Utilización del recambio plasmático como herramienta terapéutica en la práctica clínica.

To descrive the use of therapeutic plasma exchange in several pathologies and its adjustment to international reference guides. Observational, descriptive, retrospective study, of all the patients that  received plasmapheresis between January 2014-December 2015. We analized  the appropriate indication according to the bibliography consulted, and the  therapeutic outcome. Indication, replaced volume of plasma, number of sessions  and periodicity were established by the Hematology Service depending  on the disease and its clinical course. 10 patients (8 women), between 28-72 years old, received therapeutic  plasma exchange. The pathologies treated were  eurological (9 patients), Waldenström disease (1 patient). The technique used  was continuous centrifugation with albumin 5% as replacement fluid. The therapeutic plasma exchange in reviewed patients agreed to  reference guides. There was not a direct relation between the recommendation  grade and the response obtained. The reduced number of patients is a limitation  to obtain conclusive results.Objetivo: Describir la utilización del recambio plasmático terapéutico (RPT) en distintas patologías y su ajuste a las guías internacionales de referencia. Método: Estudio observacional, descriptivo y retrospectivo en pacientes que recibieron plasmaféresis entre enero de 2014 y diciembre de 2015. Se analizó la adecuación de su indicación según la bibliografía consultada, así como la respuesta obtenida. El Servicio de Hematología estableció la indicación, el volumen plasmático a recambiar, el número de sesiones y la periodicidad según la enfermedad de base y su evolución clínica. Resultados: Diez pacientes (8 mujeres) entre 28 y 72 años de edad, recibieron RPT. Las patologías eran de origen neurológico (9 pacientes), enfermedad de Waldenström (1 paciente). La técnica utilizada fue centrifugación continua con albúmina 5% como líquido de reposición. Conclusiones: El RPT en los pacientes revisados se ajustó a las guías de referencia. No se observó correlación directa entre el grado de recomendación establecido por dichas guías y la respuesta obtenida. El número reducido de pacientes supone una limitación a la hora de extraer resultados concluyentes

Efectividad de un programa de identificación de riesgos con técnicas de marketing en un servicio de Farmacia.

Comunicación y proyecto finalista presentado en: 21 Congreso Nacional de Hospitales y gestión Sanitaria. Innovación: camino de sostenibilidad. Santiago de Compostela el 8, 9 y 10 de mayo de 2019

Efectividad del Design Thinking para la mejora de la calidad y seguridad en el uso de medicamentos en un área integrada de salud

Introducción: En reuniones de grupos focales se concluyó que, dada la situación de integración asistencial y de gestión de la organización, una apuesta por la mejora interna junto con la implantación de nuevas tecnologías podría ser un mensaje que podría conducir al éxito. Esto es, priorizar la mejora en la organización interna a partir de “una mejora de la seguridad de los medicamentos orientada clínicamente a la atención al paciente”. Objetivo: Lograr la participación del Servicio de Farmacia en la mejora de la calidad técnica con una atención innovadora en la atención farmacéutica del paciente. Métodos: En un área integrada de 300 000 habitantes, con tres hospitales y 49 centros de salud, en el Servicio de Farmacia se crearon dos grupos focales para la evaluación de su situación, y a partir de la misma, proponer un despliegue de acciones de mejora. A través del Design Thinking, se realizaron sesiones conjuntas semiestructuradas consensuando el despliegue. Tras la evaluación y puesta en común se propusieron tres líneas estratégicas: 1. Orientación hacia la mejora y certificación de la calidad. 2. Orientación hacia el paciente, abriendo canales más directos de contacto a través de nuevas tecnologías. 3. Mejora en el radar de detección de problemas en el medicamento (generalmente de seguridad), con los facultativos de la EOXI (“La seguridad clínica como un objetivo”)

Prognostic value of discharge heart rate in acute heart failure patients: more relevant in atrial fibrillation?

[Abstract] Aims. The prognostic impact of heart rate (HR) in acute heart failure (AHF) patients is not well known especially in atrial fibrillation (AF) patients. The aim of the study was to evaluate the impact of admission HR, discharge HR, HR difference (admission-discharge) in AHF patients with sinus rhythm (SR) or AF on long- term outcomes. Methods. We included 1398 patients consecutively admitted with AHF between October 2013 and December 2014 from a national multicentre, prospective registry. Logistic regression models were used to estimate the association between admission HR, discharge HR and HR difference and one- year all-cause mortality and HF readmission. Results. The mean age of the study population was 72 ± 12 years. Of these, 594 (42.4%) were female, 655 (77.8%) were hypertensive and 655 (46.8%) had diabetes. Among all included patients, 745 (53.2%) had sinus rhythm and 653 (46.7%) had atrial fibrillation. Only discharge HR was associated with one year all-cause mortality (Relative risk (RR) = 1.182, confidence interval (CI) 95% 1.024–1.366, p = 0.022) in SR. In AF patients discharge HR was associated with one year all cause mortality (RR = 1.276, CI 95% 1.115–1.459, p ≤ 0.001). We did not observe a prognostic effect of admission HR or HRD on long-term outcomes in both groups. This relationship is not dependent on left ventricular ejection fraction. Conclusions. In AHF patients lower discharge HR, neither the admission nor the difference, is associated with better long-term outcomes especially in AF patients

