Control glucémico en el panciente anciano con diabetes mellitus tipo 2 tratado con antidiabéticos / Glycemic control in the elderly patient with type 2 diabetes mellitus treated with antidiabetics

El objetivo de este trabajo es evaluar el tratamiento antidiabético y la concordancia con los valores de hemoglobina glicosilada (HbA1c) recomendados por la guías en pacientes ancianos: entre 7,5 y 8,5% para el control de la diabetes mellitus tipo II (DMII) en el paciente anciano frágil, relacionándose HbA1c <6,5% con mayor morbi-mortalidad, riesgo de hipoglucemias y caídas.Se trata de un estudio retrospectivo realizado en enero 2020. Se incluyeron pacientes diagnosticados de DMII, mayores de 75 años, que llevaran tratamiento con cualquier combinación de antidiabéticos orales (ADO). Se registró el último valor de HbA1c disponible durante el año previo. Se analizó la relación entre el valor de HbA1c y el número de ADOs prescritos (+ insulina), edad del paciente y/o fragilidad. Se incluyeron 936 pacientes, edad media 81,3 años. El 15,8% de los pacientes no tenía ninguna determinación de HbA1c disponible en el último año. El resto de pacientes, tenían una media de HbA1c de 6,6%. Sólo el 13,2% de los pacientes se situaron en el intervalo terapéutico objetivo (7,5-8,5%). Un 39,9% tuvo una HbA1c <6,5% y solamente un 5,0% tenía un HbA1c ≥8,5%, (mal control). De los 617 pacientes con una HbA1c <7,5%, el 25,4% eran mayores de 85 años, el 32,1% estaban clasificados como paciente crónico complejo (PCC), lo que suponía una mayor fragilidad, el 38,6% llevaban más de un fármaco ADO y el 8,6% llevaba asociada insulina.Los valores de HbA1c en los pacientes ancianos analizados son inferiores a los recomendados por las principales guías. Los resultados de este trabajo hacen patente la necesidad de implementar estrategias que permitan establecer el tratamiento óptimo de manera individualizada. (AU)

The objective of this work is to evaluate antidiabetic treatment and concordance with the glycosylated hemoglobin (HbA1c) values recommended by the guidelines in elderly patients: between 7.5 and 8.5% for the control of type II diabetes mellitus (DMII) in frail elderly patients. HbA1c <6.5% is being associated with higher morbidity and mortality, risk of hypoglycemia and falls.This is a retrospective study conducted in January 2020. Patients diagnosed with DMII, older than 75 years, who had been treated with any combination of oral antidiabetic drugs (ADO) were included. The last HbA1c value available during the previous year was recorded. The relationship between the HbA1c value and the number of prescribed ADOs (+ insulin), age of the patient and/or frailty was analyzed.936 patients were included, mean age 81.3 years. 15.8% of the patients had no HbA1c determination available in the last year. The rest of the patients had a mean HbA1c of 6.6%. Only 13.2% of the patients were in the target therapeutic range (7.5-8.5%). 39.9% had an HbA1c <6.5% and only 5.0% had an HbA1c ≥8.5%, (poor control). Of the 617 patients with an HbA1c <7.5%, 25.4% were older than 85 years, 32.1% were classified as complex chronic patient (PCC), which meant greater frailty, 38.6% had more than one ADO drug and 8.6% had associated insulin.The HbA1c values in the analyzed elderly patients are lower than those recommended by the main guidelines. The results of this work make clear the need to implement strategies that establish the optimal treatment individually. (AU)

Association between nutritional risk based on the NRS-2002 test and hospital morbidity and mortality.

OBJECTIVE: To analyse the relationship between the presence of malnutrition (MN), as measured by the NRS-2002 nutritional evaluation, and the rate of morbidity and mortality. DESIGN: Cross-sectional study. SETTING: Patients admitted to Mateu Orfila Hospital, the regional hospital for the island of Menorca, Spain. SUBJECTS: 1,075 patients who were admitted to Mateu Orfila Hospital (Menorca) who had laboratory studies and a nutritional risk (NR) evaluation available were studied. Those who had a clinical suspicion of MN or those at risk were studied. INTERVENTION: Demographic (age, gender) and clinical (current weight, normal weight, body mass index, weight loss, oral intake, presence of intestinal failure, fistula, renal failure, respiratory infection, urinary infection, hyperglycaemia, admission to the ICU, hospital stay, days of parenteral nutrition treatment and reason for admission) were collected during hospitalisation, as well as hospital mortality and mortality at 6 months following discharge. All underwent the NRS-2002 test. RESULTS: The mean patient age was 67.9 years and 58.3% were men. 62% of patients met the criteria for manutrition according to the NRS-2002 test. A statistically significant association was seen between malnutrition according to the NRS-2002 and intestinal failure, fistula, renal failure, respiratory infection, hyperglycemia, hospital mortality and mortality at 6 months. CONCLUSION: Malnutrition affects more than half of the patients who are admitted to a medium-long admission hospital and it is associated with increased morbidity and mortality. The results underscore the need to establish an update plan and preventative and therapeutic nutritional follow-up. These measures reduce the rate of avoidable complications and save the costs associated with them.

