Cumplimiento, conocimiento y automedicación como factores asociados a los resultados clínicos negativos de la farmacoterapia

The patient plays a fundamental role in the attainment of good results in pharmacotherapy. Noncompliance,self-medication, or insufficient knowledge of the therapy being employed may provide asource for the causes of these negative clinical outcomes, otherwise known as medicine related problems(MRP). he Dader method was used in the evaluation, identification and classification of MRP. Theassociation of variables was established through the statistical Chi square test. Patient knowledge of themedicine, degree of compliance to therapy and self-medication were studied as causes of the negativeoutcomes encountered. 2556 patients were interviewed throughout the year that the study took place,giving a total of 2261 of valid cases. 33% presented an MRP as the cause of his/her visit to the hospitalemergency ward. Knowledge of the medicine, compliance and self-medication were only studied in thepopulation that presented an MRP and in this work it is demonstrated that these are aspects that areassociated with different dimensions of MRP. It is not possible to establish an association between theexistence or not of negative clinical outcomes in patients with the factors of knowledge of medication,compliance and self-medication. This is due to the fact that these variables are not attributable to thepatient himself, but rather are associated with the characteristics of each medicine.El paciente juega un papel primordial en la consecución de los resultados terapéuticos. El incumplimiento,la automedicación, o la falta de conocimiento del la farmacoterapia pueden ser causas de esosresultados clínicos negativos, denominados en ocasiones problemas relacionados con medicamentos(PRM). El método Dáder se utilizó para la evaluación, identificación y clasificación de PRM. Laasociación de variables se estableció mediante el estadístico chi cuadrado. El conocimiento de la medicación,el cumplimiento y la automedicación fueron estudiados como causa de estos resultados negativosde la medicación. Fueron entrevistados 2556 pacientes durante el año de estudio, resultando 2261 casosválidos. El 33 % presentaron un PRM como causa de visita a urgencias. El conocimiento de la medicación,el cumplimiento y la automedicación fueron estudiados solo en la población que presentó unPRM y se demuestra que son aspectos asociados a las distintas dimensiones de PRM. No es posibleestablecer asociación entre la existencia o no de resultados clínicos negativos en los pacientes con elconocimiento de la medicación, el cumplimiento y la automedicación, debido a que estas variables noson atributos del paciente sino que están asociadas a cada medicamento

Efectos del vibrado del pino piñonero (Pinus pinea L.) en el vigor de los árboles: densidad de copa, crecimiento de guías y parásitos de debilidad

In the Northwest of Spain the mechanized harvesting of pine cones is more and more frequenIn order to quantify the effects of vibration on the vigor of the trees, parcels of stone pine were planted in plateau and countryside. Both the mechanized and manual harvests were analyzed in adult and young trees. The growth of the tree shoots was measured. The presence and abundance of three insect plagues was analyzed in those same trees: Tomicus piniperda, Rhyacionia buoliana and Thaumetopoea pityocampa. The average shoot length of those trees manually harvested was superior to that of those mechanically harvested. The difference was very significant in young trees (40-50 years old) in the countryside and in adult trees (more than 80 years) on the plateau. Rhyacionia buoliana was more abundant in adult trees that young trees, but the relation of its abundance with the harvest method was not seen. The presence of Tomicus piniperda was rare and was only detected in mechanically harvested stands. Thaumetopoea pityocampa was more frequent in trees harvested by hand than those harvested mechanically and was more abundant in young stands. The percentage tree of defoliation was low in all stands independent of harvest method.En el noroeste de España es cada vez más frecuente la recolección mecanizada de piña. Para cuantificar los efectos del vibrado sobre el vigor de los árboles se instalaron en montes de páramo y de campiña parcelas donde se realizó cosecha mecanizada y manual en arbolado adulto y joven. Se midió el crecimiento de los brotes y se analizó la presencia y abundancia de tres insectos plaga sobre estos árboles, Tomicus piniperda y Rhyacionia buoliana, considerados parásitos de debilidad, así como Thaumetopoea pityocampa. La longitud media de los brotes fue superior en árboles cosechados manualmente. La diferencia es importante en árboles jóvenes (40-50 años) de campiñas y en árboles adultos (más de 80 años) de páramos. Rhyacionia buoliana fue más abundante en árboles adultos que en arbolado joven, pero no se vio relación de su abundancia con el método de cosecha. Tomicus piniperda fue escaso y sólo se detectó en rodales cosechados mecanizadamente. Thaumetopoea pityocampa es más frecuente en rodales cosechados manualmente, y en rodales jóvenes lo que indica que selecciona los árboles de crecimiento más vigoroso para alimentarse. Los porcentajes de defoliación fueron bajos en todas las parcelas

