SEOM clinical practice guideline: management and prevention of febrile neutropenia in adults with solid tumors (2018)

Febrile neutropenia (FN) is a common dose-limiting toxicity of chemotherapy, with a profound impact on the evolution of patients with cancer, due to the potential development of serious complications, mortality, delays, and decrease in treatment intensity. This article seeks to present an updated clinical guideline, with recommendations regarding the diagnosis, prevention, and treatment of febrile neutropenia in adults with solid tumors. The aspects covered include how to properly approach the risk of microbial resistances, epidemiological aspects, considerations about the initial empirical approach adapted to the risk, special situations, and prevention of complications. A decision-making algorithm is included for use in the emergency department based on a new, validated tool, the Clinical Index of Stable Febrile Neutropenia, which can be used in patients with solid tumors who appear stable in the initial phase of neutropenic infections, and can help detect those at high risk for complications in whom early discharge must be avoided

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SEOM clinical practice guideline: management and prevention of febrile neutropenia in adults with solid tumors (2018).

Febrile neutropenia (FN) is a common dose-limiting toxicity of chemotherapy, with a profound impact on the evolution of patients with cancer, due to the potential development of serious complications, mortality, delays, and decrease in treatment intensity. This article seeks to present an updated clinical guideline, with recommendations regarding the diagnosis, prevention, and treatment of febrile neutropenia in adults with solid tumors. The aspects covered include how to properly approach the risk of microbial resistances, epidemiological aspects, considerations about the initial empirical approach adapted to the risk, special situations, and prevention of complications. A decision-making algorithm is included for use in the emergency department based on a new, validated tool, the Clinical Index of Stable Febrile Neutropenia, which can be used in patients with solid tumors who appear stable in the initial phase of neutropenic infections, and can help detect those at high risk for complications in whom early discharge must be avoided.

Valoración subjetiva de los padres en el manejo de las bronquiolitis / Subjective assessment of parents on the management of bronchiolitis

Introducción: Numerosos estudios concluyen que no hay diferencias significativas entre los distintos aerosoles utilizados en el tratamiento de las bronquiolitis. Sin embargo, en protocolos recientes, la adrenalina ha demostrado mayor eficacia que el placebo y los beta-2 agonistas a corto plazo, con una mejoría en los síntomas en los primeros 60 minutos. Objetivos: Demostrar que el uso de adrenalina nebulizada en los pacientes ingresados por bronquiolitis produce una mejoría subjetiva percibida por los cuidadores (en calidad del sueño, ingesta y estado general) e interfiere en los días de ingreso, respecto al uso de suero salino fisiológico (SSF). Pacientes y métodos: Estudio experimental, prospectivo, aleatorizado y simple ciego, en el que se incluyeron lactantes menores de 12 meses ingresados en nuestro hospital entre el 15 de octubre de 2015 y el 31 de marzo de 2016. Resultados: La muestra final fue de 58 niños, un 62% varones. La mediana de edad al ingreso fue de 2 meses (rango intercuartílico: 3), el 62% recibió adrenalina y el 38% SSF. No se hallaron diferencias en el número de días de oxigenoterapia ni en el de días de ingreso entre ambos grupos. Respecto a la apreciación de los padres sobre la ingesta, el sueño y el estado general, no encontramos diferencias estadísticamente significativas entre ambos aerosoles. Conclusiones: El uso de adrenalina no produce una mejoría subjetiva percibida por los cuidadores frente al uso de SS

Introduction: Several studies have concluded that there are no significant differences between the different aerosols used in the treatment of bronchiolitis. However, in recent protocols epinephrine has shown more short-term efficiency than the placebo and beta2-agonists, with an improvement of symptoms within the first 60 minutes. Objectives: To prove that the use of nebulized epinephrine in patients admitted with bronchiolitis leads to a subjective improvement as perceived by caregivers (regarding quality of sleep, food intake and general state of health) and that it affects the days of hospitalization, compared with the use of physiological saline solution (PSS). Patients and methods: Experimental, prospective, randomized, single-blind study. It includes breastfed babies <12 months old who were admitted in our hospital from 15th October 2015 to 31st March 2016. Results: 58 patients, 62% male in total. The median age at admission was 2 months (interquartile range 3). 62% received epinephrine and 38% were given PSS. No differences were found regarding the days of oxygen therapy or the days of admission between both groups. With regard to the parents' assessment of food intake, sleeping and general state of health, we did not find statistically significant differences between different aerosols. Conclusions: The use of epinephrine does not lead to a subjective improvement perceived by the caregivers compared with the use of PSS