Association between nutritional risk based on the NRS-2002 test and hospital morbidity and mortality / Evaluación de la asociación entre el grado de riesgo nutricional según el test NRS-2002 y la morbimortalidad hospitalaria

Objective: To analyse the relationship between the presence of malnutrition (MN), as measured by the NRS-2002 nutritional evaluation, and the rate of morbidity and mortality. Design: Cross-sectional study. Setting: Patients admitted to Mateu Orfila Hospital, the regional hospital for the island of Menorca, Spain. Subjects: 1,075 patients who were admitted to Mateu Orfila Hospital (Menorca) who had laboratory studies and a nutritional risk (NR) evaluation available were studied. Those who had a clinical suspicion of MN or those at risk were studied. Intervention: Demographic (age, gender) and clinical (current weight, normal weight, body mass index, weight loss, oral intake, presence of intestinal failure, fistula, renal failure, respiratory infection, urinary infection, hyperglycaemia, admission to the ICU, hospital stay, days of parenteral nutrition treatment and reason for admission) were collected during hospitalisation, as well as hospital mortality and mortality at 6 months following discharge. All underwent the NRS-2002 test. Results: The mean patient age was 67.9 years and 58.3% were men. 62% of patients met the criteria for manutrition according to the NRS-2002 test. A statistically significant association was seen between malnutrition according to the NRS-2002 and intestinal failure, fistula, renal failure, respiratory infection, hyperglycemia, hospital mortality and mortality at 6 months. Conclusion: Malnutrition affects more than half of the patients who are admitted to a medium-long admission hospital and it is associated with increased morbidity and mortality. The results underscore the need to establish an update plan and preventative and therapeutic nutritional follow-up. These measures reduce the rate of avoidable complications and save the costs associated with them (AU)

Objetivo: Determinar la relación entre el grado de Desnutrición (DN), detectada según el test de valoración nutricional NRS-2002, y la tasa de morbimortalidad. Métodos: Estudio transversal de 1075 pacientes que ingresaron en el Hospital Mateu Orfila (Menorca) de los que se disponía una analítica de ingreso y valoración del riesgo nutricional (RN) mediante el test NRS-2002. Se recogieron datos demográficos (edad, sexo) y clínicos (peso actual, peso habitual, Índice Masa Corporal, pérdida peso, ingesta oral, presencia de fracaso intestinal, fístula, fracaso renal, infección respiratoria, infección urinaria, hiperglucemia, estancia en la UCI, estancia hospitalaria, días de tratamiento de nutrición parenteral y enfermedad motivo de ingreso) durante su hospitalización así como la mortalidad hospitalaria y a los 6 meses posteriores al alta. Resultados: La edad media de los pacientes fue de 67,9 años y el 58,3% eran hombres. El 62%de los pacientes presentaron criterios de DN según el test NRS-2002. Se halló asociación estadísticamente significativa entre DN según el test NRS-2002 y fracaso intestinal, fístula, fracaso renal, infección respiratoria, hiperglucemia, mortalidad hospitalaria, mortalidad 6 meses y estancia hospitalaria. Conclusiones: La DN afecta a más de la mitad de los pacientes que ingresan en un hospital de media-larga estancia y se asocia con mayor morbi-mortalidad. Los resultados nos permiten establecer un plan de actuación y seguimiento nutricional de prevención y tratamiento (AU)

Evaluación retrospectiva de la efectividad y seguridad de cinacalcet para el tratamiento de hiperparatiroidismo secundario dependiendo del valor basal de paratohormona intacta / Retrospective assessment of effective and safety of cinacalcet for the treatment of secondary hyperparathyroidism depending on basal iPTH level

Objetivo Cinacalcet es un calcimimético recomendado para el tratamiento del hiperparatiroidismo secundario en pacientes en diálisis. El objetivo del estudio fue evaluar la eficacia y seguridad de cinacalcet comparando pacientes con PTHi basal > 300 pg/ml vs. PTHi < 300 pg/ml. Métodos Estudio observacional retrospectivo de pacientes en tratamiento con cinacalcet 30mg/día desde enero de 2008 a enero de 2009.Estudiamos 26 pacientes, 15 PTHi > 300 pg/ml y 11 PTHi < 300 pg/ml.La variable principal de eficacia fue la reducción entre el valor basal y final de PTHi (4 meses).Como variables secundarias se registró la reducción entre valor basal y final de calcio, fósforo, CaxP, y porcentaje de pacientes con reducción de PTHi superior al 30%.La seguridad se evaluó por los efectos secundarios más frecuentes y nivel de calcio < 8,6mg/dl. Resultados Los pacientes con PTHi > 300 presentaron diferencias estadísticamente significativas entre valor basal y final de PTH (563,49+286,88 pg/ml vs. 315,15+201,948 pg/ml; p=0,017) y calcio (9,1+1,77mg/dl vs. 8,15+1,2mg/dl; p=0,02). No hubo diferencias en los pacientes con PTHi < 300 pg/ml. Se observó reducción de más del 30% de la PTHi basal en el 60% de pacientes con PTHi basal > 300 pg/ml, y en el 27,3% de los que tenían PTHi basal < 300 pg/ml (p=0,098). No se reportó intolerancia gastrointestinal. Conclusión Cinacalcet es un fármaco efectivo y seguro en el tratamiento del hiperpartiroidismo secundario en pacientes dializados, con valores basales de PTHi > 300 pg/ml (AU)

