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Objective To analyse a series of cataract surgeries performed in a third-fourth level teaching hospital, providing complementary data to the number of surgeries that can be used as a further reference, and to compare them with those published by other Public Health Systems, mainly the British one. Methods Retrospective study of 1052 cataract procedures at the University Hospital of Valladolid from January 2016 to July 2016. Collected variables: age, gender, pre- and postsurgical visual acuity, degree of complexity of the cataract, duration of the surgery, and surgical complications. Results The mean age of the patients was 74.1 ± 9.5 years, and 81.61% started from a VA Conclusions The results of the series show significant differences from those from the audit of the English National Healthcare System, with our patients being more complex and having less complications. There are missing-data in the collection of important variables such as post-surgical refraction or the duration of the surgery, which despite this, this work can be a good reference.

Many lesbian, gay, bisexual and transgender people (LGBT), and people living with HIV (PLHIV) feel estranged from and misunderstood by their Christian communities. Churches, in turn, continue to wrestle with issues of theology and pastoral care pertaining to LGBT and PHIV. In response, this article aims to construct an ecclesiological praxis of inclusivity toward LGBT and PLHIV. Framed by Elisabeth Schüsler Fiorenza’s notion of Jesus’ basileia vision as the praxis of inclusive wholeness, we analyze, interpret and theologize narratives from elite interviews with three community leader-practitioners in Singapore and the Philippines who shared on their ministerial struggles, practices and visions. We suggest that churches can take the lead to engender an ecclesiological praxis of inclusivity by being (i) spaces of support, belonging and dignity for LGBT and PLHIV; and (ii) avenues for fostering dialogue with LGBT and PLHIV to articulate God’s inclusive love.

espanolIntroduccion: Las enfermedades cardiovasculares se encuentran entre las primeras causas de muerte a nivel mundial y la evidencia cientifica sugiere que tienen un origen en edades tempranas, por lo que disminuir desde la adolescencia los riesgos que contribuyen a su aparicion es indispensable. Objetivo: Determinar riesgo cardiovascular en la poblacion adolescente de una institucion educativa de Timbio, Cauca, 2015 – 2016. Metodologia: Estudio cuantitativo, descriptivo, observacional y de corte transversal. Muestra: 100 estudiantes (47 mujeres, 53 hombres), de 10 a 19 anos de edad. Se evaluaron variables sociodemograficas, antropometricas, fisiologicas, bioquimicas (glicemia), antecedentes personales, familiares, estilos de vida y uso de anticonceptivos orales. Resultados: Se encontro una mayor prevalencia de riesgo cardiovascular en el grupo etario adolescente (15-18 anos) con 84.6%; el genero femenino presento mas posibilidad de tener riesgo cardiovascular (OR: 2.8, IC 95% 1.17 – 6.87); el 7% afirmo consumir tabaco regularmente y el 12% son fumadores pasivos. Se obtuvo que el 26% ingiere bebidas alcoholicas, con una mayor prevalencia entre las edades de 15 a 18 anos (OR: 19.4, IC 95% 2.45 – 48.11); en cuanto a la actividad fisica el 79% la practicaba de forma extracurricular. Presentar habitos alimenticios no saludables genera mayor riesgo cardiovascular (OR: 5.57, IC 95% 1.95 – 15.90). El 67% (n= 67) tiene riesgo cardiovascular. Conclusiones: El genero femenino, el grupo adolescente (15-18 anos), el consumo de bebidas alcoholicas y habitos alimenticios no saludables, se asocian con una mayor posibilidad de tener riesgo cardiovascular. Se encontro en un gran porcentaje de la poblacion de estudio riesgo cardiovascular. EnglishIntroduction: Cardiovascular diseases are among the leading causes of death worldwide and scientific evidence suggests that they have an origin at early ages, so that diminishing from adolescence the risks that contribute to its emergence is essential. Objective: To determine cardiovascular risk in the adolescent population of a high school of Timbio, Cauca, 2015 - 2016. Methodology: Quantitative, descriptive, observational and cross-sectional study. Sample: 100 students (47 women, 53 men), from 10 to 19 years old. Sociodemographic, anthropometric, physiological, biochemical variables (glycemia), personal history, family history, lifestyles and use of oral contraceptives were evaluated. Results: A higher prevalence of cardiovascular risk was found in the adolescent age group (15-18 years) with 84.6%; female gender was more likely to have cardiovascular risk (OR: 2.8, 95% CI 1.17 - 6.87); 7% said they use tobacco regularly and 12% are passive smokers. It was obtained that 26% ingested alcoholic beverages, with a higher prevalence between the ages of 15 to 18 years (OR: 19.4, 95% CI 2.45-48.11); In terms of physical activity, 79% practiced it extracurricularly. Presenting unhealthy eating habits generates greater cardiovascular risk (OR: 5.57, 95% CI 1.95 - 15.90). 67% (n = 67) have cardiovascular risk. Conclusions: The female gender, the adolescent group (15-18 years), drink alcoholic beverages and unhealthy eating habits, are associated with a greater possibility of having cardiovascular risk. It was found in a large percentage of the study population cardiovascular risk.

WOS: 000442229500021, PubMed ID: 30101073, Background: In infants with phenylketonuria (PKU), dietary management is based on lowering and titrating phenylalanine (Phe) intake from breast milk or standard infant formula in combination with a Phe-free infant formula in order to maintain blood Phe levels within target range. Professionals use different methods to feed infants with PKU and our survey aimed to document practices across Europe. Methods: We sent a cross sectional, survey monkey (R) questionnaire to European health professionals working in IMD. It contained 31 open and multiple-choice questions. The results were analysed according to different geographical regions. Results: Ninety-five centres from 21 countries responded. Over 60% of centres commenced diet in infants by age 10 days, with 58% of centres implementing newborn screening by day 3 post birth. At diagnosis, infant hospital admission occurred in 61% of metabolic centres, mainly in Eastern, Western and Southern Europe. Breastfeeding fell sharply following diagnosis with only 30% of women still breast feeding at 6 months. 53% of centres gave pre-measured Phe-free infant formula before each breast feed and 23% alternated breast feeds with Phe-free infant formula. With standard infant formula feeds, measured amounts were followed by Phe-free infant formula to satiety in 37% of centres (n = 35/95), whereas 44% (n = 42/95) advised mixing both formulas together. Weaning commenced between 17 and 26 weeks in 85% centres, >= 26 weeks in 12% and < 17 weeks in 3%. Discussion: This is the largest European survey completed on PKU infant feeding practices. It is evident that practices varied widely across Europe, and the practicalities of infant feeding in PKU received little focus in the PKU European Guidelines (2017). There are few reports comparing different feeding techniques with blood Phe control, Phe fluctuations and growth. Controlled prospective studies are necessary to assess how different infant feeding practices may influence longer term feeding development., Vitaflo, We thank Vitaflo for supporting the publication cost of this paper.

