Consideraciones sobre el tratamiento farmacológico de la vejiga hiperactiva en el paciente mayor / Pharmacological treatment of overactive bladder in elderly patients

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Guías clínicas para los síntomas del tracto urinario inferior en el varón e hiperplasia benigna de próstata: importancia de las actualizaciones periódicas según la evidencia disponible / Clinical guidelines for male lower urinary tract symptoms and benign prostatic hyperplasia: Importance of periodic updates based on available evidence

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Actualización en el tratamiento médico de los síntomas del tracto urinario inferior en el varón / Update on the medical treatment of lower urinary tract symptoms (LUTS) in men

Los síntomas del tracto urinario inferior (STUI) son una causa frecuente de consulta en atención primaria, sobre todo en varones mayores de 40 años. La hiperplasia benigna de próstata (HBP) es la causa más común de estos STUI, los cuales producen interferencia en las actividades de la vida diaria y en la calidad de vida. El propósito de esta revisión es proporcionar una actualización sobre las últimas publicaciones en relación con el tratamiento médico de los STUI en el varón (AU)

Lower urinary tract symptoms (LUTS) are a frequent cause of consultation in Primary Care, especially in men > 40 years of age. Benign prostatic hyperplasia (BPH) has been recognized as the most common cause of bothersome LUTS, causing significant interference with everyday activities and quality of life. The purpose of this study is to provide an update on recent developments regarding the medical management of male LUTS (AU)

[Update on the medical treatment of lower urinary tract symptoms (LUTS) in men]. / Actualización en el tratamiento médico de los síntomas del tracto urinario inferior en el varón.

Lower urinary tract symptoms (LUTS) are a frequent cause of consultation in Primary Care, especially in men >40 years of age. Benign prostatic hyperplasia (BPH) has been recognized as the most common cause of bothersome LUTS, causing significant interference with everyday activities and quality of life. The purpose of this study is to provide an update on recent developments regarding the medical management of male LUTS.

Validación en pediatría de un método para notificación y seguimiento de errores de medicación / Validation of a method for notifying and monitoring medication errors in pediatrics

OBJETIVO: Analizar el impacto en la notificación de errores de medicación de la puesta en marcha de un comité de seguridad multidisciplinar descentralizado en la unidad de gestión pediátrica, e implantación conjunta de una aplicación informática en red para la comunicación de errores de medicación, mediante seguimiento de los errores y análisis de las mejoras. MATERIAL Y MÉTODOS: Estudio observacional, descriptivo, transversal pre-post intervención. Se analizan los errores de medicación notificados a la comisión central de seguridad, en los 12 meses previos a la implantación, y los notificados mediante la aplicación informática descentralizada a la comisión de seguridad de la unidad de gestión, en los 9 meses posteriores, y las estrategias generadas por el análisis. Variables medidas: Número de errores notificados por 10.000 días de estancia, número de errores con daño por 10.000 días de estancia, tipo, categoría en función de la gravedad, fase del proceso, colectivo que notifica y medicamentos implicados. RESULTADOS: Se multiplican por 4,6 los errores de medicación notificados -7,6 notificaciones por 10.000 días de estancia en el periodo preintervención y 36 en el postintervención-, razón de tasas de 0,21 (IC 95%: 0,11-0,39) p < 0,001. No cambian prácticamente los errores con daño o que necesitaron monitorización notificados por 10.000 días de estancia de un periodo a otro, razón de tasas: 0,77 (IC95%: 0,31-1,91) p > 0,05. Se multiplica por 17,4 la notificación de errores sin daño o potenciales por 10.000 días de estancia, razón de tasas: 0,005 (IC 95%: 0,001-0,026) p < 0,001. CONCLUSIONES: El incremento de los errores de medicación notificados en el periodo postintervención es reflejo del aumento en la motivación de los profesionales sanitarios para notificar a través de este nuevo método

