[Importance of the detection of dysphagia in geriatric patients]. / Importancia de la detección de la disfagia en pacientes geriátricos.

INTRODUCTION: Oropharyngeal dysphagia is one of the lesser known geriatric syndromes, despite its enormous impact on functional capacity, quality of life, and health of those affected. MATERIAL AND METHODS: A descriptive and prospective study was conducted by the Geriatric Department of Barbastro Hospital (Huesca), from March 2012 to October 2014, as biannual and annual reviews in October 2015. This study included all patients on whom a volume-viscosity clinical examination (MECV-V test) was performed to suspecting dysphagia. RESULTS: The study included 266 patients with a mean age of 82.35±12.3 years, and with a mean Barthel index score of 20.5±25.4, and mean Charlson index of 1.77±1.6. The test was performed in 105 cases after stroke (40%), 53 in dementia (20%), 24 in Parkinsonism (9%), and for other different reasons in 80 (31%). Dysphagia was diagnosed in 228 (86%) cases. Enteral nutrition was given in 25 (10.9%) cases. The test results were shown in the discharge report in 45% of the tests with positive result. The mean survival obtained after test in the patients who died was 230.8±256.5 days. Differences in survival at 12 months were found in patients with positive test, without finding a clear relationship with functional status and comorbidity. CONCLUSIONS: Dysphagia has a significant mortality, and the use of thickeners after its detection should be properly reported.

[Determining factors in the sedation of geriatric and oncology patients treated at home]. / Factores condicionantes de sedación en pacientes geriátricos y oncológicos atendidos en el domicilio.

INTRODUCTION: Sedation, used as a therapeutic measure in the field of Palliative Care, continues to present difficulties for many professionals in its management and indications. Is varied existing literature in this regard, often exclusive cancer patients. Our objective is to analyse the characteristics of patients attended by a Home Care Support Team who required sedation compared to non-sedated patients, for possible determining factors for its use that could help in decision-making. METHOD: A prospective analytical study conducted in Barbastro (Huesca) from September 2007 to February 2011. The study population are patients referred to the Home Care Support Team of Barbastro. MAIN VARIABLES: Age, sex, medical history, symptoms, previous and current Barthel, Karnofsky, primary caregiver, previous drugs, drugs after intervention, sedation yes/no. RESULTS: Required sedation 16.6% (n=106) of the cases (N=638). Sedated patients were younger, with no differences in sex, and the large majority (83%) were oncology patients. The presence of metastases showed no differences in need for sedation. Sedated patients have an increased functional impairment, determined by Barthel index decreased and a worse Karnofsky. Sedated patients showed increased frequency of uncontrolled symptoms, except psychomotor agitation, a fact determined by the medications used pre- and post-intervention. CONCLUSIONS: The presence of neoplastic disease, marked with existence of functional decline, and uncontrolled clinical need for certain medications to control symptoms may determine the need for sedation at the end of the process, above other factors such as patient comorbidity.

Quantitative p24 antigenaemia for monitoring response to antiretroviral therapy in HIV-1 group O-infected patients.

Failure to recognize infection caused by human immunodeficiency virus type 1 (HIV-1) group O variants has been described using both serological and genetic techniques. Moreover, the monitoring of response to antiretroviral therapy is difficult in persons carrying this infection since most currently available tests for quantifying viral load are not reliable for group O viruses. Considering the low level of divergence between the p24 proteins of group M and O viruses, we have examined whether the quantification of circulating p24 antigenaemia might be used as a surrogate marker of response to therapy in three subjects with HIV-1 group O infection treated with antiretroviral drugs. In summary, all three patients showed a significant decline in circulating plasma p24 antigenaemia, although only one achieved undetectable levels. The decline in p24 antigenaemia was parallel to an increase in the CD4 count and was associated with an improvement in clinical status.

Human immunodeficiency virus infection in pregnant women, transmission and zidovudine therapy.

