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Introduction: One of the consequences of prolonged use of bright screens such as those of the computer or cell phone, is the computer visual syndrome where characteristic symptoms are presented that normally disappear after a couple of hours when you stop using electronic devices. The prevalence is high due to multiple risk factors., Objective: To determine the prevalence of computer vision syndrome in medical students at the University of Boyacá in times of pandemic., Methodology: Descriptive and cross-sectional observational study. The study population were medical students, the data were collected in September and October of the year, an electronic survey was carried out for data collection., Results: A total of 300 participants were invited to participate in the study. 78% (234) of participating students suffer from SVI. 67.09% (157) of the participants who reported suffering from SVI were female and 32.91% (77) were male., Conclusions: Computer visual syndrome is very common among medical students at the University of Boyacá. This study has shown that the presence of SVI has been significantly associated with exposure factors that were triggered during the pandemic period, where frequent virtual classes and long hours led to high exposure to screens. In addition, in the era of virtuality, communication through social networks increased the use of cell phones, which increases the possibility of the appearance of this syndrome., (Copyright © 2022 Sociedad Española de Oftalmología. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction: Zenker's diverticulum is an uncommon pathology of the upper oesophageal sphincter whose most frequent symptoms are the association of dysphagia and regurgitation. It is more frequent in advanced ages, and its treatment of choice is surgery in symptomatic cases., Method: A retrospective descriptive study was performed of 27 patients operated in the Otorhinolaryngology service of the Hospital Universitario de Cabueñes between 2007 and 2019 using laser endoscopic surgery., Results: 27 patients were operated, 70.4% male and 29.6% female, with a mean age of 67 years (range between 30 and 91). The most frequent symptom at diagnosis was dysphagia. No intraoperative complications were observed. One patient (3.7%) presented post-surgical fever, and another patient (3.7%) had a serious complication due to oesophageal perforation secondary to postsurgical emesis. The median hospital stay was 5 days, and the median oral intake was 4 days. Recurrence was observed in 6 patients (22.2%), 4 (14.8%) requiring a second intervention, which was performed using the same technique., Discussion and Conclusions: The surgical treatment of Zenker's diverticulum has advanced in recent decades, with endoscopic treatment currently being the choice. Among the surgical options, endoscopic CO2 laser surgery is an effective and safe alternative, although possible complications must be considered. It is also an effective alternative for the treatment of recurrences., (Copyright © 2020 Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. Published by Elsevier España, S.L.U. All rights reserved.)

Objective: To establish recommendations related to negative pressure therapy  with instillation according to effectiveness, safety, efficiency, consensus guidelines and stability data of instillation solutions., Method: A literature search was conducted to compare the available evidence  regarding effectiveness, safety and efficiency of negative pressure therapy with  instillation, as well as the existence of consensus guidelines for use. The articles  were classified according to the "Scale of evidence classification for therapeutic  studies" of the American Society of Plastic and Reconstructive Surgery., Results: A total of 13 studies were included, of which five were comparative cohort studies (level II and III of evidence), and the rest  corresponded to case series (level IV of evidence). Two consensus guidelines  were selected with recommendations regarding the type of wound, instillation solution, solution retention time, vacuum pressure and appropriate  vacuum time. According to literature and available evidence, recommendations were proposed and established on negative pressure therapy  with instillation in our hospital, including stability data of the proposed solutions., Conclusions: This paper provides preliminary guidelines on the application of  negative pressure therapy with instillation until new evidence supports or  modifies these recommendations., (Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.)

Objective: The intravesical administration of hazardous drug products is a  standard practice in the urology setting, which potentially exposing medical  personnel to these drug products. It was deemed necessary to have a consensus document among the scientific societies involved (the Spanish Urological  Association and the Spanish Society of Hospital Pharmacy) that collects the best  available evidence on the safest handling possible of dangerous drug products in the setting of urology departments., Method: We reviewed the legislation and recommendations on the handling of  dangerous drug products, both at the national and international level., Results: There is national legislation and regulations for protecting workers who  handle dangerous drugs and products, as well as  recommendations for handling to protect both the product and workers., Discussion: Following the strategic lines of the European Parliament for 2014- 2020 in the chapter on occupational safety and health, the Spanish Urological  Association and the Spanish Society of Hospital Pharmacy proposed a series of  actions that decrease the risks of exposure for practitioners and caregivers  involved in the handling of these products., Conclusions: After this review, 19 recommendations were established for  handling dangerous drug products, which can be summarised as the need to  train all individuals involved (from management teams to patients and  caregivers), adopt systems that prevent contaminating leaks, implement  exposure surveillance programmes and optimise available resources., (Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.)