Background Afatinib is a second generation irreversible EGFR tyrosine kinase inhibitor (TKI), indicated as firstline therapy in non-small cell lung cancer (NSCLC). There are two other first generation EGFR TKIs indicated in NSCLC treatment, and no direct comparison of them. Purpose To compare the efficacy of afatinib versus erlotinib or gefitinib in EGFR TKIs naive patients with NSCLC. Material and methods This was an observational retrospective study carried out between January 2015 and April 2016. All patients with NSCLC undergoing firstline treatment with an EGFR TKI were included. Patient data were taken from clinical records. Efficacy endpoints were overall survival (OS), progression free survival (PFS) and response rate, assessed by RECIST criteria. Results 46 patients were included. 76% were men, average age was 71 years. 71.8% had an ECOG performance status of 0–1 and 76% were current or past smokers. NSCLC stage was III/IV in 84.4% of patients and histologic type was adenocarcinoma in 37% of patients. 43.5% were treated with erlotinib, 39.9% with gefitinib and 17.4% with afatinib. EGFR status was determined in only 16 patients, being mutated in 7 (4 treated with erlotinib and the other 3 with afatinib). Median OS for afatinib, gefitinib and erlotinib was 5, 14 and 43 months, respectively (HR (95% CI) gefitinib vs afatinib: 0.25 (0.07–0.81); erlotinib vs afatinib: 0.16 (0.05–0.55)). Median PFS was 2 months for afatinib, 8 months for gefitinib and 16 months for erlotinib (HR (95% CI) gefitinib vs afatinib: 0.18 (0.06–0.59); erlotinib vs afatinib: 0.08 (0.02–0.29)). Response rate by group was 37.5%, 61.1% and 80% for afatinib, gefitinib and erlotinib, respectively. Conclusion According to the main clinical guidelines, EGFR mutation status should be known before the start of treatment, and EGFR TKIs should only be used in patients with a positive EGFR mutation test. Our study suggests that afatinib is less effective than erlotinib or gefitinib, but our population was small. Further studies with more patients are needed to compare afatinib with the other EGFR TKIs. References and/or acknowledgements Sequist LV, Yang JC-HC-H, Yamamoto N, et al. Phase III study of afatinib or cisplatin plus pemetrexed in patients with metastatic lung adenocarcinoma with EGFR mutations. J Clin Oncol2013;31:1–11. No conflict of interest

Background The antiretroviral combination tenofovir disoproxil, emtricitabine, cobicistat and elvitegravir (TDF/FTC/COBI/RVG) has been widely used to treat HIV infection. This regimen is related to the highest risk of kidney disease because of the ability of cobicistat to block creatinine tubular secretion, boosting tenofovir’s nephrotoxic effect because this drug is cleared using the same mechanism. Hence careful monitoring of creatinine clearance, urine glucose and protein levels, and blood phosphate levels at the start and during treatment is key. Purpose To assess the impact of TDF/FTC/COBI/RVG on renal function in our patients, evaluating the extent to which EPAR’s monitoring needs are satisfied at the start and during treatment, and describing measures taken to resolve any incidences encountered. Material and methods We undertook a descriptive retrospective study, involving all patients treated with TDF/FTC/COBI/EVG over 2 years. Data were collected from patients’ digital clinical and analytical histories. We registered demographic data, previous treatments with tenofovir or cobicistat, laboratory monitoring information, adjustment of monitoring to given criteria, use of other nephrotoxic drugs and measures taken if renal function decreased (if ClCr Results 43 patients (81% men, average age 44 years) received TDF/FTC/COBI/RVG during the study period. 53% had previously been treated with tenofovir. Average ClCr was 107 mL/min (only 19% had ClCr Conclusion Despite wide experience with their use, the number of cases of decreased renal function with TDF/FTC/COBI/RVG treatment has increased with time. In our study, we observed a progressive decrease in creatinine clearance, leading to hospital admission in one case. This could be because none of our patients received adequate monitoring. No conflict of interest

Purpose To assess the satisfaction level with our service’s internal and external customers in order to make improvements and compare current results with those from 2013. Material and methods Following our hospital pharmacy quality standards procedures, a series of anonymous, voluntary satisfaction surveys were carried out. The survey for internal customers (doctors and nurses) measured their global opinion, organisation, accessibility and ability of response via 9 questions, with 5 options each, scaled from highly satisfactory to fully unsatisfactory. The external customers’ survey contained 11 questions about accessibility, waiting times, quality of information given and ease of contact. Data were compiled between 26 October and 3 December 2015. Results 54 completed surveys were available from doctors (27%), 48 from nurses (24%) and 67 from outpatients (44.7%). 76.3% of doctors gave a high satisfaction level (satisfactory or highly satisfactory, scores 4 and 5), a higher proportion compared with 2013 (65.0%). The top rated item was the global opinion on the service, and the lowest items were those related to knowledge offered and the current state of prescription (dispensation–administration circuit). In consequence, we proposed actions such as computer provided order entry (CPOE) implementation and information circuit improvements. Nurses also reported being satisfied with our service (56.7% scores 4 and 5, slightly higher than the results in 2013 (54.8%)). Personal care and response ability were the top rated items, response time being the one that received the worst scores. We propose increasing the number of dispensing time slots, to improve our information circuits, and to request a new watchman to improve medication intrahospital logistics. Regarding patients, most gave high satisfaction scores for all items, higher than those in 2013. We decided to implement a patient citation system to shorten waiting times. In all three surveys we observed a growing trend in satisfaction. Conclusion Surveying satisfaction levels allows us to identify improvement areas, to assess if previously taken measures had increased customer satisfaction about our service. Actions taken after this series of surveys need to be followed-up to make sure they are properly applied and give the expected results. No conflict of interest

