[Patient safety in psychiatric hospitalization - What incidents are reported and managed?] / Qué se notifica y gestiona en seguridad del paciente en hospitalización psiquiátrica.

INTRODUCTION: Reporting and management systems monitoring patient safety incidents (PSIs) facilitate the understanding of mechanisms of action and allow work on improvement activities to minimise their occurrence. In our country, little is known about the adverse effects of healthcare during psychiatric hospitalisation (PH). The aim of this study is to determine the occurrence and characteristics of the PSIs, as well as the improvement actions resulting from them, in the PH services being offered at the Parc Sanitari Sant Joan de Deu (an institution specialized in mental healthcare). MATERIAL AND METHOD: An observational, descriptive, and cross-sectional study was conducted, covering the period 2013-2016. Analysis was made of the PSIs reported in the following areas of PH: acute and sub-acute (ASA), and medium and long-term stay (MLS). The following variables were identified: number, type and level of harm resulting from the PSIs, professional category of the person declaring the PSI, method of analysis used to investigate the PSI, and improvement actions generated by those PSIs that required either root-cause analysis or audit reports. The chi-squared test was used for statistical purposes when comparing percentages. RESULTS: A total of 2,940 PSIs were reported. The frequency in ASA was significantly higher (7.1 per 1,000 stays) than in MLS (5.3). Almost all (97.6%) of the incidents were related to falls, aggressive and/or disturbed behaviour, mind-altering drugs, self-harm, medication, dangerous objects, and patients escaping. PSIs recording moderate or severe harm were similar in the 2 different areas (16.5% in ASA vs. 14.2% in MLS). A small percentage (1.02%) of the PSIs resulted in root cause analysis or audit reporting, due to their severity, and from those incidents, 56 improvement actions were generated. CONCLUSIONS: PH demonstrates its own characteristics with regard to the type of PSIs and differs from general hospitalisation. Reporting of PSIs is higher in ASA than in MLS, although the level of harm experienced by the patients is similar. There is a clear understanding of reporting in PH, demonstrated by the steady increase in the numbers declared and also highlights the high level of awareness of the nursing staff.

Influencia del concentrado de plaquetas sobre la reconstrucción de defectos de cartílago articular en la rodilla de cordero / Influence of concentrated platelets on the reconstruction of cartilage defects in the lamb knee joint

Objetivo. Analizar el efecto de las plaquetas sobre el crecimiento de cartílago en los defectos articulares provocados en la rodilla ovina. Material y método. Se provocó un defecto de 4mm de diámetro y 3mm de profundidad en la tróclea femoral de ambas rodillas en corderos macho de 6 meses de edad. La distribución de los grupos fue: grupo A (n=6): el defecto de la rodilla derecha se rellenó con concentrado de plaquetas 5min después de ser activado con ClCa. Grupo B (n=6): el defecto se rellenó con colágeno y plaquetas. Material y método. Las plaquetas se obtuvieron por centrifugación de 10ml de sangre arterial obtenida de cada animal antes de la cirugía. En los defectos de la rodilla izquierda no se administraron plaquetas. Las ovejas fueron sacrificadas 10 semanas después de la cirugía. Se realizaron estudios macro y microscópicos. Resultados. En el grupo A, se observó cartílago hialino en 4 de los defectos de la rodilla derecha a las 10 semanas de la cirugía. Ninguno de los defectos de la rodilla izquierda mostró crecimiento de cartílago hialino. En el grupo B, no se observó cartílago hialino en nigún defecto. No obstante, todos los defectos presentaron mejor celularidad condral y menor fibrosis en los defectos tratados con plaquetas que en los no tratados. Conclusiones. Esta técnica para la reconstrucción con plaquetas de defectos articulares de oveja ha mostrado en nuestro estudio resultados esperanzadores que empeoran combinadas con un andamiaje de colágeno (AU)

Objective. To study the influence of platelets on cartilage growth in articular defects in the sheep knee. Material and methods. Male Rasa Aragonesa sheep (6 months) were operated under general anaesthesia. A 4mm diameter and 3mm deep defect was made in the femoral trochlea in both knees. The right knee defect was filled with platelet concentrate 5min after being activated with ClCa in group A (n=6), and similarly activated platelets + collagen scaffold in group B (n=6). Platelets were obtained by centrifuging 10ml arterial blood from the sheep prior to the surgical procedure. The left knee defect was not filled. The sheep were sacrificed 10 weeks after surgery. Macroscopic and microscopic studies were performed. Results. In group A, hyaline cartilage was observed in the right knee defect at the end of the experiment in four cases. None of the defects of the left knees showed hyaline cartilage growth. In group B, hyaline cartilage was not observed in any right knee defect. However, in group B, all sheep showed better chondral cellularity and regeneration and lower fibrosis in the defects treated with platelets than in non-treated ones. Conclusions. This technique for articular defect reconstruction with platelets has shown satisfactory results in our study. However, collagen scaffolds may decrease this positive effect (AU)

[Methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism in ischemic vascular disease]. / Polimorfismo C677T del gen de la metilentetrahidrofolato reductasa (MTHFR) en la patología isquémica vascular.