Background: The intravesical administration of hazardous drug products is a standard practice in the urology setting, which potentially exposing medical personnel to these drug products. It was deemed necessary to have a consensus document among the scientific societies involved (the Spanish Urological Association and the Spanish Society of Hospital Pharmacy) that collects the best available evidence on the safest handling possible of dangerous drug products in the setting of urology departments., Methods: We reviewed the legislation and recommendations on the handling of dangerous drug products, both at the national and international level., Results: There is national legislation and regulations for protecting workers who handle dangerous drugs and products, as well as recommendations for handling to protect both the product and workers., Discussion: Following the strategic lines of the European Parliament for 2014-2020 in the chapter on occupational safety and health, the Spanish Urological Association and the Spanish Society of Hospital Pharmacy proposed a series of actions that decrease the risks of exposure for practitioners and caregivers involved in the handling of these products., Conclusions: After this review, 19 recommendations were established for handling dangerous drug products, which can be summarised as the need to train all individuals involved (from management teams to patients and caregivers), adopt systems that prevent contaminating leaks, implement exposure surveillance programmes and optimise available resources., (Copyright © 2018 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: To develop a safety working procedure for the employees in the Intermutual Hospital de Levante (HIL) in those areas of activity that deal with the handling of hazardous drugs (MP)., Methods: The procedure was developed in six phases: 1) hazard definition; 2) definition and identification of processes and development of general correct work practices about hazardous drugs' selection and special handling; 3) detection, selection and set of specific recommendations to handle with hazardous drugs during the processes of preparation and administration included in the hospital GFT; 4) categorization of risk during the preparation/administration and development of an identification system; 5) information and training of professionals; 6) implementation of the identification measures and prevention guidelines., Results: Six processes were detected handling HD. During those processes, thirty HD were identified included in the hospital GFT and a safer alternative was found for 6 of them. The HD were classified into 4 risk categories based on those measures to be taken during the preparation and administration of each of them., Conclusions: The development and implementation of specific safety-work processes dealing with medication handling, allows hospital managers to accomplish effectively with their legal obligations about the area of prevention and provides healthcare professional staff with the adequate techniques and safety equipment to avoid possible dangers and risks of some drugs., (Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.)

Unlabelled: Propose: To describe PRP extraction devices, through a review of kits available in Spain, taking into account AEMPS and SEFH working groups (GPS, Farmacotecnia, Hemoderivados groups) contributions., Methods: Three independent searches about PRP extraction devices were carried out. Device suppliers were contacted and an individually meeting was called with each one. Characteristics of each device was reviewed by virtual demonstration. A kits comparison chart was made with all the information acquired. Kits were classified as Closed-Technique and Opened- Technique in accordance with the AEMPS technical committee report., Results: Ten devices were found: ACP®; Angel®, Cascade®, Endoret ®, GPS®, Magellan®, Minos®, Ortho-pras®, Smart-prepr® and Tricell®. However, we could found out the mechanism in detail of seven of them. Information about Cascade®, Magellan ® and Smart-prepr® kits was not enough., Conclusion: The review provided the main PRP extraction devices available with CE marking and its distinguishing characteristics, however, it is crucial to pay attention to PRP extraction procedure and administration, to guarantee the final product quality. Pharmacy Department must get involved in the device selections due to the close link with the manufactured drug quality. Working together with the AEMPS will contribute to defining extraction procedure specifically., (Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.)