Background Despite living in the high tech era, there is still a lack of software tools to help pharmacists to carry out their common tasks, pharmaceutical care being one of the most important. Purpose Designing a friendly intuitive application to gather, assess and use patients’ demographic and clinical information to obtain better results in pharmaceutical care. Material and methods We created a Filemaker database compatible with computers and tablets. Its interface was designed with Adobe PhotoshopCC. Prior to this, a bibliographical review on pharmaceutical care was performed to decide which data would be useful for pharmacists to collect. Results An iPadMini optimised (1024x669) ‘.fmp12’ file was obtained. The main page grants access to patient records. Each one allows demographic and clinical data, including history, current diagnosis and evolution to be collected. A button panel give access to the remaining areas. ‘Therapy’ section is set to collect pharmacotherapy data (drug, dose, interval, administration route, prescription date). To make follow-up easier, drugs can be flagged into five categories (restricted duration, possibility of intravenous to oral switching, common adverse reactions, potential contraindications and dose adjustment needs). A similar table records nutritional treatments. ‘Laboratory’ gathers the most relevant haematologic (cell counts, coagulation, haemoglobin, etc), biochemical (glucose, ion levels, etc) and microbiologic (culture findings, susceptibility testings) parameters related to pharmaceutical care. It calculates MDRD4 creatinine clearance, and warns the user if values are out of range. ‘PRIME zone’ allows recording of pharmaceutical problems, risk issues, drug Interactions, treatment mismatches and efficacy facts. Users can record how each problem is managed, and if they were able to influence clinicians (accepted, rejected or non-assessable interventions). The database is provided with a search engine, and can print a ‘.pdf’ case report. Conclusion Our database aims to make pharmacotherapy management easier, improving detection of medication related problems and allowing bedside work. In a pilot study in over 28 patients, our colleagues perceived an increase in the amount and quality of interventions to clinicians, but also regretted spending too much time when gathering data, due to the fact that the database cannot automatically collect data from official sources. Despite having enhanced our database functionality, Filemaker does not fulfil our needs, and professional software development would be desirable, which requires further funding. No conflict of interest

Background Digoxin is used to manage supraventricular arrhythmias and low output chronic heart failure (CHF). Due to its narrow therapeutic window, digoxin must be monitored clinically and pharmacokinetically. Blood levels below 0.6–0.8 ng/mL are infratherapeutic, but above 2–2.5 ng/mL serious gastrointestinal, cardiovascular, visual and neurological toxicity appears. Kidney failure and thyroid disease can trigger this phenomena. Purpose To describe digoxin toxicity epidemiology and clinics in a third level hospital, comparing the current situation with past data and suggesting measures to minimise its incidence. Material and methods We studied our hospital’s 2015 basic minimum dataset, which collects all the diagnoses of admitted patients at discharge, coding them using the WHO’s International Classification of Diseases (ICD9, digitalis toxicity code E942.1). Data were consigned in a Filemaker database, and statistically managed with SPSS21. Results Our hospital registered 31 257 admissions, 453 (1.45%, 248 men, average age 66.5±21.5 years) related to adverse reactions (E930-E949). E942.1 was coded 24 times (0.77‰, 23 women, average age 83.4±10.2 years, 18 in internal medicine), 9 less than in 2014, for the second year in a row being the fourth most frequent cause of adverse reactions, after antineoplastics and oral anticoagulants (64 times each), and adrenocortical steroids (43). Due to privacy issues, 4 patients’ clinical histories could not be accessed. Among the 20 studied, 1 did not experience toxicity (mistakenly coded). The remaining 19 were diagnosed with atrial fibrillation, 11 also with CHF. 8 had started digoxin within the previous month (4 within the previous week). The most frequent reactions were gastrointestinal (9), cardiovascular (9) and neurological (5). 9 episodes were severe, being the reason for admission. We found a correlation between severity and incidence of cardiovascular symptoms (χ2, p=0.04). Two cases were related to medication errors (dosing without considering kidney function). Digoxin toxicity was related to kidney failure (ClCr Conclusion The incidence of digoxin toxicity has decreased as its use has decreased, at the expense of safer alternatives. If alternatives are not possible, it seems key to tighten pharmacokinetic monitoring in older patients, mainly those with kidney failure. Doctors should be re-instructed about digoxin peculiarities (narrow window, serious toxicity) to maintain the trend. No conflict of interest

Aims/hypothesis Sugar has been suggested to promote obesity, diabetes and coronary heart disease (CHD), yet fruit, despite containing sugars, may also have a low glycaemic index (GI) and all fruits are generally recommended for good health. We therefore assessed the effect of fruit with special emphasis on low GI fruit intake in type 2 diabetes. Methods This secondary analysis involved 152 type 2 diabetic participants treated with glucose-lowering agents who completed either 6 months of high fibre or low GI dietary advice, including fruit advice, in a parallel design. Results Change in low GI fruit intake ranged from −3.1 to 2.7 servings/day. The increase in low GI fruit intake significantly predicted reductions in HbA1c (r = −0.206, p = 0.011), systolic blood pressure (r = −0.183, p = 0.024) and CHD risk (r = −0.213, p = 0.008). Change in total fruit intake ranged from −3.7 to 3.2 servings/day and was not related to study outcomes. In a regression analysis including the eight major carbohydrate foods or classes of foods emphasised in the low GI diet, only low GI fruit and bread contributed independently and significantly to predicting change in HbA1c. Furthermore, comparing the highest with the lowest quartile of low GI fruit intake, the percentage change in HbA1c was reduced by −0.5% HbA1c units (95% CI 0.2–0.8 HbA1c units, p

