Alucinaciones visuales en ancianos sin deterioro cognitivo: síndrome de Charles Bonnet / Visual hallucinations in the elderly with no cognitive impairment: Charles Bonnet syndrome

Presentamos el caso de una paciente de 90 años atendida en nuestro centro de salud cuyo síntoma principal es la aparición aislada de alucinaciones visuales complejas. La sintomatología produce una inquietud intensa a la paciente y a su entorno. La valoración por parte del equipo de atención primaria descartó enfermedades agudas subsidiarias de tratamiento urgente. Finalmente fue derivada a la unidad de demencias de zona para descartar deterioro cognitivo con inicio de síndrome de demencia como diagnóstico más probable. Allí, tras el estudio neuropsicológico se excluyó la demencia y se orientó como síndrome de Charles Bonnet, consistente en la aparición de alucinaciones visuales secundarias a déficit visual severo. Tras 5 años de seguimiento, la sintomatología ha desaparecido casi en su totalidad sin aparición de signos de deterioro cognitivo, lo cual hace patente la necesidad de incluir esta entidad en el diagnóstico diferencial de las alucinaciones visuales de los pacientes ancianos en atención primaria (AU)

We report the case of a 90 year-old female patient treated at our health centre whose main symptom was the presence of isolated visual hallucinations. The symptoms produced a state of intense concern to the patient and her family. The initial assessment by the primary care unit showed that no acute pathology was affecting the patient. So, the first option that was considered was cognitive impairment and the patient was referred to the Area Dementia Unit to exclude this pathology. However, after a neuropsychological examination, dementia syndrome was ruled out, and Charles Bonnet Syndrome, consisting of the appearance of visual hallucinations secondary to severe visual impairment, was considered instead. After five years, symptoms have almost completely disappeared and there are no signs of cognitive impairment. This shows the need to consider Charles Bonnet Syndrome in the differential diagnosis of visual hallucinations in elderly patients in primary health care (AU)

[Good morning, Mr. Representative. Anything new to tell us about? Analysis of the pharmacological products introduced by the drugs industry into a health district]. / Buenos días, señor Visitador. ¿Algo nuevo que contar? Análisis de las especialidades farmacológicas presentadas por la industria farmacéutica en un área básica de salud.

OBJECTIVE: To study whether the visits of technical health representatives (ITS) mean that new drugs are introduced. Design. Prospective, descriptive study. SETTING: Urban health centre. PARTICIPANTS: The products presented by 137 ITS from 83 drug laboratories in weekly sessions for a year were studied. MAIN MEASUREMENTS: The products presented, the year they were first marketed, intrinsic value (IV), newness and use potential, cost per package and defined daily dose and material handed over were studied. RESULTS: 472 drug products were introduced. The most common ones belonged to the cardiovascular group (27.3%), digestion and metabolism (14.8%) and anti-infection drugs (13.3%). 65.5% had been on the market for <5 years. 84.3% had a high IV. Only 31 products (6.6%) were new (95% CI, 4.5-9.2). 71% of these supposed no or very slight therapeutic improvement, 25.8% a modest improvement and 3.2% a major improvement. Mean cost was 19.3 euros per package and 2 euros per DDD, with significant differences found (P<.006) on stratifying by date of marketing (more recently marketed products cost more). 61% of the products were presented with additional material (leaflets, monographs, journals), 21.6% with gifts of symbolic value, and 19.9% with samples of the product. There were significant differences (P<.03) between the new drugs and the normal prescriptions issued at the centre. In the new drugs, there were fewer products with high IV and cost per package and per DDD was higher. CONCLUSIONS: The products introduced by the reps do not include any important new drugs. They are presented with abundant back-up and are more expensive than those normally prescribed.

Buenos días, señor visitador. ¿Algo nuevo que contar? Análisis de las especialidades famacológicas presentadas por la industria farmacéutica en un área básica de salud / Good morning Mr. Drug Industry Representative, what´s new? Analysis of drugs presented by the pharmaceutical industry in a basic health area