Objective Cinacalcet is a calcimimetic agent, recommended for treating refractory secondary hyperparathyroidism in patients undergoing dialysis. The aim of this study was to evaluate the efficacy and safety of cinacalcet, comparing patients with baseline iPTH > 300 pg/ml with those with iPTH < 300 pg/ml. Method Observational retrospective study of patients being treated with cinacalcet 30mg/day from January 2008 to January 2009.We studied 26 patients, 15 with iPTH > 300 pg/ml and 11 with iPTH < 300pg/ml. The primary efficacy outcome was that there was a reduction between baseline and final iPTH (4 month). The secondary efficacy outcome were the reduction between basal and final calcium, phosphorus, Ca x P, and the percentage of patients with an iPTH decrease > 30%. The safety was evaluated based on the most frequent adverse effects and the levels of serum calcium < 8.6mg/dl. Results Patients with initial iPTH > 300 had significant differences before and after cinacalcet treatment in iPTH (563.49+286.88 pg/ml vs 315.15+201.948 pg/ml; P=.017) and serum calcium (9.1+1.77mg/dl vs 8.15+1.2mg/dl; P=.02). There were no significant differences in patients with initial iPTH < 300 pg/ml. A decrease greater than 30% from baseline iPTH was observed in 60% of patients with baseline iPTH > 300pg/ml, and only in 27.3% of those with basal iPTH < 300 pg/ml (P=.098). Patients did not show gastric intolerance. Conclusions Cinacalcet is an effective and safe drug for controlling secondary hyperparathyroidism in dialysis, mainly when it is used in patients with baseline iPTH > 300 pg/ml. (AU)

[Retrospective assessment of effective and safety of cinacalcet for the treatment of secondary hyperparathyroidism depending on basal iPTH level]. / Evaluación retrospectiva de la efectividad y seguridad de cinacalcet para el tratamiento de hiperparatiroidismo secundario dependiendo del valor basal de paratohormona intacta.

OBJECTIVE: Cinacalcet is a calcimimetic agent, recommended for treating refractory secondary hyperparathyroidism in patients undergoing dialysis. The aim of this study was to evaluate the efficacy and safety of cinacalcet, comparing patients with baseline iPTH > 300 pg/ml with those with iPTH < 300 pg/ml. METHOD: Observational retrospective study of patients being treated with cinacalcet 30 mg/day from January 2008 to January 2009. We studied 26 patients, 15 with iPTH > 300 pg/ml and 11 with iPTH < 300 pg/ml. The primary efficacy outcome was that there was a reduction between baseline and final iPTH (4 month). The secondary efficacy outcome were the reduction between basal and final calcium, phosphorus, Ca x P, and the percentage of patients with an iPTH decrease > 30%. The safety was evaluated based on the most frequent adverse effects and the levels of serum calcium < 8.6 mg/dl. RESULTS: Patients with initial iPTH > 300 had significant differences before and after cinacalcet treatment in iPTH (563.49+286.88 pg/ml vs 315.15+201.948 pg/ml; P=.017) and serum calcium (9.1+1.77 mg/dl vs 8.15+1.2mg/dl; P=.02). There were no significant differences in patients with initial iPTH < 300 pg/ml. A decrease greater than 30% from baseline iPTH was observed in 60% of patients with baseline iPTH > 300 pg/ml, and only in 27.3% of those with basal iPTH < 300 pg/ml (P=.098). Patients did not show gastric intolerance. CONCLUSIONS: Cinacalcet is an effective and safe drug for controlling secondary hyperparathyroidism in dialysis, mainly when it is used in patients with baseline iPTH > 300 pg/ml.

