Trasplante de microbiota fecal por colonoscopía en paciente mayor de 65 años con infección recurrente de Clostridioides difficile: aún una estrategia subutilizada / Fecal microbiota transplantation in an older patient with Clostridioides difficile recurrent infection. Report of one case

Clostridioides difficile infection (CDI) is a major public health problem and responsible for significant morbidity and mortality. Eighty percent of CDIs occur in adults older than 65 years of age due to a decreased gastrointestinal microbial diversity, immunosenescence and frailty. Thus, the most reported risk factor for recurrent CDI is older age since nearly 60% of cases occur in individuals aged ≥ 65 years. Fecal microbiota transplantation (FMT) is a highly cost-effective alternative to antibiotic treatment for patients with recurrent CDI. We report a 75-year-old male with recurrent CDI, who received a FMT after several unsuccessful antimicrobial treatments. He had a satisfactory evolution after the procedure and remained without diarrhea during the ensuing five months.

Abordagem diagnóstica e de manuseio da pouchite em doença inflamatória intestinal / Diagnostic and management approach to pouchitis in inflammatory bowel disease

ABSTRACT In patients with ulcerative colitis refractory to medical therapy, total proctocolectomy and posterior ileal-anal pouch anastomosis is the standard surgical therapy. One of the possible complications is pouchitis. Depending on the duration of the symptoms, it can be classified as acute, recurrent, or chronic. The latter, according to the response to therapy, can be defined as antibiotic-dependent or refractory. The treatment of pouchitis is based on the use of antibiotics and probiotics. Thiopurine and biological therapy have been suggested in patients with refractory pouchitis. Special care should be taken in the endoscopic surveillance of these patients, especially if they present risk factors such as dysplasia or previous colorectal cancer, primary sclerosing cholangitis or ulcerative colitis for more than 10 years.

RESUMO Em pacientes com colite ulcerativa refratária à terapia médica, a proctocolectomia total e anastomose de bolsa ileal-anal posterior é a terapia cirúrgica padrão. Uma das possíveis complicações é a pouchite. Dependendo da duração dos sintomas, pode ser classificado como aguda, recorrente ou crônica. Esta última, de acordo com a resposta à terapia, pode ser definida como dependente de antibióticos ou refratária a eles. O tratamento da pouchite baseia-se no uso de antibióticos e probióticos. A thiopurina e a terapia biológica têm sido sugeridas em pacientes com pouchite refratária. Um cuidado especial deve ser tomado na vigilância endoscópica desses pacientes, especialmente se apresentarem fatores de risco, como displasia ou câncer colorretal anterior, colangite esclerosante primária ou colite ulcerativa por mais de 10 anos.

Implementación de la Política Nacional de Medicamentos de la Reforma de la Salud: percepción del profesional farmacéutico / Implementation of the Health Reform's National Medication Policy: the perception of pharmacists

Introducción: La reforma de la salud en Chile incluyó una Política Nacional de Medicamentos que posiciona al profesional químico farmacéutico en la tarea de contribuir a lograr los objetivos terapéuticos y de uso racional de los medicamentos. La investigación tuvo el objetivo de explorar las percepciones de químico farmacéuticos respecto a la implementación de los cambios introducidos por esta Política. Material y Método: Se condujo un estudio cualitativo y exploratorio en base a entrevistas individuales semi-estructuradas en profundidad a profesionales químico farmacéuticos de la red asistencial de la Región Metropolitana durante el período marzo-agosto de 2010. Se seleccionó una muestra por conveniencia de 10 profesionales de diferentes niveles de atención de la red asistencial de la Región. El análisis de las entrevistas se realizó mediante la técnica de análisis de contenido. Resultados: Para los entrevistados, la Política Nacional de Medicamentos ha permitido asignar un rol importante al farmacéutico y a la farmacia dentro de las distintas instancias de la red asistencial. No obstante, las principales dificultades en su implementación han estado determinadas por la ausencia de condiciones organizacionales y estructurales de las instituciones relacionadas con la implementación de la reforma de la salud.Discusión: La implementación de la Política Nacional de Medicamentos ha permitido mejorar algunos procesos de la gestión farmacéutica. Sin embargo; las brechas entre el diseño y la implementación de la reforma de la salud ha obstaculizado su implementación.

Introduction: Health reform in Chile included a National Medication Policy that positioned pharmacists as contributors to achieving therapeutic goals, and as promoters of the rational use of medications. The objectiveof the research was to explore the perceptions of pharmacists with respect to the implementation of changes introduced by the National Medication Policy. Materials and Methods: A qualitative and exploratory study, based on individual, semi-structured, in-depth interviews with pharmacists in the Metropolitan health care network, was carried out during March- August of 2010. A convenience sample of 10 professionals was selected from different health care levels within the Metropolitan network. The analysis of the interviews was carried out using content analysis.Results: For the interviewees, the National Medication Policy has given pharmacists and pharmacies an important role in different sectors of the health care network. Nevertheless, the principal difficulties in its implementation have been determined by the absence of different organizational and structural conditions in the institutions related to the implementation of the health reforms.Discussion: The implementation of the National Medication Policy has improved some processes of pharmaceutical management. Nevertheless, the gaps between the design and implementation of health reform have hampered its implementation.