Percepción del usuario de absorbentes de incontinencia de orina y prevención de lesiones cutáneas desde la farmacia comunitaria / User perception of urine incontinence pads and prevention of skin lesions from the community pharmacy

JUSTIFICACIÓN: el farmacéutico comunitario desempeña una labor asistencial más allá de la dispensación de medicamentos. En España hay más de 6,5 millones de incontinentes. 1 de cada 4 mujeres mayores de 35 años y 1 de cada 4 hombres mayores de 40 la padecen. La incontinencia no supone un riesgo para la vida, pero si afecta a la calidad de vida: altera el sueño, reduce la movilidad, altera las relaciones sociales y sexuales. El 25 % de los pacientes incontinentes tiene problemas en su vida laboral. La incontinencia urinaria se ha convertido en la tercera enfermedad crónica que más afecta a la calidad de vida, después de la diabetes e hipertensión. Se ha observado que cuando la piel permanece constantemente húmeda pueden aparecer erupciones, infecciones de la piel y llagas. OBJETIVO: conocer la percepción del paciente o cuidador sobre el uso del absorbente, y el estado de la piel del usuario. Mejorar el estado de la piel de estos pacientes con educación sanitaria. MÉTODOS: entre el 15 y el 31 de Enero de 2022 se realiza una encuesta a todos los pacientes que acuden a una farmacia comunitaria solicitando absorbentes de incontinencia urinaria, que son mayores de edad, con estado cognitivo correcto y que aceptan realizar la encuesta. La encuesta consiste en cinco preguntas cerradas y dicotómicas (si o no) y con opción de añadir comentarios. Cuando se encuentran incidencias se pide al paciente o cuidador que entren en la zona de atención al paciente, donde reciben educación sanitaria de forma oral y escrita. Se contacta con ellos de nuevo a los 15 días para conocer si la actuación del farmacéutico ha ocasionado alguna mejoría. (AU)

El farmacéutico comunitario y el edema de Reinke: caso clínico / The community pharmacist and Reinke's oedema: a case report

ANTECEDENTES Y EVALUACIÓN: el edema de Reinke afecta a ambas cuerdas vocales, y aunque está relacionado con el consumo de tabaco, puede deberse al reflujo o alteraciones hormonales. Produce displasia epitelial leve y carcinoma microinvasor, ronquera y empeoramiento del tono, que a veces presenta cierto grado de aspereza. Mujer de 55 años, fumadora y padece EPOC. Se encuentra en tratamiento con Vilanterol y Bromuro de umeclidinio. Ninguna otra alergia, enfermedad o situación clínica reseñable. Refiere acudir al médico por padecer tos y ronquera, pareciendo su voz más grave de lo habitual. Le prescriben acetilcisteina, que no retira de la farmacia porque tenía un envase en su domicilio. Al día siguiente de comenzar el tratamiento acude a consultar a su farmacia comunitaria ya que refiere empeoramiento de la situación clínica, pareciendo una intensa disnea. INTERVENCIÓN: tras entrevista clínica y registro en la herramienta SEFAC e_XPERT se decide derivar al médico de familia con un informe por escrito, solicitando nueva valoración médica y en el que se recomienda suspender el tratamiento con la acetilcisteína por sospecha de que un incremento de la fluidez de las secreciones puede estar dando lugar a una obstrucción de las vías respiratorias, ya que la expectoración no es adecuada. También realizamos una primera intervención para lograr que la paciente abandone el consumo del tabaco. La paciente lo rechaza. EL médico de familia realiza una nueva valoración prescribiendo amoxicilina con clavulánico y prednisona. Realizamos seguimiento telefónico encontrando empeoramiento clínico a los 5 días de inicio del tratamiento antibiótico y antinflamatorio. La paciente refiere ronquera y tos intensa, aunque mejora de la disnea. Volvemos a insistir sobre la necesidad de dejar de fumar. Un familiar del paciente acude a la farmacia a recoger un nuevo informe por escrito donde recomendamos de nuevo valoración por parte del médico especialista. (AU)