OBJECTIVE: To determine the rate of mother to child transmission of HIV infection in women treated with zidovudine (ZDV). PATIENTS AND METHODS: A consecutive series of 52 HIV-positive pregnant women who either received antenatal care or delivered at our institution. Forty-three women were known to be HIV positive before delivery. Forty were treated with ZDV, 36 intravenously. Twelve had no antenatal care and one refused antenatal treatment. All neonates were treated with ZDV. RESULTS: The HIV transmission rate in children born to mothers treated with ZDV was 6.6%. This compares with a transmission rate of 14% before we used ZDV. All three mothers who transmitted infection had low compliance, initiated therapy late in pregnancy or had advanced disease. CONCLUSION: Our experience supports the idea that ZDV treatment has reduced HIV transmission rate.

[Drug administration by inhalation systems]. / Sistemas de administración de fármacos por vía inhalatoria.

Inhalant systems are often the drug administration method of choice for numerous respiratory diseases. The use of these systems is increasing due to their many advantages, one of which is the small quantity of medication they can deliver to a specific area. However, they also have their disadvantages, as inhalers require certain techniques that are not always followed. Inhalants may be propelled by a variety of methods: pressurized canisters, pumps, dry powder dispensers, nebulizers. Because each of these systems have their own administrating technique, the patient needs to be instructed in the proper use of the inhaler, with periodic follow-ups by health care workers to insure this.

Importancia de la detección de la disfagia en pacientes geriátricos / Importance of the detection of dysphagia in geriatric patients

Introducción. La disfagia orofaríngea es uno de los síndromes geriátricos menos conocidos, a pesar de su enorme impacto sobre la capacidad funcional, la calidad de vida y la salud de los individuos afectados. Material y método. Estudio descriptivo y prospectivo, por parte del Servicio de Geriatría del hospital de Barbastro (Huesca), desde marzo del 2012 hasta octubre del 2014, con fin de revisiones semestrales y anuales en octubre del 2015. Incluidos todos los paciente a los que se realizó método de exploración clínica de volumen-viscosidad (test MECV-V) por sospecha de disfagia. Resultados. El estudio incluyó a 266 pacientes, con una edad media de 82,35+/-12,3 años, con una puntuación media en el índice de Barthel de 20,5±25,4 y en el índice de Charlson de 1,77±1,6. El motivo de realización del test fue en 105 casos accidente cerebrovascular (40%), en 53 demencia (20%), en 24 parkinsonismos (9%) y por otros motivos diferentes en 80 (31%). Fueron diagnosticados de disfagia 228 casos (86%). Se instauró nutrición enteral en 25 casos (10,9%). Se reflejaron los resultados del test en el informe de alta en el 45% de los mismos con resultado positivo. La supervivencia media obtenida en los pacientes fallecidos desde la realización de test fue de 230,8±256,5 días. Encontramos diferencias en la supervivencia a los 12 meses en pacientes con test positivo, sin una clara relación con la situación funcional ni con la comorbilidad. Conclusiones. La disfagia conlleva una importante mortalidad, debiendo reflejarse adecuadamente el uso de espesantes tras su detección

Introduction. Oropharyngeal dysphagia is one of the lesser known geriatric syndromes, despite its enormous impact on functional capacity, quality of life, and health of those affected. Material and methods. A descriptive and prospective study was conducted by the Geriatric Department of Barbastro Hospital (Huesca), from March 2012 to October 2014, as biannual and annual reviews in October 2015. This study included all patients on whom a volume-viscosity clinical examination (MECV-V test) was performed to suspecting dysphagia. Results. The study included 266 patients with a mean age of 82.35±12.3 years, and with a mean Barthel index score of 20.5±25.4, and mean Charlson index of 1.77±1.6. The test was performed in 105 cases after stroke (40%), 53 in dementia (20%), 24 in Parkinsonism (9%), and for other different reasons in 80 (31%). Dysphagia was diagnosed in 228 (86%) cases. Enteral nutrition was given in 25 (10.9%) cases. The test results were shown in the discharge report in 45% of the tests with positive result. The mean survival obtained after test in the patients who died was 230.8±256.5 days. Differences in survival at 12 months were found in patients with positive test, without finding a clear relationship with functional status and comorbidity. Conclusions. Dysphagia has a significant mortality, and the use of thickeners after its detection should be properly reported

