Identificación en farmacia comunitaria de probables resultados negativos asociados al tratamiento con rosuvastatina en una paciente polimedicada / Community pharmacy identification of probable negative outcomes associated with rosuvastatin treatment in a polymedicated patient

PRESENTACIÓN DEL CASO: mujer de 70 años acude a la farmacia comunitaria por un reciente agravamiento del insomnio que padece desde hace 3 meses y que no ha mejorado con la suplementación con melatonina. Al identificarla durante el servicio de indicación como paciente polimedicada se le propone realizar una revisión de la medicación para descartar un origen iatrogénico del problema de salud. Tras la entrevista inicial en la zona ZAP, descubrimos que la paciente ha notado también aparición de tos, que achaca a un empeoramiento del asma aunque no es adherente al tratamiento de rescate, y que hace 6 meses ha iniciado un tratamiento con rosuvastatina 10 mg.EVALUACIÓN: tras el análisis de la bibliografía disponible, identificamos algunas posibles causas de los problemas de salud. El insomnio está descrito como reacción adversa frecuente de losartán, poco frecuente de letrozol y montelukast y de frecuencia desconocida de rosuvastatina. La tos está descrita como reacción adversa frecuente de losartán, poco frecuente de amlodipino y de frecuencia desconocida de rosuvastatina. Además la tos puede indicar una inefectividad del tratamiento de mantenimiento del asma o puede ser consecuencia de la falta de adherencia a la medicación de rescate. A pesar de que la tos y el insomnio son reacciones adversas extremadamente raras de rosuvastatina, al existir una secuencia temporal entre el inicio del tratamiento y la aparición de los síntomas y ya que esta causa pueda explicar ambos resultados negativos de la medicación (RNM), seleccionamos rosuvastatina como la causa más verosímil.INTERVENCIÓN: se deriva al médico informando de nuestra sospecha y recomendando la evaluación del beneficio-riesgo de rosuvastatina.RESULTADO: en la siguiente visita, la paciente nos comenta que el médico le suspendió el tratamiento hipocolesterolemiante y que ha notado mejoría en los síntomas que presentaba. (AU)

[E-consultation as a tool for the relationship between Primary Care and Endocrinology. Impact of COVID-19 epidemic in its use]. / La e-consulta como herramienta para la relación entre Atención Primaria y Endocrinología. Impacto de la epidemia por COVID-19 en su uso.

INTRODUCTION: Electronic consultation (eConsultation) can precede, complete, or replace visits to the specialist. OBJECTIVE: To describe the profile of eConsultations issued from Primary Care (PC) to the Endocrinology Unit since their implementation in our hospital, to assess the response time and to evaluate changes in trends in relation to the COVID19 pandemic. A secondary objective is to evaluate the degree of satisfaction of PC specialists with this tool. MATERIAL AND METHODS: An observational retrospective study of Endocrinology eConsultations conducted from June 2019 to October 2020 analysing 2periods: pre-COVID and post-COVID. The degree of satisfaction of the Family and Community Medicine specialists was assessed by means of a questionnaire. RESULTS: 391 eConsultations were answered (69 pre-COVID and 322 post-COVID). The response time was less than 24h in 85% of them. A total of 35.3% were resolved without the need for visits or additional tests. Thyroid pathology was the most consulted. The incidence was significantly higher in the post-COVID period. The proportion of high resolution was significantly higher in the pre-COVID period. There were no differences in the rest of the parameters analysed in both periods. Thirty-nine point 2percent of PC specialists answered the survey. The degree of satisfaction of PC specialists was high. A total of 92.7% considered that the tool met their expectations and 90.5% were satisfied or very satisfied with its use. CONCLUSION: The COVID epidemic has driven the use of eConsultation in Endocrinology, which makes it possible to precede, complete or replace visits to the specialist, with a high degree of user satisfaction.

In vitro and in vivo development of domestic cat embryos generated by in vitro fertilization after eCG priming and oocyte in vitro maturation.