This cross-sectional, concurrent and descriptive study presents the decisions regarding patients referred to our Lung Transplantation Unit (LTxU). Each patient is discussed in a multidisciplinary clinical session (phase I), rejecting some and accepting others for assessment in our LTxU (phase II) according to criteria of the National and International Guidelines for Transplantation. A protocol assessment in phase II, leads to a decision to reject, accept, or follow-up the candidate for LTx. Among 214 evaluation requests received in our unit from May 2008 to December 2011, 37 patients (17%) were rejected based on the information sent to our LTxU. Among the patients evaluated in phase II , 62 (28.9%) were put on the waiting list, 125 (58.4%) were rejected, and twenty-seven (12.6%) were postponed for future reconsideration, results that were similar to those described in the literature. The main disease referred for LTx was obstructive airflow (n = 98; 45.7%), followed by interstitial lung disease (ILD; n = 66; 30.8%), cystic fibrosis or bronchiectasis (n = 20; 9.3%), or primary pulmonary hypertension group 1 (n = 20; 9.3%). Ten patients (4.6%) were diagnosed with other respiratory diseases. Most patients (n = 165; 77.1%) lived in the region of our hospital (Madrid). The main reasons to reject patients for LTx were malnutrition, severe disease in other organs, toxic habits, and refusal of treatment. Finally, one out of four referred patients was accepted for LTx. In addition to serious comorbidities in various organs, a high percentage of patients who were not accepted for LTx because of these factors might have been of accepted had these conditions been corrected before patient referral.

In optical tomography of parallel projections, the light rays that cross the slice of the object are experimentally approached to suffer minimal refraction, i.e. take refractional limits. Generally, a media is used for immersion whose refractive index rate tied the environment to study, but the geometry of the containment vessels also affects refraction and may be the case that the approach is not subject performed. In this work we make a numerical study of the refraction of a ray of light that enters a typical experimental system for studying the thermodynamic behaviour of a paraffinic wax around their cloud point. Since it has special properties in the heat capacity and refractive index near the phase transition, these results will be used to characterize the transition and is intended to give tomographic information to the study of thermal properties obtained using the T-History calorimetric technique. In this study, we simulate the behaviour of the refraction of parallel rays crossing the T-History test system to find the optimal values of the dimensions of the containment vessels and the index of refraction of the medium for immersion, considering that the optical properties of the sample under study vary with temperature. Thus, we obtain the optimum conditions of minimum refraction technique for which reconstruction of a tomographic slice parallel projection can be applied. The distribution of the linear attenuation coefficient on the slice of the object, typically, is obtained by applying the filtered backprojection algorithm to the set of projections (sinogram) obtained experimentally, which constitutes a way to detect mobile interfacial boundaries in real time. The projections are sequentially measuring the intensity of the wave emerging from the slice of the object at different angles.

Made available in DSpace on 2013-08-28T14:07:40Z (GMT). No. of bitstreams: 1 WOS000278383600001.pdf: 960234 bytes, checksum: 9cd26a9750ec13e67eaf9019e1f48e7b (MD5) Made available in DSpace on 2013-09-30T18:12:07Z (GMT). No. of bitstreams: 2 WOS000278383600001.pdf: 960234 bytes, checksum: 9cd26a9750ec13e67eaf9019e1f48e7b (MD5) WOS000278383600001.pdf.txt: 69473 bytes, checksum: e718db9d53c8e8829f735f82524e401f (MD5) Previous issue date: 2010-05-04 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T14:00:48Z No. of bitstreams: 2 WOS000278383600001.pdf: 960234 bytes, checksum: 9cd26a9750ec13e67eaf9019e1f48e7b (MD5) WOS000278383600001.pdf.txt: 69473 bytes, checksum: e718db9d53c8e8829f735f82524e401f (MD5) Made available in DSpace on 2014-05-20T14:00:48Z (GMT). No. of bitstreams: 2 WOS000278383600001.pdf: 960234 bytes, checksum: 9cd26a9750ec13e67eaf9019e1f48e7b (MD5) WOS000278383600001.pdf.txt: 69473 bytes, checksum: e718db9d53c8e8829f735f82524e401f (MD5) Previous issue date: 2010-05-04 Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Rede Proteoma do Estado de São Paulo Ludwig Institute for Cancer Research Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) Background: The development and progression of cancer depend on its genetic characteristics as well as on the interactions with its microenvironment. Understanding these interactions may contribute to diagnostic and prognostic evaluations and to the development of new cancer therapies. Aiming to investigate potential mechanisms by which the tumor microenvironment might contribute to a cancer phenotype, we evaluated soluble paracrine factors produced by stromal and neoplastic cells which may influence proliferation and gene and protein expression.Methods: The study was carried out on the epithelial cancer cell line (Hep-2) and fibroblasts isolated from a primary oral cancer. We combined a conditioned-medium technique with subtraction hybridization approach, quantitative PCR and proteomics, in order to evaluate gene and protein expression influenced by soluble paracrine factors produced by stromal and neoplastic cells.Results: We observed that conditioned medium from fibroblast cultures (FCM) inhibited proliferation and induced apoptosis in Hep-2 cells. In neoplastic cells, 41 genes and 5 proteins exhibited changes in expression levels in response to FCM and, in fibroblasts, 17 genes and 2 proteins showed down-regulation in response to conditioned medium from Hep-2 cells (HCM). Nine genes were selected and the expression results of 6 down-regulated genes (ARID4A, CALR, GNB2L1, RNF10, SQSTM1, USP9X) were validated by real time PCR.Conclusions: A significant and common denominator in the results was the potential induction of signaling changes associated with immune or inflammatory response in the absence of a specific protein. Sch Med FAMERP, Dept Mol Biol, Sao Jose do Rio Preto, Brazil São Paulo State Univ UNESP, IBILCE, Dept Biol, Sao Jose do Rio Preto, Brazil Sch Med FAMERP, Dept Otorhinolaryngol & Head & Neck Surg, Sao Jose do Rio Preto, Brazil Univ São Paulo, Inst Biociencias, Dept Genet & Evolutionary Biol, São Paulo, Brazil Arnaldo Vieira de Carvalho Hosp, Dept Head & Neck Surg, São Paulo, Brazil Univ São Paulo, Sch Med, Dept Surg, Div Head & Neck Surg, BR-09500900 São Paulo, Brazil Heliopolis Hosp, Dept Head & Neck Surg, São Paulo, Brazil UNESP, Fac Engn Ilha Solteria, Dept Biol & Zootechny, Ilha Solteira, Brazil São Paulo State Univ UNESP, IBILCE, Dept Biol, Sao Jose do Rio Preto, Brazil UNESP, Fac Engn Ilha Solteria, Dept Biol & Zootechny, Ilha Solteira, Brazil FAPESP: 04/12054-9 FAPESP: 06/60162-0 FAPESP: 04/14846-0 FINEP: 01.07.0290.00