Objetivo. Estudiar si las visitas de los informadores técnicos sanitarios (ITS) suponen la presentación de novedades farmacológicas. Diseño. Estudio descriptivo, prospectivo. Emplazamiento. Centro de salud urbano. Participantes. Se estudiaron los productos presentados por 137 ITS de 83 laboratorios mediante sesiones semanales durante un año. Mediciones principales. Se estudiaron los productos presentados, el año de comercialización, el valor intrínseco (VI), la novedad y el potencial de uso, el coste por envase y dosis diaria definida (DDD) y el material entregado. Dichos productos se compararon con una muestra aleatoria de la prescripción anual del centro. Resultados. Se presentaron 472 productos farmacéuticos. Los más frecuentes fueron de los grupos siguientes: cardiovascular (27,3 por ciento), digestivo y metabolismo (14,8 por ciento) y antiinfecciosos (13,3 por ciento). El 65,5 por ciento llevaba comercializado menos de 5 años. El 84,3 por ciento tenía un VI elevado. Solamente 31 productos (6,6 por ciento) eran novedades (intervalo de confianza [IC] del 95 por ciento, 4,5-9,2). De ellos, el 71 por ciento supuso una nula o muy pequeña mejora terapéutica, el 25,8 por ciento una modesta mejora y el 3,2 por ciento una importante mejora. El coste medio fue de 19,3 euros por envase y de 2,0 euros por DDD, con diferencias significativas (p < 0,006) al estratificar por la fecha de comercialización (coste superior en los productos más recientemente comercializados). El 61 por ciento de los productos se presentó con material adicional (folletos, monografías, revistas, libros), el 21,6 por ciento, con regalos de valor simbólico, y el 19,9 por ciento, con muestras del producto. Se observaron diferencias significativas (p < 0,03) respecto a la prescripción habitual del centro: proporción inferior de productos con VI elevado y coste superior por envase y por DDD. Conclusiones. Los productos presentados por los ITS no suponen novedades importantes, se presentan con abundante soporte y son más caros que los prescritos habitualmente (AU)

[Efficacy of a multistep strategy for Helicobacter pylori eradication: quadruple therapy with omeprazole, metronidazole, tetracycline and bismuth after failure of a combination of omeprazole, clarithromycin and amoxycillin]. / Eficacia de una terapia secuencial en la erradicación de Helicobacter pylori: cuádruple terapia con omeprazol, metronidazol, tetraciclina y bismuto tras el fracaso de la combinación de omeprazol, claritromicina y amoxicilina.

BACKGROUND: To evaluate the efficacy of a multistep strategy for Helicobacter pylori (HP) eradication. PATIENTS AND METHOD: 151 patients, with peptic ulcer or chronic gastritis, infected by HP, treated (first-step) with omeprazole (20 mg/12 h), clarithromycin (500 mg/12 h) and amoxycillin (1 g/12 h) for a week (OCA) and second-step (first-step failures) with omeprazole (20 mg/12 h), metronidazole (500 mg/12 h), tetracyclin (500 mg/6 h) and bismuth (120 mg/6 h) for two weeks. RESULTS: Intention-to-treat analysis, eradication was achieved with OCA in 78.1% (CI 95%: 71.6-84.7) and OMTB in 90.3% (CI 95%: 74.2-98), with an cumulative eradication rate of 96.7% (CI 95%: 92.4-98.9). CONCLUSIONS: The efficacy of multistep strategy is high. Therapy with OMTB its a good option after failure with OCA.

[Treatment with omeprazole, clarithromycin and amoxicillin for one week. Their efficacy and tolerance in eradicating Helicobacter pylori in primary care]. / Tratamiento con omeprazol, claritromicina y amoxicilina durante una semana. Efectividad y tolerancia en la erradicación de Helicobacter pylori en atención primaria.

OBJECTIVE: To study the effectiveness and tolerance of the combination of omeprazole, clarithromycin and amoxycillin taken for a week on the eradication of Helicobacter pylori (HP) in patients with peptic ulcer and symptomatic chronic gastritis. DESIGN: Intervention study. SETTING: Urban health centre. PATIENTS: 121 patients, diagnosed by fiber gastroscopy and with an HP infection demonstrated by the urease test, breath test, serology or biopsy, were studied prospectively. 13 suffered from a gastric ulcer, 54 from duodenal ulcer and 54 from chronic gastritis. Two patients stopped treatment because of side-effects, but were included in the study (analysis by treatment intention). INTERVENTIONS: The combination of omeprazole (20 mg/12 hours), amoxycillin (1 gr/12 hours) and clarithromycin (500 mg/12 hours) was administered for a week. No medication was prescribed afterwards. Therapeutic compliance (count of tablets and interview) and side-effects were systematically evaluated. Four to eight weeks later patients took a breath test with Urea C14 to confirm eradication. RESULTS: Average age was 47 (SD 14.5); 54% were women. Eradication was confirmed in 80.2% of cases (CI 95%; 73.1-87.3). Side-effects were light or moderate in all cases: the most common were dysgeusia (67%), nausea (18%) and diarrhoea (17%). CONCLUSIONS: The triple therapy of omeprazole, amoxycillin and clarithromycin for a week is efficacious in eradicating HP. It is extremely easy to apply, and there are few relevant side-effects.