Transplant renal artery stenosis: Study of incidence using doppler ultrasound, risk factors and analysis is effect in graft outcomes.

INTRODUCTION AND OBJECTIVES: Transplant renal artery stenosis (TRAS) is a vascular complication after kidney transplantation which estimated incidence is 13%. It could cause refractory arterial hypertension, kidney dysfunction and premature death in transplant recipients. METHODS: We carried out a retrospective study including every patient who underwent renal transplantation between 2014 and 2020. They were evaluated with a systematic post-transplant renal Doppler ultrasound. To identify independent risk factors for transplant renal artery stenosis we performed a multivariate analysis. RESULTS: Seven hundred twenty-four kidney transplants were included, 12% ​​were living donors and 88% were deceased donors. The mean age was 54.8 in recipients and 53 in donors. Transplant renal artery stenosis was diagnosed in 70 (10%) recipients, the majority in the first 6 months after surgery. 51% of patients with transplant renal artery stenosis were managed conservatively. The multivariate analysis showed diabetes mellitus, graft rejection, arterial resuture and donor body mass index as independent risk factors for transplant renal artery stenosis. Survival of the grafts with transplant renal artery stenosis was 98% at 6 months and 95% at two years. CONCLUSIONS: The systematic performance of Doppler ultrasound in the immediate post-transplant period diagnosed 10% of transplant renal artery stenosis in our cohort. Despite the above risk factors, an adequate monitoring and treatment could avoid the increased risk of graft loss in patients with transplant renal artery stenosis.

Lesión medular asociada a hematoma epidural espinal espontáneo / Spinal cord injury associated with spontaneous spinal epidural hematoma

Introducción: El hematoma epidural espinal espontáneo (HEEE) es una entidad de baja incidencia, de elevada morbimortalidad y que causa una importante limitación funcional en la vida de los pacientes. Material y métodos: Con el objetivo de determinar la incidencia del HEEE y el tipo de lesión medular provocada y su repercusión funcional en este centro hospitalario, se realizó un estudio descriptivo retrospectivo analizando variables demográficas, de la lesión (ISCNSCI) y de la funcionalidad (SCIMIII). Resultados: Se revisaron los casos de HEEE atendidos en este centro. El 75% eran varones, con una mediana de edad de 55años. Todas las lesiones fueron incompletas. La localización más frecuente de las lesiones fue a nivel cervical bajo y dorsal alto. La mitad de los sangrados se produjeron en la región medular anterior. Se objetivó mejoría funcional tras el programa específico de rehabilitación. Conclusión: El HEEE podría considerarse de buen pronóstico funcional, relacionado con lesiones medulares habitualmente posteriores e incompletas sensitivo-motoras que se beneficiarían de un tratamiento rehabilitador específico precoz.(AU)

Introduction: Spontaneous spinal epidural hematoma (SSEH) is a disease with low incidence and high morbidity/mortality. It can cause severe loss of function. Material and methods: In order to determine the incidence, type of spinal injury and functional impact, a descriptive and retrospective study was developed, analysing demographic data, functional scores (SCIMIII) and neurological scores (ISCNSCI). Results: Cases of SSEH were reviewed. Seventy-five percent were male, median age was 55years old. All of the spinal injuries were incomplete and were frequently in the lower cervical and thoracic regions. Fifty percent of bleedings occurred in the anterior spinal cord. Most showed with a progress after an intensive rehabilitation program. Conclusion: SSEH could be considered to have a good functional prognosis, related to usually posterior and incomplete sensory-motor spinal cord injuries that would benefit from early specific rehabilitative treatment.(AU)

[Spinal cord injury associated with spontaneous spinal epidural hematoma]. / Lesión medular asociada a hematoma epidural espinal espontáneo.

INTRODUCTION: Spontaneous spinal epidural hematoma (SSEH) is a disease with low incidence and high morbidity/mortality. It can cause severe loss of function. MATERIAL AND METHODS: In order to determine the incidence, type of spinal injury and functional impact, a descriptive and retrospective study was developed, analysing demographic data, functional scores (SCIMIII) and neurological scores (ISCNSCI). RESULTS: Cases of SSEH were reviewed. Seventy-five percent were male, median age was 55years old. All of the spinal injuries were incomplete and were frequently in the lower cervical and thoracic regions. Fifty percent of bleedings occurred in the anterior spinal cord. Most showed with a progress after an intensive rehabilitation program. CONCLUSION: SSEH could be considered to have a good functional prognosis, related to usually posterior and incomplete sensory-motor spinal cord injuries that would benefit from early specific rehabilitative treatment.