The prognostic impact of additional intrathoracic findings in patients with cancer-related pulmonary embolism

Aim. To assess the prevalence and prognostic significance of additional intrathoracic findings (AIFs) in patients with cancer and pulmonary embolism (PE). AIFs were considered alterations other than the characteristic ones intrinsic to PE or changes in cardiovascular morphology. Methods. Subjects have been taken from a Spanish national multidisciplinary and multicenter study of PE and cancer who were treated between 2004 and 2015. The endpoint was the appearance of serious complications or death within 15 days. Results. The registry contains 1024 eligible patients; 41% diagnosed by computed tomography pulmonary angiography versus 59% by non-angiographic CT. Serious complications occurred within 15 days in 18.9%, [95% confidence interval (CI), 16.6-21.4%] and 9.5% (95% CI 7.9-11.5%) died. At least one AIF was seen in 72.6%. The most common AIFs were as follows: pulmonary nodules (30.9%), pleural effusion (30.2%), tumor progression (28.3%), atelectasis (19.0%), pulmonary infarct (15.2%), emphysema (13.4%), pulmonary lymphangitic carcinomatosis (4.5%), and pneumonia (6.1%). Patients with AIF exhibited a higher complication rate at 15 days: 21.9% versus 13.0%, odds ratio (OR) 1.8 (95% CI 1.2-2.8), P = 0.03, and 15-day mortality: 15.0% versus 7.3%, OR 1.9 (95% CI 1.1-3.2), P = 0.020. Patients with pneumonia, pneumothorax, pulmonary edema, pulmonary nodules, tumor progression, pulmonary fibrosis, and pleural effusion showed an excess of adverse events. Conclusions. Additional intrathoracic findings are highly prevalent and significantly impact prognosis in patients with PE and cancer, making them germane to the classification of this population (AU)

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The prognostic impact of additional intrathoracic findings in patients with cancer-related pulmonary embolism.

AIM: To assess the prevalence and prognostic significance of additional intrathoracic findings (AIFs) in patients with cancer and pulmonary embolism (PE). AIFs were considered alterations other than the characteristic ones intrinsic to PE or changes in cardiovascular morphology. METHODS: Subjects have been taken from a Spanish national multidisciplinary and multicenter study of PE and cancer who were treated between 2004 and 2015. The endpoint was the appearance of serious complications or death within 15 days. RESULTS: The registry contains 1024 eligible patients; 41% diagnosed by computed tomography pulmonary angiography versus 59% by non-angiographic CT. Serious complications occurred within 15 days in 18.9%, [95% confidence interval (CI), 16.6-21.4%] and 9.5% (95% CI 7.9-11.5%) died. At least one AIF was seen in 72.6%. The most common AIFs were as follows: pulmonary nodules (30.9%), pleural effusion (30.2%), tumor progression (28.3%), atelectasis (19.0%), pulmonary infarct (15.2%), emphysema (13.4%), pulmonary lymphangitic carcinomatosis (4.5%), and pneumonia (6.1%). Patients with AIF exhibited a higher complication rate at 15 days: 21.9% versus 13.0%, odds ratio (OR) 1.8 (95% CI 1.2-2.8), P = 0.03, and 15-day mortality: 15.0% versus 7.3%, OR 1.9 (95% CI 1.1-3.2), P = 0.020. Patients with pneumonia, pneumothorax, pulmonary edema, pulmonary nodules, tumor progression, pulmonary fibrosis, and pleural effusion showed an excess of adverse events. CONCLUSIONS: Additional intrathoracic findings are highly prevalent and significantly impact prognosis in patients with PE and cancer, making them germane to the classification of this population.

Predicting serious complications in patients with cancer and pulmonary embolism using decision tree modelling: the EPIPHANY Index.

