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Introduction: Pedestrian-vehicle collisions are a leading cause of death among motor vehicle accidents. Recently, pedestrian injury research has been increased, mostly due to the implementation of European and Japanese regulations. This research presents an analysis of the main head injury vehicle sources and injury mechanisms observed in the field, posteriorly the data are compared with the current pedestrian regulations., Methods: The analysis has been performed through an epidemiologic transversal and descriptive study, using the Pedestrian Crash Data Study (PCDS) involving 552 pedestrians, sustaining a total of 4.500 documented injuries., Results: According to this research, the hood surface is responsible for only 15,1% of all the head injuries. On the other hand, the windshield glazing is responsible for 41,8%. In case of sedan vehicles the head impact location exceeds what is expected in the current regulation, and therefore no countermeasures are applied. From all the head injuries sustained by the pedestrians just 20% have the linear acceleration as isolated injury mechanism, 40% of the injuries are due to rotational acceleration., Conclusions: In this research, the importance of the rotational acceleration as injury mechanism, in case of pedestrian-vehicle collision is highlighted. In the current pedestrian regulation just the linear acceleration is addressed in the main injury criteria used for head injury prediction., (Copyright © 2016 Sociedad Española de Neurocirugía. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objectives: To assess the inclusion of the Therapeutic Drug Monitoring Report (TDMR) in the Electronic Clinical Record (ECR)., Method: An observational ambispective cohort study with a duration of 149 days: PRE (retrospective, 49 days) with the TDMR printed in paper, and POST (prospective, 100 days) with the TDMR included in the ECR., Exclusion Criteria: Patients not hospitalized, applications for Therapeutic Drug Monitoring by Critical Care and Neonatal Units, as well as monitoring with an objective other than dose adjustment., Variables: Number of TDMRs prepared, number of patients admitted with TDMR, time of delay for treatment adjustment, defined as the number of adjustments made to the treatment within over or under 24 hours from the time of TDMR preparation, and medication errors (MEs) associated with said delay, as well as the degree of acceptance of the TDMR., Results: 690 TDMRs were conducted in 391 patients, 339 in PRE (n = 206) and 351 in POST (n = 185). The number of treatment modifications made in under 24 hours increased from 73.9% in PRE to 87.3% in POST [RR = 1.2 (CI95% = 0.97-1.43). We identified 35 patients with ME, 9.7% of them in PRE and 8.1% in POST (RR = 0.84 (CI95% = 0.44-1.58)]. The degree of acceptance of the pharmacist recommendation increased from 53.3% in PRE to 68.3% in POST [RR = 1.3 (CI95% = 1.02- 1.62)]., Conclusions: The inclusion of the Therapeutic Drug Monitoring Report (TDMR) in the Electronic Clinical Record increases the degree of acceptance of recommendations, and may reduce the delay in treatment modifications, reducing MEs and improving the process quality in terms of efficacy and safety., (Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.)

Background and Objective: Hip fracture is a common injury in elder patients who have comorbidities, and it increases the risk of morbimortality. They could benefit from co-management (CM) between orthopaedic surgeons and internists. The objective was to evaluate the effectiveness of this CM., Patients and Method: Prospective study of 138 patients over 64 years with hip fracture treated with CM care and one-year of follow-up. The control group was a cohort of 153 patients with similar criteria who had been treated with conventional care. Several pre- and postsurgical variables, complications, and potential risk factors for mortality were analyzed. The Charlson index, mental test, Katz and SF-12 quality of life questionnaires, and Merle D'Aubigné hip score were used., Results: Surgical delay was lower in the CM cohort (P=.001). The rates of complications and readmissions were similar in both cohorts. The average stay was lower (P=.001) in the CM cohort. In-hospital and 3-month mortality were similar, but it was lower in the CM cohort at 6 (P=.04) and 12 months (P=.03). In both cohorts, gender, number of comorbidities, ASA score, Charlson index or surgery type were not predictors of mortality. Surgical delay>2 days was a predictor in the CM cohort, whereas age was a predictor in the control cohort. The final functional outcomes were similar in both cohorts., Conclusion: Our results show the effectiveness of this CM to reduce surgical delay, hospital stay and mortality at 6 months., (Copyright © 2013 Elsevier España, S.L.U. All rights reserved.)

