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Background: Since the first cases of human immunodeficiency virus (HIV), ocular manifestations secondary to infection have been known and these have been related to the CD4+ lymphocyte count., Objective: To describe the correlation between ocular manifestations in patients with HIV and the CD4+ lymphocyte count., Material and Methods: Analytical cross-sectional study of patients with HIV whose CD4+ count was correlated with the presence of ophthalmological manifestations., Results: 21 patients between 26 and 67 years were studied. Only 3 patients were not on antiretroviral therapy. 67% of the patients presented some type of ocular manifestation, 42% presented non-infection related manifestations, 47% related manifestations and 24% both. Conjunctival microangiopathy was the most frequent ocular manifestation (35.7%). There was a statistically significant correlation (r = 0.76, p = 0.0001) between eye manifestations related to infection and CD4+ lymphocyte count., Conclusions: Patients with HIV frequently present ocular manifestations, the majority related to infection; there is a correlation between the presence of these with the CD4+ count. However, a similar number of manifestations not related to infection occurred without correlation with the count; therefore, HIV patients should have periodic ophthalmological examinations, independently of CD4+ count., (© 2021 Instituto Mexicano del Seguro Social.)

Objective: The defined daily dose (DDD) is a measurement unit of drug consumption associated with the Anatomic Therapeutic Chemical (ATC) classification for its use in drug utilization studies. Due to the frequent marketing of pharmaceutical specialties with active ingredients combination, the results of the calculation of DDD product in combination with several active ingredients may vary depending on various possible calculation methods. The aim of this study was to compare different ways to calculate DDD of two groups of drugs that included monodrugs as well as combined products., Methods: From the prescription billing data during 2019 in Catalonia, the results obtained by three methods when calculating the DDDs of non-insulin hypoglycaemic drugs (nIHG) and drugs used in obstructive respiratory pathology (ORP) were compared. The three methods used were the reference calculation provided by the World Health Organization, the calculation of the considered main ingredient and the individualized calculation of all active ingredients of the combination. These methods were compared using the Wilcoxon test for paired data., Results: The results obtained showed high differences both in the total DDD and in the percentage of participation of each pharmacological subgroup within the studied groups. Differences of 17% were observed in nIHG, and of 118% in ORP drugs. The calculation system that takes into account all the active ingredients of the combinations gives a more approximate idea of the total drug consumption, as well as the relative weight of each subgroup., Conclusions: The calculation of all the active ingredients included in the specialties with drug combinations seems to be the one that can be most useful in pharmacoepidemiological management scenarios such as those in our environment.

Background and Objective: The demand of tissue for transplants requires a continuous effort in detecting potential donors and assessing the causes of death. We aimed to assess the capacity to optimise tissue donation rates with the implementation of an active detection system of hospital deaths alongside a comprehensive assessment of the causes of death according to current international and local tissue banks' standards., Material and Method: An early and pro-active detection programme of hospital deaths was implemented in 2002. The potential increase in donation was analysed according to modified criteria: age (80 to 85 years), acceptance of corneal phacoemulsification, autoimmune diseases, and sepsis reassessment. During the 2002-2011 decade, the criteria for absolute exclusion remained the same. The conversion rate from potential donors to actual donors of one or more tissue types was analysed., Results: A total of 16.531 cases of cardiac arrest were analysed, and 11.191 of the cases fulfilled criteria of absolute exclusion. The modification of criteria led to an increase of potential donors: 10.4% age factor, 4.5% autoimmune diseases/phacoemulsification factor, 11.8% sepsis factor (P<.00). The study indicated a total increase of 16% (P<.00). A total of 2.371 successful donations were generated. The efficiency to generate donors increased from 11 to 21% during the aforementioned decade (P<.00)., Conclusion: A pro-active detection system of hospital deaths combined with a continuous re-assessment of the acceptance criteria for each tissue type in the hospital setting leads to an increase in the potential donors' rate., (Copyright © 2012 Elsevier España, S.L. All rights reserved.)