Utilización de antibióticos restringidos en la práctica clínica: ceftolozano/tazobactam, ceftazidima/avibactam, ceftarolina y dalbavancina / Use of restricted antibiotics in clinical practice: ceftolozane/tazobactam, ceftazidime/avibactam, ceftaroline and dalbavancin

Objetivo: Evaluar la utilización en la práctica clínica de cuatro antibióticos de amplio espectro o innovadores: ceftolozano/tazobactam, ceftazidima/avibactam, ceftarolina y dalbavancina. Métodos: Estudio retrospectivo en que se han recogido datos de los pacientes que han recibido dichos antibióticos entre julio de 2018 y junio de 2019 en un hospital terciario. Se recogen las condiciones de uso y los resultados en efectividad a los 30 días para dalbavancina, y para el resto de antimicrobianos a los 3-5 días del inicio, a los 14 y a los 30 días para determinar mortalidad. Resultados: Se recogieron datos de 51 pacientes, con una mediana de edad de 63 años. La infección más comúnmente tratada fue neumonía (41,2%). Tres pacientes (5,9%) recibieron la terapia en estudio como primera línea y 43 (84,3%) recibieron antibióticos concomitantes. En el 66,7% de las infecciones se había aislado previamente un microorganismo sensible. En el 19,6% de los casos el cultivo fue negativo. En el grupo dalbavancina, el 75% de los pacientes se curaron a los 30 días. En el resto de antimicrobianos, el tratamiento resultó efectivo a los 3-5 días en el 65,1%. El 51,2% se curaron a los 14 días y un 30,2% fallecieron a los 30 días. Conclusiones: Los resultados de efectividad resultan comparables a estudios publicados con diseños similares. Se detecta la importancia de fomentar un uso adecuado de los antibióticos, como tratamientos dirigidos o empíricos en casos de riesgo de resistencias, priorizando su desescalada. Es esencial la implantación de equipos multidisciplinares PROA. (AU)

Objective: To evaluate the use in clinical practice of four recently marketed antibiotics: ceftolozane/tazobactam, ceftazidime/avibactam, ceftaroline, and dalbavancin. Methods: Retrospective study in which data have been collected from patients who have received these antibiotics between July 2018 and June 2019, in a third-level hospital. The conditions of use and the results in clinical efficacy measured in three periods have been studied: 3-5 days after the start of treatment, 14 days and 30 days to determine mortality. Results: Data were collected from a total of 51 patients, with a median age of 63 years. The most commonly treated infection was pneumonia (41.2%). Three patients (5.9%) received study therapy as the first line of treatment and 43 (84.3%) received concomitant antibiotics. In 66.7% of the infections, a sensitive microorganism to the antibiotic under study had been previously isolated. In 19.6% of the cases, the culture was negative. In the dalbavancin group, 75% of the pacients cured at day 30. In the other groups, the treatment was effective at 3-5 days in 65.1% of the cases. 51.2% experienced clinical cure at 14 days and 30.2% died at 30 days. Conclusions: The effectiveness results are comparable to published studies with similar designs. The importance of promoting an adequate use of antibiotics is detected, as directed or empirical treatments in cases of risk of resistance, prioritizing their de-escalation. The implementation of multidisciplinary PROA teams is essential. (AU)

Estudio observacional del uso de etanercept biosimilar en el tratamiento de enfermedades reumáticas / Etanercept in rheumatic diseases: observational study

Objetivos: 1.- Conocer la respuesta a etanercept biosimilar (E-BS) en pacientes naive y en pacientes a los que se realizó cambio desde el de referencia (E-R), diagnosticados de enfermedades reumáticas. 2.- Evaluar el impacto económico de estas actuaciones.Métodos: Estudio observacional retrospectivo de 110 pacientes en tratamiento con etanercept (referencia y/o biosimilar). Se analizaron dos grupos de pacientes: 62 pacientes que iniciaron tratamiento con E-BS y 48 pacientes a los que se les realizó cambio desde E-R (switch), y se compararon con grupos control. Variables analizadas: edad, sexo, diagnóstico, tratamiento, unidades dispensadas, modificaciones del tratamiento, motivo de suspensión o cambio, fecha de suspensión y tiempo de seguimiento. Se comparó el coste de la utilización del biosimilar y del que hubiera supuesto el de referencia.Resultados: Las tasas de retención observadas fueron: 65% en los naive (p=0,002) y 90% en los switch. En pacientes naive, el principal motivo de cambio fue respuesta parcial o insuficiente (90%) y en switch posible efecto nocebo (60%). No se observaron reacciones adversas. Al comparar estos grupos con poblaciones control, la principal diferencia fue la proporción de pacientes en los que se mantuvo tratamiento con E-BS frente a E-R, en pacientes naive (65% vs 34%; p=0,003) y switch (90% vs 27%; p<0,0001). La utilización de E-BS supuso un ahorro de 653.668 €.Conclusiones: La utilización de E-BS no fue diferente del E-R en cuanto a resultados clínicos y, desde el punto de vista económico, supone un ahorro sustancial que se debe considerar como medida que ayude a la sostenibilidad del sistema. (AU)