Effectiveness of perioperative glutamine in parenteral nutrition in patients at risk of moderate to severe malnutrition / Efectividad de la utilización perioperatoria de glutamina en nutrición parenteral en pacientes con riesgo de desnutrición moderada-severa

Background & aims: To determine whether perioperative glutamine supplementation of parenteral nutrition(PN) has an impact on morbidity and mortality of patients with previous moderate to severe risk of malnutrition. Methods: A quasi-experimental study was conducted comparing the following groups: Control group 1: without glutamine dipeptide supplementation of PN during the perioperative period. Control group 2: PN was supplemented with glutamine dipeptide (0.4 g/kg/day) after surgery only. Group 3 (follow-up group): PN was supplemented with glutamine dipeptide (0.4 g/kg/day) in the perioperative period. Postoperative morbidity and mortality was recorded. Results: Sixty-seven patients matched for baseline and surgical characteristics were recruited into the study. Univariate analysis showed a lower incidence of hyperglycemia and ICU admission in group 3, and a trend tosignificance (P = 0.078) in terms of a lower incidence of infection. In the multivariate analysis, only group 3 met the models of ICU admission (OR = 0.28), hyperglycemia(OR = 0.11), and renal failure (OR = 0.19).Conclusions: The results show that perioperative use of glutamine dipeptide in patients at risk of moderate to severe malnutrition before surgery is an effective option for decreasing the morbidity associated with malnutrition, as it improves blood glucose modulation and reduces infection and ICU stay (AU)

Introducción y objetivos: Determinar si la aditivación de glutamina perioperatoriamente en Nutrición parenteral (NP) influye sobre la morbimortalidad en pacientes con riesgo previo de desnutrición moderada severa. Métodos: Se realizó un estudio cuasi experimental en el que se comparaban: Grup control 1 : sin suplemento de glutamina en NP en el perioperatorio . Grup control 2: sólo postcirugía se les suplementó con glutamina (0,4g/kg/día) la NP. Grupo 3 seguimiento (prospectivo): perioperatoriamente suplemento de glutamina (0,4 g/kg/día)en la NP. Se registró la morbimortalidad postoperatoria. Resultados: Se reclutaron 67 pacientes homogéneos en cuanto a características de base y quirúrgicas. El análisis univariante mostró menor incidencia de hiperglucemia y estancia en UCI del grupo 3, y tendencia a la significación(p = 0,078) en cuanto a la menor incidencia de infección .En el análisis multivariable, sólo el grupo 3 entró en los modelos de estancia en UCI (OR = 0,28), hiperglucemia(OR = 0,11) y fracaso renal (OR = 0,19).Conclusiones: Los resultados obtenidos indican que el uso de glutamina a nivel perioperatorio en pacientes con desnutrición moderada-severa, previa a la cirugía, es una opción eficiente en la reducción de la morbilidad asociada a la desnutrición en términos de mejorar la modulación glucémica, reducción de la infección y de la estancia en UCI (AU)

Effectiveness of perioperative glutamine in parenteral nutrition in patients at risk of moderate to severe malnutrition.

BACKGROUND & AIMS: To determine whether perioperative glutamine supplementation of parenteral nutrition (PN) has an impact on morbidity and mortality of patients with previous moderate to severe risk of malnutrition. METHODS: A quasi-experimental study was conducted comparing the following groups: Control group 1: without glutamine dipeptide supplementation of PN during the perioperative period. Control group 2: PN was supplemented with glutamine dipeptide (0.4 g/kg/day) after surgery only. Group 3 (follow-up group): PN was supplemented with glutamine dipeptide (0.4 g/kg/day) in the perioperative period. Postoperative morbidity and mortality was recorded. RESULTS: Sixty-seven patients matched for baseline and surgical characteristics were recruited into the study. Univariate analysis showed a lower incidence of hyperglycemia and ICU admission in group 3, and a trend to significance (P = 0.078) in terms of a lower incidence of infection. In the multivariate analysis, only group 3 met the models of ICU admission (OR = 0.28), hyperglycemia (OR = 0.11), and renal failure (OR = 0.19). CONCLUSIONS: The results show that perioperative use of glutamine dipeptide in patients at risk of moderate to severe malnutrition before surgery is an effective option for decreasing the morbidity associated with malnutrition, as it improves blood glucose modulation and reduces infection and ICU stay.

Utilización de glutamina en nutrición parenteral en paciente crítico: efectos sobre la morbi-mortalidad / Glutamine use for parenteral nutritin in the critically ill patient: effects on morbimortality