Factores condicionantes de sedación en pacientes geriátricos y oncológicos atendidos en el domicilio / Determining factors in the sedation of geriatric and oncology patients treated at home

Introducción. La sedación, como medida terapéutica utilizada en el ámbito de los Cuidados Paliativos, sigue presentando para muchos profesionales dificultad en su manejo e indicaciones. Es muy variada la bibliografía existente en este sentido, muchas veces exclusiva de los pacientes oncológicos. Nuestro objetivo es analizar las características de los pacientes atendidos por un Equipo de Soporte para Atención Domiciliaria que precisaron sedación frente a los no sedados, para determinar posibles factores condicionantes de la misma que puedan ayudar en la toma de decisiones. Método. Estudio analítico prospectivo realizado en el sector sanitario de Barbastro (Huesca) desde septiembre del año 2007 hasta febrero del año 2011. La población a estudio fueron los pacientes derivados al Equipo de Soporte para Atención Domiciliaria de Barbastro. Variables principales. Edad, sexo, antecedentes médicos, síntomas, Barthel previo y actual, Karnofsky, cuidador principal, fármacos previos, fármacos tras intervención, sedación sí/no. Resultado. Requirieron sedación el 16,6% (n=106) de los casos (N=638). Los pacientes sedados fueron más jóvenes, sin diferencias por sexo. Un 83% fueron oncológicos. La presencia de metástasis no mostró diferencias respecto a la necesidad de sedación. Los pacientes sedados presentaron un mayor declive funcional, determinado mediante un descenso en el índice de Barthel y un peor Karnofsky. Los pacientes sedados mostraron una mayor frecuencia de síntomas no controlados, con excepción de agitación psicomotriz, hecho determinado por las medicaciones usadas pre y postintervención. Conclusiones. La presencia de enfermedad oncológica, con existencia de declive funcional marcado, clínica no controlada y necesidad de determinadas medicaciones para el control de la sintomatología pueden determinar la necesidad de sedación al final del proceso, por encima de otros factores como la comorbilidad del paciente (AU)

Introduction. Sedation, used as a therapeutic measure in the field of Palliative Care, continues to present difficulties for many professionals in its management and indications. Is varied existing literature in this regard, often exclusive cancer patients. Our objective is to analyse the characteristics of patients attended by a Home Care Support Team who required sedation compared to non-sedated patients, for possible determining factors for its use that could help in decision-making. Method. A prospective analytical study conducted in Barbastro (Huesca) from September 2007 to February 2011. The study population are patients referred to the Home Care Support Team of Barbastro. Main variables. Age, sex, medical history, symptoms, previous and current Barthel, Karnofsky, primary caregiver, previous drugs, drugs after intervention, sedation yes/no. Results. Required sedation 16.6% (n=106) of the cases (N=638). Sedated patients were younger, with no differences in sex, and the large majority (83%) were oncology patients. The presence of metastases showed no differences in need for sedation. Sedated patients have an increased functional impairment, determined by Barthel index decreased and a worse Karnofsky. Sedated patients showed increased frequency of uncontrolled symptoms, except psychomotor agitation, a fact determined by the medications used pre- and post-intervention. Conclusions. The presence of neoplastic disease, marked with existence of functional decline, and uncontrolled clinical need for certain medications to control symptoms may determine the need for sedation at the end of the process, above other factors such as patient comorbidity (AU)

Papel del ESAD en el tratamiento del dolor. Análisis pre-post intervención en un entorno rural / HSCT role in the treatment of pain. Analysis pre-post intervention in a rural environment