Identificación y adquisición de dispositivos de entrenamiento para mejorar la técnica de administración en una farmacia comunitaria / Identification and procurement of training devices to improve dispensing technique in a community pharmacy

JUSTIFICACIÓN: el asma y la EPOC son dos patologías muy prevalentes y con una alta tasa de mortalidad. El tratamiento de ambas suele incluir medicación que tiene que ser administrada vía inhalada, mediante dispositivos en los que su manejo es complejo. Esto genera un mal control de la enfermedad y altas tasas de no adherencia, lo que agrava aún más el problema. La educación sanitaria, se convierte en un factor trascendental en el abordaje de esta patología respiratoria, y el farmacéutico comunitario en una figura clave en su difusión. Si el paciente no domina la técnica de inhalación, es muy útil disponer de dispositivos de inhalación no medicamentosos, para poder ofrecer una educación sanitaria de calidad. OBJETIVOS: identificar dispositivos de inhalación comercializados, averiguar si el laboratorio comercializador dispone de simuladores para entrenamiento de los pacientes en su manejo y adquirirlos para su uso en una farmacia comunitaria como herramienta de educación sanitaria. MATERIAL Y MÉTODOS: revisión bibliográfica para conocer los dispositivos autorizados y los laboratorios comercializadores. Se empleó la base de datos del consejo Botplus, y se consultó páginas de sociedades científicas así como guías clínicas. Se contacta con los laboratorios y se solicita los dispositivos. RESULTADOS/DISCUSIÓN: se localizaron once tipos de dispositivos de inhalación (Relvar®, Handihaler®, Accuhaler®, cartuchos a presión, Genuair®, Turbuhaler®, Respimat®, Nexthaler®, Modulite®, Breezhaler® y Spiromax®) comercializados por seis laboratorios farmacéuticos GlaxoSmithKline (GSK), AstraZeneca, Boehringer Ingelheim, Chiesi, Novartis y TEVA. Cinco laboratorios si contestaron, pero solo tres mandaron los dispositivos. (AU)

Utilidad y aceptación del seguimiento telefónico de un asistente virtual a pacientes COVID-19 tras el alta / Usefulness and acceptance of telephone monitoring by a virtual assistant for patients with COVID-19 following discharge

La COVID-19 ha supuesto una gran sobrecarga para el sistema sanitario, y ha sido necesario poner en marcha herramientas nuevas para realizar el seguimiento no presencial de los pacientes y garantizar la calidad de sus cuidados. Se evalúa la utilidad y aceptación de los pacientes de un cuidador virtual diseñado para su seguimiento tras el alta hospitalaria por COVID-19. El asistente virtual, con tecnología de voz e inteligencia artificial, realizó llamadas telefónicas a las 48h, 7, 15 y 30 días del alta, formulando 5 preguntas sobre su estado de salud. Si la contestación era afirmativa, generaba una alerta que se transfería a un profesional sanitario. Se incluyeron 100 pacientes en el proyecto. Se generaron 85 alertas en 45 de los pacientes, la mayoría de ellas al mes del alta; el 94% lo resolvió enfermería telefónicamente. La satisfacción de los pacientes con el cuidador virtual fue alta (AU)

COVID-19 has placed a significant burden on the healthcare system, making it necessary to implement new tools that allow patients to be monitored remotely and guarantee quality and continuity of care. The usefulness and acceptance by patients of a virtual caregiver designed for follow-up in the month following hospital discharge for COVID-19 are evaluated. The virtual assistant, based on voice and artificial intelligence technology, made telephone calls at 48hours, seven days, 15 days, and 30 days after discharge and asked five questions about the patient's health. If the answer to any of the questions was affirmative, it generated an alert that was transferred to a healthcare professional One hundred patients were included in the project and 85 alerts were generated in 45 of the patients, most at one month after hospital discharge. The nursing staff resolved 94% of them by telephone. Patient satisfaction with the virtual caregiver was high (AU)

Evaluation and Management of Genitourinary Emergencies in Patients with Cancer.