Objetive: 1.- To know the response to biosimilar etanercept (E-BS) in naive patients and in patients who change from the reference (E-R), diagnosed with rheumatic diseases. 2.- To evaluate the economic impact of these actions.Methods: Retrospective observational study of 110 patients in treatment with etanercept (reference and/or biosimilar). Two groups of patients were analyzed: 62 patients who started with E-BS and 48 patients who change from E-R (switch), and they were compared with control groups. Variables analyzed: age, sex, diagnosis, treatment, units dispensed, treatment modifications, reason for suspension or change, date of suspension and follow-up time. The cost of using the biosimilar was compared with that of the reference one.Results: The retention rates observed were: 65% in the naive (p=0.002) and 90% in switch. In naive patients, the main reason for change was partial or insufficient response (90%) and a possible nocebo effect in switch (60%). No adverse reactions were observed. When comparing these groups with control populations, the main difference was the proportion of patients in whom treatment with E-BS was maintained versus ER, in naive patients (65% vs 34%; p=0.003) and in switch (90% vs 27%; p<0.0001). The use of E-BS meant a saving of € 653,668.Conclusions: The use of E-BS was not different from the E-R in terms of clinical results and, from the economic point of view, represents a substantial saving that should be considered as a measure that helps the sustainability of the system. (AU)

Farmacocinética de dabigatrán y utilización de su antídoto idarucizumab / Pharmacokinetics of dabigatran and use of its antidote idarucizumab

Una de las ventajas de dabigatrán, un nuevo anticoagulante oral de acción directa, es la disponibilidad de un antídoto que permite revertir su actividad: idarucizumab. Este fármaco es utilizado en procedimientos o intervenciones quirúrgicas de urgencia y en hemorragias potencialmente mortales o no controladas.Dabigatrán presenta una semivida de 12-14 horas, alargándose si la función renal está afectada. La decisión de cuándo interrumpir su administración depende del valor del aclaramiento de creatinina y del riesgo hemorrágico de la intervención.Presentamos el caso de un paciente en tratamiento con dabigatrán que ingresa para la realización de una cirugía de cadera tras una caída. Al ingreso se suspende dabigatrán, llevándose a cabo la cirugía al décimo día tras su suspensión. Antes de la cirugía se decide la administración de idarucizumab por continuar alterados los tiempos de coagulación.Exponemos en este caso la falta de mejoría de los tiempos de coagulación tras el uso del antídoto, cuya explicación se pueda deber al largo periodo entre la administración de idarucizumab y la última dosis de dabigatrán administrada (10 días).Por lo tanto, en caso de no poder medir los niveles de dabigatrán, es importante tener en cuenta además de los tiempos de coagulación, aspectos farmacológicos del dabigatrán como la farmacocinética, para evitar la administración innecesaria del antídoto, que puede suponer un riesgo y costes innecesarios. (AU)

One of the advantages of dabigatran, a new direct-acting oral anticoagulant, is the availability of an antidote to reverse its activity: idarucizumab. This drug is used in emergency surgical procedures or interventions and in life-threatening or uncontrolled bleeding.Dabigatran has a half-life of 12-14 hours, lengthening if renal function is affected. The decision on when to interrupt the administration depends on the creatinine clearance rate and the bleeding risk of the procedure.We present the case of a patient on dabigatran treatment who was hospitalized for hip surgery after a fall. On admission, dabigatran was suspended, and surgery was performed on the tenth day after its suspension. Before surgery, it was decided to administer idarucizumab due to continued altered coagulation times.In this case, it is reported the lack of improvement in clotting times after the use of the antidote, which may be explained by the long period of time between the administration of idarucizumab and the last dose of dabigatran administered (10 days).Therefore, in case of dabigatran levels cannot be measured, it is important to consider, in addition to clotting times, pharmacological aspects of dabigatran such as pharmacokinetics, in order to avoid unnecessary administration of the antidote, which may entail unnecessary risk and costs. (AU)

