Transoral Flexible Laser Surgery of the Larynx with Blue Laser.

INTRODUCTION: Laser surgery of the larynx is currently the standard of clinical practice in a multitude of procedures. Lasers with photoangiolytic properties have a wide application in endolaryngeal lesions. One of their most prominent features is the ability to coagulate blood vessels, reducing unwanted tissue damage. Our objective is to expose the uses of the blue laser (445 nm) in the larynx. MATERIAL AND METHODS: A retrospective study was carried out including 47 patients treated with blue photoangiolytic laser from October 2021 to January 2023 at a university hospital. Demographic data, type of lesion presented, date of intervention and scope of the procedure, as well as the parameters of the laser used, were recorded. The number of sessions received per patient, the result and complications were also collected. RESULTS: A total of 47 patients with laryngeal lesions were treated, including vascular angiomas, laryngeal sulcus vocali, vocal cord polyps, Reinke's edemas, laryngeal papillomatoses, subglottic stenosis, laryngeal synechiae, subglottic granulomas, glottic scars, vocal fold leukoplakias, laryngeal dysplasias and tracheostomal granulomas. The mean age was 52.5 years, and 64.3% of the patients were women. The range of power used in the resective surgeries was 2-10 Watts with a 20-millisecond window. The average number of sessions received was 2.1 (range 1-4). A satisfactory situation was obtained in 45 of the 47 patients treated (95.75%), and an evident decrease in lesions was seen in the remaining two. There was no evidence of any complications directly derived from the use of the blue laser. Twenty-seven cases (54%) were treated exclusively in-office. CONCLUSIONS: The blue laser is safe and effective in the treatment of a wide range of laryngeal pathologies. Its advantages include its portability, its photoangiolytic qualities as well as its ability to vaporize tissue in contact mode, which can treat subepithelial vessels or resect lesions.

The Medical Science Liaison Role in Spain: Opinion of the Commercial Department Personnel.

INTRODUCTION: The Medical Science Liaison (MSL) works in a cross-functional way, especially with the commercial department. The aim of the present study was to evaluate the knowledge of these positions about the MSL role in their companies and describe the grade of internal interaction between them in daily practice. METHODS: An online survey was completed by 151 employees from commercial departments between January and April 2020. It consisted of 29 or 31 items, depending on answers. RESULTS: Of participants, 22.5% and 77.5% occupied management or non-management positions, respectively. Most respondents stated that the MSL role belongs primarily to the medical department (94.6%), considered important that promotional materials are elaborated or supported by the medical department (95.4%), highlighted the importance of sharing their daily activity with MSLs (77.8%) and vice versa (89.3%). The most valuable activity of MSLs was clinical sessions (55.3%), followed by speaker briefings (16.0%), and data discussions (14.7%). Most useful activities of MSLs for participant's day to day were external training (sessions to healthcare providers, HCPs, 34.9%), support of key opinion leaders' (KOLs) unmet needs (22.1%), and feedback from fieldwork aimed at redefining new strategies of the company (15.4%). The mean overall assessment (0-10) of the MSL was 8.1. CONCLUSION: The MSL represents a key role inside pharmaceutical and biotechnological companies, providing scientific value. The members of the commercial departments interact with the MSL on a daily basis and consider that it is a strategic position with a great future that adds value within the company.

Segundos tumores primarios y sus factores de riesgo en pacientes con tumores índice de cabeza y cuello / Second primary tumors and their risk factors in patients with primary head and neck tumors

Introducción y objetivo: El término de segundo tumor primario (STP) es utilizado para designar un nuevo cáncer primario que se presenta en una persona a la que se le ha diagnosticado un cáncer previamente. Se considera que los STP se producen de forma independiente y no como resultado de un resurgimiento o metástasis del tumor índice o primer tumor primario (PTP). El objetivo de este estudio es investigar la prevalencia, factores de riesgo, localización y tratamiento de los STP, así como el tiempo transcurrido entre la aparición de los tumores. Método: Se realiza un estudio retrospectivo descriptivo con pacientes con diagnóstico de STP entre enero del 2004 y diciembre de 2021 en el Hospital Universitario de Fuenlabrada. Se analizó la prevalencia y localización de los STP, los factores de riesgo relacionados, el tiempo entre la aparición del PTP y el STP, el tratamiento del PTP y STP y su resultado. Resultados: Del total de 360 casos del registro de tumores, 73 pacientes (20,2%) fueron incluidos en el estudio por padecer un STP. De los participantes, el 75% eran fumadores y el 46,6% bebedores. La mayor parte de estos pacientes fueron tratados quirúrgicamente. Se observó que el PTP con mayor desarrollo de STP fue el de cáncer de laringe, siendo la supraglotis la sublocalización más frecuente. El STP más frecuente fue el carcinoma epidermoide de pulmón. Conclusiones: En nuestra serie los STP aparecen en el 20% de los pacientes con tumores índice de cabeza y cuello. Son más frecuentes tras el cáncer de laringe, siendo la localización más frecuente el pulmón. Tanto el tabaco como el alcohol juegan un papel importante en su desarrollo, acortando el tiempo entre la aparición de los tumores, además de poder aparecer recidivas, persistencias y metástasis. (AU)