BACKGROUND: Genitourinary emergencies in cancer patients are common. Most cancer treatments are administered in the outpatient setting, and patients with complications often visit the emergency department. However, there is no recent emergency medicine literature review focusing on genitourinary emergencies in the oncologic population. Objective of the review. To increase awareness of common genitourinary emergencies in patients with cancer and enable the prompt recognition and appropriate management of these conditions. Discussion. Genitourinary emergencies in patients with cancer require a multidisciplinary approach to treatment. The most common genitourinary emergencies in patients with cancer are related to infection, obstructive uropathy, hemorrhagic cystitis, and complications associated with urinary diversions. The treatment approach in patients with infections, including viral infections, is similar to those without cancer. Understanding the changes in the anatomy of patients with urinary diversions or fistulas can help with the management of genitourinary emergencies. CONCLUSIONS: Familiarization with the uniqueness of genitourinary emergencies in patients with cancer is important for emergency physicians.

Usefulness and acceptance of telephone monitoring by a virtual assistant for patients with COVID-19 following discharge.

COVID-19 has placed a significant burden on the healthcare system, making it necessary to implement new tools that allow patients to be monitored remotely and guarantee quality and continuity of care. The usefulness and acceptance by patients of a virtual caregiver designed for follow-up in the month following hospital discharge for COVID-19 are evaluated. The virtual assistant, based on voice and artificial intelligence technology, made telephone calls at 48 h, seven days, 15 days, and 30 days after discharge and asked five questions about the patient's health. If the answer to any of the questions was affirmative, it generated an alert that was transferred to a healthcare professional One hundred patients were included in the project and 85 alerts were generated in 45 of the patients, most at one month after hospital discharge. The nursing staff resolved 94% of them by telephone. Patient satisfaction with the virtual caregiver was high.

[Usefulness and acceptance of telephone monitoring by a virtual assistant for patients with COVID-19 following discharge]. / Utilidad y aceptación del seguimiento telefónico de un asistente virtual a pacientes COVID-19 tras el alta.

COVID-19 has placed a significant burden on the healthcare system, making it necessary to implement new tools that allow patients to be monitored remotely and guarantee quality and continuity of care. The usefulness and acceptance by patients of a virtual caregiver designed for follow-up in the month following hospital discharge for COVID-19 are evaluated. The virtual assistant, based on voice and artificial intelligence technology, made telephone calls at 48 hours, seven days, 15 days, and 30 days after discharge and asked five questions about the patient's health. If the answer to any of the questions was affirmative, it generated an alert that was transferred to a healthcare professional One hundred patients were included in the project and 85 alerts were generated in 45 of the patients, most at one month after hospital discharge. The nursing staff resolved 94% of them by telephone. Patient satisfaction with the virtual caregiver was high.

Clinical and Cancer-Related Predictors for Venous Thromboembolism in Cancer Patients Presenting to the Emergency Department.