Objective: To describe the features of computer program to support the activity of the responsible for surveillance of medical devices. To evaluate their use after one year of implementation in a hospital., Method: The stages of the process were: description of the activities of medical devices surveillance and implant registration, definition of functionality and data processing, creation of databases, implementation in a private hospital which manages PS, validation of the program and analysis of their usefulness., Results: SIVIPS was developed using Acces. Main variables were described for all the activities of the responsible for medical device surveillance (implants, alert, medical device incidents, including for in vitro diagnostics) and all the functionalities of the computer program. SIVIPS was introduced in a pharmacy service with one pharmacist for the management of medical devices. One year after its implementation we had registered 564 implants with a description by type of implant, 31 alerts and 6 incidents. SIVIPS allow monitoring of the actions taken in these cases., Conclusions: SIVIPS is the first tool to support the activity of medical device surveillance. It is an easy tool that allows the registration of alerts and medical device related incidents, and registration of implants performed in the center, which will improve the traceability of the PS., (Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.)

Introduction: Platelet-Rich Plasma (PRP) is autologous plasma with higher concentration of platelet than basal level, because of an extracting and concentration process. PRP therapeutical use, as osteinductor role, is a controversial issue, due to there are no clinical studies with rigorous design and no firm conclusions can be drawn regarding its uses. Propose: To provide information about methods to obtain PRP, legal considerations about its extraction and use, molecular mechanism of action, as well as available evidence about security and tolerance., Results: PRP can be obtained by manual procedures (opened technique) or disposable kits (closed technique), the latter being medical devices classified as type IIa. AEMPS considers PRP as a drug, establishing some minimum requirements to guarantee safety, traceability, pharmacovigilance and information. PRP provides ideal qualities to play a powerful osteoinductor role to speed up fracture healing or to produce an efficiently and quickly osseointegration of different bone implants, due to the high growth factors content. Infiltration tolerance is generally good, however, it has to be taken into account its great angiogenical potential., Conclusions: In view of its production and application characteristics, PRP is considered as a drug on restricted medical prescription by the AEMPS, so pharmacy department must, at least, supervise its management and handling., (Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.)

Objective: To develop recommendations for the preparation of parenteral drugs (MAP), to assess the transferability of their preparation, from nursing units in the hospital ward to the pharmacy service (SF)., Method: A table of stabilities of parenteral drugs included in the pharmacotherapeutic guideline was developed using the american and spanish guidelines. Information about MAP was collected (method of preparation, support, maintenance, validity, administration specifications and packaging) by consulting product technical sheets, pharmaceutical industries, literature review and databases., Results: After reviewing 209 drugs, a list of recommendations was developed. According to the data, MAP will be prepared as follows: 89 drugs will be prepared from SF, 62 drugs at nursing units because of its immediate administration requirement and 58 are already packed for its administration by the industry. Of these 62 drugs prepared a nursing units, 14 of them will be prepared in the following doses by the SF. Therefore, 48 drugs will be prepared at nursing units from the 209 parenteral drugs reviewed., Conclusions: A standardized method of preparation, storage, administration and validity of MAP was established by the SF. The preparation of MAP in the SF extends its shelf life, by considering physicochemical stability, level of risk and product vulnerability to microbiological contamination. The information provided will contribute to a reduction of errors associated with the preparation and administration of MAP., (Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.)

Objective: The aim of this work is to establish the standard procedure for use and preservation of drugs, dietary products and cosmetic products in multi-dose containers., Method: a summary table containing all the drugs, dietary and cosmetic products included in the hospital vademecum available in multi-dose containers was elaborated and information on preservation and good-for-use periods was gathered from the products technical sheets, consultation to the pharmaceuticals companies, and lite rature search., Results: 205 pharmaceutical specialties and magisterial formulations elaborated at the hospital were reviewed. A standardized working procedure was created with general instructions and a table of recommendations in case of missing information., Conclusions: with the present study, the information on the good-for-use period and preservation of multi-dose containers after being opened is improved. This information should always be kept available and updated., (Copyright © 2013 SEFH. Published by AULA MEDICA. All rights reserved.)