Introduction and objective: The term second primary tumor (SPT) is used to designate a new primary cancer that occurs in a person previously diagnosed with cancer. SPT are considered to occur independently and not as a result of a resurgence or metastasis of the index tumor or first primary tumor (FPT). The aim of this study is to investigate the prevalence, risk factors, location and treatment of STP, as well as time elapsed between tumor occurrence. Method: A retrospective descriptive study was performed including patients diagnosed with SPT between January 2004 and December 2021 at Hospital Universitario de Fuenlabrada. The prevalence and location of SPT, related risk factors, time between the onset of FPT and SPT, treatment of FPT and SPT and their outcome were analyzed. Results: From a total of 360 cases, 73 patients were included in the study because of SPT. 75% were smokers and 46.6% were drinkers. Most of these patients were treated surgically. It was observed that the FPT with the highest development of SPT was the larynx, with supraglottis being the most frequent sublocalization. The most frequent SPT was epidermoid carcinoma of the lung. Conclusions: In our series SPT appear in 20% of head and neck tumors. They are more frequent after laryngeal cancer, the most frequent location being the lung. Both tobacco and alcohol play an important role in their development, shortening the time between the appearance of tumors, in addition to the possibility of recurrence, persistence and metastasis. (AU)

Infiltración temprana en la parálisis laríngea: evolución y factores pronósticos / Early infiltration in laryngeal paralysis: course and prognostic factors

Introducción y objetivo: La parálisis de las cuerdas vocales (CCVV) es una patología prevalente e incapacitante. El objetivo principal de este estudio es comparar la recuperación de la movilidad y funcionalidad de las CCVV, así como el requerimiento de tiroplastia en dos grupos de pacientes, los que se trataron con infiltración temprana con ácido hialurónico (GIT) y los no infiltrados (GNI). Método: Estudio retrospectivo observacional. Para formar el GNI se filtró la base de datos de 715 exploraciones de parálisis laríngeas y se seleccionaron 33 pacientes que cumplieran los criterios de inclusión. Para el GIT se incluyeron a los pacientes infiltrados por parálisis laríngea en los últimos 3 años (n=22). En el GNI se analizó como medida de resultado: la recuperación de la movilidad y funcionalidad de la cuerda y la necesidad de tiroplastia. En el GIT se midió, adicionalmente, la fecha de la infiltración. Resultados: Los resultados del GIT son significativamente mejores (p=0.001) en la recuperación de la movilidad de las CCVV. Se observa una reducción no significativa (p=0.14) en la necesidad de tiroplastia en los pacientes infiltrados. Existen diferencias significativas entre los pacientes con parálisis unilateral del GNI vs GIT (p=0.009), mientras que los grupos con parálisis bilaterales no son comparables entre sí, debido al compromiso de la vía aérea que sufren los pacientes con la cuerda en posición medial. Discusión: La infiltración con ácido hialurónico proporciona el tratamiento temporal del defecto de cierre glótico con baja tasa de complicaciones, prolongando el tiempo máximo de fonación y la funcionalidad de la cuerda vocal parética, pudiendo reducir tratamientos posteriores. Se ha propuesto como un tratamiento que puede mejorar la calidad de vida del paciente. Sin embargo, es importante seleccionar adecuadamente los pacientes, ya que no todos pueden ser candidatos... (AU)

Introduction and objective: Vocal cord paralysis is a prevalent and disabling pathology. The main objective is to compare the recovery of movility and functionality of vocal cords, as well as the requirement of definitive surgery in two groups of patients: non-infiltrated group (NIG) versus early infiltration group with hyaluronic acid (EIG). Method: Retrospective observational study. To set up the NIG, we sorted the database of 715 videos labeled as “laryngeal paralysis” and selected n=33 patients who met the inclusion criteria of the study. To create the EIG, we selected patients injected with hyaluronic acid in the last 3 years (n=22). In the NIG, the following were analyzed as outcome measures: recovery of mobility and functionality of the cord and the need for thyroplasty. In the EIG, the date of infiltration was also measured. Results: The results of the EIG are significantly better (p=0,001) in terms of vocal cord mobility recovery. A non-significant reduction (p=0.14) was observed in the need for thyroplasty in injected patients. There are significant differences between patients with unilateral paralysis of the NIG vs EIG (p=0.009), while the bilateral groups are not comparable, due to the compromise of the airway suffered by patients with the cord in a medial position. Discussion: Early infiltration with hyaluronic acid provides temporary treatment of the glottic closure defect with a low rate of complications, prolonging the maximum phonation time and improving the vocal movement, which may reduce the need for subsequent treatments. It has been proposed as a treatment that can improve the patient’s quality of life. However, it is important to properly select patients, since not all may be candidates... (AU)

Future lines of research on phase angle: Strengths and limitations.