Introduction: During the last years the number of patients on waiting list for kidney transplantation has been stable. Living donor kidney transplantation is nowadays a chance to increase the pool of donors. However, there are a group of patients with ABO incompatibility, making impossible the transplant until now. The aim of the present study is to describe the experience of Hospital Clinic Barcelona on ABO incompatible living transplantation., Methods: A retrospective- descriptive study was made based on 11 living donor kidney recipients with ABO incompatibility in Hospital Clinic of Barcelona from October'06 to January'09. Selective blood group, antibody removal with specific immunoadsortion, immunoglobulin and anti- CD 20 antibody were made until the immunoglobulin (IgG) and isoaglutinine (IgM) antibody titters were 1/8 or lower. Immunosuppressive protocol was adjusted to particular recipient characteristics. Isoaglutinine titters were set before, during and post desensitization treatment and two weeks after transplant. Immunological, medical and surgical evaluation was the standard in living donor kidney transplant program., Results: Medium age of donors and recipients were 47.8 +/- 12.4 and 44.4 +/- 14.1 years, respectively. 90% of donors were females and 73% of recipients males. Follow-up time was 10.2 +/- 10.2 months. Siblings and spouses were the most frequent relation (n=4, 36.4%, respectively). Chronic glomerulonephritis, adult polycystic kidney disease and Alport syndrome, the most frequent cause of end-stage renal disease. All the patients acquire appropriate isoaglutinine titters pre transplant (< 1/8), requiring 5.54 +/- 2.6 immunoadsorption sessions pretransplant and 2.82 posttransplant. One patient didn t need any immunoadsorption session (incompatibility blood group B) and another patient plasma exchange instead of immunoadsorption for being hypersensitized with positive flow cytometry crossmatch. Posttransplant isoaglutinine titters remained low. Two patients had cellular acute rejection episode (type IA and IB of Banff classification) with good response to corticosteroid treatment. Patient and graft survival were 91% at first year and remain stable during the follow-up. A graft lost by death of patient in relation to haemorrhagic shock developed within the first 72 hours after transplantation. Renal graft function at first year was excellent with serum creatinine of 1.3 +/- 0.8 mg/dl, creatinine clearance of 62.6 ml/min/1.73 m2 and proteinuria of 244.9 mg/U-24h., Conclusion: ABO incompatible living donor kidney transplantation represent an effective and safe alternative in certain patients on waiting list for renal transplant, obtaining excellent results in patient and graft survival, with good renal graft function.

Objective: To describe our first 2 years' experience following implementation of the BAHA program at our hospitals with special emphasis on the benefits and complications of use in each patient., Material and Method: Retrospective review since the beginning of the programme at two Teaching Hospitals in 2004. Twelve patients were implanted with BAHA, and their complications are described, along with hearing loss and their audiological gain with the hearing aid., Results: Eleven patients with BAHA completed the follow-up. The average age was 31.6 +/- 18.9 years, and their average conductive hearing loss of was 45.5 dB with an audiological gain of 33.6 dB. We had one patient with a minor complication (mild infection of the skin flap) and another with a major one (loss of the titanium implant)., Conclusions: The BAHA programme started in 2004 has generated good results in terms of positive audiological data, patient acceptance and low complication rates.

Current medical practice has made great progress over the past century which permits people to live longer and better than before. But this improvement has not been transferred to the field of death. To die with dignity today is a privilege only a few have. Those close to death claim their right to a death with dignity. Their petition usually goes unheard by the medical profession. The patients' autonomous law, which regulates last will and testaments or anticipated final wishes, is a step in this direction. The objective of this article is to publicize the current legal regulations related to last wills and testaments or last wishes by means of a critical review of the existing legislation.

Objectives: To determine the effects of a diet based on carbohydrates on the nutritional status of a pediatric population through a study performed in a rural area of the province of Los Ríos (Ecuador)., Patients and Methods: We evaluated 871 Ecuadorian children from a rural environment in an ambulatory medical clinic created for the purposes of the study. Basic anthropometric measurements (weigh, height, head circumference and upper arm circumference) and clinical data from physical examination were recorded. The anthropometric measurements were compared with the growth charts used in Spanish children, which were taken as the standard reference measurements. Information on nutrition was obtained from interviews with the mothers., Results: A total of 871 children were evaluated (53 % boys; 47 % girls). Mean age was 6.39 years (range: 0-14 years; mode 4). Comparison of the data obtained with the standard growth charts for the Spanish pediatric population revealed significant differences in body mass index in boys aged 5-14 years and in girls aged 3-12 years and highly significant differences in boys aged 6-13 years and in girls aged 3-12 years. Significant differences in middle upper arm circumference were found in boys and girls aged 1-14 years and highly significant differences were found in boys aged 1-12 years and in girls aged 2-12 years. A middle upper arm circumference of less than 14 cm (slight malnutrition) was found in 6.67 % of boys and in 9.15 % of girls; a middle upper arm circumference of less than 12.5 cm (serious malnutrition) was found in 1.82 % of boys and in 2.82 % of girls. Nutritional interviews revealed that the overall caloric intake was approximately 1,500 cal/ day. Eight percent of calories came from carbohydrates, 15 % from fats and 5 % from proteins., Conclusions: A poor diet affects the child population's nutritional status qualitatively but not quantitatively. Nutritional deficit favors the prevalence of childhood diseases that could be avoided by suitable feeding and hygiene. Because of the lack of economic and health resources, prevention is the fundamental weapon for maintaining health in underdeveloped countries. Childhood nutritional status is influenced by diet, which in turn is influenced by physical, climatic, cultural and political factors, and by stress, which is provoked by infections and parents' behavior. Nutritional status in children is a clear reflection of the socioeconomic status of a given population.