Objetivos: Determinar la relación entre aditivar dipéptidos de glutamina a la nutrición parenteral (NP) y la morbi-mortalidad en paciente crítico. Material y métodos: Estudio retrospectivo de casos y controles. Como casos se recogieron pacientes a los que se administró NP suplementada con 2 g de nitrógeno (glutamina) durante el período 2001-2004. Los controles fueron pacientes con NP sin glutamina recogidos durante el 2000. Todos los pacientes incluidos presentaban infección definida como la presencia de un foco infeccioso más 2 de los siguientes criterios: leucocitos > 12.000 x 106/L, fiebre > 38 ºC, frecuencia cardíaca > 90 latidos/minuto o PCO2 100 mg/L o fístula. Se excluyeron los pacientes con insuficiencia renal, diálisis previa, encefalopatía hepática o dieta mixta. Las variables de morbi-mortalidad registradas fueron: hiperglucemia, fracaso renal, días con NP, días en UCI, días de hospitalización y mortalidad. Resultados: Se incluyeron 202 pacientes (75 casos y 127 controles). En el estudio univariante previo no aparecieron diferencias significativas para las variables independientes entre los 2 grupos. En el estudio multivariante, la aditivación de glutamina se asoció significativamente a menor incidencia de fracaso renal (OR:0,28; IC:0,08-1,00), menor hiperglucemia (OR:0,38; IC:0,19-0,75), menos días de hospitalización (OR:0,64; IC: 0,44-0,92) y menos días en UCI (OR:0,64; IC: 0,45-0,93). Para la variable exitus, la adición de glutamina mostró tendencia a la inclusión en el modelo (p = 0,097). En cuanto a los días con NP la variable glutamina no se incluyó en modelo Conclusiones: En pacientes críticos, la adición de glutamina a la NP conlleva una recuperación más rápida y menor incidencia de hiperglucemia y fracaso renal. Dados estos resultados, la adición de glutamina a las NP de determinados pacientes es un recurso efectivo para acelerar su recuperación y evitar determinadas complicaciones

Objective: To determine the relationship between adding glutamine dipeptides to parenteral nutrition (PN) and morbimortality in the critically ill patient. Material and methods: Case-control retrospective study. The cases were patients to whom PN supplemented with 2 g of nitrogen (glutamine) was administered during the period 2001-2004. Controls were patients with PN without glutamine, collected during the year 2000. All included patients had infection defined as the presence of an infectious site plus more than two of the following criteria: leucocytes > 12.000 x 106/L, fever > 38 ºC, heart rate > 90 bmp, or PCO2 100 mg/L or a fistula. Patients with renal failure, previous dialysis, hepatic encephalopathy, or mixed diet were excluded from the study. Morbimortality variables collected were: hyperglycemia, renal failure, days on PN, days in the ICU, hospitalization days, and mortality. Results: Two hundred and two patients (75 cases and 127 controls) were included. In the previous univariate analysis no significant differences appeared for independent variables between both groups. In the multivariate analysis, glutamine addition was significantly associated to lower renal failure incidence (OR: 0.28; CI: 0.08- 1.00), lower hyperglycemia (OR: 0.38; CI: 0.19-0.75), less hospitalization days (OR: 0.64; CI: 0.44-0.92), and fewer days in the ICU (OR: 0.64; CI: 0.45-0.93). For the variable “exitus”, glutamine addition showed a trend towards inclusion into the model (p = 0.097). About the days on PN, the variable glutamine was not included into the model. Conclusions: In critically ill patients, adding glutamine to PN leads to quicker recovery and lower incidence of hyperglycemia and renal failure. In view of these results, adding glutamine to PN of particular patients is an effective measure to speed up their recovery and avoid certain complications

[Glutamine use for parenteral nutrition in the critically ill patient: effects on morbimortality]. / Utilización de glutamina en nutrición parenteral en paciente crítico: efectos sobre la morbi-mortalidad.

OBJECTIVE: To determine the relationship between adding glutamine dipeptides to parenteral nutrition (PN) and morbimortality in the critically ill patient. MATERIAL AND METHODS: Case-control retrospective study. The cases were patients to whom PN supplemented with 2 g of nitrogen (glutamine) was administered during the period 2001-2004. Controls were patients with PN without glutamine, collected during the year 2000. All included patients had infection defined as the presence of an infectious site plus more than two of the following criteria: leucocytes > 12.000 x 10(6)/L, fever > 38 degrees C, heart rate > 90 bmp, or PCO2 < 31 mmHg. Besides, they had to have prealbumin plasma levels < 15 g/L or albumin levels < 25 g/L, and CRP > 100 mg/L or a fistula. Patients with renal failure, previous dialysis, hepatic encephalopathy, or mixed diet were excluded from the study. Morbimortality variables collected were: hyperglycemia, renal failure, days on PN, days in the ICU, hospitalization days, and mortality. RESULTS: Two hundred and two patients (75 cases and 127 controls) were included. In the previous univariate analysis no significant differences appeared for independent variables between both groups. In the multivariate analysis, glutamine addition was significantly associated to lower renal failure incidence (OR: 0.28; CI: 0.081.00), lower hyperglycemia (OR: 0.38; CI: 0.19-0.75), less hospitalization days (OR: 0.64; CI: 0.44-0.92), and fewer days in the ICU (OR: 0.64; CI: 0.45-0.93). For the variable "exitus", glutamine addition showed a trend towards inclusion into the model (p = 0.097). About the days on PN, the variable glutamine was not included into the model. CONCLUSIONS: In critically ill patients, adding glutamine to PN leads to quicker recovery and lower incidence of hyperglycemia and renal failure. In view of these results, adding glutamine to PN of particular patients is an effective measure to speed up their recovery and avoid certain complications.