OBJECTIVE: To analyze the impact of a multidisciplinary and decentralized safety committee in the pediatric management unit, and the joint implementation of a computing network application for reporting medication errors, monitoring the follow-up of the errors, and an analysis of the improvements introduced. MATERIAL AND METHODS: An observational, descriptive, cross-sectional, pre-post intervention study was performed. An analysis was made of medication errors reported to the central safety committee in the twelve months prior to introduction, and those reported to the decentralized safety committee in the management unit in the nine months after implementation, using the computer application, and the strategies generated by the analysis of reported errors. Measured variables: Number of reported errors/10,000 days of stay, number of reported errors with harm per 10,000 days of stay, types of error, categories based on severity, stage of the process, and groups involved in the notification of medication errors. RESULTS: Reported medication errors increased 4.6 -fold, from7.6 notifications of medication errors per 10,000 days of stay in the pre-intervention period to 36 in the post-intervention, rate ratio 0.21 (95% CI; 0.11-0.39) (P < .001). The medication errors with harm or requiring monitoring reported per 10,000 days of stay, was virtually unchanged from one period to the other ratio rate 0,77 (95% IC; 0,31-1,91) (P>.05). The notification of potential errors or errors without harm per 10,000 days of stay increased 17.4-fold (rate ratio 0.005., 95% CI; 0.001-0.026, P < .001). CONCLUSIONS: The increase in medication errors notified in the post-intervention period is a reflection of an increase in the motivation of health professionals to report errors through this new method

Energía dual y angioTC de carótidas: calidad, eliminación de hueso y dosis de radiación de 80/140 kV frente a 100/140 kV / Dual energy CT angiography of the carotid arteries: quality, bone subtraction, and radiation dosage using tube voltage 80/140 kV versus 100/140 kV

Objetivo: Estudiar las diferencias en la calidad de imagen vascular, la capacidad de eliminar el hueso y la dosis de radiación de la angio-TC de troncos supraaórticos con la técnica de energía dual utilizando dos diferentes potenciales del tubo. Material y métodos: Se revisaron retrospectivamente los estudios de angio-TC de troncos supraaórticos realizados a 46 pacientes con un equipo de TC de doble fuente de 128 cortes, tilizando 2 protocolos de voltaje diferente (80/140 kV y 100/140 kV). El posproceso se hizo con la herramienta «head bone removal». Las arterias se dividieron en 15 segmentos. En ellos se evaluó la calidad de los vasos y la capacidad de eliminar el hueso en imágenes multiplanares (MPR) y de proyección de máxima intensidad (MIP) con cada protocolo, analizando de forma separada los huesos trabecular y cortical. También se evaluó la dosis de radiación recibida. Resultados: Se realizaron 13 estudios con 80/140 kV y 33 con 100/140 kV, sin diferencias significativas entre los grupos en edad y sexo. Las diferencias fueron significativas en la calidad de los vasos en 4 segmentos, mayor en el grupo de 100/140 kV. También en este grupo fue mejor la eliminación automática de hueso cortical en MPR y MIP, y del trabecular en las imágenes MIP. La dosis de radiación (1,16 mSv con 80/140 kV y 1,59 mSv con 100/140 kV) fue significativamente mayor en el grupo de 100/140 kV. Conclusión: El potencial 100/140 kV incrementa la dosis de radiación, pero también mejora la calidad del estudio por segmentos arteriales y la eliminación de hueso (AU)

Objective: To study the differences in vascular image quality, bone subtraction, and dose of radiation of dual energy CT angiography of the supraaortic trunks using different tube voltages. Material and methods: We reviewed the CT angiograms of the supraaortic trunks in 46 patients acquired with a 128-slice dual source CT scanner using two voltage protocols (80/140 kV and 100/140 kV). The ‘‘head bone removal’’ tool was used for postprocessing. We divided the arteries into 15 segments. In each segment, we evaluated the image quality of the vessels and the effectiveness of bone removal in multiplanar reconstructions (MPR) and in maximum intensity projections (MIP) with each protocol, analyzing the trabecular and cortical bones separately.We also evaluated the dose of radiation received. Results: Of the 46 patients, 13 were studied using 80/140 kV and 33 with 100/140 kV. There were no significant differences between the two groups in age or sex. Image quality in four segments was better in the group examined with 100/140 kV. Cortical bone removal in MPR and MIP and trabecular bone removal in MIP were also better in the group examined with 100/140 kV. The dose of radiation received was significantly higher in the group examined with 100/140 kV (1.16 mSv with 80/140 kV vs. 1.59 mSv with 100/140 kV). Conclusion: Using 100/140 kV increases the dose of radiation but improves the quality of the study of arterial segments and bone subtraction (AU)

[Validation of a method for notifying and monitoring medication errors in pediatrics]. / Validación en pediatría de un método para notificación y seguimiento de errores de medicación.