Sarcoidosis is a systemic disease that only exceptionally affects the gastrointestinal tract. We report the case of a man with systemic sarcoidosis who developed achalasia revealed by esophageal manometry, barium radiographs and echoendoscopy. No response was obtained with steroid therapy, and finally laparoscopic cardiomyotomy was performed with excellent results., (Copyright © 2012 Elsevier España, S.L. and AEEH y AEG. All rights reserved.)

Objective: To quantify levels of exposure to cytotoxic drugs among health professionals in order to establish an exposure threshold and implement measures to increase protection and safety., Material and Method: Contamination with 5-fluorouracil, gemcitabine and cyclophosphamide was measured on work surfaces in the following areas: a class II type B3 biological safety cabinet (S(1)), a treatment prep table in an antechamber (S(2)) and a desk from the administrative room in the Outpatient Unit (S(3)). We took samples from the work surfaces by wiping them with an absorbent cloth at time t(0), prior to the work session, and at t(1) after three hours of work. For each surface, we calculated the median mass value with respect to the baseline value and the 90th, 75th, 50th and 25th percentiles for each cytotoxin in μg/m(2). Distribution normality was assessed using the Shapiro-Wilk test. Statistical analysis included the Kruskal-Wallis and Mann-Whitney-Wilcoxon tests. Statistical significance was established for values of P<.05., Results: We gathered a total of 90 samples, 30 from each of the studied work surfaces. The mean recorded mass of any of the cytotoxic compounds was higher for S(1) and t(1), with values of P=.017 and P=.004 respectively. The target value for each cytotoxic drug was established at the 25th percentile, where undetectable contamination values were obtained., Conclusions: Introducing a continuous programme to monitor work surfaces for an array of cytotoxic compounds is fundamental in order to establish acceptable levels of residual contamination and reduce exposure in the workplace., (Copyright © 2011 SEFH. Published by Elsevier Espana. All rights reserved.)

Objective: To evaluate the impact and type of side-effects in patients treated with cetuximab and provide a description of the general measures and treatment., Methods: Retrospective safety study. We included all patients that received cetuximab from January to December 2009. All information was obtained from the Pharmacy and Oncology Department's Access databases and reviewed the patient's medical history. All data was registered in an Excel workbook. Skin toxicity was graded by the current National Cancer Institute-Common Toxicity Criteria (NCI-CTC)., Results: During the study period 43 patients received treatment with cetuximab. Acneiform eruption was present in 30 of the cases (69.8%): 14 patients with grade 1 (48.3%), 13 with grade 2 (44.8%) and 3 with grade 3 (10.3%). These adverse effects appeared in a median of seven (4-28) days. In a median of 40 (20-56) days, ten patients (23.3%) presented xerosis, and three (7%) suffered painful fissures in hands and feet after a median of 28 (21-35) days. Paronychia was present in two patients after a median of 42 (35-49) days. Finally, an alteration in hair growth was observed in two patients with overgrowth of facial hair and one patient with overgrowth of the eyelashes. Five patients presented important conjunctivitis. Three infusion reactions occurred. A grade-based treatment algorithm was used for all patients that presented cutaneous toxicity., Conclusions: A considerable number of patients treated with cetuximab develop dermatological side-effects which left untreated could represent a threat to the efficacy of the therapy. Therefore effective management is mandatory, patient education and immediate treatment based on a grade-based algorithm to alleviate symptoms is necessary, so that patient compliance is guaranteed., (Copyright © 2010 SEFH. Published by Elsevier Espana. All rights reserved.)