Intoxicaciones agudas en el servicio de urgencias de un hospital universitario de nivel III: cambios producidos en los últimos 10 años / Acute poisoning in the emergency department of a level III universitary hospital: changes produced in the last 10 years

El objetivo fue evaluar los cambios epidemiológicos enlas intoxicaciones agudas (IA) entre 1994 y 2004. Para ello seestudiaron todos los casos atendidos en Urgencias con el diagnósticode intoxicación aguda, mediante un estudio transversal descriptivoanalítico desarrollado en dos períodos de un mes separados por 10 años, y comparando los resultados. Se registraron los datosdemográficos, clínicos y toxicológicos.La prevalencia de IA en Urgencias entre los períodos estudiadosaumentó significativamente (0,83 vs 1,25%) mientras que lahospitalización por esta causa pasó del 30,5% al 6,34%. La edadmedia se mantuvo entre los 32-33 años, así como la relaciónhombre/mujer, que osciló alrededor de 1. No se registraronfallecimientos.Los medicamentos fueron el tóxico más frecuente (51,3% y 62,7%respectivamente) con un aumento debido principalmente a lasbenzodiazepinas (BDZ). Asimismo, el alcohol incrementó supresencia en intoxicaciones múltiples, disminuyendo como agenteúnico. Las admisiones por drogas de abuso experimentaron unretroceso, del 26 al 19%. Los pacientes que recibieron tratamiento dealgún tipo disminuyeron aunque no de forma significativa, del 52,8 al44,4% y, a pesar del aumento de las BDZ, la utilización deflumazenilo varió de un 7% a un 8,5% de los casos. La utilización denaloxona disminuyó a la mitad.Los intentos de suicidio aumentaron el 25%, lo que supuso el 65% deltotal de la IA en el segundo período estudiado. La hospitalización, porel contrario, pasó de un 45% a un 6% en estos pacientes. Losfármacos, y entre ellos los psicotropos, fueron el tóxico másfrecuente, implicados en el 62% y 78% de los intentos de suicidio. Laasociación fármaco y alcohol aumentó de manera significativa (10% vs 22%). El registro de pacientes con antecedentes psiquiátricos seincrementó del 29% al 75%. En el intervalo de 21 a 30 años, elporcentaje de mujeres implicadas es el doble que el de hombres enambos períodos.La prevalencia de la IA experimentó un incremento significativo,paralelamente a los intentos de autolisis; sin embargo los ingresos enunidades de hospitalización, disminuyeron considerablemente tanto en el global de la IA como en los intentos de suicidio. Losmedicamentos, y entre ellos las BDZ fueron el tóxico más frecuente(AU)

The aim was to evaluate the epidemiological changes in the acutepoisonings (AP) between 1994 and 2004. For this purpose, all thecases attended at the Emergency Service with the diagnosis of acutepoisoning were studied, by means of a transverse descriptiveanalytical study developed in two periods of one month separated for 10 years, and comparing the results. The demographic, clinical andtoxicological data were recorded.The acute poisoning's prevalence in the Emergency Service increasedsignificantly (0,83 vs. 1,25%) whereas the hospitalization for thisreason decreased from 30,5% to 6,34%. The average age of our serieswere unchanged, (between 32-33 years) as well as the relation man /woman,that it ranged about 1. No deaths were recorded.Drugs were the most frequent poisoning agent (51,3% and 62,7%respectively) with an increase due principally to the benzodiazepines.Likewise, the alcohol increased its presence in multiple poisonings, diminishing as the only agent. The admissions for drugs of abuseexperienced a setback, from 26 to 19%. The patients who receivedany type of treatment diminished but not in a significant form, from 52,8 to 44,4% and, in spite of the benzodiazepines increase, theutilization of flumazenil changed from 7% to 8,5% of the cases. Theutilization of naloxone diminished to the half.The attempts of suicide increased 25%, which supposed 65% of thewhole of the IA in the second studied period. The hospitalization, onthe contrary, descended from 45% to 6% in these patients. Drugs, andamong them the psychotropes, were the most frequent poisoningagent, implied in 62% and 78% of the suicide attempts. Theassociation drug and alcohol increased in a significant way (10% vs.22%). The patients' record with psychiatric precedents was increasedfrom 29% to 75%. In the age interval from 21 to 30, the percentage ofwomen is twice than that of men in both periods.The prevalencia of the IA experienced a significant increase, parallelto the attempts of autolisis; nevertheless the admission inhospitalization units, diminished both in the global of the IA and inthe suicide attempts. Drugs, and among them the benzodiacepineswere the toxic agent most frequently involved(AU)

[Automation of parenteral nutrition elaboration: adaptation to in force legislation]. / Automatización de la elaboración de nutrición parenteral: adecuación a la legislación actual.