Objective: The time at which lung transplantation is indicated is determined by clinical and functional criteria that vary according to the particular disease. The aim of our study was to present the criteria according to which patients were placed on waiting lists for lung transplantation in our hospital., Patients and Methods: We analyzed retrospectively the clinical characteristics, lung function, heart function, and 6-minute walk test results of patients who had received a lung transplant in our hospital from January 2002 through September 2005., Results: During the study period 100 lung transplants were performed. The mean age of the patients was 45 years (range, 15-67 years) and 57% were men. The diseases that most often led to a lung transplant were chronic obstructive pulmonary disease (COPD) (35%), pulmonary fibrosis (29%), and bronchiectasis (21%). Lung function values differed by disease: mean (SD) forced expiratory volume in 1 second (FEV1) was 20% (11%) and forced vital capacity (FVC) was 37% (15%) in patients with COPD; FEV1 was 41% (15%) and FVC, 40% (17%) in patients with pulmonary fibrosis; and FEV1 was 23% (7%) and FVC, 37% (10%) in patients with bronchiectasis., Conclusions: The patients who received lung transplants in our hospital were in advanced phases of their disease and met the inclusion criteria accepted by the various medical associations when they were placed on the waiting list.

Objective: Lung transplantation is a valid therapeutic approach for patients with bronchiectasis. The objective of the present study was to evaluate our experience with bronchiectasis patients and compare the results in patients with cystic fibrosis to results in those with bronchiectasis caused by other processes., Patients and Method: We carried out a retrospective study of bronchiectasis patients treated by lung transplantation in order to analyze demographic, functional and microbiological characteristics before and after transplantation, and survival., Results: From 1991 to 2002 lung transplants were performed on 171 patients, 44 of whom had suppurative lung disease (27 had cystic fibrosis and 17 had bronchiectasis caused by other processes). There were no significant differences in the demographic variables between the 2 groups. At transplantation, lung function variables showed severe bronchial obstruction (mean [SD] forced expiratory volume in 1 second of 808 [342] mL and forced vital capacity of 1,390 [611] mL) and respiratory insufficiency (PaO2 at 52 [10] mm Hg and PaCO2 at 48 [9] mm Hg). Only PaO2 was significantly lower in patients with bronchiectasis from causes other than cystic fibrosis. Airway colonization was present in 91% of the patients; Pseudomonas spp germs were detected in 64% of the cases and were multiresistant in 9%. In the early postoperative period germs were isolated in 59% of the cases, half of which involved the same germ as had been isolated before transplantation. One year after lung transplantation, 34% of the patients continued to have bronchial colonization. Survival at 1 year was 79% and at 5 years, 49%, with no significant difference between the patients with cystic fibrosis and those with other suppurative diseases, nor between the patients with and without Pseudomonas colonization. Only 2 patients had died of bacterial pneumonia at 1 month after transplantation., Conclusions: Although airway colonization in patients with suppurative diseases complicates postoperative management, the results in terms of survival are good.

Background: Fungal infections are a frequent cause of morbidity an mortality in transplant recipients. Aspergillus spp. is an ubiquitous fungus capable of producing diverse clinical entities with varying severity., Objective: To study the incidence and severity of Aspergillus spp. infections in lung transplantation, analysing the different clinical presentations and response to antifungal drugs., Methods: A review was made of the clinical histories of all patients undergoing lung transplantation who developed positive Aspergillus spp. cultures in our centre between June 1991 and December 1996., Results: Eleven of 49 transplanted patients (22%) developed Aspergillus spp. infections. Four patients presented invasive aspergillosis forms and 7 tracheobronchitis. In spite of antifungal treatment 3 patients (30%) died of invasive aspergillosis as a direct consequence of the infection. Of the 7 patients with tracheobronchitis, 2 were ulcerative and 1 pseudomembranous, all responded to antifungal treatment. Three patients (10.3%) developed Aspergillus spp. infections despite prophylaxis with itraconazole., Conclusion: Invasive aspergillosis in the immediate posttransplant period was mortal despite treatment. As opposed, aspergillar tracheobronchitis have been overcome using combined treatments of liposomal or lipidic amphotericin, itraconazole and nebulised amphotericin.