Impacto económico de las nuevas terapias orales en esclerosis múltiple / Economic impact of the new oral treatments for multiple sclerosis

INTRODUCCIÓN: La esclerosis múltiple (EM) es una enfermedad crónica del sistema nervioso central que se caracteriza por la existencia de inflamación, desmielinización, gliosis y daño axonal. La introducción de dimetilfumarato y teriflunomida ha supuesto un aumento de las alternativas terapéuticas en la primera línea de tratamiento de la EM. El objetivo de este estudio fue evaluar el impacto económico de la incorporación de estas nuevas terapias orales en la Unidad de Referencia (CSUR) del Hospital Universitario Puerta de Hierro Majadahonda. MATERIAL Y MÉTODOS: Se realizó un estudio observacional retrospectivo en la población de pacientes diagnosticados de EM, en tratamiento con fármacos modificadores de la enfermedad durante el año 2015, y su seguimiento se prolongó hasta obtener un seguimiento medio superior a un año de tratamiento. Los datos se recogieron de la historia clínica electrónica y del programa de dispensación de medicamentos a pacientes externos y ambulantes del Servicio de Farmacia. RESULTADOS: Evaluando el coste del cambio del tratamiento en 125 pacientes desde otros fármacos a dimetilfumarato o teriflunomida y comparando con el coste que habría supuesto el mantenimiento de los tratamientos previos, el ahorro total durante el periodo de observación fue de 169.107,31 (Euro). CONCLUSIONES: Dimetilfumarato y teriflunomida, además de aportar nuevas alternativas terapéuticas, no solo no han supuesto un incremento sino, por el contrario, una disminución en los costes del tratamiento de la EM en nuestro hospital

INTRODUCTION: Multiple sclerosis (MS) is a chronic disease affecting the central nervous system and is characterised by inflammation, demyelination, gliosis, and axonal damage. The introduction of dimethyl fumarate and teriflunomide has led to an increase in the number of alternative first-line therapies for MS. The objective of this study was to evaluate the economic impact of the incorporation of new oral therapies at the reference unit (CSUR) at Hospital Universitario Puerta de Hierro Majadahonda. MATERIALS AND METHODS: We performed a retrospective observational study including patients diagnosed with MS, who underwent treatment with disease-modifying drugs in 2015 and were followed up for a minimum mean time of one year. Data were collected from patients' electronic clinical histories and the pharmacy service's programme for dispensing drugs to outpatients. RESULTS: Evaluating the cost of changing 125 patients' treatment from other drugs to dimethyl fumarate and teriflunomide, and comparing this with the cost that would have resulted from maintaining their previous treatment, demonstrated a total saving of (Euro)169,107.31 over the study period. CONCLUSIONS: In addition to contributing new therapeutic alternatives, dimethyl fumarate and teriflunomide produced an economic saving in MS treatment at our hospital

Economic impact of the new oral treatments for multiple sclerosis. / Impacto económico de las nuevas terapias orales en esclerosis múltiple.

INTRODUCTION: Multiple sclerosis (MS) is a chronic disease affecting the central nervous system and is characterised by inflammation, demyelination, gliosis, and axonal damage. The introduction of dimethyl fumarate and teriflunomide has led to an increase in the number of alternative first-line therapies for MS. The objective of this study was to evaluate the economic impact of the incorporation of new oral therapies at the reference unit (CSUR) at Hospital Universitario Puerta de Hierro Majadahonda. MATERIALS AND METHODS: We performed a retrospective observational study including patients diagnosed with MS, who underwent treatment with disease-modifying drugs in 2015 and were followed up for a minimum mean time of one year. Data were collected from patients' electronic clinical histories and the pharmacy service's programme for dispensing drugs to outpatients. RESULTS: Evaluating the cost of changing 125 patients' treatment from other drugs to dimethyl fumarate and teriflunomide, and comparing this with the cost that would have resulted from maintaining their previous treatment, demonstrated a total saving of €169,107.31 over the study period. CONCLUSIONS: In addition to contributing new therapeutic alternatives, dimethyl fumarate and teriflunomide produced an economic saving in MS treatment at our hospital.