AIM: Genetic and metabolism of C677T methylenetetrahydrofolate reductase (MTHFR) mutation and its relationship with ischemic vascular disease are revised. DEVELOPMENT: Homocygotes for C677T MTHFR mutation, 10-15% of general population, develop a thermolabil variant of the MTHFR enzyme which has a reduced functional activity. Because of this lower activity, is more likely for these patients to have mild hyperhomocysteinemia, a potential vascular risk factor, through their lives. A correct intake of folates and group B vitamins can help to compensate this genetic trend caused by the mutation. CONCLUSION: Molecular finding of C677T MTHFR mutation allow us to identify a part of population with a potential risk factor for ischemic vascular disease, with the advantage that is an easily revertible factor by modulation of the diet.

Polimorfismo C677T del gen de la metilentetrahidrofolato reductasa (MTHFR) en la patología isquémica vascular / Methylenetetrahydrofolate reductase (mthfr) c677t polymorphism in ischemic vascular disease

Objetivo. Se analizan las características genéticas y metabólicasde la mutación C677T del gen de la metilentetrahidrofolatoreductasa (MTHFR) y su relación con la enfermedad isquémicavascular a través de una revisión de la bibliografía. Desarrollo.Los homocigotos para la mutación C677T MTHFR, que constituyenel 10-15% de la población general, desarrollan una variedadtermolábil de la enzima MTHFR con una actividad funcional reducida,que hace que tengan una tendencia sostenida a lo largo de suvida a padecer hiperhomocisteinemia moderada, que es candidataa ser un factor de riesgo vascular. El aporte adecuado de folatos yvitaminas del grupo B contribuye a revertir el condicionamientogenético que sobre el metabolismo de los folatos y de la metioninadetermina la mutación. Conclusión. La determinación molecularde la mutación C677T MTHFR permitirá identificar a un gruponotable de la población con tendencia a desarrollar un factor deriesgo potencial y fácilmente prevenible

Aim. Genetic and metabolism of C677T methylenetetrahydrofolate reductase (MTHFR) mutation and its relationshipwith ischemic vascular disease are revised. Development. Homocygotes for C677T MTHFR mutation, 10-15% of generalpopulation, develop a thermolabil variant of the MTHFR enzyme which has a reduced functional activity. Because of thislower activity, is more likely for these patients to have mild hyperhomocysteinemia, a potential vascular risk factor, throughtheir lives. A correct intake of folates and group B vitamins can help to compensate this genetic trend caused by the mutation.Conclusion. Molecular finding of C677T MTHFR mutation allow us to identify a part of population with a potential risk factorfor ischemic vascular disease, with the advantage that is an easily revertible factor by modulation of the diet

[Prevalence of methylenetetrahydrofolate reductase C677T mutation among patients with acute ischemic cerebrovascular disease in Aragon]. / Prevalencia de la mutación C677T del gen de la metilentetrahidrofolato reductasa en pacientes con patología isquémica cerebrovascular aguda en la Comunidad Autónoma Aragonesa.

BACKGROUND: Mutation C677T of the methylenetetrahydrofolate reductase (MTHFR) is the main cause of mild hyperhomocysteinemia. Hyperhomocysteinemia is a recognized risk factor for aterothrombosis. MTHFR C677T patients have higher levels of homocysteine in absence of dietary folates. METHODS: Retrospective study over data from patients studied for MTHFR C677T diagnosed of ischemic stroke (IS) younger 50 or older 50 without classic vascular risk factors or with familiar or personal history suggesting thrombophilia in a period of 3 years. MTHFR C677T was screened in 90 healthy blood donors as a control group. Computer database was used for descriptive statistics. RESULTS: Blood samples from 99 patients and from 90 donors (control). Mean age: 44.3 with Standard deviation (SD) 13.9 years in IS group and 39.1 with SD 8.3 years in control group. We found 19 (19.19%) homozygotes for MTHFR C677T in IS group and 14 (15.55%) in control group. CONCLUSIONS: Homozygosis for MTHFR C667T is more frequent in the IS group than in the control one, although there is no significant differences. Anyway, we suggest that, because of the high prevalence of the mutation MTHFR C677T found, screening should be made in the thombophilia studies, so that we could find patients with a risk factor that could be lowered by folates in the diet.

[Acquired and inherited hypercoagulability among patients with cerebral venous thrombosis]. / Hipercoagulabilidad hereditaria y adquirida en pacientes con trombosis venosa cerebral.