Bioelectrical impedance analysis (BIA) is the most widely used technique in body composition analysis. When we focus the use of phase sensitive BIA on its raw parameters Resistance (R), Reactance (Xc) and Phase Angle (PhA), we eliminate the bias of using predictive equations based on reference models. In particular PhA, have demonstrated their prognostic utility in multiple aspects of health and disease. In recent years, as a strong association between prognostic and diagnostic factors has been observed, scientific interest in the utility of PhA has increased. In the different fields of knowledge in biomedical research, there are different ways of assessing the impact of a scientific-technical aspect such as PhA. Single frequency with phase detection bioimpedance analysis (SF-BIA) using a 50 kHz single frequency device and tetrapolar wrist-ankle electrode placement is the most widely used bioimpedance approach for characterization of whole-body composition. However, the incorporation of vector representation of raw bioelectrical parameters and direct mathematical calculations without the need for regression equations for the analysis of body compartments has been one of the most important aspects for the development of research in this area. These results provide new evidence for the validity of phase-sensitive bioelectrical measurements as biomarkers of fluid and nutritional status. To enable the development of clinical research that provides consistent results, it is essential to establish appropriate standardization of PhA measurement techniques. Standardization of test protocols will facilitate the diagnosis and assessment of the risk associated with reduced PhA and the evaluation of changes in response to therapeutic interventions. In this paper, we describe and overview the value of PhA in biomedical research, technical and instrumental aspects of PhA research, analysis of Areas of clinical research (cancer patients, digestive and liver diseases, critical and surgical patients, Respiratory, infectious, and COVID-19, obesity and metabolic diseases, Heart and kidney failure, Malnutrition and sarcopenia), characterisation of the different research outcomes, Morphofunctional assessment in disease-related malnutrition and other metabolic disorders: validation of PhA with reference clinical practice techniques, strengths and limitations. Based on the detailed study of the measurement technique, some of the key issues to be considered in future PhA research. On the other hand, it is important to assess the clinical conditions and the phenotype of the patients, as well as to establish a disease-specific clinical profile. The appropriate selection of the most critical outcomes is another fundamental aspect of research.

Nutritional ultrasound®: Conceptualisation, technical considerations and standardisation.

Nutritional ultrasound® is a new concept that uses ultrasound to assess body composition. It is composed of the evaluation of fat-free mass and fat mass. It is an emerging, economical, portable, non-invasive technique that evaluates the musculoskeletal area with linear, broadband, multifrequency probes, with a depth field of 20-100mm. It quantifies muscle modifications in malnutrition and provides information on functional changes (echogenicity). Although there are no validated specific cut-off points, the anterior rectum area of the quadriceps can be used as a criterion for malnutrition. The distribution of adipose tissue provides information on the energy reserve and the inflammatory pattern. It is important to integrate nutritional ultrasound® measures in clinical practice adapted to different settings and pathologies. It is necessary to establish training plans in nutritional ultrasound® for use by Endocrinology and Nutrition Specialists, with the aim of improving the diagnosis and treatment of their patients.

Phase angle and COVID-19: A systematic review with meta-analysis.

Phase angle (PhA) has been identified as a poor prognostic factor in patients with COVID-19. This study aimed to achieve a systematic review, where we discussed the potential role of PhA value as a prognostic marker of adverse clinical outcomes such as mortality and complication in hospitalized with SARS-CoV2 infection and established the strength of recommendations for use. A systematic literature review with meta-analysis was done in the main electronic databases from 2020 to January 2023. The selected articles had to investigate adverse consequences of the COVID-19 population and raw bioimpedance parameters such as PhA and published in peer-reviewed journals. GRADE tools regarded the quality of the methodology. The review protocol was registered in PROSPERO. Only eight studies, 483 studies, were eligible for the analysis. In general, differences in PhA were seen between the comparative study groups. Patients with a low PhA experienced poor outcomes. A low PhA was associated with a significantly increased mortality risk [RR: 2.44; 95% CI (1.20-4.99), p = 0.01; I2 = 79% (p = 0.0008)] and higher complications risk [OR: 3.47, 95% CI (1.16 - 10.37), p = 0.03; I2 = 82% (p = 0.004)] in COVID-19 patients. Our analysis showed four evidence-based recommendations on the prognostic value of PhA with two strong recommendations, one of moderate and another of low-moderate quality, for predicting mortality and complications, respectively. We recommend using PhA as a prognostic marker for mortality and complications in this population. Although the results are promising, future studies must identify the PhA cut-off to guide therapeutic decisions more precisely.Registration code in PROSPERO: CRD42023391044.

