Hemolacria or bloody tears in presumed lacrimal endometriosis: a case report / Hemolacria o lágrimas hemáticas en sospecha de endometriosis lacrimal: reporte de un caso

Background: Hemolacria or the presence of blood in tears is a rare condition, and there are only a few cases reported in the literature. Hemolacria is associated with multiple underlying diseases, including vicarious menstruation due to extragenital endometriosis. Case report: We present a 26-year-old woman with hemolacria and abdominal pain related to her menstrual cycle. The patient was diagnosed with bilateral ovarian endometriomas. After ruling out other possible causes of hemolacria, a progestin-only treatment was applied, with improvement of the abdominal pain and complete remission of hemolacria. Conclusions: When faced with hemolacria, a thorough anamnesis and physical examination must be performed, sometimes involving more than one specialist to reach a diagnosis. Considering hemolacria is a sign of a subjacent pathology, its treatment should be specific one for the disease in each case.

Antecedentes: La hemolacria o presencia de sangre en las lágrimas es una afección poco frecuente y sólo hay unos pocos casos descritos en la literatura. La hemolacria se asocia a múltiples enfermedades subyacentes, incluida la menstruación vicaria debida a endometriosis extragenital. Caso clínico: Presentamos a una mujer de 26 años con hemolacria y dolor abdominal relacionado con su ciclo menstrual. La paciente fue diagnosticada de endometriomas ováricos bilaterales. Tras descartar otras posibles causas de hemolacria, se aplicó un tratamiento sólo con progestágenos, con mejoría del dolor abdominal y remisión completa de la hemolacria. Conclusiones: Ante una hemolacria se debe realizar una anamnesis y exploración física minuciosa, en la que a veces interviene más de un especialista para llegar al diagnóstico. Teniendo en cuenta que la hemolacria es signo de una patología subyacente, su tratamiento debe ser el específico para la enfermedad en cada caso.

Parental Incarceration, Development, and Well-Being: A Developmental Systematic Review.

Despite an increasing number of studies examining the impact of parental incarceration on children's well-being, there are few comprehensive reviews that collect this information, and even fewer from a developmental perspective. This study aims to clarify the effects of parental incarceration on children's well-being and development, as well as the moderating and mediating factors from a developmental perspective. A systematic review was conducted according to PRISMA guidelines, selecting 61 studies of children from early childhood to adolescence. The results show differences in the current evidence regarding the effects of parental incarceration on children depending on the developmental stage, with the most evidence in the 7-11-year-old stage. Being male appears as a risk moderator factor while the mental health of the caregiver and their relationship with the child appears as a mediating variable, especially from 7 to 18 years old. These results reveal the impact of parental incarceration based on children's age, providing a basis for developing protective and intervention measures.

Physical compatibility of alprostadil with selected drugs commonly used in the neonatal intensive care units.

This study aimed to determine the physical compatibility of alprostadil with 17 continuous infusion drugs commonly administered in neonatal intensive care units. Test samples were prepared in a laminar airflow hood. Alprostadil 20 mcg/ml was mixed with each drug in a 1:1 ratio, in two orders of mixing. Physical stability of the admixtures was assessed by visual examination and by measuring turbidity. Visual examination was conducted by two observers by two methods: visual examination against a black and white background under normal fluorescent light and using a high-intensity monodirectional light. pH was measured as chemical stability predictor. Evaluations were performed immediately and 4 h after mixing. An additional visual control was performed at 24 h. Visual examination was positive or doubtful for the four drug combinations not considered compatible. Turbidity values were under 0.5 NTU throughout the study in all samples. No modifications of one pH unit or more was detected in any drug pair over time.Conclusion: Alprostadil was considered physical compatible with 13 drugs (adrenalin, amiodarone, calcium gluconate, dobutamine, dopamine, fentanyl, flecainide, furosemide, heparin, ketamine, midazolam, milrinone and morphine). Incompatibility could not be ruled out for 3 drugs (cisatracurium, dexmedetomidine and noradrenalin), and insulin was considered incompatible with alprostadil. What is Known: • Y-site administration is common in neonatal intensive care units, and volume of diluents and rate of infusions in newborns were lower than in adults which might result in high concentrations and prolonged contact time at Y-site administration. • Available data about compatibility of alprostadil with other drugs was scarce. What is New: • Alprostadil was compatible with 13 drugs commonly used in neonatal intensive care units. • Insulin was considered incompatible with alprostadil, and incompatibility cannot be ruled out for cisatracurium, dexmedetomidine and noradrenalin with alprostadil.