OBJECTIVE: The aim of the study was to determine which was the optimal side for the conduit to be placed (right or left colon) for antegrade continence enema implantation. MATERIALS AND METHODS: Between July 1999 and March 2006, 31 patients underwent the construction of a catheterizable conduit using the Malone principle (MACE) In 22 cases the conduit was re-implanted in the right colon and in 9 cases in the left colon. There were 20 male patients and 11 female patients, with a mean age of 10.23 years. The follow-up period varied from 3 from 83 months (average 25 months). Right and left implantation of the conduit in the colon were compared with regards to the presence of complications, volume of the solution utilized, frequency of colonic lavage, time needed for performing the enema, and degree of satisfaction. RESULTS: One patient with the conduit in the right colon, using the appendix, lost the mechanism after two month follow-up. Thirty patients remain clean and are all capable of performing self-catheterization. No statistically significant differences were found between the groups regarding the variables studied: complications (p = 1.000), solution volume (p = 0.996), time required (p = 0.790) and patient's rating (p = 0.670). The lavage frequency required for patients with the conduit in the right colon may be lower. CONCLUSION: The MACE principle was considered effective for treating fecal retention and leaks, independent of the implantation site. The success of this surgery appears to be directly related to the patient's motivation and not to the technique utilized.

Background Vitamin K (VK), whose recommended daily intake is easily achieved by food, enteral or parenteral nutrition, is mainly indicated as an antidote against hypoprothrombinaemia due to excessive coumarin anticoagulation. It’s activity correlates with the international normalised ratio (INR), which is also influenced by other conditions affecting the extrinsic coagulation pathway (liver disease, intravascular diffuse coagulation, antiphospholipid syndrome). According to benchmarking data, VK expenses are 9 times higher than the country’s average. Purpose Our aim was to assess if VK is being used according to the available clinical evidence, estimating the impact of unnecessary prescriptions and checking if pharmacists’ interventions could modify doctors’ prescription habits. Material and methods We included all VK prescriptions written during July 2015, studying how posology evolved until treatment interruption or patient discharge. Gathered demographic and clinical data were coded in a Filemaker database, using SPSS 22 for statistical treatment. When necessary, by leaving a note in the patient’s history, doctors were required to make changes in order to fit clinical evidence. Results 66 patients (47 male, average age 65.1 ± 17.2 years) received VK, emergencies being the area with the most prescriptions (16). Only 10 were signed by an haematologist. The main indication (anticoagulant hypoprothrombinaemia) had the lowest expense (204.05€) and better compliance with evidence (54.0% of the doses unnecessary). 1245.55€ were spent on management of malabsorption, liver disease and prolonged antibiotic use, poorly supported by evidence (78.7% doses unnecessary). We proved no correlation between VK dosing changes and INR evolution in a complex cirrhotic patient (Spearman’s rho, p > 0.05). Perioperative hypoprothrombinaemia (INR Conclusion Unnecessary VK prescription, worrying because of its high incidence, has an important impact on health system budget (up to 34 000€ yearly if we extrapolate our results). Considering how pharmacists succeeded in optimising prescriptions, our conclusions will be presented to the next Pharmacy and Therapeutics Committee. We will remark on the main role of pharmacist intervention, and propose formative activities for doctors in order to improve VK prescription quality. References and/or Acknowledgements 15 references. No conflict of interest.

Background Secondary macrophage activation syndrome (MAS) is a group of diseases, especially due to autoimmune (AI) and hemato-oncology (HO). It would be interesting to find any clinical and analytics data to differentiate both etiologies. Objectives To describe and compare demographics, clinical and laboratories features and mortality of patients diagnosed with secondary MAS due to HO and AI diseases at the Donostia University Hospital. Methods A cohort of patients diagnosed with MAS was studied by reviewing medical reports in the period Dec/2008-Jan/2015. We analyzed and compared only patients with AI and HO diseases. The variable studied were diagnosis, age, sex, fever, organomegaly, hospital and overall mortality, analytical findings, hospital stay, days from admission to diagnosis and days from diagnosis to the end of the study or death after discharge. Quantitative variables are shown with the median and interquartile range. For the bivariate analysis Wilcoxon and Chi square test were used. Median survival in months and Hazar Ratio (HR) was calculated with the Kaplan Meier plot. Results Nineteen patients were found diagnosed with MAS, 6 and 9 were due to AI and HO diseases respectively. The AI diseases found were: 3 Systemic Lupus Erythematosus, 2 Adult Still9s Disease and 1 disease associated with IgG4. HO diseases found were: 3 acute myeloid leukemias, 2 B cells Not Hogkin Lymphoma (NHL), 1 T anb B cells NHL, 1 Natural Killers cells extranodal lymphoma, 1 myelodysplastic syndrome and 1 gastric plasmacytoma. The table shows the descriptive analysis of 19 patients and the bivariate analysis between AI and HO. The median survival of HO diseases was 1.2 months and AI diseases can not be calculated. The mortality of HO and AI diseases was 77.8% and 16.7% respectively with a p=0.04 in the log rank test. The HR of mortality among HO against AI diseases was 6.84. Conclusions In the present study the following differences were found: 1) Patients with MAS due to AI diseases have a higher elevated liver enzymes compared to HO disease. 2) Patients with MAS due to HO diseases have a greater pancytopenia compared to AI diseases, especially in leukocytes and neutrophils. 3) Patients with MAS due to HO have a higher mortality compared to AI diseases. Disclosure of Interest None declared

Optical tomography of phase objects could be carried out with optical derivatives at the phase detecting stage. A particularly convenient related technique is the use of a fractional derivative of fractional order 1/2, which consists of a spatial filter with square-root amplitude transmittance. An advantage of this type of filter is that it can be implemented as a real filter when dealing with phase objects. Irradiance is proportional to the phase derivative of order one, and it can be obtained. If a tomographic detection system is equiped with such a filter, phase gradient of projections can be determined, and directional derivatives of phase slices can be displayed. Slice images resulting from an experimental tomographic system for parallel projections includes a spatial filter. with square-root amplitude transmittance made from a liquid crystal display operating in amplitude modulation are shown.