Tratamiento quirúrgico de la patología tumoral de la glándula parótida. Estudio descriptivo de 263 parotidectomías / Surgical treatment of tumor pathology of the parotid gland. Descriptive study of 263 parotidectomies

Introducción y objetivo: Los tumores salivales representan el 3-10% de los tumores de cabeza y cuello, siendo el 75-80% de origen parotídeo y en su mayoría benignos. La parotidectomía es una técnica quirúrgica que consiste en la exéresis de la glándula parótida. Existen diversos tipos; parotidectomía superficial (PS), parotidectomía superficial parcial (PSP) y parotidectomía total (PT). En esta última, al no respetarse el nervio facial (NF), las complicaciones son más frecuentes. Nuestro objetivo es analizar el resultado (tasa de recidiva y complicaciones) de la parotidectomía como técnica quirúrgica empleada en el manejo de la patología parotídea, así como evaluar qué prueba complementaria es la más eficaz en el diagnostico prequirúrgico de la patología parotídea tumoral. Material y método: Se realiza un estudio retrospectivo incluyendo 263 pacientes tratados mediante PS o PT entre enero de 2004 y diciembre de 2020 en el Hospital Universitario de Fuenlabrada. Se registraron datos demográficos, tiempo de evolución de la lesión, pruebas complementarias, protocolo quirúrgico y complicaciones postoperatorias. Se analiza principalmente la correlación positiva entre las pruebas realizadas prequirúrgicas (PAAF, ecografía, TC y RMN), con el diagnóstico definitivo anatomopatológico obtenido tras examinar la pieza quirúrgica. También se describe la tasa de paresia y parálisis facial y otras complicaciones habidas. Resultados: Se incluyeron 263 pacientes tratados mediante parotidectomía. El tiempo de evolución medio de las lesiones parotídeas fue de 15 meses (DE 19.88). La sensibilidad de la PAAF en nuestro estudio fue de 68.7%. Se realizó ecografía en un 44.10% de los pacientes, TC en un 77.94% y RMN en un 15.20%, mostrando una sensibilidad de 18.05%, 31.21% y 45%, respectivamente. (AU)

Introduction and objetive: Salivary tumors account for 3-10% of head and neck tumors, 75-80% being of parotid origin and mostly benign. Parotidectomy is a surgical technique that consists of exeresis of the parotid gland. There are various types; Superficial parotidectomy (PS), partial superficial parotidectomy (PSP), and total parotidectomy (PT). In the latter, since the facial nerve (FN) is not spared, complications are more frequent. Our objective is to analyze the outcome (recurrence rate and complications) of parotidectomy as a surgical technique used in the management of parotid pathology, as well as to evaluate which complementary test is the most effective in the pre-surgical diagnosis of tumorous parotid pathology. Material and methods: We performed a retrospective study including 263 patients treated by SP or TP between January 2004 and December 2020 at the Fuenlabrada University Hospital. Demographic data, time of lesion evolution, complementary tests, surgical protocol and postoperative complications were recorded. The positive correlation between the pre-surgical tests performed (Fine needle aspiration (FNA), ultrasound, CT and MRI) and the definitive anatomopathological diagnosis obtained after examining the surgical specimen is analyzed. The rate of paresis/facial paralysis and other complications is also described. Results: We included 263 patients treated by parotidectomy. (AU)

Rectus Femoris Muscle and Phase Angle as Prognostic Factor for 12-Month Mortality in a Longitudinal Cohort of Patients with Cancer (AnyVida Trial).

BACKGROUND: Cancer-related malnutrition is still unrecognized and undertreated in clinical practice. The morphofunctional assessment of disease-related malnutrition (DRM) is a new approach that focuses on evaluating changes in body composition and function. The aim of this study is to evaluate the prognostic value of classic and emerging assessment of malnutrition at 12-months survival in cancer patients. METHODS: We conducted a prospective study on cancer outpatients. Bioelectrical impedance with phase angle (PhA), nutritional ultrasound by rectus femoris cross-sectional area (RFCSA), hand grip strength, and "Timed Up and Go Test" (TUG) were evaluated as predictors of mortality. RESULTS: Fifty-seven patients were included. The non-survivors had lower PhA values than the survivors (4.7° vs. 5.4°; p < 0.001), and we had the same results with RFCSA 2.98 cm2/m2 vs. 4.27 cm2/m2 (p = 0.03). Cut-off points were identified using the ROC (receiver operating characteristic) curves for PhA (≤5.6° cancer patients, ≤5.9° men, ≤5.3° women), RFCSA (≤4.47 cm2/m2 cancer patients, ≤4.47° men, ≤2.73° women) and rectus femoris-Y-axis (RF-Y-axis; ≤1.3 cm cancer patients, ≤1.06 men, ≤1 women). In multivariate logistic regression analysis, we found that high PhA was significantly associated with a lower mortality hazard ratio (HR: 0.42 95% CI: 0.21-0.84, p = 0.014). Likewise, high RFCSA was associated with a decrease in mortality risk in the crude model (HR: 0.61 95% CI: 0.39-0.96, p = 0.031). This trend was also maintained in the adjusted models by the confounding variables. CONCLUSIONS: Low PhA and RFCSA values are significant independent predictors of mortality in cancer patients. These cut-off points are clinical data that can be used for nutritional assessment and the prediction of clinical outcomes.

