Analysis of the management of antipsychotics in a group of prisons.

Objective: To assess the use of prescribed antipsychotic treatments in the Spanish prison population in order to determine whether there are differences in efficacy and cost between the different long-acting antipsychotic injectables (LAIs). Material and method: An observational, retrospective study was carried out in twelve prisons and in two prison psychiatric hospitals. To assess efficacy, all the clinical histories of patients with some kind of LAI were reviewed and only those who were in a situation of therapeutic stability were selected, defined as those treatments that had not undergone any change in the three last months, both in doses and in the association of another antipsychotic. Results: Of the 11,953 inmates included in the study, 1,851 (15.5%) received prescriptions for an antipsychotic, 415 in penitentiary psychiatric hospitals (87%) and 1,436 in prisons (12%), which is a much higher prevalence than that found in the population. Regarding the prescription pattern of LAIs, paliperidone is the most widely prescribed in prison psychiatric hospitals and prisons, followed by aripiprazole, zuclopenthixol and risperidone. Finally flufenazine, olanzapine and paliperidone quarterly, which are scarcely represented. Of the 292 patients with LAI, 41% (121 patients) are with monotherapy and 59% (171 patients) are with polytherapy, which is similar to the data found in the bibliography. Discussion: The use of prescribed LAIs amongst inmates is widespread. Polytherapy is also a common phenomenon, although there is a downward trend due to the use of more recently marketed drugs. Since the use of LAI is long-term, with numerous side effects and a wide range of prices, it is essential to consider the patient's risk factors and the cost of treatment alongside the therapeutic efficacy.

Análisis del manejo de antipsicóticos inyectables de larga duración en varios centros penitenciarios / Analysis of the management of antipsychotics in a group of prisons

Objetivos: Evaluar el uso de los tratamientos antipsicóticos prescritos en la población reclusa española y determinar si hay diferencias, en cuanto a eficacia y coste, entre los diferentes antipsicóticos inyectables de larga duración (ALD). Material y método: Estudio observacional, retrospectivo, efectuado en doce centros penitenciarios (CCPP) y en dos hospitales psiquiátricos penitenciarios. Para evaluar la eficacia, se revisaron todas las historias clínicas de pacientes con algún ALD y se seleccionaron los que estaban en situación de estabilidad terapéutica, definida como aquellos tratamientos que no habían experimentado ningún cambio en los tres últimos meses, tanto en dosis como en la asociación de otro antipsicótico. Resultados: De 11.953 internos incluidos, 1.851 (el 15,5%) tenían prescrito algún antipsicótico; 415 (el 87%) en los hospitales psiquiátricos penitenciarios y 1.436 (el 12%) en los CCPP. La paliperidona es el ALD más prescrito en hospitales psiquiátricos penitenciarios y en CCPP, seguido del aripiprazol, el zuclopentixol y la risperidona. La flufenazina, la olanzapina y la paliperidona trimestral están poco prescritos. El 41% de los pacientes eran tratados con monoterapia y el 59% con politerapia. Con los ALD de más reciente incorporación, se ha observado una tendencia a la disminución de la politerapia. Discusión: La prevalencia de prescripción de ALD en población reclusa es muy superior a la de la población no presa. La politerapia está muy extendida, aunque muestra una tendencia descendente con el uso de los fármacos más recientemente comercializados. Se recomienda que además de la eficacia terapéutica se valore a la hora de prescribir el riesgo de interacciones farmacológicas y el coste del tratamiento

Objective: To assess the use of prescribed antipsychotic treatments in the Spanish prison population in order to determine whether there are differences in efficacy and cost between the different long-acting antipsychotic injectables (LAIs). Material and method: An observational, retrospective study was carried out in twelve prisons and in two prison psychiatric hospitals. To assess efficacy, all the clinical histories of patients with some kind of LAI were reviewed and only those who were in a situation of therapeutic stability were selected, defined as those treatments that had not undergone any change in the three last months, both in doses and in the association of another antipsychotic. Results: Of the 11,953 inmates included in the study, 1,851 (15.5%) received prescriptions for an antipsychotic, 415 in penitentiary psychiatric hospitals (87%) and 1,436 in prisons (12%), which is a much higher prevalence than that found in the population. Regarding the prescription pattern of LAIs, paliperidone is the most widely prescribed in prison psychiatric hospitals and prisons, followed by aripiprazole, zuclopenthixol and risperidone. Finally flufenazine, olanzapine and paliperidone quarterly, which are scarcely represented. Of the 292 patients with LAI, 41% (121 patients) are with monotherapy and 59% (171 patients) are with polytherapy, which is similar to the data found in the bibliography. Discussion: The use of prescribed LAIs amongst inmates is widespread. Polytherapy is also a common phenomenon, although there is a downward trend due to the use of more recently marketed drugs. Since the use of LAI is long-term, with numerous side effects and a wide range of prices, it is essential to consider the patient's risk factors and the cost of treatment alongside the therapeutic efficacy

Insuficiencia hepática secundaria a hepatitis por amoxicilina-ácido clavulánico. Tratamiento con corticoides / Hepatic failure secondary to hepatitis due to amoxicilin-clavulanic acid. Treatment with corticoids

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[Bacteremia in the elderly: associated and prognostic factors]. / Bacteriemia en el anciano: factores asociados y pronósticos.

BACKGROUND: Bacteremia is associated with high morbidity and mortality rates and its prevalence increases with age. The objective of the present investigation was to know the epidemiology, associated factors and prognosis in patients with bacteremia in our environment and in relation with age. METHODS: Two hundred and twenty-nine episodes of bacteremia were prospectively studied; 97 (42%) cases corresponded to patients aged > 70 years. The prognostic factors were evaluated by the univariate and multivariate analysis in the whole cohort and univariate study of associated factors for an age > 70 years. RESULTS: The etiology, infectious sources, nosocomial acquisition, and complications apart from shock (p = 0.02) were similar in the elderly patients. The associations of diabetes (p = 0.05), COPD and/or heart disease (p = 0.01), and exitus were higher for patients > 70 years. The main independent prognostic factor in the series was disseminated intravascular coagulation (p < 0.001, multivariate OR 14.2). CONCLUSIONS: Patients older than 70 years have a higher incidence of shock and mortality associated with infection. The higher overall mortality rate in the series was associated with disseminated intravascular coagulation and multisystemic failure irrespective of age.

[Tracheobronchopathia osteochondroplastica . Apropos a case]. / Traqueobroncopatía osteocondroplástica. A propósito de un caso.

We present one case of osteochondroplastic tracheobronchopathy in a patient with right laterocervical tumoration as a manifestation of a normofunctional nodular goiter detected in a thyroid morphofunctional study, and tracheal stenosis secondary both to the goiter and the tracheobronchial process. The coincidence of these two processes, probably fortuitous, has never been described before.