Intravenous medicine preparation technique training programme for nurses in clinical areas.

OBJECTIVE: The key objective of this study was to highlight the weak points in the medicine use process. METHOD: We collected 15 videos from eight neonatal intensive care units where staff nurses showed how medicine preparation was performed. Recorded medicines were: vancomycin (6), gentamicin (5), caffeine citrate (2) and phenobarbital (2). RESULTS: We did not review any video without errors. In 8/15 (53.3%) videos, the same syringe was used to measure the medicine and the diluent. In 8/15 (53.3%) videos, the syringes used were not the correct size for the volume being measured. In 4/15 (26.6%) videos, the volume measured into the syringes was not checked after it was measured from vials or ampoules. In just one vancomycin preparation could the reconstitution process be described as a correct process; in the other five videos, mixing after diluent addition to the vancomycin vial was almost non-existent (less than 10 s). Mixing after the medicine and diluent were in the same syringe was also non-existent in all of the videos. CONCLUSIONS: Hospitals should provide training programmes outlining the correct preparation technique.

Mineral metabolism disorders, vertebral fractures and aortic calcifications in stable kidney transplant recipients: The role of gender (EMITRAL study) / Alteraciones del metabolismo mineral, fracturas vertebrales, y calcificaciones aórticas en receptores estables de trasplante renal: papel del género (estudio EMITRAL)

Antecedentes y objetivos: La relación entre las alteraciones del metabolismo mineral, las fracturas óseas y las calcificaciones vasculares en receptores de un trasplante renal no han sido establecidas. Método: Realizamos un estudio transversal en 727 receptores estables procedentes de 28 centros de trasplante españoles. Se determinaron de manera centralizada los parámetros del metabolismo mineral; también se centralizó la semicuantificación de las fracturas vertebrales y de las calcificaciones de la aorta abdominal. Resultados: La deficiencia de vitamina D (25OHD3 < 15ng/ml) fue más frecuente en mujeres y en los estadios CKD-T I-III (29,6 vs. 44,4%; p=0,003). La relación inversa y significativa observada entre los niveles de 25OHD3 y PTH fue modificada por el género de tal manera que la pendiente fue mayor en las mujeres que en los hombres (p=0,01). Un 15% de los receptores mostró alguna fractura vertebral (VFx) con un grado de deformidad ≥2. Los factores relacionados con la VFx diferían en función del género: en los hombres, la edad (OR: 1,04; IC 95%: 1,01-1,06) y el tratamiento con CsA (OR: 3,2; IC 95: 1,6-6,3); en las mujeres la edad (OR: 1,07; IC 95%: 1,03-1,12) y los niveles de PTH (OR per 100pg/ml increase: 1,27; IC 95%: 1,043-1,542). Las calcificaciones de la aorta abdominal fueron comunes (67,2%) y se relacionaron con los factores de riesgo clásicos, pero no con los parámetros del metabolismo mineral. Conclusiones: La deficiencia de vitamina D es más frecuente en las mujeres receptoras de un trasplante renal y en los estadios más tempranos de la CKD-T, y es un factor que contribuye al desarrollo de hiperparatiroidismo secundario. Las VFx prevalentes están relacionadas con unos niveles más elevados de PTH solamente en las mujeres (AU)