OBJECTIVE: To analyze the impact of a multidisciplinary and decentralized safety committee in the pediatric management unit, and the joint implementation of a computing network application for reporting medication errors, monitoring the follow-up of the errors, and an analysis of the improvements introduced. MATERIAL AND METHODS: An observational, descriptive, cross-sectional, pre-post intervention study was performed. An analysis was made of medication errors reported to the central safety committee in the twelve months prior to introduction, and those reported to the decentralized safety committee in the management unit in the nine months after implementation, using the computer application, and the strategies generated by the analysis of reported errors. MEASURED VARIABLES: Number of reported errors/10,000 days of stay, number of reported errors with harm per 10,000 days of stay, types of error, categories based on severity, stage of the process, and groups involved in the notification of medication errors. RESULTS: Reported medication errors increased 4.6 -fold, from 7.6 notifications of medication errors per 10,000 days of stay in the pre-intervention period to 36 in the post-intervention, rate ratio 0.21 (95% CI; 0.11-0.39) (P<.001). The medication errors with harm or requiring monitoring reported per 10,000 days of stay, was virtually unchanged from one period to the other ratio rate 0,77 (95% IC; 0,31-1,91) (P>.05). The notification of potential errors or errors without harm per 10,000 days of stay increased 17.4-fold (rate ratio 0.005., 95% CI; 0.001-0.026, P<.001). CONCLUSIONS: The increase in medication errors notified in the post-intervention period is a reflection of an increase in the motivation of health professionals to report errors through this new method.

[Dual energy CT angiography of the carotid arteries: quality, bone subtraction, and radiation dosage using tube voltage 80/140 kV versus 100/140 kV]. / Energía dual y angioTC de carótidas: calidad, eliminación de hueso y dosis de radiación de 80/140 kV frente a 100/140 kV.

OBJECTIVE: To study the differences in vascular image quality, bone subtraction, and dose of radiation of dual energy CT angiography of the supraaortic trunks using different tube voltages. MATERIAL AND METHODS: We reviewed the CT angiograms of the supraaortic trunks in 46 patients acquired with a 128-slice dual source CT scanner using two voltage protocols (80/140 kV and 100/140 kV). The "head bone removal" tool was used for postprocessing. We divided the arteries into 15 segments. In each segment, we evaluated the image quality of the vessels and the effectiveness of bone removal in multiplanar reconstructions (MPR) and in maximum intensity projections (MIP) with each protocol, analyzing the trabecular and cortical bones separately. We also evaluated the dose of radiation received. RESULTS: Of the 46 patients, 13 were studied using 80/140 kV and 33 with 100/140 kV. There were no significant differences between the two groups in age or sex. Image quality in four segments was better in the group examined with 100/140 kV. Cortical bone removal in MPR and MIP and trabecular bone removal in MIP were also better in the group examined with 100/140 kV. The dose of radiation received was significantly higher in the group examined with 100/140 kV (1.16 mSv with 80/140 kV vs. 1.59 mSv with 100/140 kV). CONCLUSION: Using 100/140 kV increases the dose of radiation but improves the quality of the study of arterial segments and bone subtraction.

Lista modelo de medicamentos de alto riesgo / A model list of high risk drugs

Introducción: Los «medicamentos de alto riesgo» son aquellos con un «riesgo» muy elevado de causar daños graves o incluso mortales cuando se produce un error en el curso de su utilización. El Institute for Safe Medication Practices (ISMP) elaboró una relación aplicable a la población general, sin diferenciar población pediátrica y adulta, por lo que existe carencia de información para la población pediátrica. El objetivo de este trabajo es elaborar una lista de medicamentos de alto riesgo adaptada a la población pediátrica y neonatal que sirva de referencia para el personal sanitario de un hospital pediátrico. Material y métodos: Se realizó una búsqueda bibliográfica en mayo del 2012 en las principales bases de datos biomédicas, para identificar posibles listas o referencias publicadas en relación con medicamentos de alto riesgo en población pediátrica y neonatal. Resultados: Se encontraron 15 trabajos, seleccionándose 9 para el objetivo principal del estudio. Se elaboró una lista guía tomando como base la del ISMP, añadiendo fármacos con alta percepción de riesgo para la población pediátrica y eliminando aquellos cuyo uso en pediatría era anecdótico. Conclusiones: No se encontró una lista publicada que se adaptase totalmente a nuestro objetivo. La lista de medicamentos de alto riesgo en población pediátrica y neonatal elaborada puede ser modelo de referencia para hospitales pediátricos. Su conocimiento y utilización, así como actividades derivadas de la misma enmarcadas dentro de la política de seguridad, ayudará a evitar errores de medicación en cada proceso de la cadena terapéutica (prescripción, transcripción, dispensación y administración) (AU)