Objetivos: Determinar la frecuencia de uso de analgésicos en pacientes terminales atendidos en domicilio, analizando factores que pudieran intervenir en la percepción del dolor, además de las actuaciones llevadas a cabo. Material y métodos: Estudio analítico prospectivo e intervencional con pacientes derivados al Equipo de Soporte para Atención Domiciliaria (ESAD) de Barbastro. Variables estudiadas: edad, sexo, número de visitas, tiempo de seguimiento, presencia de dolor y de otros síntomas concomitantes, Escala Visual Analógica (EVA), diagnóstico, analgésicos previos y post-intervención, dosis media previa de analgésicos y post-intervención. Estudio estadístico con SPSS 15.0. Resultados: n = 638, 53,9 % hombres (n = 344), edad media 79,64 ± 10,8 años, 56 % oncológicos (n = 357), seguimiento medio 56 ± 56,56 días, media de 2,68 ± 2,5 visitas por proceso. Dolor en primera visita 43,3 % (n = 276), EVA media 6,54 ± 1,87, dolor 47,1 % de hombres (n = 162) y 38,8 % de mujeres (n = 114) (p < 0,05), dolor en 56,6 % de oncológicos (n = 202) y en 26,3 % de crónico-dependientes (n = 74) (p < 0,001). No diferencias en EVA entre grupos. Entre analgésicos pautados en pacientes con dolor controlado y sin controlar previa intervención del ESAD encontramos diferencias estadísticamente significativas (p < 0,005) en morfina y tramadol, y con mayor significación (p < 0,001) en fentanilo transdérmico y transmucosa, paracetamol, metamizol y AINE, todos más frecuentes en dolor no controlado. Las dosis medias previas de todos estos fármacos no mostraron diferencias significativas entre los grupos, aunque eran mayores en el grupo de dolor no controlado. En estos, se pautan o modifican analgésicos, encontrándose diferencias estadísticamente significativas pre-post intervención (p < 0,001) en fentanilo transdérmico y transmucosa, tramadol, paracetamol, metamizol, AINE, pregabalina y con p < 0,05 en gabapentina. Se obtiene diferencias (p < 0,05) únicamente en las dosis posteriores a la actuación del ESAD en fentanilo transdérmico y codeína. Obtenemos correlaciones positivas entre dolor y anorexia, ansiedad, depresión e insomnio; en pacientes oncológicos entre dolor y ansiedad e insomnio, y en pacientes crónico-dependientes entre dolor, náuseas y depresión. No diferencias entre grupos en uso previo de benzodiacepinas, antidepresivos y otros tratamientos, aunque sí en clínica de depresión, ansiedad e insomnio. Tras intervención, diferencias significativas en uso de estos tratamientos y de sedación. Conclusiones: Tras la actuación del ESAD se puede apreciar el aumento progresivo de todas las medicaciones analgésicas; se debería realizar una valoración completa de la sintomatología del paciente y un tratamiento de síntomas multifactorial, además de interrogar al paciente de forma adecuada acerca de la presencia de síntomas asociados, dada la elevada correlación de los mismos (AU)

Objectives: To determine the frequency of use of analgesics in terminal patients attended in home, and factors that may be involved in pain perception, in addition to the interventions carried out. Methods: prospective, interventional and analytical study in patients attended to Homecare Support Team (HSCT) of Barbastro. Variables studied: age, sex, number of visits, time tracking, presence of pain and other concomitant symptoms, Visual Analogic Scale (VAS), diagnosis, analgesics previous and post-intervention, previous and post-intervention average dose of analgesics. Statistical study with SPSS 15.0. Results: n = 638, men 53.9 % (n = 344), mean age 10.8 ± 79.64 years, cancer patient 56 % (n = 357), mean follow-up time 56 ± 56.56 days, 2.5 ± 2.68 mean visits per process. Pain in first visit 43.3 % (n = 276), mean VAS 6.54 ± 1.87, pain 47.1 % of men (n = 162) and 38.8 % of women (n = 114) (p < 0.05), pain in oncology 56.6 % (n = 202) and 26.3 % of non-cancer patients (n = 74) (p < 0.001). No differences between groups in VAS. Before intervention by HCST we found statistically significant differences (p < 0.005) on morphine and tramadol, and greater significance (p < 0.001) in transdermal and transmucosal fentanyl, paracetamol, metamizol and NSAIDs, all more common in uncontrolled pain. Previous mean doses of all these drugs showed no significant differences between groups, although they were higher in the group of uncontrolled pain. In these, analgesics were prescribed or modified, being statistically significant difference pre-post-intervention (p < 0.001) in transdermal and transmucosal fentanyl, tramadol, paracetamol, metamizol, NSAIDs, pregabalin and with p < 0.05 in gabapentin. Was obtained difference (p < 0.05) in mean dose only in transdermal fentanyl and codeine dose post-intervention of HCST. We obtain positive correlations between pain and anorexia, anxiety, depression and insomnia; in cancer patients between pain and anxiety and insomnia, and non-cancer patients between pain, nausea and depression. No differences between groups in previous use of benzodiazepines, antidepressants and other treatments; there was differences in depression, anxiety and insomnia. After intervention, we obtain significant differences in use of these treatments and sedation. Conclusions: after intervention of HCST there was gradual increase of all analgesic; it should conduct a full assessment of the patient’s symptoms and treatment of multifactorial symptoms in addition to questioning the patient adequately about the presence of associated symptoms, given the high correlation of them (AU)