BACKGROUND: The accurate detection of cancer-associated venous thromboembolism (VTE) can avoid unnecessary diagnostic imaging or laboratory tests. OBJECTIVE: We sought to determine clinical and cancer-related risk factors of VTE that can be used as predictors for oncology patients presenting to the emergency department (ED) with suspected VTE. METHODS: We retrospectively analyzed all consecutive patients who presented with suspicion of VTE to The University of Texas MD Anderson Cancer Center ED between January 1, 2009, and January 1, 2013. Logistic regression models were used to identify risk factors that were associated with VTE. The ability of these factors to predict VTE was externally validated using a second cohort of patients who presented to King Hussein Cancer Center ED between January 1, 2009, and January 1, 2016. RESULTS: Cancer-related covariates associated with the occurrence of VTE were high-risk cancer type (odds ratio [OR] 3.64 [95% confidence interval {CI} 2.37-5.60], p < 0.001), presentation within 6 months of the cancer diagnosis (OR 1.92 [95% CI 1.62-2.28], p < 0.001), active cancer (OR 1.35 [95% CI 1.10-1.65], p = 0.003), advanced stage (OR 1.40 [95% CI 1.01-1.94], p = 0.044), and the presence of brain metastasis (OR 1.73 [95% CI 1.32-2.27], p < 0.001). When combined, these factors along with other clinical factors showed high prediction performance for VTE in the external validation cohort. CONCLUSIONS: Cancer risk group, presentation within 6 months of cancer diagnosis, active and advanced cancer, and the presence of brain metastases along with other related clinical factors can be used to predict VTE in patients with cancer presenting to the ED.

On the interaction between ultrasound waves and bubble clouds in mono- and dual-frequency sonoreactors.

Since the last decades, extensive work have been done on the numerical modeling of mono-frequency sonoreactors, we here consider the modeling of dual-frequency sonoreactors. We first present the basic features of the CAMUS code (CAvitating Medium under UltraSound), for mono-frequency excitation. Computation at low, medium and high frequency are presented. Extension of the numerical tool CAMUS is also presented: Caflisch equations are modified to take into account the dual-frequency excitation of the sound. We consider 28-56, 28-100 and 28-200 kHz sonoreactors. Fields of cavitation bubble emergence are quite different from the ones under mono-frequency. Study of spatio-temporal dynamics of cavitation bubbles in a 28-56 kHz sonoreactor is also considered. Taking into account the pressure field induced by the dual-frequency wave propagation, we compute the Bjerknes force applied on the cavitation bubble that is responsible for the bubble migration. A two phase flow approach allows to compute the bubble migration.

Spatio-temporal dynamics of cavitation bubble clouds in a low frequency reactor: comparison between theoretical and experimental results.

The propagation of ultrasound through a liquid induces the growth of inceptions and germs into bubbles. In a low frequency reactor, fragmentary transient bubbles emerge due to the acoustic driving. They violently collapse in one cycle and fragment into many smaller bubbles than in turn cavitate. This violent collapse is responsible for the mechanical effects of ultrasounds effects. The latter bubbles gather in a ball-shaped cloud and migrate to pressure antinodes. During their migration, their nonexplosive collapses mainly contribute to activate chemical reactions by producing OH. radicals. Mathematical modelling is performed as a new approach to predict the bubbles field. Through numerical simulation, we determinate emergence sites of mechanically active cavitation bubbles. Calculus are compared with aluminium foil degradation. The modelling of bubble migration allow us to have an insight on the privileged sites of the chemical reactions. Validation of the modelling is made through direct comparison with chemiluminescence photo. All experiments and computations are made in a 28.2 kHz sonoreactor.

Intimal angiosarcoma of the aorta with tumour embolisation causing mesenteric ischaemia. Report of a case diagnosed using CD31 immunohistochemistry in an intestinal resection specimen.

Primary intimal angiosarcomas of the aorta (i.e. mostly intraluminal sarcomas with evidence of endothelial differentiation) are extraordinarily rare. We report a case in which the diagnosis was accurately made using immunohistochemistry in an intestinal resection specimen and confirmed during autopsy. The patient was a 64-year-old woman with mesenteric ischaemia and a "thrombus" in the abdominal aorta. Two segments of the ileum and the right colon were surgically removed. Histological examination showed multiple tumour emboli in small arteries of the submucosa, serosa and mesentery. The highly atypical cells comprising these emboli were positive immunohistochemically with antibodies to Ulex Europaeus, von Willebrand factor and CD31 and negative for CD34. During post-mortem examination, the intraaortic mass was located around the orifices of the coeliac and the superior mesenteric arteries, and gross tumour thrombi were found in the left renal and splenic arteries. This case emphasises the need for a wide panel of immunohistochemical antibodies when tumour emboli of unknown origin are under study.