Background and objectives: The relationship between mineral metabolism disorders, bone fractures and vascular calcifications in kidney transplant recipients has not been established. Method: We performed a cross-sectional study in 727 stable recipients from 28 Spanish transplant clinics. Mineral metabolism parameters, the semi-quantification of vertebral fractures and abdominal aortic calcifications were determined centrally. Results: Vitamin D deficiency (25OHD3 < 15 ng/ml) was more common in female recipients at CKD-T stages I–III (29.6% vs 44.4%; p=0.003). The inverse and significant correlation between 25OHD3 and PTH was gender-specific and women exhibited a steeper slope than men (p=0.01). Vertebral fractures (VFx) with deformity grade ≥2 were observed in 15% of recipients. Factors related to VFx differed by gender; in males, age (OR 1.04; 95% CI 1.01-1.06) and CsA treatment (OR: 3.2; 95% CI: 1.6-6.3); in females, age (OR 1.07; 95% CI: 1.03-1.12) and PTH levels (OR per 100 pg/ml increase: 1.27; 95% CI: 1.043-1.542). Abdominal aortic calcifications were common (67.2%) and related to classical risk factors but not to mineral metabolism parameters. Conclusions: Vitamin D deficiency is more common among female kidney transplant recipients at earlier CKD-T stages, and it contributes to secondary hyperparathyroidism. Prevalent vertebral fractures are only related to high serum PTH levels in female recipients (AU)

Mineral metabolism disorders, vertebral fractures and aortic calcifications in stable kidney transplant recipients: The role of gender (EMITRAL study).

BACKGROUND AND OBJECTIVES: The relationship between mineral metabolism disorders, bone fractures and vascular calcifications in kidney transplant recipients has not been established. METHOD: We performed a cross-sectional study in 727 stable recipients from 28 Spanish transplant clinics. Mineral metabolism parameters, the semi-quantification of vertebral fractures and abdominal aortic calcifications were determined centrally. RESULTS: Vitamin D deficiency (25OHD3<15ng/ml) was more common in female recipients at CKD-T stages I-III (29.6% vs 44.4%; p=0.003). The inverse and significant correlation between 25OHD3 and PTH was gender-specific and women exhibited a steeper slope than men (p=0.01). Vertebral fractures (VFx) with deformity grade ≥2 were observed in 15% of recipients. Factors related to VFx differed by gender; in males, age (OR 1.04; 95% CI 1.01-1.06) and CsA treatment (OR: 3.2; 95% CI: 1.6-6.3); in females, age (OR 1.07; 95% CI: 1.03-1.12) and PTH levels (OR per 100pg/ml increase: 1.27; 95% CI: 1.043-1.542). Abdominal aortic calcifications were common (67.2%) and related to classical risk factors but not to mineral metabolism parameters. CONCLUSIONS: Vitamin D deficiency is more common among female kidney transplant recipients at earlier CKD-T stages, and it contributes to secondary hyperparathyroidism. Prevalent vertebral fractures are only related to high serum PTH levels in female recipients.

Medicine preparation errors in ten Spanish neonatal intensive care units.

This study assessed the rate of errors in intravenous medicine preparation at the bedside in neonatal intensive care units vs the preparation error rate in a hospital pharmacy service. We conducted a prospective observational study between June and September 2013. Ten Spanish neonatal intensive care units and one hospital pharmacy service participated in the study. Two types of preparation errors were considered: calculation errors and accuracy errors. A total of 522 samples were collected: 238 of vancomycin, 139 of gentamicin, 39 of phenobarbital and 88 of caffeine citrate preparations. Of these, 444 samples were collected by nurses in neonatal intensive care units, and 60 were provided by the hospital pharmacy service. Overall, 18 samples were excluded from the analysis. We detected calculation errors in 6/444 (1.35%) and accuracy errors in 243/444 (54.7%) samples from the neonatal intensive care units. In contrast, in samples from the hospital pharmacy service, no calculation errors were detected, but there were accuracy errors in 23/60 (38.3%) samples. CONCLUSION: While calculation errors can be eliminated using protocols based on standard drug concentrations, accuracy error rates depend on several variables that affect both neonatal intensive care units and hospital pharmacy services. WHAT IS KNOWN: Medication use is associated with a risk of errors and adverse events. Medication errors are more frequent and have more severe consequences in paediatric patients. Lack of knowledge of drug pharmacokinetics and pharmacodynamics in relation to physiological immaturity makes neonates more vulnerable to medication errors. WHAT IS NEW: Calculation errors are avoided using concentration standard preparation protocols. Accuracy in the preparation process depends mainly on the degree to which commercial drug preparations meet current legal requirements and the syringes and preparation techniques used.

Strategies implementation to reduce medicine preparation error rate in neonatal intensive care units.