Background Adequate coverage of the nutritional needs during hospitalisation is of the utmost importance for patients’ recovery. Purpose To evaluate the quality of parenteral nutritional support in our hospital to find points for improvement. Material and methods Prospective observational study of all patients with parenteral nutrition (PN) over a period of two months. PN prescription was considered justified, if was in agreement with the ESPEN 2009 criteria. PN length was appropriate if it was for less than 7 days for peripheral PN (PPN) or for more than 7 days for central PN (CPN). Protein and energy needs were calculated by weight and adjusting for metabolic stress factor (Low, Moderate and High: 1, 1.2 and 1.4 g protein/kg/day respectively for proteins and 150, 130 and 110 nonprotein Kcal/gN respectively for energy). Nutritional needs were calculated only in patients with CPN and recorded weight. PN was considered adequate if it covered 85–115% of the calculated needs. Spss 20.0 was used for statistical calculation. Results 49 patients were included. The average age was 65 ± 14 years and average body mass index was 26 ± 5 Kg/m2. 40 patients (81.6%) had CPN and 9 (18.4%) PPN. PN prescription was justified in 46 patients (93.6%). PN length was optimal in 30 patients (75%) with CPN and 3 (33%) with PPN (p = 0.043). Nutritional needs were calculated in 37 patients. Caloric and protein intakes were suitable in 22 (59.5%) and 15 (40.5%) patients respectively. 6 patients (16.2%) had caloric overfeeding and 20 (54.1%) had protein overfeeding. 9 patients (24.3%) had insufficient calories and 2 (5.4%) insufficient protein. 10 patients (20.4%) met all objectives and therefore had appropriate PN. Conclusion PN prescription is generally justified but PPN length is often inappropriate. In the light of these results, the appropriate coverage of nutritional needs and PPN prescription for seven or fewer days, are the most important points to improve. References and/or acknowledgements To the other professionals from pharmacy department and clinical units, who contributed to conducting this study. No conflict of interest.

Background Despite using steroid premedication before administering potentially highly allergenic chemotherapy (taxanes, platinum drugs, biological macromolecules, etc.), some patients get sensitised during the first cycles and tend to develop hypersensitivity reactions. This leads to early treatment interruption, which could be critical for the patient’s outcome. Once identified, the allergen may be re-administered under a desensitisation protocol, inducing a tolerance state in which the patient doesn’t react again. During each session, the whole dose is administered starting at a very low infusion rate, which is periodically increased until the regular rate is achieved. Patients with a positive skin test, severe reaction despite negative test, and those who react again during controlled administration are candidates for desensitisation. Purpose To describe the management and outcomes of patients who reacted to chemotherapy, and how oncologists changed their prescriptions to available options. Material and methods We carried out a retrospective study (period 2011–2014), obtaining data from patients’ clinical histories and chemotherapy records. SPSS20 was used for data coding and statistical processing. Results Sixteen patients (81.2% female, average 62.9 ± 7.3 years, diagnosed with ovarian cancer) experienced mild (9), moderate (3) or severe (4) hypersensitivity reactions to chemotherapy (68.8% platinum drugs). Five patients had a positive skin test; only three were enrolled on desensitisation programmes, the remaining two switched treatment line. Two patients had a severe reaction but a negative test, one of them was enrolled and the other switched treatment. The remaining nine (negative test, mild-moderate reaction) didn’t experience a second reaction during controlled infusions, so they kept the same treatment; just one reacted and was proposed for the programme. Four desensitisations were carried without incident, the remaining one had to be stopped due to a reaction when the infusion reached the top rate during the first session. Conclusion Desensitisation, provided by Drug Allergy and Hospital Pharmacy departments, allows standard treatment lines to be continued, modifying oncologists’ decisions and improving patient outcomes. References and/or Acknowledgements No conflict of interest.

Background Surgical patients are especially susceptible to nutritional disorders; additionally an adequate nutritional status is important in achieving prompt recovery. Purpose To describe and analyse possible shortcomings related to nutritional status of surgical patients associated with an inadequate prescription of parenteral nutrition (PN). Material and methods A prospective, observational study, lasting two months, of post-surgical patients in a third level hospital with PN support. Estimated calorie requirements (CR) of surgical patients were calculated. The Harris-Benedict formula was the method used to evaluate CR taking into account the degree of metabolic stress in each surgical patient. Data were collected from the medical history of each patient: age, diagnosis, duration of PN support, glycaemia, electrolytes, total proteins and other haematological parameters. An assessment was made of how many blood tests were requested for every patient, at the beginning, during and at the end of parenteral support. Results A total of 75 patients were studied. In 19.2% of cases the CR were successfully supplied. In 72.6% of cases the prescribed caloric intake was insufficient compared to their estimated CR. In the remaining 8.2% of cases the caloric intake exceeded their estimated CR. 23.2% of the patients studied were obese. In 76.5% of them, the prescribed caloric intake differed from the estimated CR, despite the body weight calculation being adjusted for these patients. Conclusion Our study showed that 80.8% of patients were not given sufficient nutritional support, missing their estimated CR. It shows the lack of a structured protocol to addresses the nutritional assessment in surgical patients. References and/or Acknowledgements Keith JN. Bedside nutrition assessment past, present, and future: a review of the subjective global assessment. Nutr Clin Pract 2008;23(4):410–16 Martins CP, Correia JR, Do Amaral TF. Undernutrition risk screening and length of stay of hospitalized elderly. J Nutr Elder 2005;25(2):5–21 No conflict of interest.