Recent studies suggested herpes simplex virus type 1 as a major etiologic factor in Bell's palsy. To analyze different aspects of facial nene infections, Swiss mice were inoculated with HSV-l in tongue (41 animals) and auricle (44). Nineteen mice developed unequivocal signs of nevous infection, but only in 1 mouse was evident a facial palsy. Mice were sacrificed at different intervals from inoculation, and facial nerves, Gasser ganglia and brain stem were obtained to test the presence of HSV-1 by nested PCR and viral culture. Virus was detected in the 3 types of samples, but identification was more frequent in animals injected in tongue and sacrificed during the acute infection. Nested PCR was far more sensitive than culture, particularly during viral latency. According with our results, HSV-1 could origin facial palsy, but is possible that lesions are immunomediated and localized at brain stem.

Objective: To determine the outcome of lung transplantation in patients with chronic obstructive pulmonary disease (COPD) in Spain., Methods: In all COPD patients transplanted at four Spanish hospitals over a period of seven years, we studied actuarial survival rates retrospectively using the Kaplan Meier test in relation to demographic characteristics, type of transplant, underlying disease, lung function evolution in terms of forced vital capacity (FVC), maximum expiratory flow in 1 second (FEV1) and gasometric evolution (PaO2 and PaCO2)., Results: Seventy-four transplants were performed in COPD patients over a five-year period. Mean age was 47 +/- 7 years (26-61) and 77% of the patients were men. A diagnosis of emphysema was made in 58%, alpha-1 antitrypsin deficiency emphysema in 14% and chronic bronchitis in 28%. The likelihood of survival was 75% for the first year, 63% for two years and 41% for the third year. Lung function and blood gases improved significantly by the third month after transplantation: FVC was 1677 +/- 637 ml before transplantation and 2631 +/- 670 ml afterwards; FEV1 was 585 +/- 189 ml before transplantation and 2118 +/- 673 ml afterwards (p < 0.001). Double lung transplants achieved significantly greater improvement in function variables than did single-lung transplants (FVC 2843 +/- 681 ml and FEV1 2543 +/- 620 ml by the third month in DLT patients versus FVC 2402 +/- 587 ml and FEV1 1659 +/- 350 ml for SLT), with no significant differences in blood gases after the two types of transplant. Half the sing-lung transplant patients developed hyperinflation of the native lung and reached maximum lung function values, which tended to be lower than those for patients who did not experience this complication (FEV1 1638 +/- 349 ml versus 1930 +/- 307 ml, p = 0.051)., Conclusions: First-year mortality in patients with COPD undergoing lung transplantation in Spain is similar to that described in the International Transplant Registry. We found no differences between double- and single-lung transplant patients. Functional change is good for both types of transplantation, although this aspect of outcome is significantly better when two lungs are transplanted.

Thyroid carcinomas usually have a good prognosis, particularly well-differentiated tumors confined to the gland. An analysis was made of the treatment and prognosis of thyroid neoplasms with invasion of the upper respiratory and digestive tract. Of 211 patients treated at our institution from 1975 to 1994, only 18 had invasion of the upper respiratory and digestive system. All patients were treated surgically. The procedures included total thyroidectomy, laryngectomy, partial esophagectomy, and tracheal resection. The neoplasm recurred locally after complete resection in 33%. Cervical lymph node metastases occurred in 17% and distant metastases in 33%. The 5-year survival rate was 46% for well-differentiated carcinomas. Invasion of the respiratory and digestive tract had negative prognostic significance in the statistical analysis. Locally advanced thyroid neoplasms had a poorer prognosis than those limited to the thyroid gland. However, complete surgical resection of the malignancy was achieved in most patients without functionally mutilating procedures and with satisfactory survival results.

The objective of this study was to analyze patient survival after lung transplants performed at the Puerta de Hierro clinic in Madrid (Spain) between 1991 and 1996. Survival probability was 65% after one year and 50% after three years. We found no significant differences in survival related to sex or type of transplant. Early survival tended to be higher for the last two years analyzed (71%) than for the first two (55%) (p < 0.00001). The rate was 100% for patients with cystic fibrosis and 0% for pulmonary hypertension and lymphangiomyomatosis. Short- and medium-term lung function results were good in surviving patients who did not develop obliterating bronchiolitis. We conclude that actuarial survival after lung transplant in our program is comparable to that reported in the literature. There are no significant differences related to sex, type of transplant or period. Survival varies greatly, however, depending on disease.