UNLABELLED: This study assessed the rate of errors in intravenous medicine preparation at bedside in neonatal intensive care units versus preparation error rate in a hospital pharmacy service before and after several strategies were implemented. We performed a prospective observational study during 2013-2015. Ten Spanish neonatal intensive care units and one hospital pharmacy service participated in the study. Two types of preparation errors were considered, calculation errors and accuracy errors. The study was carried out over three consecutive phases: (1) pre-intervention phase, when medicine preparation samples were collected from neonatal intensive care units and hospital pharmacy service according to their normal clinical practice; (2) intervention phase, when protocol standardisation and educational strategy took place; and (3) post-intervention phase, when new medicine samples were collected after strategy implementation. In neonatal intensive care units, 1.35 % of samples registered calculation errors in pre-intervention phase; no calculation errors were registered in hospital pharmacy service samples. In post-intervention phase, no calculation errors were registered in either group. Accuracy error rate decreased both in neonatal intensive care units (54.7 vs 23 %) and hospital pharmacy service (38.3 vs 14.6 %). CONCLUSION: Calculation errors can disappear with good standardisation protocols. Decrease in accuracy error depends on good preparation technique and environmental factors. WHAT IS KNOWN: • Medication use is associated with a risk of errors and adverse events. Medication errors are more frequent and have more severe consequences in paediatric patients. • Lack of commercial drug formulations adapted to newborn infants makes medicine preparation process more prone to error. What is New: • Calculation errors are minimising using concentration standard protocols. Preparation rules are essential to ensure the accuracy process. • Environmental conditions affect the accuracy process.

Resistencias a fármacos de Mycobacterium tuberculosis en la Comunidad de Castilla y León (España), 2001–2005: tercer estudio multicéntrico / Drug-resistance in Mycobacterium tuberculosis in Castilla y León, Spain, 2001–2005: Third collaborative study

Introducción Durante el período 2001–2005 se llevó a cabo el tercer estudio de resistencia a los fármacos antituberculosos de primera línea en Castilla y León, España, en casos nuevos de tuberculosis (TB).Métodos Se estudiaron 918 cepas de Mycobacterium tuberculosis procedentes de pacientes virus de la inmunodeficiencia humana negativos correspondientes a 6 hospitales que atienden al 46,7% del total de la población de la comunidad, y se utilizó el método de las proporciones en medio sólido. Resultados La proporción de resistencias (resistencia primaria) fue del 4,2% y la resistencia simple (monorresistencia) fue del 2,6%. El 1,2% fueron resistentes a estreptomicina; el 3,2% a isoniacida (I); el 0,3% a rifampicina (R); el 0,1% a etambutol, y el 0,5% a pirazinamida, y se observó una cepa (0,1%) multirresistente (resistencia a I y a R). No hubo diferencias significativas con los estudios previos. Conclusiones La incidencia de resistencia primaria y de multirresistencia en la Comunidad de Castilla y León es baja, asimismo, la resistencia a I es aceptable. Consecuentemente, la pauta de tratamiento de la TB puede incluir solamente a los 3 fármacos (R, I y etambutol). Es conveniente, de acuerdo con los programas de control de la TB, realizar estudios de resistencia a los fármacos antituberculosos para optimizar las pautas de tratamiento (AU)

Introduction During 2001–2005, a regional anti-tuberculosis drug resistance survey was conducted in Castilla y León, Spain, in newly treated HIV negative tuberculosis (TB) patients. Methods A total of 918 Mycobacterium tuberculosis strains were studied (one strain per patient) from six hospitals corresponding to 46.7% of the total population of Castilla y León, using the proportion method on solid medium. Results Primary drug resistance was 4.2% (streptomycin 1.2%, isoniazid 3.2%, rifampin 0.3%, ethambutol 0.1% and pyrazinamide 0.5%). Mono-resistance was observed in 24 (2.6%) and resistance to both isoniazid and rifampin (multi-drug resistance) was detected in one case (0.1%). These results were not statistically significant compared to previous studies in the same Community. Conclusion The incidence of primary drug resistance in the surveyed area was low, including isoniazid, allowing new anti-tuberculosis treatment with the standardised three-drug regimen to be started. Regular surveillance of drug resistance is recommended by the TB control programme in representative patient populations to optimize treatment regimens (AU)

[Drug-resistance in Mycobacterium tuberculosis in Castilla y León, Spain, 2001-2005: third collaborative study]. / Resistencias a fármacos de Mycobacterium tuberculosis en la Comunidad de Castilla y León (España), 2001-2005: tercer estudio multicéntrico.