Background Aplastic anaemia comes from a bone marrow failure which affects all blood lineages. Treatment is based on immunosuppression or allogeneic transplant, but some patients are refractory to these options. Eltrombopag, a thrombopoietin receptor agonist administered orally, promotes megakaryopoiesis and platelet release. Purpose To assess eltrombopag effectiveness as off-label treatment for immunosuppression-refractory aplastic anaemia. Material and methods A 10-month (1/12/2013–30/09/2014) retrospective study was carried out including immunosuppression-refractory aplastic anaemia patients who weren’t allotransplantation candidates. After approval by the Regional Committee for drug use under Special Circumstances, each patient received different eltrombopag doses. In order to assess the effect, data were gathered from platelet count at baseline and subsequently, considering the response positive when the platelet count increased enough to avoid transfusion. Clinical data were obtained from the patient’s history and from Outpatient records. Results We recovered data from two patients (male, aged 26 and 34) diagnosed with aplastic anaemia refractory to anti-thymocyte globulin, ciclosporin and high-dose steroids. Neither of them were candidates for allotransplantation. Initial dose was 50 mg/day, causing a platelet count increase of 7 and 272 mill/mm 3 after three weeks. Then, doses were modified according to current response to an average of 6.25 mg/day, reaching counts of 5–125 mill/mm 3 (average 44.33 mill/mm 3 ) in one patient and 1–553 mill/m 3 (average 139.76 mill/mm 3 ) in the other. The average treatment length was 6.75 months. Those results are similar, even better, to the ones shown in a phase-II study (Olnes et al , 2012) involving 25 patients with the same diagnosis and dose (response in 44%, average increase 44.0 mill/mm 3 , nine of them transfusion independent). Conclusion Both patients reached platelet counts higher than 100 mill/mm 3 , avoiding transfusions and their associated risks, with an improvement in their quality of life. Because of the unavailability of other treatments for this kind of patients, the off-label use of eltrombopag is a promising alternative when there’s little chance of cure. References and/or acknowledgements No conflict of interest.

Background Drugs interact when the effect of a drug is modified by another co-administered drug, food or herb. According to a number of studies, almost half the prescriptions are accompanied by interactions (8–43%, depending on the ward), but few (12–25%) are clinically relevant. Antibiotics are a wide group of drugs used a great deal in our environment (in 49.8% of inpatients), and are associated with important interactions. Pharmacists help doctors to manage them by writing an intervention on the patient history, after evaluating patient clinical status. Purpose To describe quantitative and qualitative antibiotic-drug interactions among our patients, assessing their expected clinical impact and intervening if they are relevant; to see how doctors modify prescriptions. Material and methods We searched interactions involving antibiotics in all available prescriptions of every ward at the time of screening. We used Medscape app as screening tool, adopting their rating system (minor, significant, serious or contraindicated), considering intervention only in the relevant ones. SPSS20 was used for data coding and statistical processing. To improve intervention quality, additional data were reviewed in trusted sources like Stockley or Lex Interact. Results Antibiotics were found in 156 prescriptions, mostly penicillins (45 prescriptions), quinolones (35) and carbapenems (34). A total of 1,415 interactions were detected (average per patient 9.07 ± 9.39), only 271 (19.2%) involving antibiotics. Among those, 76 minor, 116 significant, 78 serious and one contraindicated interaction were found. We intervened in only 16 cases (mostly about nephro/ototoxicity, serotonergic syndrome involving linezolid and monoamine-oxidase inhibitors, and proarrhythmic combinations). Only four prescriptions were modified after the interaction had been reported. Conclusion Antibiotics play an important role in interactions; despite this few are dangerous, and must be filtered before choosing to intervene. Despite their relevance, doctors seem to underestimate the associated risks, ignoring the advice given. To improve their knowledge and respect for this topic, our Service will soon be teaching a course for healthcare professionals. References and/or Acknowledgements (NONE) No conflict of interest.

Background The secondary macrophage activation syndrome (SMAS) is a group of diseases that include the: Autoimmune (AI), Hemato-Oncological (HO), Infectious (Inf) and Oncological (Onco). We make a review of the the cases presented in a our hospital. Objectives Describe the characteristics demographic, clinical, laboratory, treatment, underlying disorders and mortality of patients diagnosed with SMAS. Methods A cohort was studied retrospectively of patients diagnosed with SMAS between the period December/2008-January/2014 by reviewing medical records from the diagnosis until January/2014. The nominal variables were: diagnosis, treatments during hospitalization and after discharge. Dichotomous variables were: sex, fever, organomegaly, mortality, admission to the Intensive Care Unit (ICU) and recurrence of SAMS. Quantitative variables were: age, laboratory findings, hospital stay, days from admission to the bone marrow biopsy (BMB). Patients were divided into 4 groups (AI, HO, Inf and Onc). The variables were analyzed between the 4 groups and between AI and HO. Quantitative variables showed asymetric distribution so it showed with the median and interquartile range. For the bivariate analysis the Kruskal-Wallis, Pearson Chi Square and Fisher9s Exact tests were used. Results 13 patients (6 female) with median age of 54 (32-63) were found: 5 with AI diseases (2 Systemic Lupus Erythematosus, 2 Adult Still9s Disease and 1 IgG4 associated disease), 5 HO diseases (3 Non Hogkin Lymphoma, 1 acute myeloid leukemia and 1 Lymphoma of Natural Killers cells), 2 Inf. diseases (Campylobacter jejuni and human immunodeficiency virus) and 1 Onc. disease (Chemotherapy in Glioblastoma multiforme). Table shows the descriptive and bivariate analysis of the most important variables. The treatments used were: glucocorticoids in all patients, immunoglobulins in 8 (3 AI, 2 HO, 2 Onc. and 1 Inf.), Cyclosporine in 8 (5 AI and 3 HO), anakinra in 4 (2 HO and 2 AI), tocilizumab and chemotherapy in 2 HO. Conclusions We found that leukopenia was lower in AI disease than HO diseases with statistically significant p. AI diseases had worse prognosis, increased mortality and hospital days than other diseases. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.5055