INTRODUCTION: Quality and efficiency criteria of allowances associated to technological procedures are developing in a setting that values quality, and from there the Real Decree RD175/2001 has been issued by which the rules of correct elaboration and quality control of formulations and pharmacy preparations. Parenteral nutrition (PN) is a formulation and, as such, its elaboration and control have to agree with the in force regulations. With this aim, at the Bellvitge University Hospital we have developed a project for automation of elaboration of PN mixtures with the MicroMacro Pump 23 Baxa Compounder. OBJECTIVES: To assess the impact of implementing an automated system of volumetric control in PN elaboration. MATERIAL AND METHODS: The project development may be divided into two differentiated aspects. The first one consisted in the implementation and optimization of the automated system of volumetric control (ASVC). The second aspect comprehends the comparative control performed between the new system and the previous one, and which consisted of a gravimetric system with visual control. For that, real weights were gathered and were compared to predicted weights, and the time of elaboration per bag before and at two times after the implementation of the automated system was registered; the first time just after implementation of the system, and the second time within one year. RESULTS: For the comparison study between both systems used, 141 preparations in total, corresponding to individualized PN, were analyzed: 47 elaborated by means of the gravimetric system (GS), 47 with the ASVC during the implementation period (PN ASVC period 1), 47 PN elaborated with the ASVC within one year of implementation (PN ASVC period 2). The average variation between real weight and predicted weight at the three periods (pre-ASVC, NP ASVC period 1, NP ASVC period 2) was 2.41%, 1.35% and 1.25% respectively (table I). This decrease was statistically significant (p = 0.014). When analyzing the percentage of preparations out of the 3% variation range, we observed a significant reduction (p = 0.00001) by comparing the three periods (Table II). The average elaboration time with the ASVC increased approximately in 4 minutes by bag (3 min 58 sec) during the first studied period, and 3 min 10 sec during the second period, as compared with the study period with the GS. CONCLUSIONS: The new bag-filling system by means of volumetric control represents an improvement in accuracy control and a decrease in the risk for surpassing the acceptable limits. The implementation of a new technological procedure is a difficult task that implies the change of many aspects of the daily practice and that requires a "cultural" change in the PN Unit with the aim of optimizing the process. However, these issues allow for an adaptation to legal requisites in force regarding the regulations of proper elaboration and quality control of formulations as well as an improvement in the integral quality of care.

Implantación y evaluación del análisis de peligros y puntos de control críticos (APPCC) en las industrias tinerfeñas productoras de Gofio / Implementation and evaluation of critical hazards and check points analysis (chcpa) in gofio-producing industries from Tenerife

Objetivo: Implantar de manera satisfactoria el Sistema de Análisis de Peligros y Puntos de Control Críticos. Ámbito: la Isla de Tenerife. Sujetos: 15 industrias. Intervención: se procedió realizando visitas a las fábricas productoras de gofio, con el fin de asesorar a los empresarios y operarios de las mismas, posteriormente se valoró la intervención verificando condiciones higiénico-sanitarias de la industria y la correcta aplicación del Sistema de Autocontrol establecido. Resultados: Después de la intervención de asesoramiento, se observa que determinados parámetros tenidos en cuenta desde el punto de vista higiénico-sanitario se han corregido, como modificar sus instalaciones para adecuarlas a las normativas vigentes o pedir que los proveedores certifiquen las materias primas. En cuanto al proceso de producción del alimento, la intervención fue efectiva para que más de la mitad de las industrias redujeran el tiempo de aquellas fases más susceptibles de contaminación y para que se llevaran a cabo los de registros de control que se establecieron. Conclusiones: Todas las industrias instauraron el sistema de autocontrol mediante cuadros de registros de cada una de las fases de elaboración. El 86% de las industrias han introducido materiales más higiénicos. Un 60% aplicaron una reducción en los plazos de tiempo intermedios en las fases de producción. Un 26% realizaron alguna sustitución de maquinaria obsoleta, modernizando las instalaciones (AU)

Objective: To satisfactorily implement the critical hazards and check points analysis. Setting: Tenerife Island. Subjects: 15 industries. Intervention: visits to gofio-manufacturing industries were done with the aim of giving advice to employers and workers, and thereafter, the intervention was assessed verifying the hygiene and sanitary conditions of the industry and the correct application of the established auto-control system. Results: After the advising intervention, we observed that certain parameters taken into account from the hygiene and sanitary perspective have been corrected, such as modifying the facilities to adapt them to in force regulations, or asking the suppliers to certify raw materials. With regards to food production process, the intervention was effective in such a way that more than have of the industries reduced the time of those phases with higher contamination susceptibility and to carry out the control registries that were established. Conclusions: All industries implemented the autocontrol system by means of registration charts of each one of the elaboration phases. - 86% of the industries have introduced more hygienic materials. - 60% implemented a reduction in intermediate times of production phases. - 26% performed some obsolete machinery replacement modernizing the facilities (AU)

[Perioperative management of chronic medications not related with surgical procedures]. / Manejo perioperatorio de la medicación crónica no relacionada con la cirugía.