Objective: To identify and quantify the influence of different variables on the implementation of pharmacotherapy optimisation measures in hospitalised patients., Method: Descriptive transversal study., Period: 2000-2007., Environment: public university general hospital (25,000 patients admitted/year). The Programme implemented to improve pharmacotherapy quality and patient safety covers 30% of all patients. Using records from the Atefarm(®) Farmis application, we analysed pharmacotherapy recommendations (PRs) made by pharmacists to doctors. The selected variables were the following: Risk of the medication for ADE (1-high, 0-low), ADE category, (0-indication, 1-effectiveness, 2-safety), potential severity (scale of 1 to 5), impact of the PR (0-effectiveness, 1-safety, 2-efficiency) and implementation of the PR (yes/no). We calculated the frequency (%) and 95% CI for the categorical variables and performed a multivariate logistical regression analysis to identify the variables' degree of influence on implementing the PRs., Results: We identified 7,920 ADEs in 4,680 patients. A PR was issued in 85% of the cases (6,762), and it was implemented in 83% (95% CI 74.2-89.8). Potential severity of the ADE ≥2 (OR 1.57; 95% CI 1.27-1.94), and ADE category for effectiveness and safety (OR 1.19; 95% CI 1.02-1.39) were shown to be determining factors for implementing the PR for the patient., Conclusions: The probability that a PR will be implemented for a patient is related to the potential severity and the category of the identified ADE. Therefore, recommendations intended to improve effectiveness of pharmacotherapy or patient safety, and those with potential clinical consequences have a greater chance of being applied to a patient., (Copyright © 2009 SEFH. Published by Elsevier Espana. All rights reserved.)

Background: A retrospective study on the epidemiology of fungaemia due to yeasts of medical importance at the Hospital Nacional de Pediatría Prof. Dr. J. Garrahan, Buenos Aires was conducted between September 2001 and September 2003., Objectives: To learn the distribution of yeast species and to evaluate their in vitro antifungal susceptibility profile., Methods: The minimum inhibitory concentration (MIC) was determined according to the CLSI M27-A2 procedure, and time kill curves against amphotericin B were also performed., Results-Conclusions: The species isolated were Candida parapsilosis (32.6% of isolates); Candida albicans (26.5%), Candida tropicalis (24.5%), and other yeasts (16.4%). Candida isolates were susceptible to the antifungals evaluated, but amphotericin B-tolerant isolates were detected using time kill curves., (Copyright © 2009 Revista Iberoamericana de Micología. Published by Elsevier Espana. All rights reserved.)

Objective: Create a model to predict the risk of acute rejection of kidney transplant considering variables related to the immunosuppressant agent used, the receiver, the donor and the transplanted organ., Methods: Cohort study in a population of 68 patients with kidney transplants being treated with tacrolimus triple therapy. Predicting the risk of acute rejection was carried out with a logistic regression analysis using age, sex, re-transplant status, number of HLA incompatibilities, cold ischaemia time, acute tubular necrosis, induction with basiliximab or thymoglobulin and treatment type as explanatory variables. The contribution of variables associated with determining the blood concentration of tacrolimus was also evaluated; these variables include the average blood concentration, the number of values below and included in the pre-defined therapeutic interval, and the time during which those values remained within that interval., Results: The logistic regression analysis indicates that the risk of acute rejection depends on the acute tubular necrosis (OR: 3; CI 95%, 0.7 to 13.2) and on the time that the blood concentrations of tacrolimus remains within the therapeutic interval (OR: 0.8; CI 95%, 0.7 to 0.9). The final model presents an optimal discrimination power (AUCROC: 77%; CI 95%, 62% to 92%). For the selected cut-off point (probability greater than or equal to 0.24) the model shows a sensitivity of 83% (CI 95%, 74 to 90%) and a specificity of 71% (CI 95%, 61 to 80%)., Conclusions: In patients with kidney transplants, the presence of acute tubular necrosis, together with the time the blood concentration of tacrolimus remained within the predetermined therapeutic interval, permitted the identification of patients with a higher probability of having an acute rejection episode during the first two weeks following the transplant.

Background: Incisional hernia is one of the most common complications in abdominal surgery. The aim of this retrospective study was to examine the true incidence of incisional hernia and its risk factors in patients undergoing surgery for colorectal cancer., Patients and Method: Two hundred ninety-five patients who underwent colorectal cancer surgery between 1993 and 2003 were included. The mean follow-up was 37.5 +/- 22 months., Results: Forty-three patients developed incisional hernia, representing 14.5% of the total. The cumulative percentage of patients developing incisional hernia was 7% at 6 months, 16% at 1 year, 21% at 2 years and 33% at 5 and 10 years. The only significant independent risk factors were chronic obstructive pulmonary disease (COPD) (2-year cumulative incidence of incisional hernia of 53%, p = 0.04) and abdominal wound infection (2-year cumulative incidence of incisional hernia of 28%; p = 0.02)., Conclusion: COPD and abdominal wound infection predispose to incisional hernia in colorectal surgery. Abdominal wound infection is the only factor over which the surgeon can act preventively by using antibiotic prophylaxis and an aseptic technique.