Expert Consensus on Morphofunctional Assessment in Disease-Related Malnutrition. Grade Review and Delphi Study.

Disease-related malnutrition (DRM) affects approximately a third of hospitalized patients and is associated with an increased risk of morbimortality. However, DRM is often underdiagnosed and undertreated. Our aim is to evaluate the prognostic value of morphofunctional tools and tests for nutritional assessment in clinical practice. A systematic literature review was conducted to identify studies relating to the morphofunctional assessment of nutritional status and mortality or complications. Evidence was evaluated using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) method. Twelve GRADE recommendations were made and divided into seven topics: food intake and nutrient assimilation, anthropometry, biochemical analysis, hand grip strength, phase angle, muscle imaging, and functional status and quality of life. From these recommendations, 37 statements were developed and scored in a two-survey Delphi method by 183 experts. A consensus was reached on accepting 26/37 statements. Surveys had high internal consistency and high inter-rater reliability. In conclusion, evidence-based recommendations were made on the prognostic value of morphofunctional assessment tools and tests to assess malnutrition, most of which were found to be feasible in routine clinical practice, according to expert opinions.

Estudio descriptivo del proceso de preparación de sistemas personalizados de dosificación en una farmacia comunitaria rural / A descriptive study on the provision of multi compartmental compliance aids in a rural community pharmacy

Introducción: el aumento de patologías crónicas en edades avanzadas conlleva un elevado grado de polimedicación, entendido como el consumo simul-táneo de cinco o más medicamentos. La polimedi-cación aumenta el riesgo de problemas relaciona-dos con los medicamentos (PRM). Puede provocar la aparición de resultados negativos asociados a la medicación y una disminución en la adherencia terapéutica, que se acentúa en el ámbito rural don-de la población está especialmente envejecida. Los sistemas personalizados de dosificación (SPD) son una buena herramienta para solventar esta situa-ción. Su preparación se basa en procedimientos normalizados de trabajo (PNT) y documentos de buenas prácticas.Método: hemos realizado una adaptación de un PNT incidiendo en puntos clave como el estudio detallado de la farmacoterapia y la posibilidad de fraccionamiento y reacondicionamiento, incluyendo una revisión del uso de la medicación y la realiza-ción de un estado de situación. Con la información obtenida, hemos valorado la existencia de PRM.Resultados: de los pacientes adscritos al servicio, la mayoría eran mujeres mayores de 75 años y polimedicadas. Las patologías más prevalentes fueron hipertensión arterial, hipercolesterolemia y diabetes. Casi el 80% de los pacientes tenían al menos una pauta irregular en sus tratamientos. Menos del 5% de formas farmacéuticas no pudie-ron ser finalmente reacondicionadas. Se detectaron 77 PRM, destacando el aumento de probabilidad de efectos adversos por asociación de fármacos. La adherencia se incrementó del 28.2% al 79.5% después de seis meses.Conclusiones: la preparación de SPD es un servi-cio complejo, sistemático e individualizado que ha permitido una mejora sustancial en la adherencia. (AU)

Introduction: the high prevalence of chronic di-seases in older ages frequently leads to the simul-taneous intake of five or more drugs, a condition known as polymedication. This results in a higher risk of drug-related problems, which can cause negative outcomes associated with medication and a decrease in therapeutic adherence. This fact is noteworthy in rural areas where the population is particularly aged. Compliance aids system, elabo-rated according to specific working protocols and standards, can be a suitable tool to address this issue.Method: we have adapted our regional working pro-tocol by focusing on the analysis of the pharmaco-therapy, pharmaceutical dosage form splitting and stability, including and initial medication review and assessment of the patient. Medication and drug-re-lated problems were also assessed according to this procedure.Results: most of the ascribed patients were poly-medicated women over 75 years of age. Hyper-tension, hypercholesterolemia, and diabetes were found to be the most prevalent pathologies, while 80% of the patients were taking, at least, one drug at irregular dosing intervals. Less than 5% of the prescribed dosage forms were not suitable for reconditioning in compliance aids systems. We detected 77 drug-related problems, adverse drug reactions being the most frequently recorded. The-rapeutic adherence increased from 28.2% to 79.5% after six months.Conclusions: compliance aids system elaboration is a complex process, which should be individuali-zed for each patient. These devices may be useful to improve therapeutic adherence in polymedicated aged patients. (AU)