The correct management of chronic medications not related with surgical procedures in the perioperative period has a relevant place because each year millions of patients around the world undergo surgical procedures. For this reason the assistencial team should be aware of the importance of continuate or discontinuate determinate drugs during perioperative period because some of them are considered an important risk factor in the development of complications. The key is to differentiate necessary from unnecessary medication. This is a complex aspect, little studied, which difficult clinical decisions and favours the coexistence of several trends of clinical practice. The purpose of this review is to describe the factors that determinate the continuity or suspension of chronic medications which are not related with surgery in the perioperative period and to provide practice recommendations in lights of available publications.

Manejo perioperatorio de la medicación crónica no relacionada con la cirugía / Perioperative management of chronic medications not related with surgical procedures

El correcto manejo de la medicación crónica no relacionada con la cirugía adquiere un papel relevante ya que en todo el mundo millones de pacientes se someten año tras año a intervenciones quirúrgicas. El equipo asistencial debe tener presente la importancia de continuar o suprimir determinados fármacos durante el perioperatorio ya que algunos de ellos se consideran un factor de riesgo en el desarrollo de complicaciones. La cuestión fundamental es diferenciar la medicación necesaria de la innecesaria, o bien perjudicial. Éste es un aspecto complejo y todavía poco estudiado lo cual dificulta en algunos casos la toma de decisiones y conlleva a la coexistencia de diversas tendencias de práctica clínica. En este trabajo se revisan los aspectos que condicionan la suspensión o continuidad de la medicación crónica que no está relacionada con la cirugía y se proporcionan recomendaciones prácticas para el manejo de la misma en base a la bibliografía disponible (AU)

Profilaxis y tratamiento del angioedema hereditario y adquirido en el HUB; utilización del inhibidor de la C1-esterasa / Profhylaxis and treatment of hereditary and acquired angioedema at HUB; use of the C1-esterase inhibitor

Introducción: El angioedema hereditario o adquirido está producido por el déficit del inhibidor de la esterasa del primer componente del complemento (C1-INH). Se caracteriza por síntomas transitorios de hinchazón de tejidos subcutáneos, pared intestinal y vías respiratorias superiores, que puede derivar en muerte por asfixia. Se presenta la fisiopatología, clasificación, diagnóstico y tratamiento, así como un seguimiento de los pacientes diagnosticados, a los que se les entrega 1 vial de concentrado de C1-INH (Berinert®), valorando la aportación del Servicio de Farmacia en el circuito de dispensación y control de dicho fármaco. Material y métodos: Se realizó una búsqueda a través de PubMed y otras fuentes relevantes. Mediante las recetas controladas se tomaron los datos del paciente y de las dispensaciones e indicación de Berinert®; se completó el seguimiento mediante la historia clínica, los datos de laboratorio y la entrevista al paciente cuando fue preciso. Resultados: Del total de 9 casos, 8 fueron angioedema hereditario y 1 adquirido. El danazol se utilizó como profilaxis a largo plazo en 8 casos, pero sus efectos secundarios obligaron a discontinuarlo en alguno de ellos. El concentrado de C1-INH fue efectivo en los 6 brotes agudos detectados en el estudio, así como en las 3 profilaxis quirúrgicas (consumo global de 6.500 U).Conclusión: El danazol fue un fármaco eficaz como profilaxis, pero con efectos secundarios importantes. El concentrado de C1-INH ha sido eficaz tanto en la profilaxis como en el tratamiento de los brotes agudos. El Servicio de Farmacia dispondrá de un stock suficiente de producto (AU)

[Profhylaxis and treatment of hereditary and acquired angioedema at HUB; use of the C1-esterase inhibitor]. / Profilaxis y tratamiento del angioedema hereditario y adquirido en el HUB; utilización del inhibidor de la C1-esterasa.

INTRODUCTION: Hereditary and acquired angioedema result from a deficiency in first complement component esterase (C1-esterase) inhibitor. It is characterized by transient subcutaneous tissue, intestinal wall, and upper airway swelling, which may lead to asphyxia and death. The pathophysiology, classification, diagnosis, and treatment of this condition are discussed, as is the follow-up of patients diagnosed with angioedema who received 1 vial of concentrated C1-INH (Berinert); the contribution of the Pharmacy Department in the dispensation and control of said drug is also assessed. MATERIAL AND METHODS: PubMed and other relevant sources were searched. Patient, dispensation, and Berinert(R) indication data were collected from controlled prescriptions; follow-up was completed by performing a medical history, collecting laboratory data, and patient interview when needed. RESULTS: Eight out of 9 cases were of hereditary angioedema, and 1 case was of acquired angioedema. Danazol was used as long-term prophylaxis in 8 patients, but side effects forced discontinuation in some of them. The C1-INH concentrate was effective in 6 acute episodes that were detected during the study, as well as in 3 surgical prophylaxis cases (overall use 6,500 U). CONCLUSION: Danazol was effective as prophylactic treatment, but had severe side effects. The C1-INH concentrate was effective both as prophylactic therapy and treatment for acute episodes. An adequate stock of this product will be available at the Pharmacy Department.