The impact of an in-department pharmacist on the prevention of drug iatrogenesis in a rheumatology department.

INTRODUCTION/OBJECTIVES: The primary objective was to evaluate the impact of an in-department pharmacist on the prevention of drug iatrogenesis in a rheumatology department. Secondary objectives were to determine (i) if medication history discrepancies were detected more frequently in the elderly or not, and (ii) if the mean number of treatments at admission had an impact on the number of medication history discrepancies. METHODS: Implementation of a clinical-pharmacy program based on medication reconciliation and medication review of prescription for all patients admitted to a rheumatology department between January and June 2017. The analytical approach was mainly descriptive and data were expressed as mean ± standard deviation (i.e., number of treatments at admission, number of medication reconciliations) and as proportions (i.e., acceptance rate, impact). Chi-squared tests and Student's test were performed to determine if there was a significant difference in outcomes. RESULTS: Three hundred twelve patients were included in the study, 517 medication history discrepancies in 243 (77.8%) patients and 196 pharmaceutical interventions in 133 (42.6%) patients. A significant difference was found in the number of medication history discrepancies and pharmaceutical interventions between the two age groups and in the mean number of treatments at admission between patients with or without medication history discrepancies. 15.4% of study patients had major medication history discrepancies and major pharmaceutical interventions. All patients and practitioners reported the usefulness of an in-department pharmacist. CONCLUSION: This program was found effective in terms of safety and improvement in the continuity of care. Key Points • This clinical-pharmacy program with an in-department pharmacist had a positive impact on the prevention of drug iatrogenesis in one rheumatology department. • 15.4% (n = 48) of study patients had major medication history discrepancies and major pharmaceutical interventions. • All practitioners and patients were satisfied with this clinical-pharmacy program.

Actinomicosis de la pared abdominal: a propósito de un caso / Abdominal wall actinomycosis: apropos of 1 case

Se comunica el caso de un paciente portador de actinomicosis abdominal no visceral, que se manifestó por un cuadro de dolor abdominal subagudo con importante compromiso de su estado general y una masa de músculo recto abdominal abscedada y perforada hacia la cavidad peritoneal. El paciente fue sometido a taparotomía exploradora y drenaje. El diagnóstico se determinó por la biopsia del tejido muscular. Se trató por diez días con un esquema antibiótico tríasociado y posteriormente con cotrimoxazol por dos meses, presentando buena respuesta clínica y desaparición de sus lesiones. La actinomicosís es una infección poco habitual y la localización en la musculatura abdominal es excepcional, debiendo descartarse patología neoplásica especialmente sarcomas. El diagnóstico es difícil, al igual que para otras localizaciones, y en nuestro medio se obtiene sólo del estudio histopatológico. Se analizan los aspectos relevantes de la actinomicosís abdominal y se discute el rol de la cirugía en su tratamiento

Trauma maxilofacial: manejo de partes blandas / Maxillofacial trauma: soft tissue management

Existe abundante bibliografía acerca del trauma maxilofacial, sin embargo casi toda está referida a aspectos traumatológicos, dejando un vacío en el tratamiento de las partes blandas que, sin duda, es la situación más frecuente con la cual se enfrenta el médico general. El objetivo de este trabajo es dar una visión global del tema, abordando criterios generales y específicos en el manejo de partes blandas de un paciente con trauma maxilofacial

[Colo-hepatic fistula secondary to hydatid disease. Clinical case]. / Fístula colohepática secundaria a enfermedad hidatídica. Caso clínico.

The fistulization of a hepatic hydatid cyst to the colon is a very rare complication and only two cases have been described in the medical literature. We report a 49 year-old male in whom this complication was suspected in the preoperative period. He was submitted to a cystotomy and colonic exteriorization. Recovery was uneventful.

Fístula colohepática secundaria a enfermedad hidatídica: caso clínico / Colo-hepatic fistula secondary to hydatid disease: clinical case

The fistulization of a hepatic hydatid cyst to the colon is a very rare complication and only two cases have been described in the medical literature. We report 49 year-old male in whom this complication was suspected in the preoperative period. He was submitted to a cystotomy and colonic exteriorization. Recovery was uneventful