Lymphocytic colitis is a rare clinicopathologic syndrome, characterized by chronic watery diarrhea, diffuse inflammatory changes in the colonic mucous in spite of normal findings on colonoscopy and marked intraepithelial lymphocytic infiltration on biopsy. Although the physiological mechanism of diarrhea is not clear, patients do not usually present hydroelectrolytic alterations and the results of routine laboratory investigations are usually normal. The association between lymphocytic colitis and thyroid disease, possibly autoimmune, in the form of hypo- or hyperthyroidism is relatively common. We report a 61-year-old woman with a history of multinodular toxic goiter, whose previously uninvestigated chronic diarrhea became more acute and led to the diagnosis of lymphocytic colitis. Results of laboratory investigations revealed only a significant hypokalemia with an associated nonfunctioning bilateral adrenal incidentaloma. The patient evolved well when treated with sulfasalazine. Hypokalemia as a complication of lymphocytic colitis and an association between lymphocytic colitis and toxic multinodular goiter does not seem to have been previously described.

A study was made of the work climate, which was understood to be the overall group of factors that influence nursing professionals in critical-care units. A descriptive study was made by carrying out an anonymous survey among the staff of four adult critical-care units: intensive care unit, coronary unit, reanimation unit, and cardiac postoperative care unit. The survey included seven factors: occupational satisfaction, occupational stress, occupational pressures, work relations, professional skills, professional training, and sociodemographic variables. Of 132 questionnaires completed, 80% of the persons who answered accepted their tasks, but only 51% indicated that they planned to continue in the critical-care unit. Sixty percent of the persons surveyed indicated that their work was stressful and that they felt physically fatigued as the workday progressed. Similarly, 60% reported that their work sometimes had a negative impact on family life and 35% indicated that it affected their health. Relations among members of the health-care team were reported as good by 90%. Seventy-five percent were capable of working independently and resolving situations at their own initiative. Ninety-five percent of the persons who completed the survey considered the possibilities for professional advancement to be scant and 88% were interested in the development of specialization. It was interesting that one third of the persons in the sample wanted to leave the hospital. Unit ergonomics had a negative effect on work activities. Staff felt a lack of information in spite of good relations with superiors and other team members. They felt the need for more social and professional recognition, as well as better economic remuneration, but they expected specialization to palliate these needs to some degree.

Aim: The aim of this survey was to know the dental caries prevalence and severity in the 6 years old population from San Fernando (Cádiz)., Design: This is a cross sectional survey., Emplacement: We studied every schoolchildren at this age (100%) from the 27 city schools, in 1993., Participants: We studied 1439 schoolchildren of this age. This is one of the ages recommended by WHO in this class of surveys., Interventions: We made an oral exploration following the WHO recommendations in this type of surveys., Results: Dental caries prevalence reached 79% at this age. Dental decay index were; df-t index was 3.19; DMF-T was 0.68 and filling index was 11.2%., Conclusions: Our results of caries prevalence and epidemiological dental index, are higher in comparison with the results of other studies, which shows the severity of the dental decay problem in San Fernando. We still need educational and preventive programs in order to decrease dental caries prevalence and severity.

Two cases of juvenile familiar polyposis (one 40-year-old male and his 14-year-old daughter) are presented. The girl presented intermittent rectal bleeding since the age of 10 with growth retardation and chronic anemia. The child was treated by colectomy with more than 100 juvenile polyps without adenomatous alterations being observed in the surgical specimen. Juvenile gastric polyps were also endoscopically observed. The father underwent sigmoidectomy for a adenomatous polyp of this localization. Later review of the surgical specimen demonstrated a juvenile polyp with zones of adenomatous alterations. The diagnostic difficulties of this rare entity and the therapeutic options available are discussed.