Sistemas personalizados de dosificación en el seguimiento del paciente diabético: problemas relacionados con medicamentos originados por excipientes / Monitored Dosage Systems in Diabetic Patients Follow-Up: Drug Related Problems Due to Excipients

C. es una paciente polimedicada frágil de 83 años incluida en nuestro servicio de sistemas personali-zados de dosificación (SPD). Su control glucémico no es adecuado, por lo que su endocrino modifica el tratamiento antidiabético oral e inicia insulinote-rapia. Se consigue mejorar el control de su gluce-mia gracias al nuevo tratamiento. Días después, a causa de una infección respiratoria, su médico de atención primaria (MAP) le prescribe Dextrome-torfano (Romilar®) 3 mg/ml jarabe y Cefuroxima (Zinnat®) 500 mg granulado para suspensión oral. Debido al reciente problema del control glucémico decidimos revisar el contenido en azúcares simples de ambas presentaciones en el momento de la dis-pensación. Según la posología prescrita, la paciente podría llegar a ingerir 50 g de sacarosa al día con este tratamiento. Se opta por intervenir proponien-do un cambio en la forma farmacéutica del anti-biótico prescrito. En el caso del antitusivo, que no precisa prescripción médica, se aplica el protocolo de indicación farmacéutica: dispensamos en su lugar Dextrometorfano (Normotus®) 2mg/ml jarabe (cuya formulación no incluye sacarosa) y realiza-mos el correspondiente ajuste en la posología. El servicio SPD no solo mejora la adherencia terapéu-tica, sino que nos aporta conocimientos relevantes de la situación clínica del paciente y constituye una valiosa herramienta para la detección y el abordaje de problemas relacionados con los medicamentos (PRM).(AU)

C. is a 83-year-old fragile patient included in our monitored dosage system (MDS) service. Due to an inappropriate glycemic control, her oral antidia-betic medication was recently modified and insulin therapy was started. Two weeks later, glycemic control showed a notorious improvement. Today, she has been prescribed new medication for treat-ing a respiratory infection: an antitussive solution and an antibiotic powder for oral suspension. Since we are aware of the recent hyperglycemic issue, we decided to check the simple sugars content of the new prescriptions before dispensation. According to technical information, C. would take 50 g of sac-charose per day with both medicines. We conduct-ed an intervention proposing her doctor a pharma-ceutical dosage form change, recommending the prescription of coated tablets instead of powder. As far as the antitussive is concerned, we selected a sugar free dextromethorphan solution following our standard indication service algorithms. MDS service provides important information regarding patient therapy and it is a valuable tool to detect drugs related problems (DRP).(AU)

Morphofunctional assessment of patient's nutritional status: a global approach / Evaluación morfofuncional del estado nutricional de los pacientes: un nuevo enfoque

Disease-related malnutrition represents an imbalance between the intake and the requirements of energy and nutrients. It produces a series of metabolic and functional changes in the body. There are multiple limitations in the classic parameters for nutrition assessment including body mass index, weight loss, food intake, or standard laboratory parameters such as albumin or lymphocytes. We can establish some points of interest in this new approach to nutrition focused on the assessment of nutritional status by evaluating changes in composition and function using parameters such as PhA and other electrical measurements of bioimpedance, dynamometry, functional tests, muscle ultrasound, or laboratory parameters such as CRP/prealbumin.Each of these parameters has a number of uses and limitations that should be understood when evaluating its ability to diagnose malnutrition as related to disease, its concordance with other tests, and its prognostic value. Emerging nutritional param­eters for future use should be sensitive, specific, and interrelated to allow a better understanding of each patient's status at different time points during their disease. (AU)

La malnutrición relacionada con la enfermedad representa un disbalance entre el aporte y los requerimientos de energía y nutrientes, que produce una serie de cambios metabólicos y funcionales a nivel corporal. Existen múltiples limitaciones de los parámetros clásicos de valoración nutricional, como el índice de masa corporal, la pérdida de peso, la ingesta o los parámetros analíticos clásicos, como es el caso de la albúmina o los linfocitos. Sugerimos un nuevo enfoque de la nutrición clínica centrado en la valoración del estado nutricional del paciente evaluando los cambios de composición y función con nuevos parámetros como el ángulo de fase y otras medidas eléctricas de la bioimpedanciometría, la ecografía nutricional©, los nuevos parámetros analíticos como el cociente PCR/prealbúmina, la dinamometría o los test funcionales.Cada uno de estos parámetros tiene una serie de utilidades y limitaciones que es importante conocer a la hora de evaluar su capacidad de diagnosticar la desnutrición relacionada con la enfermedad, la concordancia con otros tests y su valor pronóstico. La nueva visión global de la nutrición clínica debería integrar diferentes aspectos de composición y función del organismo para poder establecer un diagnóstico más preciso de la situación nutricional y un plan terapéutico individualizado. Los parámetros nutricionales emergentes deben ser sensibles y específicos, y estar relacionados entre sí, de forma que permitan un mejor conocimiento de la situación particular de cada paciente en los diferentes momentos evolutivos de su proceso patológico. (AU)

Morphofunctional assessment of patient´s nutritional status: a global approach.