BACKGROUND: Our objective was to develop a prognostic stratification tool that enables patients with cancer and pulmonary embolism (PE), whether incidental or symptomatic, to be classified according to the risk of serious complications within 15 days. METHODS: The sample comprised cases from a national registry of pulmonary thromboembolism in patients with cancer (1075 patients from 14 Spanish centres). Diagnosis was incidental in 53.5% of the events in this registry. The Exhaustive CHAID analysis was applied with 10-fold cross-validation to predict development of serious complications following PE diagnosis. RESULTS: About 208 patients (19.3%, 95% confidence interval (CI), 17.1-21.8%) developed a serious complication after PE diagnosis. The 15-day mortality rate was 10.1%, (95% CI, 8.4-12.1%). The decision tree detected six explanatory covariates: Hestia-like clinical decision rule (any risk criterion present vs none), Eastern Cooperative Group performance scale (ECOG-PS; <2 vs ⩾2), O2 saturation (<90 vs ⩾90%), presence of PE-specific symptoms, tumour response (progression, unknown, or not evaluated vs others), and primary tumour resection. Three risk classes were created (low, intermediate, and high risk). The risk of serious complications within 15 days increases according to the group: 1.6, 9.4, 30.6%; P<0.0001. Fifteen-day mortality rates also rise progressively in low-, intermediate-, and high-risk patients: 0.3, 6.1, and 17.1%; P<0.0001. The cross-validated risk estimate is 0.191 (s.e.=0.012). The optimism-corrected area under the receiver operating characteristic curve is 0.779 (95% CI, 0.717-0.840). CONCLUSIONS: We have developed and internally validated a prognostic index to predict serious complications with the potential to impact decision-making in patients with cancer and PE.

Performance of the clinical index of stable febrile neutropenia (CISNE) in different types of infections and tumors

Purpose. The clinical index of stable febrile neutropenia (CISNE) can contribute to patient safety without increasing the complexity of decision-making. However, febrile neutropenia (FN) is a diverse syndrome. The aim of this analysis is to assess the performance of CISNE according to the type of tumor and infection and to characterize these patients. Methods. We prospectively recruited 1383 FN episodes in situations of apparent clinical stability. Bonferroni-adjusted z tests of proportions were used to assess the association between the infections suspected at the time of onset and the type of tumor with the risk of serious complications and mortality. The performance of CISNE was appraised in each category using the Breslow-Day test for homogeneity of odds ratios and Forest Plots. Results. 171 patients had a serious complication (12.3 %, 95 % confidence interval 10.7-14.2 %). The most common initial assumptive diagnoses were: fever without focus (34.5 %), upper respiratory infection (14.9 %), enteritis (12.7 %), stomatitis (11.8 %), and acute bronchitis (10.7 %). Lung and breast were the most common tumors, accounting for approximately 56 % of the series. The distribution of complications, mortality, and bacteremia varies for each of these categories. However, Breslow-Day tests indicate homogeneity of the odds ratio of the dichotomized CISNE score to predict complications in all infection and tumor subtypes. Conclusion. Despite FN’s clinical and microbiological heterogeneity, the CISNE score was seen to be consistent and robust in spite of these variations. Hence, it appears to be a safe tool in seemingly stable FN (AU)

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Performance of the clinical index of stable febrile neutropenia (CISNE) in different types of infections and tumors.

PURPOSE: The clinical index of stable febrile neutropenia (CISNE) can contribute to patient safety without increasing the complexity of decision-making. However, febrile neutropenia (FN) is a diverse syndrome. The aim of this analysis is to assess the performance of CISNE according to the type of tumor and infection and to characterize these patients. METHODS: We prospectively recruited 1383 FN episodes in situations of apparent clinical stability. Bonferroni-adjusted z tests of proportions were used to assess the association between the infections suspected at the time of onset and the type of tumor with the risk of serious complications and mortality. The performance of CISNE was appraised in each category using the Breslow-Day test for homogeneity of odds ratios and Forest Plots. RESULTS: 171 patients had a serious complication (12.3 %, 95 % confidence interval 10.7-14.2 %). The most common initial assumptive diagnoses were: fever without focus (34.5 %), upper respiratory infection (14.9 %), enteritis (12.7 %), stomatitis (11.8 %), and acute bronchitis (10.7 %). Lung and breast were the most common tumors, accounting for approximately 56 % of the series. The distribution of complications, mortality, and bacteremia varies for each of these categories. However, Breslow-Day tests indicate homogeneity of the odds ratio of the dichotomized CISNE score to predict complications in all infection and tumor subtypes. CONCLUSION: Despite FN's clinical and microbiological heterogeneity, the CISNE score was seen to be consistent and robust in spite of these variations. Hence, it appears to be a safe tool in seemingly stable FN.