Toxicidad ungueal asociada al tratamiento con urea / Nail toxicity associated with urea treatment

La melanoniquia es la pigmentación de la lámina ungueal, esta alteración es inducida por diversas causas: procesos inflamatorios, traumatismos, enfermedades autoinmunes o medicamentos. Existen numerosos fármacos que pueden producir alteraciones en las uñas (antiinfeciosos, antineoplásicos, retinoides), siendo reversibles en la mayoría de casos tras la suspensión del fármaco. La hidroxiurea es uno de los agentes quimioterápicos identificados como causante en raras ocasiones de toxicidad ungueal. Se trata de un derivado hidoxilado de la urea, que actúa inhibiendo la síntesis de ADN.En este artículo, presentamos el caso de una paciente trasplantada pulmonar de 61 años con diagnóstico de diabetes insípida que, sin embargo, durante su ingreso desarrolló un SIADH (secreción inadecuada de hormona antidiurética). El SIADH fue tratado con restricción hídrica y urea, tras el inicio de dicho tratamiento empezó a presentar lesiones en uñas de las manos y de los pies, que remitieron con el tiempo tras su retirada. Ningún otro fármaco de los prescritos durante su ingreso se ha relacionado con la toxicidad ungueal, por tanto se consideró la urea como posible causante de las lesiones ungueales en esta paciente. Esta reacción fue notificada al Sistema Español de Farmacovigilancia. (AU)

Melanonychia is the pigmentation of the nail, this alteration is induced by diverse causes: inflammatory processes, traumatisms, autoimmune diseases or medications. There are numerous drugs that can produce alterations in the nails (anti-infectious, chemotherapy agents, retinoid), the alterations are reversible in most cases after drug discontinuation. Chemotherapeutic agent hydroxyurea is identified as a cause of nail toxicity rarely. It is a hydroxylated derivative of urea, which acts by inhibiting DNA synthesis.In this article, we present the case of a 61-year-old lung transplant patient diagnosed with diabetes insipidus who, however, developed SIADH (inadequate secretion of antidiuretic hormone) during his hospitalization, the patient received treatment with water restriction and urea. After the start of treatment, the patient began to present lesions on the nails of the hands and feet, which remitted with time after drug discontinuation. No other medication prescribed during admission has been linked to nail toxicity, so urea was considered a possible cause of nail lesions in this patient. This reaction was notified to the Spanish Pharmacovigilance System. (AU)

Major As species, lipid peroxidation and protein carbonylation in rice plants exposed to increasing As(V) concentrations.

Arsenic (As) uptake by plants is mainly carried out as arsenate (As(V)), whose chemical analogy with phosphate is largely responsible for its elevated toxicity. Arsenate is known to stimulate reactive oxygen species (ROS) formation in plants that provoke oxidative stress. This manuscript reports the results of a hydroponics study using rice (Oryza sativa L.) seedlings as a test plant, where the effects of increasing arsenate concentrations (0-10 mg L-1) on both lipid and protein oxidation, as well as As accumulation and speciation in plant roots and shoots were examined. Plant yield was negatively affected by increasing As concentration. Accumulation in plant roots was higher than in shoots at low arsenate doses (0.5-2.5 mg L-1), while root to shoot transport was drastically enhanced at the highest doses (5 and 10 mg L-1). Moreover, As(V) was the dominating species in the shoots and As(III) in the roots. Rice leaves in the 10 mg As L-1 treatment showed the highest lipid peroxidation damage (malondialdehyde concentration), whilst protein oxidation was not remarkably influenced by As dose. Lipid peroxidation seems to be therefore conditioned by As accumulation in rice plants, particularly by the presence of high As(V) concentrations in the aerial part of the plants as a consequence of unregulated translocation from roots to shoots above a threshold concentration (1.25-2.5 mg L-1) in the growing media. These results provide relevant information regarding As(V) toxic concentrations for rice plants, highlight the importance of major As species analysis in plant tissues regarding As toxicity and contribute to better understand plants response to elevated As concentrations in the growing media.

Combination of soil organic and inorganic amendments helps plants overcome trace element induced oxidative stress and allows phytostabilisation.