BACKGROUND: Cerebral venous thrombosis (CVT) is considered to be a relative unusual pathology, probably underdiagnosed. Many acquired and inherited hypercoagulability states (HS) have been described as cause of CVT. OBJECTIVE: [corrected] We evaluated the incidence of acquired and inherited thrombophilic risk factors in a population of CVT patients. METHODS: Hypercoagulability studies were to carried out for patients suffering from radiologically confirmed CVT during a 3 year period (1998-2000). Prothrombin time, aPTT, protein C, protein S and antithrombin III activities, screening and confirmatory tests for lupus anticoagulant (LA), and activated protein C resistance (APCR) were tested. Genetic tests for G1691A factor V (Factor V Leiden), G20210A prothrombin and C677T methylentetrahidrofolate reductase (MTHFR) were performed. Computer database was used for descriptive statistics. RESULTS: 16 patients with CVT (M/F, 6/10) were screened for inherited and acquired coagulation disorders. Mean age of 23.66 years with standard desviation of 19.74 years. Two older patients had antecedents of thrombosis (ischemic stroke and deep-vein thrombosis in leg). We found 1 heterocygosis factor V Leiden associated to LA, 2 heterocygosis G20210A prothrombin (one associated to LA), 2 homocygosis C677T MTHFR, 1 hereditary antithrombin III deficiency and 4 LA. COMMENTS: Although this is a small series, we found a high incidence of hereditary (37.5%) and acquired (37.5%) thrombophilia in patients with CVT.

Hipercoagulabilidad hereditaria y adquirida en pacientes con trombosis venosa cerebral / Acquired and inherited hipercoagulability among patients with cerebral venous thrombosis

FUNDAMENTO: La trombosis venosa cerebral (TVC) se considera una afección relativamente infrecuente, aunque es probable que se encuentre infradiagnosticada. OBJETIVO: Con el propósito de valorar la contribución de los síndromes de hipercoagulabilidad (SHC) hereditarios y adquiridos al desarrollo de la TVC, realizamos este estudio en pacientes con dicha enfermedad. MÉTODOS: Se realizó estudio de SHC a todos los pacientes diagnosticados de TVC en los últimos 3 años. Se determinaron el tiempo de Quick, el tiempo de cefalina, la actividad de las proteínas S y C, la actividad de la antitrombina III, el escrutinio y test confirmatorio de anticoagulante lúpico (AL), la resistencia a la proteína C activada (RPCA) y el fibrinógeno. Se realizaron pruebas genéticas para las mutaciones G1691A del factor V (factor V Leiden), G20210A de la protrombina y C677T de la metilentetrahidrofolato reductasa (MTHFR). Se llevó a cabo una estadística descriptiva basada en datos informatizados. RESULTADOS: Se recogieron muestras de 16 pacientes (6 varones y 10 mujeres) con una media de edad de 23,66 ñ 19,74 años (rango, 2-71 años). Los 2 pacientes mayores tenían antecedentes de trombosis (TVP y ACVA). Encontramos un caso de heterocigosis del factor V Leiden con AL; 2 heterocigosis G20210A de la protrombina (una de ellas asociada a AL); 2 homocigosis C677T de la MTHFR; un déficit congénito de antitrombina III (AT III) y 4 AL. CONCLUSIONES: Si bien la muestra es reducida, se encontró una notable incidencia de SHC de causa hereditaria (37,5 per cent) y adquirida (37,5 per cent) en pacientes con TVC. (AU)

Eritropoyetina y cirugía de cadera a un testigo de Jehová anémico con espondilitis anquilopoyética, hepatopatía crónica y enfermedad de Crohn / Erythropoietin and hip surgery in a Jehová´s Witness with anemia, ankylopoietic spondylitis, chronic liver disease and Crohn´s disease

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Respuesta a eritropoyetina humanarecombinante de anemiasecundaria a úlceras por presión enun paciente con esclerosis múltiple / Response to recombinant human erythropoietin of anemia secondary to pressure ulcers in a patient with multiple sclerosis

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[Nasal leishmaniasis in an HIV-positive patient]. / Leishmaniasis nasal en paciente HIV+

Leishmania is currently one of the most clinically important protozoa in otorhinolaryngology. Mediterranean countries, including Spain, have endemic HIV and L. infantum. Dogs are the most important Leishmania reservoir. Leishmaniasis is transmitted basically by the bite of infected female Phlebotomus sandflies. Its clinical development depends mainly on the host's cellular immunity (TCD4+ lymphocyte count). About 400 cases of HIV-visceral leishmaniasis have been reported in Spain. However, exclusively cutaneous presentation of HIV-leishmaniasis coinfection has been observed in only 2-3% of cases. We report the case of a female HIV+ patient who developed cutaneous leishmaniasis of the nasal vestibule by L. infantum. The patient was treated satisfactorily with a combination of parenteral Pentostam (sodium stilbogluconate) and periodic intralesional injections of Pentostam. The patient was included in a secondary prophylaxis protocol for visceral leishmaniasis with a monthly dose of Glucantime (meglumine antimoniate) for life.