On the necessity of new decision-making methods for cancer-associated, symptomatic, pulmonary embolism.

BACKGROUND: Acute symptomatic pulmonary embolism (PE) varies in its clinical manifestations in patients with cancer and entails specific issues. The objective is to assess the performance of five scores (PESI, sPESI, GPS, POMPE, and RIETE) and a clinical decision rule to predict 30-day mortality. METHODS: This is an ambispective, observational, multicenter study that collected episodes of PE in patients with cancer from 13 Spanish centers. The main criterion for comparing scales was the c-indices and 95% confidence intervals (CIs) of the models for predicting 30-day mortality. RESULTS: 585 patients with acute symptomatic PE were recruited. The 30-day mortality rate was 21.3 (95% CI; 18.2-24.8%). The specific scales (POMPE-C and RIETE) were equally effective in discriminating prognosis (c-index of 0.775 and 0.757, respectively). None of these best performing scales was superior to the ECOG-PS with a c-index of 0.724. The remaining scores (PESI, sPESI, and GPS) performed worse, with c-indexes of 0.719, 0.705, and 0.722, respectively. The dichotomic "clinical decision rule" for ambulatory therapy was at least equally reliable in defining a low risk group: in the absence of all exclusion criteria, 30-day mortality was 2%, compared to 5% and 4% in the POMPE-C and RIETE low-risk categories, respectively. CONCLUSION: The accuracy of the five scales examined was not high enough to rely on to predict 30-day mortality and none of them contribute significantly to qualitative clinical judgment.

Central adiposity in children born small and large for gestational age.

OBJECTIVE: To evaluate body composition differences between children that were born small (SGA) or large for gestational age (LGA) compared with their counterparts born adequate for gestational age (AGA). METHODS: Body composition was assessed in 124 healthy Caucasian children (50% girls) aged 6-10, classified according to their birth weight for gestational age as AGA, SGA and LGA. Fat mass (FM), percentage of FM, lean mass (LM), bone mineral content (BMC) and bone mineral density were measured by dual-energy X-ray absorptiometry (DXA) in the whole body and at different body regions. RESULTS: LM (adjusted for age and sex) and total BMC (adjusted for age, sex and weight) were both significantly higher in LGA children and lower in SGA when compared with those born AGA. After adjustments for height, LM and BMC differences between groups were not significant. In SGA children, truncal (P<0.05) and abdominal fatness (P<0.01) were higher when compared with both AGA and LGA children, after adjustments for age, sex and height. There were no differences in the percentage of total and central FM between children born LGA and AGA. CONCLUSIONS: During childhood, children born SGA had higher central adiposity regardless of their body size. Children born LGA seem to have a higher body size but with harmonic body composition and adequate body fat distribution. Small size for gestational age at birth could programme excess abdominal fat deposition in children, which is a major factor for the clustering of cardiovascular disease risk factors defining the metabolic syndrome.

Central adiposity in children born small and large for gestational age / Adiposidad central en niños que nacieron con poco o con excesivo peso para su edad gestacional

Objective: To evaluate body composition differences between children that were born small (SGA) or large for gestational age (LGA) compared with their counterparts born adequate for gestational age (AGA). Methods: Body composition was assessed in 124 healthy Caucasian children (50% girls) aged 6-10, classified according to their birth weight for gestational age as AGA, SGA and LGA. Fat mass (FM), percentage of FM, lean mass (LM), bone mineral content (BMC) and bone mineral density were measured by dual-energy X-ray absorptiometry (DXA) in the whole body and at different body regions. Results: LM (adjusted for age and sex) and total BMC (adjusted for age, sex and weight) were both significantly higher in LGA children and lower in SGA when compared with those born AGA. After adjustments for height, LM and BMC differences between groups were not significant. In SGA children, truncal (P < 0.05) and abdominal fatness (P < 0.01) were higher when compared with both AGA and LGA children, after adjustments for age, sex and height. There were no differences in the percentage of total and central FM between children born LGA and AGA. Conclusions: During childhood, children born SGA had higher central adiposity regardless of their body size. Children born LGA seem to have a higher body size but with harmonic body composition and adequate body fat distribution. Small size for gestational age at birth could programme excess abdominal fat deposition in children, which is a major factor for the clustering of cardiovascular disease risk factors defining the metabolic syndrome (AU)