Trace element (TE)-contaminated soils require the improvement of their physico-chemical properties in order to allow their restoration through phytostabilization technologies. This study aimed to determine the usefulness of oxidative stress related parameters to validate the suitability of two different combinations of organic (solid fraction of pig slurry) and inorganic (paper mill sludge or a commercial red mud derivative) amendments for the phytostabilization of an acidic (4.2) TE-contaminated mine soil from SE Spain. Two wild species (Silybum marianum and Piptatherum miliaceum) were greenhouse cultivated and the development of the plants, their ionome, and oxidative stress related parameters were determined. Both amendment combinations increased significantly soil pH (to 5-6) and soil/pore water total organic C and total N concentrations, allowing an adequate plant growth and development (plants did not grow in untreated soils). The combination of amendments significantly reduced metal availability and showed to be effective (specially the one including the red mud derivative) in limiting shoot TE concentrations, which were all within common ranges (exclusion based tolerance of these species). Both protein carbonylation and lipid peroxidation were significantly higher in S. marianum plants from phytostabilized soils than in those from non-contaminated soils, which confirms the oxidative stress these plants suffer despite their satisfactory growth in the treated soils. P. miliaceum plants showed no differences between phytostabilized and non-contaminated soils. Therefore, the combination of amendments and TE-tolerant autochthonous species would be a suitable option for the phytostabilisation of soils contaminated by mining activities, reducing TE solubility and allowing an adequate plant growth.

Desabastecimientos de medicamentos en un hospital de tercer nivel en España / Shortages in medicinal products in a tertiary care hospital in Spain

No disponible

Conciliación de la medicación al ingreso y alta hospitalaria. Una experiencia consolidada / Medication reconciliation at admission and discharge. A consolidated experience

La conciliación de la medicación es actualmente una de las principales estrategias para reducir los errores de medicación relacionados con la transición asistencial. Objetivo. Describir una metodología de trabajo que permita garantizar la continuidad asistencial del paciente en relación con la farmacoterapia, al ingreso y al alta hospitalaria. Material y método. Se describe la metodología implantada en un hospital de tercer nivel y los principales resultados de la conciliación de medicación al ingreso y alta de pacientes mayores de 75 años en el Servicio de Traumatología durante el año 2014. Resultados. Las fases de la metodología fueron: 1. obtención de la historia farmacoterapéutica (al menos 2 fuentes de información); 2. análisis de discrepancias y validación de la medicación al ingreso: se realizó un check list para estandarizar el proceso; 3. comunicación del perfil farmacoterapéutico: se diseñó un formulario en la historia clínica electrónica; y 4. conciliación de la medicación al alta hospitalaria e información al paciente: entrega de esquema posológico y recomendaciones al paciente. Aplicando esta metodología, en 2014 se conciliaron 318 pacientes ingresados en traumatología (294 al ingreso y alta). El 35,5% presentó al menos un error de conciliación. La media de errores por paciente conciliado fue de 0,69. En el 74,1% de los pacientes se entregó información escrita al alta. Conclusiones. Esta metodología ha permitido establecer un flujo de trabajo que facilita la coordinación interprofesionales; disminuir los errores de medicación y dar respuesta a uno de los principales problemas de la continuidad asistencial (AU)

Medication reconciliation is currently one of the main strategies to reduce medication errors related to transitional care. Objective. To describe a method that would ensure continuity of patient care as regards drug therapy from admission to discharge. Methods. A description is presented on the methodology implemented in a tertiary hospital and the main results of medication reconciliation at admission and discharge of patients older than 75 years in the Trauma Unit during 2014. Results. The phases of the methodology were: 1. Obtain medication history (at least two sources of information); 2. Analysis of discrepancies and validation of medication on admission: A checklist was made to standardise the process, 3. Report on the pharmacotherapeutic profile: a form was designed in electronic medical records, and 4. Medication reconciliation at discharge and patient information: presenting the dosing schedule and recommendations to the patient. The medication of 318 patients admitted to Trauma was reconciled (294 at admission and discharge) by applying this methodology during the study period. There was at least one medication reconciliation error in 35% of cases. The mean error per patient reconciled was 0.69. Written discharge information was given to 74.1% of patients. Conclusions. This methodology has allowed a workflow to be established that facilitates coordination between healthcare providers, in order to reduce medication errors and to respond to one of the main problems of continuity of care (AU)

[Medication reconciliation at admission and discharge. A consolidated experience]. / Conciliación de la medicación al ingreso y alta hospitalaria. Una experiencia consolidada.

UNLABELLED: Medication reconciliation is currently one of the main strategies to reduce medication errors related to transitional care. OBJECTIVE: To describe a method that would ensure continuity of patient care as regards drug therapy from admission to discharge. METHODS: A description is presented on the methodology implemented in a tertiary hospital and the main results of medication reconciliation at admission and discharge of patients older than 75 years in the Trauma Unit during 2014. RESULTS: The phases of the methodology were: 1. Obtain medication history (at least two sources of information); 2. Analysis of discrepancies and validation of medication on admission: A checklist was made to standardise the process, 3. Report on the pharmacotherapeutic profile: a form was designed in electronic medical records, and 4. Medication reconciliation at discharge and patient information: presenting the dosing schedule and recommendations to the patient. The medication of 318 patients admitted to Trauma was reconciled (294 at admission and discharge) by applying this methodology during the study period. There was at least one medication reconciliation error in 35% of cases. The mean error per patient reconciled was 0.69. Written discharge information was given to 74.1% of patients. CONCLUSIONS: This methodology has allowed a workflow to be established that facilitates coordination between healthcare providers, in order to reduce medication errors and to respond to one of the main problems of continuity of care.

