Efficacy of the tissue regenerating agent (RGTA) in the treatment of neurotrophic corneal ulcers and persistent epithelial defects

Purpose : To report the results obtained in a series of 58 eyes with chronic corneal ulcers and persistent epithelial defects resistant to conventional therapy and treated with 0.01% poly-carboxymethylglucose sulfate (RGTA, Cacicol®). Methods : A prospective study was made of 58 eyes of patients with corneal ulcers and persistent epithelial lesions secondary to neurotrophic disorders, caustic damage, ulcerated metaherpetic lesions, Stevens-Johnson syndrome, peripheral ulcerative keratitis and severe dry eye, among other conditions. The ulcers were essentially chronic and slow-evolving, with mean vertical and horizontal diameters of 2.4 and 2.7 mm, respectively (range 1-5.5 mm). All patients had been previously treated with classical tear substitutes, and some had also received blood products, topical cyclosporine, corticosteroids, amniotic membrane coverings, therapeutic contact lenses and/or a vitamin-based eye ointment. The patients received an initial dose of one drop in the morning every 48 hours during 10 days. After evaluation of the effects of treatment, new dosing schemes were prescribed for those patients who had improved their clinical condition though without complete resolution of the disease. Results : Important variation was observed in the time to recovery of corneal integrity, ranging from a few days to some weeks, depending on the severity and etiology of the case. Full healing was recorded in 50 patients. The patients with large neurotrophic ulcers showed improvement of the lesions, with a decrease in lesion size after 15 days of treatment. Eight eyes did not achieve complete healing. In the case of severe ulceration and when a positive effect was observed after one month, treatment was continued with spacing of the applications until complete healing was achieved. All patients reported subjective improvement. The drug showed immediate efficacy in 11 eyes with epithelialisation disorders following PRK or trauma, with recovery of tissue integrity after the first treatment period. Conclusions : The tissue regenerating agent (RGTA, Cacicol®) is an interesting and effective topical adjuvant product for the treatment of severe and chronic corneal ulcers resistant to conventional treatment. Its efficacy remains to be confirmed in the context of double-blind, randomised clinical trials

Vigilancia diaria de la gripe pandémica (H1N1) 2009 mediante registros de la historia clínica electrónica de atención primaria en la Comunidad de Madrid

Fundamentos: La pandemia de gripe A(H1N1) supuso la puesta en marcha en la Comunidad de Madrid (CM) de nuevas estrategias de vigilancia epidemiológica que diesen respuesta a las necesidades de inmediatez y exhaustividad. Los objetivos de este estudio son describir las características de los casos recogidos por este sistema así como mostrar las posibilidades de desagregación geográfica de estos datos. Métodos: Estudio descriptivo transversal entre el 1 de mayo de 2009 y el 22 de mayo de 2010. Se recabaron diariamente todos los episodios registrados y declarados como gripe en las historias clínicas electrónicas de Atención Primaria del Sistema Sanitario Público de la CM. Se analizaron los datos por fecha, edad, sexo y zonificación sanitaria, desagregando hasta profesional sanitario. Resultados: Se registraron 165.492 episodios de gripe (53,8% en mujeres). El mayor número de casos fue en el grupo de 25 a 49 años (70.691) y el grupo de 5 a 14 años alcanzó la mayor tasa de incidencia semanal (1.618,65 por 100.000 en la semana 43). La tasa total semanal máxima fue 458,47 por 100.000 (semana 44). Los pediatras tuvieron el máximo de casos atendidos y de tasas acumuladas (12 de ellos atendieron a más del 20% de su cupo). Conclusiones: La vigilancia de la gripe pandémica (H1N1) 2009 mediante la captura automática diaria de datos de las historias clínicas electrónicas de Atención Primaria fue una fuente de información de especial utilidad en el seguimiento de la evolución de la pandemia y la toma de decisiones estratégicas