Objetivo: Evaluar las diferencias que existen en la composición corporal de aquellos niños que nacieron pequeños (PEG) o grandes para su edad gestacional (GEG) en comparación con los que presentaban un peso adecuado al nacer (AEG). Métodos: La composición corporal se valoró en 124 niños caucásicos (50% niñas) con edades entre 6 y 10 años, clasificados según su peso al nacer como AEG, PEG y GEG. La masa grasa (MG), el porcentaje de MG, la masa magra (MM), el contenido mineral óseo (CMO) y la densidad mineral ósea se midieron mediante absorciometría dual de rayos X (DXA) tanto globalmente como en las diferentes regiones corporales. Resultados: La MM (ajustada por edad y sexo) y el CMO (ajustado por edad, sexo y peso) fueron mayores en los GEG y menores en los PEG al compararlos con los AEG; al ajustar la MM el CMO por la altura, dichas diferencias ya no fueron significativas. En los PEG, la grasa abdominal (p < 0,01) y en el tronco (p < 0,05) eran mayores que en los AEG y que en los GEG tras ajustar por edad, sexo y altura. No existían diferencias en el porcentaje de MG total corporal y en porcentaje de grasa central entre los niños nacidos GEG y AEG. Conclusiones: Durante la infancia, los niños que nacieron PEG tenían mayor adiposidad central independientemente de su tamaño corporal. Los nacidos GEG seguían siendo grandes pero con una distribución armónica de la composición corporal y una adecuada distribución de la grasa corporal. Nacer con poco peso puede programar la grasa abdominal durante la infancia, cuyo aumento constituye uno de los factores de riesgo cardiovascular que definen el síndrome metabólico (AU)

Consumo de televisión y nivel socioeconómico en niños y adolescentes / Television consumption and socioeconomic level in children and adolescent

Antecedentes. El sedentarismo en niños y adolescentes, principalmente el consumo de televisión, está muy relacionado con determinantes medioambientales como el nivel socioeconómico. Los comportamientos sedentarios establecen estilos de vida que predisponen a obesidad. Objetivo: Pretendemos estudiar si un nivel socioeconómico bajo predispone al sedentarismo, el cual es factor de riesgo de obesidad. Material y métodos: Realizamos un estudio descriptivo transversal de una muestra representativa de los colegios del Área sanitaria 3 de Zaragoza. Doscientos sesenta sujetos, 137 varones de 13,30 ± 1,63 años de edad y 123 mujeres de 13,36 ± 1,84 contestaron voluntariamente un cuestionario para valorar el patrón de actividades sedentarias mediante: las horas de televisión, de ordenador, de estudio y deberes, el medio de transporte usado para ir al colegio-instituto y las horas de sueño. Se valoró el nivel socio-económico según el nivel de estudios e ingresos de madre y padre por separado. En varones se muestra significativamente que, a menor nivel de estudios de la madre y del padre y a menores ingresos del padre, hay un mayor número de horas viendo la televisión. Además los niños emplean más tiempo en el ordenador. Las mujeres emplean más tiempo en estudiar o hacer los deberes, aunque no guarda relación con el nivel de estudios o ingresos de los padres. Conclusiones: No hay diferencias entre los dos sexos respecto al consumo de televisión aunque un gran porcentaje de los niños de nuestra muestra sobrepasa las recomendaciones de la Academia Americana de Pediatría de menos 2 horas de televisión al día. Los niños varones con menor estatus socioeconómico emplean más tiempo en hábitos sedentarios (AU)