Fenómenos de despolarización cortical propagada en los pacientes con lesiones cerebrales traumáticas e isquémicas. Resultados de un estudio piloto / Cortical spreading depolarization phenomena in patients with traumatic and ischemic brain injuries. Results of a pilot study

OBJETIVOS: Determinar la frecuencia y duración de episodios de despolarización cortical propagada (CSD y CSD-like) en pacientes con lesiones por traumatismo craneoencefálico (TCE) e infartos malignos de la arteria cerebral media (IMACM) que requirieron craneotomía. DISEÑO: Estudio descriptivo-observacional desarrollado durante 19 meses. Ámbito: Pacientes neurocríticos. PACIENTES: Estudio realizado en 16 pacientes (9 IMACM y 7 TCE graves) que requirieron tratamiento quirúrgico. INTERVENCIONES: Colocación de una tira de 6 electrodos en el córtex perilesional para el registro continuo de electrocorticografía (ECoG). Variables de interés principales: En todos los casos se determinó la hora, el número y la duración de los episodios de CSD y CSD-like detectados. RESULTADOS: De los 16 registros de ECoG analizados, 9 presentaron fenómenos CSD y CSD-like, de duración y frecuencias muy variables. CONCLUSIONES: Los episodios de CSD y CSD-like se detectan con frecuencia en el córtex en las regiones de penumbra isquémica y/o traumática de pacientes con un IMACM que han requerido craniectomía descompresiva o afectos de un TCE con contusiones cerebrales

OBJECTIVES: To determine the frequency and duration of cortical spreading depolarization (CSD) and CSD-like episodes in patients with traumatic brain injury (TBI) and malignant middle cerebral artery infarction (MMCAI) requiring craniotomy. DESIGN: A descriptive observational study was carried out during 19 months. SETTING: Neurocritical patients. PATIENTS: Sixteen patients were included: 9 with MMCAI and 7 with moderate or severe TBI, requiring surgical treatment. Interventions A 6-electrode subdural electrocorticographic (ECoG) strip was placed onto the perilesional cortex. MAIN VARIABLES OF INTEREST: An analysis was made of the time profile and the number and duration of CSD and CSD-like episodes recorded from the ECoGs. RESULTS: Of the 16 patients enrolled, 9 presented episodes of CSD or CSD-like phenomena, of highly variable frequency and duration. CONCLUSIONS: Episodes of CSD and CSD-like phenomena are frequently detected in the ischemic penumbra and/or traumatic cortical regions of patients with MMCAI who require decompressive craniectomy or of patients with contusional TBI

[Cortical spreading depolarization phenomena in patients with traumatic and ischemic brain injuries. Results of a pilot study]. / Fenómenos de despolarización cortical propagada en los pacientes con lesiones cerebrales traumáticas e isquémicas. Resultados de un estudio piloto.

OBJECTIVES: To determine the frequency and duration of cortical spreading depolarization (CSD) and CSD-like episodes in patients with traumatic brain injury (TBI) and malignant middle cerebral artery infarction (MMCAI) requiring craniotomy. DESIGN: A descriptive observational study was carried out during 19 months. SETTING: Neurocritical patients. PATIENTS: Sixteen patients were included: 9 with MMCAI and 7 with moderate or severe TBI, requiring surgical treatment. INTERVENTIONS: A 6-electrode subdural electrocorticographic (ECoG) strip was placed onto the perilesional cortex. MAIN VARIABLES OF INTEREST: An analysis was made of the time profile and the number and duration of CSD and CSD-like episodes recorded from the ECoGs. RESULTS: Of the 16 patients enrolled, 9 presented episodes of CSD or CSD-like phenomena, of highly variable frequency and duration. CONCLUSIONS: Episodes of CSD and CSD-like phenomena are frequently detected in the ischemic penumbra and/or traumatic cortical regions of patients with MMCAI who require decompressive craniectomy or of patients with contusional TBI.