Valoración de los niveles de PCR tras artroplastia total de cadera

Objetivo: Determinación de la respuesta fisiológica de la Proteína C Reactiva (PCR) y la velocidad de sedimentación glomerular (VSG) tras la artroplastia total de cadera (ATC) no infectada. Material y Métodos: se realizó un estudio descriptivo sobre 20 pacientes afectos de coxartrosis primaria e intervenidos mediante ATC (18 pacientes tipo Auto-fit cementada y 2 pacientes tipo Prophor no cementada). Se determinaron los valores de VSG, PCR, fibrinógeno, hematocrito, hematíes y temperatura corporal matinal preoperatoriamente y en los días 1º, 2º, 3º, 7º, decimocuarto y a los 3 meses tras la intervención. Resultados: Se realizó el test de ANOVA para medidas repetidas con los valores obtenidos. Existieron diferencias significativas entre los niveles de PCR medidos en los diferentes momentos del estudio (p<0,001), alcanzando los niveles máximos dicho parámetro el 2º día postoperatorio y descendiendo sensiblemente a partir del 7º día postintervención. Conclusiones: La permanencia de valores altos de PCR o la aparición de nuevos picos tras el 2º -3er día postoperatorio puede ser un indicador de complicaciones graves en la ATC.Objectives: To determine the physiological answer of the reactive protein C (RPC) and the speed of globular sedimentation (SGS) after non infected total hip arthroplasty (THA). Material and methods: a descriptive study on a total sample of 20 patients suffering primary coxarthrosis and operated with THA was performed (18 patients with cemented Auto-Fit Prosthesis and 2 patients with cementless Prophor Prosthesis). The values of SGS, RPC, fibrinogen and morning body temperature were determined before the surgical proce- dure and on day 1, 2, 3, 7, 14 and 90 after it. Results: an ANOVA test was used for repeated measurements of the obtained results. There were statistically significant differences in the levels of RPC obtained in the different days of the study (p<0.001), obtaining the highest levels of it on day 2 after surgery and highly decreasing from day 7 after surgery onwards. Conclusions: the maintenance of increased levels of RPC or the appearance of new peaks after the day 2 or 3 after surgery may be an indicator of severe complications in THA

Eating quality of beef from biotypes included in the PGI “Ternera Asturiana” showing distinct physicochemical characteristics and tenderization pattern

determine if their differences in physicochemical characteristics and tenderization pattern during maturation (3 to 21 days) had an effect on the consumer evaluation of beef palatability. Biotype affected significantly pH, water holding capacity, chemical composition (Pb0.001) and meat lightness (Pb0.05). Ageing time affected significantly (Pb0.05) colour, meat toughness and sensory attributes in a different way within each biotype. Multivariate analysis showed two different meat groups: 1) meat from mh-genotypes, characterized by high juice losses, lightness (L*), protein content and high sensory acceptability at intermediate (7 and 14 days) ageing times; 2) meat from rustic (AM) breed and biotypes free of myostatin mutation (AV (+/+) and AV×AM), showing higher intramuscular fat, myoglobin content, and instrumental toughness and requiring longer storage times (21 days). This should be taken into account for the proper post-mortem management and commercialization of each product to achieve its best sensory quality

Cost-effectiveness of midostaurin in the treatment of acute myeloid leukemia with the FLT3 mutation in Spain

The addition of midostaurin to standard chemotherapy (cytarabine and daunorubicin) has shown significant improvements in the survival of patients with acute myeloid leukemia with the FLT3 mutation (FLT3-AML). The objective of this study was to determine whether this intervention would be cost-effective in Spain. A partitioned survival model with five health states was developed (diagnosis and induction, complete remission, no complete remission, transplantation and death). A lifetime time horizon and the Spanish National Health System perspective were adopted. During the first three years, permanence in the different health states was determined according to the results of the RATIFY study. In successive years, the death rates of the Spanish population adjusted by a factor to reflect long-term disease-related mortality were used. Utilities were obtained from the literature. Pharmacological costs (first and second line) and the costs of other health resources (hospitalizations, visits and tests) were included. The robustness of the model was evaluated by deterministic and probabilistic sensitivity analyses. The addition of midostaurin resulted in 1.46 life years gained (LYG) and 1.23 quality-adjusted life years (QALY) gained and implied an additional cost of € 47,955, resulting in an incremental cost-effectiveness ratio (ICER) of € 32,854/LYG and an incremental cost-utility ratio of € 38,985/QALY. In the univariate sensitivity analysis, the threshold of € 50,000/QALY was not exceeded in any case; taking into consideration potential discounts of 20-40% in the PVL of midostaurin the ICER would be below € 30,000/QALY, a commonly accepted threshold in Spain. In the probabilistic analysis, when the threshold was € 50,000/QALY, midostaurin was cost-effective in 82.3% of simulations. According to our modeling, midostaurin, in combination with standard chemotherapy, could be an efficient alternative for the treatment of FLT3-AML in Spain. © 2019 Arenaza et al