Sedentary behaviour in children and adolescent, mainly television consumption, are related with environmental factors such as socioeconomic status. High sedentary leisure time may establish behavioral patterns that predispose to obesity. Objetive: We aim to test whether people with a low socioeconomic status tend to be more inactive. Materials and methods: The study used a cross-sectional design for a representative schools of the 3rd sanitaria area in Zaragoza. A questionnaire was answered by a representative sample for 260 subjects: 137 boys (13.30 ± 1.63 years old) and 123 girls (13.36 ± 1.84 years old). Behavioral variables were evaluated: television and computer use, active commuting to school, hours of study and homework and sleeping time. Additionally, socioeconomic variables, such as, father and mother level of studies and incomes were also evaluated. Results: In boys, low level of mother and father studies and low level of father incomes was significative associated with more television viewing. In addition, they were more computer users. Girls spent more time on studying and doing homework, but it was not associated with parents´ studies or incomes. Conclusions: there is no evidence of television viewing separately by gender. In our sample both do not meet the recommendation of the American Academy of Paediatrics of less that 2 hours per day. Boys with low socioeconomic status used more time in sedentary activities (AU)

[Use of psychoactive drugs in a health and welfare centre]. / Utilización de psicofármacos en un centro sociosanitario.

OBJECTIVE: To analyse the use of psychoactive drugs in a health and welfare centre and compare this use with current guidelines. METHOD: A cross-sectional study of the drug treatment regime of hospitalised patients in a health and welfare centre was carried out. Information was obtained from prescriptions and the clinical histories of patients in the centre. The following variables were assessed: demographic data, treatment with psychoactive drugs, date of commencing treatment, dosage, drug combinations, indication and total number of drugs analysed. The results were compared with the literature and current prescription guidelines. RESULTS: 45 of the 70 patients analysed were taking psychoactive drugs: 51.1% were being treated with neuroleptic drugs, 42.2% with antidepressants, and 6.7% with anxiolytic agents. 62% were women. The overall mean age was 80.3 years old. The average number of psychoactive drugs administered to each patient was 1.6 and the average number of total drugs prescribed was 10.5. The most frequently administered psychoactive drugs were risperidone, lorazepam and citalopram. The most frequent association was neuroleptic drugs with benzodiazepine. The indication and dosage prescribed were appropriate according to the data sheet, although some inappropriate prescription practices were observed. CONCLUSIONS: The results of the study would recommend controlling the duration of treatment with benzodiazepine, confirming the diagnosis of states of depression and correctly monitoring the associations between psychoactive drugs.

Utilización de psicofármacos en un centro sociosanitario / No disponible

Objetivo: Analizar la utilización de psicofármacos en un centro sociosanitario y compararlo con las guías de recomendación existentes. Material y métodos: Se realizó un estudio transversal del perfil farmacoterapéutico de los residentes ingresados en un centro sociosanitario. Las fuentes de información fueron las prescripciones médicas y las historias clínicas del centro. Se evaluaron variables demográficas, del tratamiento con psicofármacos, fecha de inicio, dosis y combinaciones, indicación y número total de medicamentos estudiados. Se compararon los resultados con la bibliografía y las guías de prescripción existentes. Resultados: Tomaban psicofármacos 45 de los 70 pacientes estudiados observándose que el 51,1% estaban siendo tratados con fármacos neurolépticos, el 42,2% con antidepresivos, el 6,7% con ansiolíticos. El 62% eran mujeres. La edad media global fue de 80,3 años. El número medio de psicofármacos por paciente fue 1,6 y del total de medicamentos 10,5. Los psicofármacos más utilizados fueron risperidona, lorazepam y citalopram. Las asociación más frecuente fue neuroléptico más benzodiazepina. La indicación y dosis prescritas eran adecuadas según ficha técnica, aunque se observaron pautas de prescripción desaconsejadas. Conclusiones: Los resultados del estudio aconsejarían controlar la duración de los tratamientos con benzodiazepinas, asegurar el diagnóstico de los estados depresivos y realizar un adecuado seguimiento de las asociaciones entre psicofármaco