INTRODUCTION: Disease-related malnutrition represents an imbalance between the intake and the requirements of energy and nutrients. It produces a series of metabolic and functional changes in the body. There are multiple limitations in the classic parameters for nutrition assessment including body mass index, weight loss, food intake, or standard laboratory parameters such as albumin or lymphocytes. We can establish some points of interest in this new approach to nutrition focused on the assessment of nutritional status by evaluating changes in composition and function using parameters such as PhA and other electrical measurements of bioimpedance, dynamometry, functional tests, muscle ultrasound, or laboratory parameters such as CRP/prealbumin. Each of these parameters has a number of uses and limitations that should be understood when evaluating its ability to diagnose malnutrition as related to disease, its concordance with other tests, and its prognostic value. Emerging nutritional parameters for future use should be sensitive, specific, and interrelated to allow a better understanding of each patient's status at different time points during their disease.

INTRODUCCIÓN: La malnutrición relacionada con la enfermedad representa un disbalance entre el aporte y los requerimientos de energía y nutrientes, que produce una serie de cambios metabólicos y funcionales a nivel corporal. Existen múltiples limitaciones de los parámetros clásicos de valoración nutricional, como el índice de masa corporal, la pérdida de peso, la ingesta o los parámetros analíticos clásicos, como es el caso de la albúmina o los linfocitos. Sugerimos un nuevo enfoque de la nutrición clínica centrado en la valoración del estado nutricional del paciente evaluando los cambios de composición y función con nuevos parámetros como el ángulo de fase y otras medidas eléctricas de la bioimpedanciometría, la ecografía nutricional©, los nuevos parámetros analíticos como el cociente PCR/prealbúmina, la dinamometría o los test funcionales. Cada uno de estos parámetros tiene una serie de utilidades y limitaciones que es importante conocer a la hora de evaluar su capacidad de diagnosticar la desnutrición relacionada con la enfermedad, la concordancia con otros tests y su valor pronóstico. La nueva visión global de la nutrición clínica debería integrar diferentes aspectos de composición y función del organismo para poder establecer un diagnóstico más preciso de la situación nutricional y un plan terapéutico individualizado. Los parámetros nutricionales emergentes deben ser sensibles y específicos, y estar relacionados entre sí, de forma que permitan un mejor conocimiento de la situación particular de cada paciente en los diferentes momentos evolutivos de su proceso patológico.

Riesgos del tratamiento crónico con ácido acetilsalicílico: comparación entre las prescripciones en prevención primaria y secundaria de enfermedades cardiovasculares / Risks of chronic acetylsalicylic acid use: a comparison between primary vs. secondary prevention of cardiovascular disease prescriptions

INTRODUCCIÓN: El ácido acetilsalicílico (AAS) es el antiagregante de elección en el tratamiento de la enfermedad cardiovascular. Sus beneficios en prevención secundaria (PS) han sido claramente demostrados, pero existe controversia en su uso en prevención primaria (PP): los riesgos de sufrir eventos adversos, principalmente hemorragias, pueden superar a los beneficios potenciales del tratamiento. El farmacéutico dispone de las herramientas apropiadas para la detección de problemas relacionados con los medicamentos (PRMs) tanto en PP como en PS. OBJETIVOS: Estimar la proporción de PP vs. PS en tratamientos con AAS. Evaluar el riesgo hemorrágico y otros PRMs en ambos casos. MÉTODOS: Estudio observacional y prospectivo en dos farmacias comunitarias. Se registraron las prescripciones de AAS, variables demográficas y farmacoterapéuticas del paciente. Cada prescripción se asignó a PP o PS según la existencia de enfermedad cardiovascular (ECV) previa. Los PRMs se evaluaron con BOT Plus Web(R). RESULTADOS: 82 dispensaciones de AAS válidas, 47 (57%) correspondían a PP y 35 (43%) a PS. Se encontró asociación estadística entre las variables PP y diabetes. Se detectaron 67 PRMs de los que el 80% (53) suponían un aumento del riesgo hemorrágico. No se apreciaron diferencias significativas para el aumento de riesgo hemorrágico entre PP o PS. CONCLUSIONES: Encontramos mayor prevalencia de prescripción para el tratamiento crónico con AAS en PP que en PS. Observamos asociación entre PP y diabetes y entre PS y total de PRMs. No se encuentra asociación entre el aumento de riesgo hemorrágico y PP o PS