The objective of this study was to evaluate, in the domestic cat, the effect of ovarian stimulation with eCG prior to oocyte in vitro maturation (priming) on in vitro and in vivo development after in vitro fertilization (IVF). For this purpose, oocyte donors were either 1) treated with a single dose of 200 IU eCG four days before oocyte recovery (eCG group), or, 2) given no treatment before oocyte recovery (control group). Ovaries of both groups were collected by ovariohysterectomy (OVH) and cumulus-oocyte complexes (COCs) were recovered by slicing. Immature COCs from both groups were matured in vitro (IVM) for 26-28 h. IVF was done with refrigerated epididymal sperm. After 24 h co-incubation, presumptive zygotes were cultured in vitro for eight days. The rates of cleavage, morulae, blastocyst development and hatching were estimated. Some blastocysts were stained for total cell counting and others were used for gene expression analysis of pluripotency (OCT4, SOX2 and NANOG) and differentiation markers (CDX2 and GATA6). Additionally, to evaluate in vivo development, embryos from the eCG group were transferred at Day 5 and Days 7 or 8 of IVC to synchronized cat recipients. The results showed that, eCG priming increased significantly the rate of blastocyst development as compared to the control group (37.9 and 25.6%, respectively) (P < 0.05). No differences were observed in total cell number of blastocysts and hatching blastocysts (mean ± SD) between the eCG and control groups (420.6 ± 193.6 and 347.0 ± 237.1, respectively) (P > 0.05). In the gene expression analysis, blastocysts generated in the eCG group had higher expression of OCT4 than blastocysts from the control group (P < 0.05). However, no significant differences were observed in the relative expression of SOX2, NANOG, CDX2 and GATA6 (P > 0.05). Additionally, six embryo transfer (ET) procedures were done, three with Day 5 embryos and three with Day 7 or 8 embryos. Recipients from both ET groups delivered live kittens. The total pregnancy rate was 4/6 (67%), meanwhile the live birth rate was 2/6 (33%). In conclusion, eCG priming improved the rate of blastocyst development in vitro and increased relative expression of OCT4. These results demonstrate that eCG priming of oocytes donors before IVM improves oocyte competence, enhance in vitro embryo development and allows live births of healthy offspring after ET.

Cardiovascular risk biomarkers and metabolically unhealthy status in prepubertal children: Comparison of definitions.

BACKGROUND AND AIMS: The early onset of cardio-metabolic abnormalities, known as metabolically unhealthy (MU) status, is highly associated with obesity and cardiovascular disease (CVD), as well as with increased morbidity and mortality later in life. Given the lack of a consensus MU classification for prepubertal children, we aimed to compare available MU definitions in terms of their association with CVD risk biomarkers. METHODS AND RESULTS: A total of 930 prepubertal children (622 with overweight/obesity, 462 males) aged 5-10.9 years were recruited, anthropometric measures were taken and biomarkers were analyzed. Children were classified using eight MU definitions based on different cut-offs for blood pressure, triacylglycerides, high-density lipoprotein cholesterol, glucose and homeostasis model assessment for insulin resistance (HOMA-IR). MU prevalence in children with overweight/obesity ranged between 30% and 60% across definitions. Plasma concentrations of resistin, leptin, myeloperoxidase (MPO) and total plasminogen activator inhibitor 1 (tPAI-1) were higher, and those of adiponectin were lower, in MU compared to MH children with overweight/obesity. Linear regression analyses confirmed the contribution of MPO and tPAI-1 concentrations to MU status, with most significant results derived from definitions that use age and sex-specific criteria and that account for HOMA-IR. CONCLUSION: Plasma concentrations of MPO and tPAI-1 are increased in prepubertal MU children irrespective of having normal-weight or overweight/obesity. Inclusion of age and sex-specific cut-offs for cardio-metabolic components as well as insulin resistance criteria increases the quality of MU definitions as seen by their stronger association with CVD biomarkers concentrations.

Vesiculobullous variant of erythema elevatum diutinum.

The vesiculobullous variant of erythema elevatum diutinum (EED) is a very rare variant of EED. We describe a 16-year-old boy who presented with symmetrical nodular lesions accompanied by vesicles on the dorsa of his hands. Biopsy findings were consistent with EED. The histopathological presence of IgA and neutrophils in the vesicles indicates that the joint action of both is responsible for formation of these subepidermic vesicles. We hypothesize that absence of human leucocyte antigen related to dermatitis herpetiformis (DH) in our patient might have influenced the location and distribution of the lesions, so that they were not typical of DH. We report the second case of the vesiculobullous variant of EED with IgA deposits in the dermoepidermal membrane. To our knowledge, there are only 14 previously reported cases of the vesiculobullous variant of EED.

Pápula pediculada y fisura en línea cervical anterior de recién nacido / Pedunculated Papule and Fissure in the Anterior Midline of the Neck

No disponible

Tratamiento multimodal de la calcifilaxis con tiosulfato sódico, alprostadil y oxigenoterapia hiperbárica / Multimodal treatment of calciphylaxis with sodium thiosulfate, alprostadil, and hyperbaric oxygen therapy

No disponible

Preradiotherapy MR Imaging: A Prospective Pilot Study of the Usefulness of Performing an MR Examination Shortly before Radiation Therapy in Patients with Glioblastoma.

