise should take into account the data derived from both the laboratory and the field studies concerning cardiorespiratory system and metabolism.