Introduction: «High-risk drugs» are those that have a very high «risk» of causing death or serious injury if an error occurs during its use. The Institute for Safe Medication Practices (ISMP) has prepared a high-risk drugs list applicable to the general population (with no differences between the pediatric and adult population). Thus, there is a lack of information for the pediatric population. The main objective of this work is to develop a high-risk drug list adapted to the neonatal or pediatric population as a reference model for the pediatric hospital health workforce. Material and methods: We made a literature search in May 2012 to identify any published lists or references in relation to pediatric and/or neonatal high-risk drugs. Results: A total of 15 studies were found, from which 9 were selected. A model list was developed mainly based on the ISMP one, adding strongly perceived pediatric risk drugs and removing those where the pediatric use was anecdotal. Conclusions: There is no published list that suits pediatric risk management. The list of pediatric and neonatal high-risk drugs presented here could be a «reference list of high-risk drugs » for pediatric hospitals. Using this list and training will help to prevent medication errors in each drug supply chain (prescribing, transcribing, dispensing and administration) (AU)

[A model list of high risk drugs]. / Lista modelo de medicamentos de alto riesgo.

INTRODUCTION: «High-risk drugs¼ are those that have a very high «risk¼ of causing death or serious injury if an error occurs during its use. The Institute for Safe Medication Practices (ISMP) has prepared a high-risk drugs list applicable to the general population (with no differences between the pediatric and adult population). Thus, there is a lack of information for the pediatric population. The main objective of this work is to develop a high-risk drug list adapted to the neonatal or pediatric population as a reference model for the pediatric hospital health workforce. MATERIAL AND METHODS: We made a literature search in May 2012 to identify any published lists or references in relation to pediatric and/or neonatal high-risk drugs. RESULTS: A total of 15 studies were found, from which 9 were selected. A model list was developed mainly based on the ISMP one, adding strongly perceived pediatric risk drugs and removing those where the pediatric use was anecdotal. CONCLUSIONS: There is no published list that suits pediatric risk management. The list of pediatric and neonatal high-risk drugs presented here could be a «reference list of high-risk drugs ¼ for pediatric hospitals. Using this list and training will help to prevent medication errors in each drug supply chain (prescribing, transcribing, dispensing and administration).

Neuromyelitis optica and multiple sclerosis in sisters.

INTRODUCTION: The association of neuromyelitis optica (NMO) and multiple sclerosis (MS) has been reported, but details of the cases were not described. We report two Venezuelan Caucasian sisters with human leukocyte antigen (HLA) typing. RESULTS: Patient 1 fulfilled McDonald, et al. criteria with HLA A*24; B*07,*15; DRB1*01,*16 (DR2 positive). Patient 2 fulfilled the NMO revised criteria of Wingerchuck, et al. with HLA A*02,*24; B*07,*40; DRB1*04,*08, similar to Canadian aboriginal NMO cases and the Yukpa population from Venezuela. CONCLUSION: These cases confirmed the coexistence of NMO and MS in sisters, and further studies are needed to understand the genetic linkage between these diseases.

Cribado neonatal piloto para hipotiroidismo congénito, fenilcetonuria, galactosemia y deficiencia de biotinidasa / Neonatal pilot screening for congenital hypothyroidism, phenylketonuria, galactosemia and biotinidase

El hipotiroidismo congénito (HC), la fenilcetonuria (FCU), la galactosemia (GAL) y la deficiencia de biotinidasa (DB), son enfermedades metabólicas que pueden causar retraso mental y en donde el diagnóstico temprano constituye la clave para el tratamiento exitoso. Se describen los resultados de un estudio piloto en 1.038 recién nacidos para el cribado de HC, FCU, GAL y DB usando las determinaciones de hormona estimulante del tiroides (TSH), fenilalanina (Phe), galactosa (Gal) y actividad biotinidasa en muestras de sangre seca sobre papel de filtro. Se emplearon los estuches de reactivos Umelisa TSH Neonatal y los Umtest PKU, GAL y Biotinidasa, producidos por el Centro de Inmunoensayo. Los valores promedio para la edad de toma de muestra, edad gestacional y peso al nacer fueron de 53,1 horas (EEM ñ 2,1), 39,5 semanas (EEM ñ 0,002) y 3.027,4 g (EEM ñ 6,2) respectivamente. Los valores medios obtenidos para los analitos fueron 2,8 mUI TSH/L (EEM ñ 0,004), 58,2 µmol Phe/L (EEM ñ 0,8) y 0,04 mmol Gal/L (EEM ñ 0,0004). La actividad biotinidasa fue normal en todos los casos. No se encontraron individuos enfermos, pero la caracterización de los niveles de estos marcadores revisten especial importancia en el diagnóstico precoz de estas enfermedades (AU)