BACKGROUND AND PURPOSE: Current protocols in patients with glioblastoma include performing an MR examination shortly after surgery and then 2-6 weeks after ending concomitant chemoradiotherapy. The assessment of this first postradiotherapy examination is challenging because the pseudoprogression phenomenon may appear. The aim of this study was to explore if performing an MR examination shortly before radiation therapy (preradiotherapy MR imaging) could improve the radiologic assessment of patients with glioblastoma. MATERIALS AND METHODS: A preradiotherapy MR imaging examination was prospectively performed before the start of radiation therapy in 28 consecutive patients with glioblastoma who had undergone surgical resection. Tumor response to chemoradiotherapy was assessed twice: with the early postoperative MR examination as baseline and with the preradiotherapy MR imaging examination as baseline. In addition, tumor growth in the preradiotherapy MR imaging examination was evaluated, and its correlation with patient survival was assessed with Kaplan-Meier analysis and Cox regression. RESULTS: Tumor progression after radiation therapy was found in 16 patients, corresponding to pseudoprogression in 7 of them (44%). Four assessments of pseudoprogression switched to partial response or stable disease when preradiotherapy MR imaging was the baseline examination, and the ratio of pseudoprogression was reduced to 25% (3 of 12). Significant differences in survival were found when patients were stratified according to the pattern of tumor growth on preradiotherapy MR imaging (median overall survival "no-growth," 837 days; "focal-growth," 582 days; "global-growth," 344 days; P = .001). CONCLUSIONS: Performing a preradiotherapy MR imaging examination may improve the clinical management of patients with glioblastoma by reducing the ratio of pseudoprogression assessments and providing prognostic information.

Consumo, características y perfil del consumidor de suplementos nutricionales en gimnasios de Santiago de Chile / Consumo, características e perfil do consumidor de suplementos nutricionais em academias de Santiago do Chile / Consumption, characteristics, and profile: consumers of nutritional supplements in gymnasiums in Santiago, Chile

Introducción. Los deportistas son los principales consumidores de suplementos nutricionales; presentan en general la utilización más alta. En Chile existe un creciente interés por consumir estos suplementos, sin tener mucho conocimiento de sus efectos. Objetivos. Determinar el perfil del consumidor, quiénes lo recomiendan, los productos más usados y distinguir posibles diferencias de acuerdo al sexo, la finalidad de su uso y otras variables. Métodos. Se aplica un cuestionario de 19 preguntas abiertas y cerradas a 446 voluntarios hombres y mujeres, asistentes a 6 gimnasios de la ciudad de Santiago de Chile durante el año 2013, pertenecientes a un grupo etario de entre 17 y 49 años de edad. Resultados. Los hombres son los mayores consumidores de suplementos, lo cual aumenta de acuerdo al tiempo de entrenamiento semanal que realizan. Ellos prefieren batidos proteicos con el objetivo de aumentar su masa muscular. Las mujeres consumen principalmente vitaminas y agentes lipolíticos con el objetivo de disminuir la masa grasa. Un alto porcentaje cree que el consumo de suplementos les ayuda a cumplir sus objetivos. Conclusión. Un número considerable de personas que asiste regularmente a los gimnasios consume suplementos sin la orientación especializada y posiblemente sin tener que utilizarlos realmente, pero es necesario regular el uso irracional y potencialmente inseguro de los suplementos nutricionales en mejora del rendimiento físico (AU)

Introduction. Athletes are the principle consumers of nutritional supplements, and generally present the highest rate of usage. In Chile, there is a growing interest in consuming these supplements, although there is little knowledge of their effects. Objectives. To determine the consumer profile, who recommends the usage of these nutritional supplements, what the most used products are, and to distinguish possible differences in variables like sex, the purpose of their use, and others. Methods. A survey with 19 open and closed questions was given to 446 men and women volunteers, from between the ages of 17 and 49, who were participants from six gymnasiums in Santiago, Chile, in 2013. Results. Men are the greatest consumers of supplements, and usage increases according to the amount of time spent training every week. This group prefers protein shakes with the aim of increasing muscle mass. Women principally consume vitamins and lipolytic agents with the aim of reducing fatty mass. A high percentage believes that consuming supplements aids in meeting their goals. Conclusion. A considerable number of those who regularly attend a gymnasium consume supplements without specialized orientation and (possibly) without the real need of doing so. It is necessary to regulate irrational and potentially unsafe use of nutritional supplements in bettering physical output (AU)

Introdução. Os atletas são os principais consumidores de suplementos nutricionais, e geralmente apresentam a maior taxa de uso. No Chile, há um crescente interesse em consumir estes suplementos, embora haja pouco conhecimento de seus efeitos. Objetivos. Determinar o perfil do consumidor, quem recomenda, os produtos mais utilizados e distinguir possíveis diferenças de acordo com sexo, a finalidade do seu uso e outras variáveis. Métodos. Foi aplicado um questionário com 19 perguntas abertas e fechadas a 446 voluntários homens e mulhere pertencentes a faixa etária de 17 a 49 anos de idade, participantes de 6 academias na cidade de Santiago do Chile, durante o ano de 3013. Resultados. Os homens são os maiores consumidores de suplementos, o qual aumenta de acordo com o tempo de treinamento semanal que realizam. Eles preferem shakes de proteína, a fim de aumentar a sua massa muscular. Principalmente as mulheres consomem vitaminas e agentes lipolíticos, a fim de reduzir a massa gorda. Uma percentagem alta acredita que o consumo de suplementos irá ajudá-lo a cumprir seus objetivos. Conclusão. Um número considerável de pessoas que frequentam regularmente academias, consomem suplementos sem orientação especializada e, possivelmente, nenhuma necessidade real para isso, portanto é necessário regulamentar o uso irracional e potencialmente inseguro de suplementos nutricionais para melhorar o desempenho (AU)