INTRODUCTION: During 2001-2005, a regional anti-tuberculosis drug resistance survey was conducted in Castilla y León, Spain, in newly treated HIV negative tuberculosis (TB) patients. METHODS: A total of 918 Mycobacterium tuberculosis strains were studied (one strain per patient) from six hospitals corresponding to 46.7% of the total population of Castilla y León, using the proportion method on solid medium. RESULTS: Primary drug resistance was 4.2% (streptomycin 1.2%, isoniazid 3.2%, rifampin 0.3%, ethambutol 0.1% and pyrazinamide 0.5%). Mono-resistance was observed in 24 (2.6%) and resistance to both isoniazid and rifampin (multi-drug resistance) was detected in one case (0.1%). These results were not statistically significant compared to previous studies in the same Community. CONCLUSION: The incidence of primary drug resistance in the surveyed area was low, including isoniazid, allowing new anti-tuberculosis treatment with the standardised three-drug regimen to be started. Regular surveillance of drug resistance is recommended by the TB control programme in representative patient populations to optimize treatment regimens.

Lesiones papulopustulosas en las extremidades inferiores de un paciente joven / Papular-pustular lesions on the lower limbs of a young patient

No disponible

Un estudio sobre las historias de vida de los sujetos mayores / A study on life stories of elderly people

En este trabajo se recogen mediante entrevistas semiestructuradas las historias de vida de personas mayores, entre 65 y 90 años, con el fin de indagar en los ámbitos del desarrollo personal y social a lo largo de su historia. Estos, en primer lugar conducen a la creación de una línea o trayectoria de evolución y crecimiento de la vida de los sujetos de personas mayores. Además, se halla como la sabiduría vital es un rasgo que alcanza diferentes esferas de la personalidad, véase, una actitud de coherencia, satisfacción personal, éxitos vividos con humildad y fracasos que intentan relativizarse. Por otra parte, respecto al ámbito social, se encuentra como los acontecimientos sociopolíticos de la posguerra y la dictadura les han marcado a nivel personal El dato más significativo es el cómo la familia constituye su contexto prioritario de desarrollo personal, al que más tiempo dedican durante su estado de jubilación y el que mayor satisfacción les produce. A parte de estos resultados, se presentan algunos aspectos para la intervención

This work is focussed on life stories of elderly people, from 65 up to 90, who have been interviewed with the purpose of researching in the fields of personal and social development during their lives. Firstly, these results lead to the creation of an evolutionary line or experience of elderly people. Moreover, vital wisdom is a characteristic which influences the different areas of personality, such as an attitude of coherence, personal satisfaction, successes experienced with humility and failures, which have been softened. On the other hand, with regard to social environment, we find out that the socio-political events of postwar and dictatorship have marked them to an extent. The most significant data is that family constitutes a priority context for personal development, to which they devote more time during their retirement and which satisfies them most. Apart from the results, several aspects are presented for intervention

Bacteriemia por Lactobacillus caseipost-CPRE: a propósito de un caso / Post-ERCP bacteriemia due to Lactobacillus casei: a case history

No disponible

No disponible

El reto del trabajo interdisciplinar: ¿hasta dónde hemos llegado? / No disponible

Este trabajo se propone investigar como está distribuida la asunción de tareas asistenciales entre los profesionales de salud mental de la Comunidad de madrid, fundamentalmente psiquiatras y psicólogos. A la luz de estos datos, analiza hasta donde se refrenda y potencia el modelo comunitario de atención, supuestamente basado en la interdisciplinariedad y las responsabilidades compartidas(AU)

The objective of this article is to research how the clinical work (diagnosis, treatments, etc) is distributed among the mental health professionals of the Community of Madrid, mainly between psychiatrist and psychologists. the community mental health based ont he interdisciplinary team is also analyzed(AU)