Squamous-cell carcinoma of the nasal septum occurs infrequently and only a few cases have been reported. Because of the small number of cases, comparisons between treatment groups have been inadequate. Five patients with this type of tumor are presented. All of them underwent surgery (4 as primary treatment and 1 for recurrence after radiation therapy). One patient had a local recurrence, 2 had cervical metastases, and 2 (40%) died as a consequence of the tumor. In the squamous cell carcinoma of the nasal septum our study supports surgical resection with wide margins combined with postoperative irradiation as the preferred treatment with prophylactic neck dissection for tumors over 2 cm or extended to adjacent areas.

Herpes simplex type 1 (HSV-1) has been implicated as a cause of facial paralysis. We developed an experimental model in rabbits in which we injected HSV-1 into the tongue. The animals were killed after one and three weeks. The geniculate and trigeminal ganglia and medulla were extracted and the samples were processed. The polymerase chain reaction (PCR), nested-PCR and cultures were carried out in order to detect the viral genome in the samples. The viral genome was found in all but two rabbits. None of the animals developed clinical facial palsy. We conclude that nested PCR is more sensitive for the identification of HSV-1 in samples.

Lung transplantation has become the therapeutic hope of terminal respiratory patients. Infections are among the main causes of morbidity and mortality in these patients. We therefore analyze infections suffered after lung transplants performed at Clínica Puerta de Hierro over a two-year period. The cases of 14 transplanted patients, 6 bilateral and 8 unilateral, were analyzed. Pre-transplant data available for all included analysis of serum antibodies to several viruses, as well as bacterial and fungal cultures, and Ziehl's sputum test. All received prophylactic antibiotic, antifungal and antiviral treatment according to protocol. The bronchial aspirate of the donor, and recipient specimens of bronchial aspirate, bronchoalveolar lavage and biopsies obtained by bronchoscopy after transplantation were cultured. Bronchoscopies were performed according to protocol, based on clinical picture. Other cultures were obtained as needed. We recorded 27 respiratory infections, among which 4 were pneumonia transmitted by the donor, 3 were tuberculosis, 3 were Aspergillus infections, 5 were cytomegalovirus pneumonitis and one, P. carinii pneumonia. Lung infections have a strong impact on outcome of lung transplant patients. Knowledge of the chronological development of infections made appropriate prophylaxis and early detection possible, such that survival during the first two years after transplantation was approximately 70% in our hospital.

The clinical features, radiological and therapeutic response of 46 cases of abdominal tuberculosis (AT) seen at a university hospital are presented. Diagnosis was anatomopathologic in 39 cases (85%) and clinical with response to tuberculostatic in 7 cases (15%). Most of the patients did not have history nor exposition to tuberculosis. Both sexes were similar affected, mean age 43 years old, between 11 and 79. Clinical manifestations were no specific, the most frequent fever (65%), abdominal pain (63%) and constitutional syndrome with asthenia, anorexia and weight loss (63%). Thorax radiograph was normal in 50% and PPD negative in 42%, so in 10% of patients both tests were negative. More than half of the patients had other disease. 82% of patients were cured with tuberculostatic. 18% of patients died. AT seen now is different from classic descriptions. Is not a complication of pulmonary tuberculosis (PT) as it was to be in the past. Thinking in AT only in patients with PT make most patients lead without diagnosis.

Due to the controversy on the need of performing temporal artery biopsies for the diagnosis of giant cell arteritis (GCA), we have reviewed 204 biopsies of temporal arteries as well as the clinical histories of the 190 patients. Patients without local manifestations were excluded from this study. From the 173 remaining patients, 54 presented a diagnostic biopsy of GCA. The 119 patients with a negative biopsy were divided into different groups according to the final diagnosis. From our data we could not find a clinical pattern which could permit the prediction of biopsy positiveness. We could not find either any clinical entity in the nondiagnostic group which would permit to exclude a diagnosis before performing the biopsy. We consider that the biopsy of the temporal artery can not be avoided nowadays and that it represents the only decisive diagnostic method of GCA.