Nefropatía asociada a fosfatos posterior a preparación para colonoscopia: dos casos anátomo-clínicos / Acute phosphate nephropathy after bowel cleansing for colonoscopy: two clinical-pathological case reports

Oral sodium phosphate (OSP) solutions are widely used for bowel cleansing before colonoscopy, for stercoral retention phenomena and persistent chronic constipation. Its main risk, is acute phosphate nephropathy (APN), which is a clinic-pathological entity characterized by acute kidney disease secondary to deposition of calcium phosphate crystals in the renal tubules. Its recognition has been documented over the last decade in relation to case reports and the warning of the FDA. This report discusses two cases of APN certified by renal biopsy after the administration of OSP. One of them had an acute symptomatic presentation, and the other one, was a late finding. Both developed renal failure.

Las soluciones de fosfato de sodio oral (FSO) son ampliamente utilizadas para la preparación de colon previo a colonoscopia, para fenómenos de retención estercorácea y constipación crónica pertinaz. Su principal riesgo, la nefropatía aguda por fosfatos (NAF), es una entidad clínico-patológica caracterizada por falla renal aguda secundaria a depósito de cristales de fosfato de calcio en los túbulos renales. En la última década se han comunicado reportes de casos clínicos y una advertencia del uso de FSO por parte de la Food and Drug Administration de EE.UU. (FDA). En esta publicación se comunican dos casos de NAF, posterior a la administración de FSO, confirmadas por biopsia. Uno de ellos tuvo una presentación aguda y sintomática y el otro fue un hallazgo tardío. Ambos se acompañaron de falla renal.

Tryptophan hydroxylase 1 knockout and tryptophan hydroxylase 2 polymorphism: effects on hypoxic pulmonary hypertension in mice.

Serotonin [5-hydroxytryptamine (5-HT)] biosynthesis depends on two rate-limiting tryptophan hydroxylases (Tph): Tph1, which is expressed in peripheral organs, and Tph2, which is expressed in neurons. Because 5-HT is involved in pulmonary hypertension (PH), we investigated whether genetic variations in Tph1 and/or Tph2 affected PH development in mice. To examine the functional impact of peripheral Tph1 deficiency on hypoxic PH, we used Tph1(-/-) mice characterized by very low 5-HT synthesis rates and contents in the gut and lung and increased 5-HT synthesis in the forebrain. With chronic hypoxia, 5-HT synthesis in the forebrain increased further. Hypoxic PH, right ventricular hypertrophy, and distal pulmonary artery muscularization were less severe (P < 0.001) than in wild-type controls. The Tph inhibitor p-chlorophenylalanine (100 mgxkg(-1)xday(-1)) further improved these parameters. We then investigated whether mouse strains harboring the C1473G polymorphism of the Tph2 gene showed different PH phenotypes during hypoxia. Forebrain Tph activity was greater and hypoxic PH was more severe in C57Bl/6 and 129X1/SvJ mice homozygous for the 1473C allele than in DBA/2 and BALB/cJ mice homozygous for the 1473G allele. p-Chlorophenylalanine reduced PH in all groups and abolished the difference in PH severity across mouse strains. Hypoxia increased 5-hydroxytryptophan accumulation but decreased 5-HT contents in the forebrain and lung, suggesting accelerated 5-HT turnover during hypoxia. These results provide evidence that dysregulation of 5-HT synthesis is closely linked to the hypoxic PH phenotype in mice and that Tph1 and Tph2 may contribute to PH development.