Colorectal cancer: morphologic variables related with carcinoembryonic antigen serum elevation (CEA).

OBJECTIVE: The purpose of this study is to identify morphologic parameters of colorectal adenocarcinoma which may be of influence in the increase of preoperatory CEA serum levels. METHOD: This study includes 127 patients on whom colectomy was performed. Twenty-eight morphologic parameters were analyzed in each surgical specimen. Serum determinations were made by enzymatic immunoassay. A multivariate study (logistic regression analysis) was made. Independent risk factors for CEA serum elevation were Cytologic Atypia (odd ratio: 2.85) Infiltrative Growth Pattern (odd ratio: 2.91) and the presence of tumoral cell infiltration directly among adipocytes (odd ratio: 2.62). When clinical variables (age, sex, tumor location, perforation, occlusion, hepatic metastases and peritoneal carcinomatosis) were added the infiltrative growth pattern (odd ratio: 3.12) and cytologic atypia persisted as independent risk factors, together with the clinical variable Hepatic Metastases (odd ratio: 24.84). CONCLUSION: In our series the morphologic variables Infiltrative Growth Pattern and Cytologic Atypia are independently related with CEA serum increase and are not influenced by the variable Hepatic Metastases.

Does medical treatment of mild intraocular hypertension prevent glaucoma?

Glaucoma is a serious disease that may cause a decrease in peripheral vision as well as blindness. Although the treatment of extreme levels of high intraocular pressure (p > 35 mm) reduces the risk of glaucoma it is not known if the treatment of mild and moderate intraocular pressure prevents the onset of glaucoma. A bibliographic search in Medline CD-ROM was performed from 1967 to 1995, as well as in SIGLE CD-ROM. The keywords used were 'glaucoma prevention' and 'glaucoma suspects'. After the search 18 papers which treated moderate and mild intraocular pressure were selected. Of all these papers, those that used the same methodology; randomization and timolol as treatment, were chosen. The possibility of publication bias was controlled by plotting effect size vs. number of papers, as well as effect size vs. year of publication. A meta-analysis using two methods, weighted zetas and adding zetas, was performed. The combined effect size was -6.25%, and the weighted effect size was -6.45%. We computed the pooled z by two methods: adding Zs and adding weighted Zs. The Z obtained by adding Zs has a value of 2.31120 p = 0.0177, one tail). Using the method of adding weighted Zs we obtained a value of 2.4201 (p = 0.0082, one tail). Our results show that the treatment with timolol of patients with mild and moderate intraocular pressure may help to prevent the onset of glaucoma.

Receiver operating characteristic (ROC) curve analysis of the tumor markers CEA, CA 19-9 and CA 72-4 in gastric cancer.

Pre-surgery serum levels of CA 72-4, CEA and CA 19-9 were quantified by the enzyme immunoassay method in 167 patients with histological diagnosis of gastric adenocarcinoma and in 92 patients with an endoscopic diagnosis of benign gastric pathology. CA 72-4 showed a better correlation between its serum levels and the different clinical stages of the disease than CEA and CA 19-9. At the individual study of stages I-II, CA 72-4 proved positive in 36.9% of patients while CEA and CA 19-9 appeared positive in 10.8% and 8.6%, respectively. In the ROC curve, at a specificity of 95%, the sensitivities of CA 72-4, CEA and CA 19-9 were 59.8%, 21% and 26.3% respectively. The discriminatory capacity of the test (area under the ROC curve +/- SD) was 0.86 +/- 0.03 in the case of CA 72-4, 0.52 +/- 0.03 for CEA and 0.58 +/- 0.03 for CA 19-9. In conclusion, in our series and with regard to CEA and CA 19-9, CA 72-4 shows better sensitivity and discriminatory capacity. CEA and CA 19-9 do not provide significant benefits when combined with CA 72-4 due to the good results obtained with the later marker alone.