Numerical simulation of cavitation bubble dynamics induced by ultrasound waves in a high frequency reactor.

The use of high frequency ultrasound in chemical systems is of major interest to optimize chemical procedures. Characterization of an open air 477 kHz ultrasound reactor shows that, because of the collapse of transient cavitation bubbles and pulsation of stable cavitation bubbles, chemical reactions are enhanced. Numerical modelling is undertaken to determine the spatio-temporal evolution of cavitation bubbles. The calculus of the emergence of cavitation bubbles due to the acoustic driving (by taking into account interactions between the sound field and bubbles' distribution) gives a cartography of bubbles' emergence within the reactor. Computation of their motion induced by the pressure gradients occurring in the reactor show that they migrate to the pressure nodes. Computed bubbles levitation sites gives a cartography of the chemical activity of ultrasound. Modelling of stable cavitation bubbles' motion induced by the motion of the liquid gives some insight on degassing phenomena.

Fluid dynamics phenomena induced by power ultrasounds

Propagation of power ultrasound (from 20 to 800 kHz) through a liquid inside a cylindrical reactor initiates acoustic cavitation and also fluid dynamics phenomena such as free surface deformation, convection, acoustic streaming, etc. Mathematical modelling is performed as a new approach to predict where active bubbles are and how intense cavitation is. A calculation based on fluid dynamics equations is undertaken using computational fluid dynamics code; this is of great interest because such code provides not only the pressure field but also velocity and temperature fields. The link between the acoustic pressure and the cavitation field is clearly established. Moreover, the pressure profile near a free surface allows one to predict the shape of the acoustic fountain. The influence of the acoustic fountain on the wave propagation is shown to be important. The convective flow inside a reactor is numerically obtained and agrees well with particle image velocity measurements. Non-linearities arising from the dissipation of the acoustic wave are computed and lead to the calculation of the acoustic streaming. The superimposed velocity field (convective flow and acoustic streaming) succeeds in simulating the bubble behaviour at 500 kHz, for instance.

[Effect of enalaprilat on postischemic systolic and diastolic dysfunction (stunned myocardium) on the isolated rabbit heart]. / Efecto del enalaprilato sobre la disfunción postisquémica sistólica y diastólica ("miocardio atontado") en el corazón aislado de conejo.

The aim was to determine: 1) whether Enalaprilat (0.08 mg/kg/min) administration: a) before ischemia or b) at the beginning of reperfusion improved the postischemic systolic and diastolic dysfunction ("stunned myocardium") and attenuated the "hyperfunction" phase at the beginning of reperfusion; and 2) whether creatine kinase (CPK), and lactate dehydrogenase (LDH) activities, and lactate release are involved in the protective effects of Enalaprilat. An isolated isovolumic rabbit heart preparation was used as experimental model and subjected to 15 minutes of ischemia followed by 30 minutes of reperfusion, without (group 1), and with Enalaprilat before the ischemia (group 2) and at the beginning of reperfusion (group 3). Left ventricular developed pressure, and end diastolic pressure (diastolic stiffness) were measured and the time constant of isovolumic relaxation (t, Tau) and the ratio between +dP/dtmax and -dP/dtmax were calculated. For the determinations of lactate release and CPK and LDH activities in the perfusate, samples were taken from the coronary effluent for spectrophotometrical measurements. In comparison to the stunned group (group 1) both Enalaprilat preischemia (group 2) and postischemia (group 3) exerted a significant protective effect on the postischemic recovery of contractile state and diastolic stiffness, and attenuated the "hypercontractile" phase in both groups. However Enalaprilat failed to improve myocardial relaxation. Lactate release was also attenuated, but the enzyme activities were not modified.