HTLV-1 infection in solid organ transplant donors and recipients in Spain

HTLV-1 infection is a neglected disease, despite infecting 10-15 million people worldwide and severe illnesses develop in 10% of carriers lifelong. Acknowledging a greater risk for developing HTLV-1 associated illnesses due to immunosuppression, screening is being widely considered in the transplantation setting. Herein, we report the experience with universal HTLV testing of donors and recipients of solid organ transplants in a survey conducted in Spain. All hospitals belonging to the Spanish HTLV network were invited to participate in the study. Briefly, HTLV antibody screening was performed retrospectively in all specimens collected from solid organ donors and recipients attended since the year 2008. A total of 5751 individuals were tested for HTLV antibodies at 8 sites. Donors represented 2312 (42.2%), of whom 17 (0.3%) were living kidney donors. The remaining 3439 (59.8%) were recipients. Spaniards represented nearly 80%. Overall, 9 individuals (0.16%) were initially reactive for HTLV antibodies. Six were donors and 3 were recipients. Using confirmatory tests, HTLV-1 could be confirmed in only two donors, one Spaniard and another from Colombia. Both kidneys of the Spaniard were inadvertently transplanted. Subacute myelopathy developed within 1 year in one recipient. The second recipient seroconverted for HTLV-1 but the kidney had to be removed soon due to rejection. Immunosuppression was stopped and 3 years later the patient remains in dialysis but otherwise asymptomatic. The rate of HTLV-1 is low but not negligible in donors/recipients of solid organ transplants in Spain. Universal HTLV screening should be recommended in all donor and recipients of solid organ transplantation in Spain. Evidence is overwhelming for very high virus transmission and increased risk along with the rapid development of subacute myelopathy

Incidence, Clinical Characteristics and Management of Inflammatory Bowel Disease in Spain : Large-Scale Epidemiological Study

(1) Aims: To assess the incidence of inflammatory bowel disease (IBD) in Spain, to describe the main epidemiological and clinical characteristics at diagnosis and the evolution of the disease, and to explore the use of drug treatments. (2) Methods: Prospective, population-based nationwide registry. Adult patients diagnosed with IBD-Crohn's disease (CD), ulcerative colitis (UC) or IBD unclassified (IBD-U)-during 2017 in Spain were included and were followed-up for 1 year. (3) Results: We identified 3611 incident cases of IBD diagnosed during 2017 in 108 hospitals covering over 22 million inhabitants. The overall incidence (cases/100,000 person-years) was 16 for IBD, 7.5 for CD, 8 for UC, and 0.5 for IBD-U; 53% of patients were male and median age was 43 years (interquartile range = 31-56 years). During a median 12-month follow-up, 34% of patients were treated with systemic steroids, 25% with immunomodulators, 15% with biologics and 5.6% underwent surgery. The percentage of patients under these treatments was significantly higher in CD than UC and IBD-U. Use of systemic steroids and biologics was significantly higher in hospitals with high resources. In total, 28% of patients were hospitalized (35% CD and 22% UC patients, p < 0.01). (4) Conclusion: The incidence of IBD in Spain is rather high and similar to that reported in Northern Europe. IBD patients require substantial therapeutic resources, which are greater in CD and in hospitals with high resources, and much higher than previously reported. One third of patients are hospitalized in the first year after diagnosis and a relevant proportion undergo surgery

Correction : Chaparro et al. Incidence, Clinical Characteristics and Management of Inflammatory Bowel Disease in Spain: Large-Scale Epidemiological Study. J. Clin. Med. 2021, 10, 2885

The authors wish to make the following corrections to this paper [...]

Diverse Large HIV-1 Non-subtype B Clusters Are Spreading Among Men Who Have Sex With Men in Spain

In Western Europe, the HIV-1 epidemic among men who have sex with men (MSM) is dominated by subtype B. However, recently, other genetic forms have been reported to circulate in this population, as evidenced by their grouping in clusters predominantly comprising European individuals. Here we describe four large HIV-1 non-subtype B clusters spreading among MSM in Spain. Samples were collected in 9 regions. A pol fragment was amplified from plasma RNA or blood-extracted DNA. Phylogenetic analyses were performed via maximum likelihood, including database sequences of the same genetic forms as the identified clusters. Times and locations of the most recent common ancestors (MRCA) of clusters were estimated with a Bayesian method. Five large non-subtype B clusters associated with MSM were identified. The largest one, of F1 subtype, was reported previously. The other four were of CRF02_AG (CRF02_1; n = 115) and subtypes A1 (A1_1; n = 66), F1 (F1_3; n = 36), and C (C_7; n = 17). Most individuals belonging to them had been diagnosed of HIV-1 infection in the last 10 years. Each cluster comprised viruses from 3 to 8 Spanish regions and also comprised or was related to viruses from other countries: CRF02_1 comprised a Japanese subcluster and viruses from 8 other countries from Western Europe, Asia, and South America; A1_1 comprised viruses from Portugal, United Kingom, and United States, and was related to the A1 strain circulating in Greece, Albania and Cyprus; F1_3 was related to viruses from Romania; and C_7 comprised viruses from Portugal and was related to a virus from Mozambique. A subcluster within CRF02_1 was associated with heterosexual transmission. Near full-length genomes of each cluster were of uniform genetic form. Times of MRCAs of CRF02_1, A1_1, F1_3, and C_7 were estimated around 1986, 1989, 2013, and 1983, respectively. MRCA locations for CRF02_1 and A1_1 were uncertain (however initial expansions in Spain in Madrid and Vigo, respectively, were estimated) and were most probable in Bilbao, Spain, for F1_3 and Portugal for C_7. These results show that the HIV-1 epidemic among MSM in Spain is becoming increasingly diverse through the expansion of diverse non-subtype B clusters, comprising or related to viruses circulating in other countries

Guía itinerario formativo pregrado y postgrado servicio: Farmacia hospitalaria. INT-XXIPS-FAR-01-2021

Guía do itinerario formativo dos residentes no servizo de Farmacia hospitalaria do Complexo Hospitalario Universitario de Pontevedra.Guía del itinerario formativo de los residentes en el servicio de Farmacia hospitalaria del Complejo Hospitalario Universitario de Pontevedra