Objective: To analyse the use of psychoactive drugs in a health and welfare centre and compare this use with current guidelines. Method: A cross-sectional study of the drug treatment regime of hospitalised patients in a health and welfare centre was carried out. Information was obtained from prescriptions and the clinical histories of patients in the centre. The following variables were assessed: demographic data, treatment with psychoactive drugs, date of commencing treatment, dosage, drug combinations, indication and total number of drugs analysed. The results were compared with the literature and current prescription guidelines. Results: 45 of the 70 patients analysed were taking psychoactive drugs: 51.1% were being treated with neuroleptic drugs, 42.2% with antidepressants, and 6.7% with anxiolytic agents. 62% were women. The overall mean age was 80.3 years old. The average number of psychoactive drugs administered to each patient was 1.6 and the average number of total drugs prescribed was 10.5. The most frequently administered psychoactive drugs were risperidone, lorazepam and citalopram. The most frequent association was neuroleptic drugs with benzodiazepine. The indication and dosage prescribed were appropriate according to the data sheet, although some inappropriate prescription practices were observed. Conclusions: The results of the study would recommend controlling the duration of treatment with benzodiazepine, confirming the diagnosis of states of depression and correctly monitoring the associations between psychoactive drugs

Minimal incision in parotidectomy.

Conservative parotidectomy has been for years an effective and well-established technique. Recently, aesthetic considerations have been reviewed. A minimal pre- and retroauricular incision is proposed that does not extend to the hair-bearing skin. This reduces the length of the scar and the extent of the dissection improving aesthetic results. This is a retrospective study of 32 parotidectomies performed through this incision because of benign parotid diseases and diagnosed by fine needle aspiration cytology. The minimal incision is mainly indicated in small and medium-sized tumours located in the superficial lobe of the parotid gland. Neither operating time nor the morbidity associated with parotidectomy is increased with this safe and effective technique for the treatment of benign parotid masses.

Seguimiento de la utilización de metformina en la población de riesgo / Follow-up of the use of metformin among the risk population

Objetivo: Realizar un seguimiento de utilización de metforminapara comprobar la adecuada prescripción del medicamento en lapoblación con mayor riesgo de desarrollar reacciones adversas.Método: Se ha realizado un seguimiento prospectivo de utilizaciónde metformina durante un periodo de cuatro meses. En lospacientes seleccionados se ha registrado: edad, sexo, peso y talla,motivo del ingreso, perfil farmacoterapéutico, origen de la prescripción(anterior al ingreso o durante la estancia hospitalaria),glucemia, función renal, efectos adversos y el motivo de interrupcióndel tratamiento, si procede.Resultados: La media diaria de pacientes ingresados duranteeste periodo fue de 352 (desviación estándar ± 36,8), la edadmedia fue de 73 años (33-102), el total de pacientes estudiadosfue de 135, siendo un 46% hombres.La prescripción de metformina está contraindicada en pacientescon valores de creatinina superiores a 0,132 mMol/L, por ellose controló la función renal. Con los datos de 20 pacientes, serealizaron seis intervenciones farmacéuticas para aconsejar la suspensióndel tratamiento, aceptadas en un 83% de los casos. Tambiénse registraron efectos adversos y glucemia.Conclusiones: Durante el periodo de seguimiento no hemosobservado ningún efecto adverso grave como la acidosis lácticaasociada, aunque en ocasiones la prescripción de metformina seha realizado en pacientes en los que no estaría recomendada. Sinembargo, consideramos interesante el seguimiento de estospacientes puesto que hemos observado efectos adversos (diarrea)que han requerido la disminución de la dosis de metformina

Objective: To perform a follow-up of the use of metformin inorder to ensure the appropriate prescription of the drug amongthe population with the highest risk of adverse reactions.Method: A prospective follow-up was conducted of the use ofmetformin during a four-month period. In the patients recruitedfor the study, the following data were recorded: age, sex, weightand height, cause of hospitalization, pharmacotherapeutic profile,origin of the prescription (prior to hospitalization or during thehospital stay), glycemia, renal function, side effects and cause ofthe discontinuation of the treatment, if appropriate.Results: The mean number of patients hospitalized each dayduring the study period was 352 (standard deviation ± 36,8), themean age was 73 years (33-102) and the total number of patientsstudied was 135, with 46% of males.Since prescription of metformin is contraindicated in patientswith creatinine values > 0.132 mMol/L, renal function was monitored.Based on the data of 20 patients, six pharmaceutical interventionswere performed in order to recommend the discontinuationof the treatment, which was accepted in 83% of the cases.Side effects and glycemia were also recorded.Conclusions: During the follow-up period, we did not observeany severe side effects such as associated lactic acidosis, althoughin some cases metformin was prescribed to patients inwhich it was not recommended. However, the follow-up ofpatients is important, since we have observed side effects (diarrhea)that require reduction of the dose of metformin

[Follow-up of the use of metformin among the high risk population]. / Seguimiento de la utilización de metformina en la población de riesgo.