Manejo conservador de las lesiones esplénicas: experiencia en 136 pacientes con traumatismo esplénico cerrado / Conservative management of splenic lesions: experience in 136 patients with blunt splenic injury

Objetivo. Evaluar la eficacia de las pruebas de imagen en la selección del manejo terapéutico de los pacientes. Relacionar el grado de lesión esplénica con el tratamiento instaurado. Exponer los beneficios de la embolización en el trauma esplénico. Material y métodos. Se han estudiado retrospectivamente un total de 136 lesiones esplénicas. Se analizaron los principales mecanismos lesionales, los hallazgos de imagen obtenidos mediante ecografía FAST y TC, el espectro lesional, el manejo terapéutico y la evolución. Resultados. La edad media fue 34,81 años y el principal mecanismo lesional los accidentes de tráfico. El 39,70% de los casos (54 pacientes) mostraban signos de inestabilidad hemodinámica, y el 60,30% restante (82 pacientes) estaban estables o respondían a maniobras de resucitación. La ecografía FAST fue la técnica de imagen inicial y más utilizada en los pacientes inestables, mientras que la TC fue la técnica más empleada en los pacientes estables. El tratamiento fue quirúrgico en el 79,99% de las lesiones de alto grado y conservador expectante en el 55,69% de las lesiones de bajo grado. El 8,54% de los pacientes estables se manejó con arteriografía y embolización. Conclusión. La ecografía FAST demostró ser una técnica decisiva en la elección del tratamiento quirúrgico en los enfermos inestables. Las lesiones de alto grado se asociaron con mayor frecuencia a un tratamiento quirúrgico y las de bajo grado a un manejo no quirúrgico. La arteriografía con embolización demostró ser una terapia eficaz en el tratamiento de lesiones vasculares en enfermos estables (AU)

Objective. To evaluate the usefulness of imaging tests in selecting the treatment for patients with blunt splenic trauma. To relate the grade of splenic lesion with the treatment. To describe the benefits of embolization in splenic trauma. Material and methods. We retrospectively studied 136 splenic lesions. We analyzed the main mechanisms of injury, the imaging findings at focused assessment with sonography for trauma (FAST US) and CT, the spectrum of lesions, the therapeutic management, and the outcome. Results. The mean age of patients was 34.81 years and the most common mechanism of injury was traffic accidents. Signs of hemodynamic instability were observed in 54 (39.70%) patients; the remaining 82 (60.30%) patients remained stable or responded to resuscitation. FAST US was the initial imaging technique and the most commonly used technique in unstable patients, whereas CT was the most commonly used technique in stable patients. Surgical treatment was used in 79.99% of the high grade lesions and conservative treatment was used in 55.69% of the low grade lesions. Angiography and embolization were used to manage 8.54% of the stable patients. Conclusion. FAST US is decisive in choosing the surgical treatment in unstable patients. High grade lesions are associated with a higher frequency of surgery and lower grade lesions are associated with a higher frequency of nonsurgical management. Angiography with embolization is efficacious in the treatment of vascular lesions in stable patients (AU)

[Conservative management of splenic lesions: experience in 136 patients with blunt splenic injury]. / Manejo conservador de las lesiones esplénicas: experiencia en 136 pacientes con traumatismo esplénico cerrado.

OBJECTIVE: To evaluate the usefulness of imaging tests in selecting the treatment for patients with blunt splenic trauma. To relate the grade of splenic lesion with the treatment. To describe the benefits of embolization in splenic trauma. MATERIAL AND METHODS: We retrospectively studied 136 splenic lesions. We analyzed the main mechanisms of injury, the imaging findings at focused assessment with sonography for trauma (FAST US) and CT, the spectrum of lesions, the therapeutic management, and the outcome. RESULTS: The mean age of patients was 34.81 years and the most common mechanism of injury was traffic accidents. Signs of hemodynamic instability were observed in 54 (39.70%) patients; the remaining 82 (60.30%) patients remained stable or responded to resuscitation. FAST US was the initial imaging technique and the most commonly used technique in unstable patients, whereas CT was the most commonly used technique in stable patients. Surgical treatment was used in 79.99% of the high grade lesions and conservative treatment was used in 55.69% of the low grade lesions. Angiography and embolization were used to manage 8.54% of the stable patients. CONCLUSION: FAST US is decisive in choosing the surgical treatment in unstable patients. High grade lesions are associated with a higher frequency of surgery and lower grade lesions are associated with a higher frequency of nonsurgical management. Angiography with embolization is efficacious in the treatment of vascular lesions in stable patients.