Pneumonia associated with meningococcal bacteremia and/or meningitis.

Four children between 5 and 12 years of age had pneumonia as a secondary complication of meningococcal bacteremia and/or meningitis. The diagnosis of meningococcal disease was established by culture of blood and/or cerebrospinal fluid. Fine inspiratory rales were found in one patient. In the other three cases pulmonary infiltrates were evidenced on chest roentgenogram. All patients recovered with penicillin G sodium therapy.

The possible value of ascorbic acid as a prophylactic agent for urinary tract infection.

The effect of ascorbic acid on urine pH was studied in spinal cord injury patients. Their urine was not colonized by urease positive microorganisms. The study was designed to compare the baseline urine pH value and the urine pH value after the administration of placebo or ascorbic acid 500 mg/6 h. The diet and medical treatment were not controlled. A significant decrease in urine pH value was not obtained. There was no clinical benefit from the use of ascorbic acid.

[Internal invoicing of end products manufactured by a hospital Pharmacy Department] / Facturación interna de los productos finales elaborados por el Servicio de Farmacia Hospitalaria.

OBJECTIVE: To calculate actual costs of end products manufactured by a Pharmacy Department. MATERIAL AND METHODS: Quality standards, overall production in relative value units (RVUs), and complexity degree of a pharmacy department are assessed. Actual cost of RVUs and manufactured end products is calculated. RESULTS: The Pharmacy Department is classified as quality level II. The total number of produced RVUs is 2,334,355.86, with a complexity degree of 2.20 and a cost per RVU of 0.87 euros. Pharmacy Department cost imputation per RVU has relevant discrepancies when compared to traditional shared cost systems regarding drug consumption. CONCLUSIONS: The inclusion of a product catalogue within Pharmacy Departments allows overall and department-specific activities to be acknowledged, as well as mean complexity, strengths and issues in need of improvement, in order to include them within pharmacy department planning. Furthermore, it allows for more realistic product charging to requesting departments.

YAC and cosmid FISH mapping of an unbalanced chromosomal translocation causing partial trisomy 21 and Down syndrome.

Most cases of Down syndrome (DS) result from a supernumerary chromosome 21; however, there are rare cases in which DS is due to partial trisomy of chromosome 21, involving various segments of the chromosome. The characterization of cases of DS that are due to partial trisomy 21 allows the phenotype to be correlated with the genotype. We present a case with features of DS and a partial trisomy of chromosome 21 inherited from a paternal balanced translocation involving chromosomes 13 and 21. Fluorescence in situ hybridization analysis using yeast artificial chromosome (YAC) probes mapped the breakpoint to 21q22.1, within YAC 230E8, which contains markers CBR, D21S333 and D21S334. Further mapping using cosmids positioned the breakpoint proximal to CBR. The patient was also monosomic for the distal portion of chromosome 13 (q33-qter). Many phenotypic features of DS were present including hypotonia, flat occiput, flat facies, up-slanted palpebral fissures, epicanthic folds, flat nasal bridge, macroglossia, open mouth, small ears and a heart murmur. This case further supports the contention that the majority of the phenotypic features of DS map to 21q22-qter and further refines the location of some of them. In addition to the DS phenotype, the patient had a prominent upper maxilla with protruding upper incisors, and low levels of the coagulation factors VII and X, consistent with a syndrome resulting from monosomy 13q33-qter. Since some features overlap between the two syndromes, including severe mental retardation, it is unclear to what extent monosmy for 13q33-qter, trisomy for 21q22.1-qter, or a combination of both, contributed to the common features of the phenotype.