Background Hemophagocytic Lymphohistiocytosis (HLH) is a severe and acute inflammatory syndrome, underdiagnosed, difficult to treat and can occur at any stage of life. The macrophage activation syndrome is a variant of secondary HLH occurs in autoimmune diseases.1 Objectives Describe the clinical, laboratory, treatment and outcome of patients diagnosed with secondary HLH, identifying probable etiological and triggers causes. Methods A retrospective study was performed between 2008 and 2012 at the Donostia University Hospital, Spain. Inclusion criteria were to met diagnostic criteria for HLH and had a bone marrow biopsy with hemophagocytics cells. Mains endpoints were: demographics, diagnostic criteria, probable etiology, triggers causes and treatments. Secondary endpoints were: time delay in diagnosis, days of hospitalization, need for admission to the Intensive Care Unit (I.C.U.) and the cause, and overall mortality. Results We recruited 11 patients (7 men and 4 women) with a mean age of 48.9 years (16 - 78 years). The below table describes the probable etiologies and triggers of secondary HLH. As no data in the literature described, we found as etiologies and triggers causes of secondary HLH: Campylobacter jejuni in a previously healthy patient without comorbidities; Pneumocystis jirovecii in a patient with Human immunodeficiency virus (H.I.V.); and patient with grade IV glioblastoma multiforme after starting chemotherapy with temozolomide. Hemophagocytics cells were found in ascitic fluid in one patient with Adult Still´s Disease. The mean delay in diagnosis was 14.5 days (3 – 31 days) and average time of hospitalization was 46.7 days (10 – 130 days). The 45% of patient required admission in I.C.U, the leading cause was the multiple organ failure (MOF). The overall mortality rate was 36.4% (4 MOF and 1 massive hemoptysis). Treatment given was steroids, synthetic immunosuppressants and biological drugs. Conclusions The secondary HLH should be suspected in any patient with prolonged fever unresponsive to broad-spectrum antibiotics, hepatosplenomegaly, cytopenias, coagulation and liver disorders. Hemophagocytics cells might be found in pathological body fluids before a bone marrow biopsy had been done or when there are doubts in the result of it. Meet all the diagnostic criteria is not necessary to start treatment when you have a high clinical suspicion and a bone marrow biopsy with hemophagocytics cells. Mortality can be influenced by etiology, trigger cause, and diagnosis and treatment delay. References Henter JI, et al. HLH-2004: Diagnostic and therapeutic guidelines for hemophagocytic lymphohistiocytosis. Pediatr Blood Cancer 2007; 48:124. Disclosure of Interest None Declared

Eating disorders are behavioural syndromes which diagnoses criteria have been widely studied during the last decades. Anorexia nervosa, bulimia nervosa and partial syndromes stand out. Metabolic and electrolyte abnormalities and endocrine alterations can be present. Early diagnosis and an adequate management of these complications are important to reduce the risks associated. The objective of the study was to assess the prevalence of suggestive behaviours of eating disorders and associated factors, in undergraduate female students from a public university in the city of Rio de Janeiro. Cross-sectional study was conducted in 2004. The sample consisted of 512 students who answered a self-reported questionnaire based on the Eating Attitudes Test (EAT-26), Bulimic Investigatory Test of Edinburgh (BITE), used to investigate behaviours suggestive of disorders. It also included the General Health Questionnaire and questions about body image perception, leisure-time physical activity and nutritional evaluation. Ratios prevalences were estimated through Poisson regression. The mean age was 21.5 years old. Prevalences of 16.99% have been detected in the EAT-26, 25.00% in the BITE, and 33.40% in the joint analysis of both instruments. There was significant association between behaviour suggestive of eating disorders and attending a course in the field of Education and Humanities (PR 1.41; 95% CI 1.06 to 1.89), age between 17 and 20 years (PR 1.78; 95% CI 1.01 to 3.14), and between 20 and 30 years old (PR 1.75; 95% CI 1.01 to 3.04), self-perception of being overweight (PR 1.84; 95% CI 1.39 to 2.42), and presence of common mental disorder (PR 1.42; 95% CI 1.01 to 1.83). These results showed that educational actions for control and prevention of eating behaviour suggestive of disorders among undergraduate female must be fostered.

Introduction Studies conducted all over the world show that the rates of pregnancy in adolescence are increasing, especially in the early adolescence (10–14 years of age). Although the majority of pregnancies in this period are not desired some studies suggest that a number of them are wanted. Aims: (1) Assess the prevalence of wanted pregnancy and possible associations with socioeconomic, demographic factors and social support network in a population of pregnant adolescents (2) Verify if age should be an effect modifier in these associations. Methods Cross sectional study conducted with pregnant adolescents regularly attending two public maternity units. A sample of 232 pregnant adolescents aged 13–20 years (mean 17.3 years) completed a self-reported questionnaire. Results Prevalence of intended pregnancy was 46.2%. Final adjusted model showed that being married (PR 1.80, 95% CI 1.27 to 2.56) and not having friends (PR 1.48, 95% CI 1.15 to 1.90) showed association with the desire to be pregnant. Girls studying in the elementary grade and aged 12–16 years desired to be pregnant less (PR 0.57, 95% CI 0.38 to 0.88). Conclusion Pregnancy in adolescence may not always be unwanted. Some factors, such as being married and not having any friends may have influence in these cases. Professionals dealing with adolescents should be aware of these issues in order to identify high risk situations that could be managed.

Introduction: Studies conducted all over the world show that the rates of pregnancy in adolescence are increasing especially in the early adolescence (10 to 14 years of age). Although the majority of pregnancies in this period are not desired some studies suggest that an expressive number of them could be even wanted. Aims: Methods: Cross sectional study conducted with pregnant adolescents regularly attending two public maternity. A sample of 232 pregnant adolescents between 13 and 20 years of age (mean: 17.3) completed a self-reported questionnaire to access socioeconomic and demographic data. Results: Prevalence of pregnancy willingness was 46.2%. Final adjusted model showed that being married (PR = 1.80; CI 95% 1.27-2.56) and do not have friends (PR = 1.48; CI 95% 1.15-1.90) showed association with desire of being pregnant. Girls studying in the elementary grade and with 12 to 16 years of age showed less desire of being pregnant (PR = 0.57; IC 95% 0.38-0.88). Conclusion: Pregnancy may not always be unwanted. Some factors, as being married and do not have friends may have influence in these cases. Professionals dealing with adolescents should be aware of these issues to identify risk situations that could be successfully managed.

Malignant atrophic papulosis usually presents as pathognomonic skin lesions followed by acute abdominal pain, bowel perforation, peritonitis, and death. Rare patients who may lack gastrointestinal symptoms present with central nervous system manifestations, including headache, paresthesias, weakness, and rapid deterioration to death. The patient reported here was a 47-year-old man whose neurological symptoms apparently preceded his cutaneous lesions. His course consisted of a disseminated neurological disease and exacerbated following a herpes zoster infection. His condition rapidly deteriorated despite corticotropin, glucocorticoids, and low-molecular-weight dextran. Necropsy revealed a disseminated occlusive vasculopathy and diffuse encephalomyelomalacia of the brain and spinal cord. A review of autopsied patients with central nervous system involvement is provided.