OBJECTIVE: To perform a follow-up of the use of metformin in order to ensure the appropriate prescription of the drug among the population with the highest risk of adverse reactions. METHOD: A prospective follow-up was conducted of the use of metformin during a four-month period. In the patients recruited for the study, the following data were recorded: age, sex, weight and height, cause of hospitalization, pharmacotherapeutic profile, origin of the prescription (prior to hospitalization or during the hospital stay), glycemia, renal function, side effects and cause of the discontinuation of the treatment, if appropriate. RESULTS: The mean number of patients hospitalized each day during the study period was 352 (standard deviation +/- 36,8), the mean age was 73 years (33-102) and the total number of patients studied was 135, with 46% of males.Since prescription of metformin is contraindicated in patients with creatinine values > 0.132 mMol/L, renal function was monitored. Based on the data of 20 patients, six pharmaceutical interventions were performed in order to recommend the discontinuation of the treatment, which was accepted in 83% of the cases. Side effects and glycemia were also recorded. CONCLUSIONS: During the follow-up period, we did not observe any severe side effects such as associated lactic acidosis, although in some cases metformin was prescribed to patients in which it was not recommended. However, the follow-up of patients is important, since we have observed side effects (diarrhea) that require reduction of the dose of metformin.

Intestinal pseudo-obstruction in systemic lupus erythematosus.

In order to document intestinal pseudo-obstruction (IPO) as a recently recognized manifestation of systemic lupus erythematosus (SLE), we report the case or a woman with SLE who presented with IPO and we review 21 other previously reported cases from an English literature search. In 41% of the cases, IPO was the initial manifestation of their underlying lupus. The clinical and laboratory features were not significantly different from those reported in large series of patients with SLE, except for an apparent association with an urinary tract involvement (ureterohydronephrosis and interstitial cystitis). The pathogenic mechanism of this complication is not fully understood, but seems to be heterogeneous. IPO responded readily to high dose steroid therapy in all patients, but in some cases this complication evolved regardless of the underlying disease activity. A high level of awareness of this complication is needed to avoid unnecessary surgical intervention.

[Congenital absence of the inferior vena cava as a risk factor for pulmonar thromboembolism]. / Agenesia de vena cava inferior como factor de riesgo de tromboembolismo pulmonar.

The absence of the inferior vena cava is a rare congenital anomaly. Currently its diagnosis is based on non-invasive imaging techniques (computerised axial tomagraphy and nuclear magnetic resonance). In most cases, it constitutes a casual finding upon practising these image tests unrelated to this congenital anomaly. In the symptomatic patients, the complaints associated are secondary to venous insufficiency and/or deep vein thrombosis. Recently the congenital absence of inferior vena cava has been described as a risk factor of deep vein thrombosis in young patients. We present a case of congenital absence of inferior vena cava that was admitted in our hospital because of pulmonary thromboembolism.

Agenesia de vena cava inferior como factor de riesgo de tromboembolismo pulmonar / Congenital absence of the inferior vena cava as a risk factor for pulmonar thromboembolism

La agenesia de vena cava inferior es una malformación congénita poco frecuente. Actualmente su diagnóstico se basa en técnicas de imagen no invasivas (tomografía axial computerizada y resonancia magnética nuclear). En la mayoría de casos constituye un hallazgo casual al practicar estas pruebas de imagen por otra causa no relacionada con la anomalía congénita. En los pacientes sintomáticos, la clínica asociada es la de insuficiencia venosa y/o trombosis venosa profunda. Recientemente la agenesia de vena cava inferior ha sido descrita como factor de riesgo de trombosis venosa profunda en pacientes jovenes. Presentamos un caso de agenesia de vena cava inferior que ingresó en nuestro servicio a raíz de un tromboembolismo pulmonar. (AU)