INTRODUCTION: Acetyl salicylic acid (AAS) is the antiplatelet drug of choice for long-term treatment of cardiovascular disease. The benefits in secondary prevention (SP) have been thoroughly demonstrated, although it remains unclear whether these benefits may be offset by bleeding complications in primary prevention (PP). Community pharmacist can detect and solve drug related problems (DRPs) involving both SP and PP treatments. OBJECTIVES: To assess PP vs. SP prescription ratio for AAS. To evaluate and analyze DRPs, specially bleeding risk, in both cases. METHODS: It was carried out an observational and cross-sectional study in two community pharmacies. Demographic and therapeutical variables were recorded for each AAS treatment. Prescriptions were assigned to PP or PS group on the basis of previous cardiovascular disease record. DRPs were evaluated using BOT Plus web(R). RESULTS: 82 AAS treatments were recorded. 47 (57%) were PP and 35 (43%) PS. Statistically significant association between PP and diabetes was found. 67 DRPs were recorded, 53 (80%) being related with a higher bleeding risk. As far as bleeding risk is concerned, there was no statistically significant difference between PP and SP in our data. CONCLUSIONS: Long-term treatments with AAS were mainly PP. We found statistically significant association between PP and diabetes and between SP and total DRPs. Nevertheless, no statistically significant differences for bleeding risk between PP and SP were found

Nuevo enfoque de la nutrición. Valoración del estado nutricional del paciente: función y composición corporal / A new nutritional approach. Assessment of the patient's nutritional status: function and body composition

La malnutrición puede considerarse un disbalance entre el aporte y los requerimientos de energía y nutrientes que produce una serie de cambios metabólicos y funcionales a nivel corporal. Existen múltiples limitaciones en los parámetros clásicos de valoración nutricional como índice de masa corporal, pérdida de peso, ingesta o parámetros analíticos clásicos como albúmina o linfocitos. Podemos establecer algunos puntos básicos de interés en este nuevo enfoque de la nutrición centrado en la valoración del estado nutricional del paciente evaluando los cambios de composición y función con nuevos parámetros como el ángulo de fase y otras medidas eléctricas de la bioimpedanciometría, dinamometría, test funcionales, ecografía muscular o nuevos parámetros analíticos como PCR/prealbúmina. Cada uno de estos parámetros tiene una serie de utilidades y limitaciones que es importante conocer a la hora de evaluar los resultados de los mismos. La nueva visión global de la nutrición debe integrar diferentes aspectos de composición y función del organismo para poder establecer un diagnóstico más preciso de la situación nutricional y un plan terapéutico individualizado. Los parámetros nutricionales avanzados del futuro deben ser sensibles y específicos, relacionados entre sí, de forma que permitan un mejor conocimiento de la situación particular de cada paciente en diferentes momentos evolutivos de su proceso patológico

Malnutrition can be considered a mismatch between the intake and the requirements of energy and nutrients. It produces a series of metabolic and functional changes to the body. There are multiple limitations to the classic parameters of nutrition assessment, as body mass index, weight loss, intake or standard analytical parameters, such as albumin or lymphocytes. We can establish some points of interest in this new approach to nutrition focused on the assessment of the nutritional status of the patient by evaluating changes in composition and function with new parameters such the phase angle and other electrical measurements of bioimpedance, dynamometry, functional test, muscle ultrasound or new analytical parameters such as PCR/prealbumin. Each of these parameters has many utilities and limitations that are important to know when evaluating the results. Advanced nutritional parameters of the future must be sensitive and specific, interrelated, so as to allow a better understanding of the particular situation of each patient in different moments of their disease

Leprosy ulcers in a rural hospital of Ethiopia: pattern of aerobic bacterial isolates and drug sensitivities.

BACKGROUND: Plantar ulcers, which commonly occur in leprosy patients, tend to recur increasing physical disability. The aim of this study is to identify both the bacteriological profile of these ulcers and the antibiotic susceptibility of the isolated bacteria. MATERIALS AND METHODS: 68 leprosy patients with chronic ulcers attending the in-patient department of Gambo General Hospital, West Arsi, were included in this study. Proper sample collection, inoculation on culture media, and final identification using biochemical methods were undertaken. RESULTS: 66 patients (97.1%) had a positive culture. A total of 81 microorganisms were isolated. Multiple organisms (two or more) were isolated in 15 (22.7% out of positive culture) patients. The main isolation was Proteus spp (30.9%), followed by Escherichia coli (21.0%), Staphylococcus aureus (18.5%) and Pseudomonas aeruginosa (9.9%). In the total number of the isolated bacteria, the antibiotics with less resistance were gentamicin (18.5%), fosfomycin (22.2%) cefoxitin (24.7%), ceftriaxone (25.9%) ciprofloxacin (25.9%), and amoxicillin-clavulanic acid (28.49%). CONCLUSION: The bacteriological study of plantar ulcers of leprosy patients revealed Enterobacteriaceae and S. aureus as the main pathogens involved in such infections. The results of this study may guide empirical therapy in a rural area hospital where culture and susceptibility testing facilities are scarce.