Biodegradability of extractives in sapwood and heartwood from Scots pine by sapstain and white rot fungi

1 Division of Wood Science, Sub-department of Forestry, Wageningen Agricultural University, Wageningen, The Netherlands 2 Instituto de Recursos Naturales y Agrobiología (IRNA), Consejo Superior de Investigaciones Científicas (CSIC), Sevilla, SpainThe fungal degradation of lipophilic extractives in sapwood and heartwood from Scots pine (Pinus sylvestris) was studied. In sapwood, the white rot fungi, Bjerkandera sp. and Funalia trogii, removed higher amounts of extractives than the sapstain strains, Ophiostoma ainoae and Ceratocystis allantospora. Triglycerides, long chain fatty acids, steryl esters and waxes in pine sapwood were almost completely degraded by all the fungi. Sterols and resin acids were also extensively degraded by the white rot strains; however, these components were not or only poorly removed by the sapstain fungi. The removal of total extractives by all the fungal strains was higher in sapwood as compared to heartwood. The highly concentrated extractive fraction in pine heartwood mainly consists of resin acids. As observed in sapwood, sapstain were also poorly effective in the degradation of the resin acids present in heartwood. The fungal degradation of heartwood extractives was not only limited by the degradative ability of the various test microorganisms, but also by the inhibitory effect exerted by the extractive fraction. The white rot fungus F. trogii was particularly inhibited on heartwood. Bjerkandera sp. showed a higher tolerance to toxic extractives and was the most efficient fungus in degrading extractive constituents in both Scots pine heartwood and sapwood. Therefore, Bjerkandera sp. strain BOS55 should be considered as a potential agent for pitch control in pulp and paper manufacture.This study has been carried out with financial support from the Commission of the European Communities, Agriculture and Fisheries (FAIR) contract no. CT 95–0560, “Wood extractives in pulp and paper manufacture: technical and environmental implications and biological removal”.Peer reviewe

SARS-CoV-2 infection induces a dual response in liver function tests: Association with mortality during hospitalization

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is associated with abnormal liver function tests. We hypothesized that early altered liver biochemistries at admission might have different clinical relevance than subsequent changes during hospitalization. A single-center retrospective study was conducted on 540 consecutive hospitalized patients, PCR-diagnosed with SARS-CoV-2. Liver test abnormalities were defined as the elevation of either gamma-glutamyltransferase (GGT), alanine aminotransferase (ALT), or aspartate aminotransferase (AST), above the upper limit of normality set by our laboratory. Linear mixed models (LMM) evaluated longitudinal associations, incorporating all available follow-up laboratory chemistries. By the end of the follow-up period, 502 patients (94.5%) were discharged (109 (20.5%) died). A total of 319 (64.3%) had at least one abnormal liver test result at admission. More prevalent were elevated AST (40.9%) and GGT (47.3%). Abnormalities were not associated with survival but with respiratory complications at admission. Conversely, LMM models adjusted for age and sex showed that longitudinal increases during hospitalization in ferritin, GGT, and alkaline phosphatase (ALP), as well as a decreased albumin levels, were associated with reduced survival. This dual pattern of liver damage might reconcile previous conflicting reports. GGT and ALP trajectories could be useful to determine who might need more surveillance and intensive care

Clinical Study of Memory Disorders in Aging Patients with Associated Cardiovascular, Neurological, Neurobehavioral and Metabolic Diseases”. A Review

We have observed semantic memory and episodic memory disorders (100%) in patients ranging from 40 to 92 years-old, associated to cardiovascular diseases and blood hypertension (82%), sleep disorders (50%), neurobehavioral disorders (44%), such as depression, anxiety, aggression, and vascular demencia, disorders of language (36%), neurosensory disorders (28%), as diminution of visual and hearing acuity, dizziness (26%), Parkinson disease (34%), Alzheimer disease (21%), gait disturbances (10%), vertigo (10%), cervicalgia and cervicogenic headache (10%) trigeminal neuralgia (2%,), We observed as comorbidities the following non-nervous diseases: metabolic diseases as diabetes (21%) and hypothyroidism (5%), gastrointestinal pathology (21%), such as constipation, loss of sphincter control, and gastritis, arthritis (13%), prostatic hypertrophy (1%) and loss of weight (1%). We consider that according to their high frequency the most risk factors associated to memory disorders are cardiovascular diseases and blood hypertension (82%), sleep disorders (50%), neurobehavioral disorders (44%), such as depression, anxiety, aggression, and vascular demencia, disorders of language (36%), neurosensory disorders (28%), as diminution of visual and hearing acuity, dizziness (26%), and Parkinson disease (34%)

La expresión dramática: un intento de globalización de la educación artística. Fundamentación y propuesta para la formación del maestro de educación primaria

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