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To investigate the effect of an Enhanced Recovery After Surgery (ERAS) program on complications and length of stay (LOS) after radical cystectomy (RC) and to assess if the number and type of components of ERAS play a key role on the decrease of surgical morbidity. We analyzed the data of 277 patients prospectively recruited in 11 hospitals undergoing RC initially managed according to local practice (Group I) and later within an ERAS program (Group II). Two main outcomes were defined: 90-day complications rate and LOS. As secondary variables we studied 90-day mortality, 30-day readmission and transfusion rate. Patients in Group II had a higher use of ERAS measures (98.6%) than those in Group I (78.2%) (p

Background Although mortality has decreased in recent decades and patient survival rates have increased, cardiovascular disease remains one of the leading causes of mortality and morbidity in developed countries these days. The purpose of this study is to analyze the available literature that describes the economic burden of coronary artery disease and to compare costs. The study is framed in the Horizon 2020 project “A patient-centered early risk prediction, prevention, and intervention platform to support the continuum of care in coronary artery disease (CAD) using eHealth and artificial intelligence - TIMELY”. Methods A systematic literature review has been carried out using various databases such as PubMed, Web of Science, Cochrane Library and Scopus. Precisely, a 5-year retrospective horizon has been considered until the present (April 2021). In all databases, terms related to “Coronary artery disease” and “Cost*” were combined. Results 113 publications were primary located. After examining the titles based on the eligibility criteria, 16 articles were selected. Of these, 5 articles were excluded because they did not meet the inclusion criteria. Therefore, a final set of 11 selected studies were considered in this review. The costs included in the review correspond, mainly, to direct healthcare costs. Our results affirm that the highest costs are derived from the possible adverse effects (€41,450, approx.). Conclusions The figures presented in this literature review will provide a good framework to quantify these costs for both economic experts and researchers and political decision-makers, both nationally and internationally. Key messages The costs included in the review correspond, mainly, to direct healthcare costs. The highest costs are derived from the possible adverse effects.

Background Infectious diseases are one of the most frequent reasons for consultation in the Emergency Department (ED), as well as one of the main causes of mortality and admission in the hospital. According to recent studies, antimicrobials are the second most common type of medication prescribed in the ED, so it is important to optimise their use. Purpose To describe and to analyse the prescription of antimicrobials prescribed empirically in the ED of a third-level hospital and to analyse if microbiological samples are collected in order to establish a targeted treatment. Material and methods Cross-sectional study of all antimicrobial prescriptions of patients waiting in the ED for admission to hospital from February 2018 to March 2018.The following variables were collected: age, sex, type of infection and microbiological samples (yes/no). It was analysed if the patient after admission maintained the same empirical antimicrobial treatment and if it was correct according to the microbial sensibility data from the sample studied. Data were collected from electronic health records and electronic prescription systems. Results Ninety-three patients were included, 68 male and 25 female (mean 70 years, SD 13.5 years). The main clinical infections treated were: non-pneumonic lower respiratory tract (41%), urinary tract (18%) intrabdominal (12%), pneumonia (7.5%), chronic obstructive pulmonary disease exacerbation (7.5%) and other type of infections (14%). After admission, 34% of the patients maintained empirical antimicrobial treatment, 51% treatments were changed to another antimicrobial agent and 15% of patients were discharged from the hospital. Microbiological samples were collected before treatment in 48% of patients. According to the laboratory sample results, the empirical antimicrobial was correct in 63% of patients. Conclusion Less than 50% of patient samples were collected before treatment and more than 35% of the empirically prescribed treatments were inadequate according to the laboratory sample results. In order to prescribe suitable antimicrobial treatments, it is important to take microbiological samples in advance to establish a targeted treatment that could be optimised by developing a multidisciplinary group (program for optimising the use of antimicrobials (PROA)) in the ED. References and/or acknowledgements No conflict of interest.

Background Daratumumab is a human monoclonal antibody that binds to CD38 protein, expressed in a high level in the tumour cells of multiple myeloma (MM), inhibiting their proliferation. It has been authorised in combination with bortezomib, melphalan and prednisone for newly diagnosed MM not candidates for an autologous haematopoietic stem cell transplant or in combination with lenalidomide and dexamethasone, or bortezomib and dexamethasone, for patients who have received at least one previous treatment and in monotherapy for adult patients with MM relapsed and refractory to treatment, who have previously received a proteasome inhibitor and an immunomodulatory. Purpose Assessment of prescription profile of Daratumumab for the treatment of MM in a third-level hospital and the effectiveness of different regimens in terms of progression-free survival (PFS). Material and methods Retrospective review of patients with MM who received treatment with Daratumumab from February 2017 to October 2018. Data were collected from the electronic prescribing system for Oncology Haematology patients, and electronic medical records. Results Ten patients received treatment with Daratumumab (60% males, 40% females, median age 68 years). DLd (daratumumab 16 mg/kg, lenalidomide 10 mg or 25 mg, dexamethasone 40 mg) every 28 days was prescribed for five patients (50%), one as first-line, one as second-line and three as third-line treatment. Median PFS was 10 months for the group of patients treated. Daratumumab 16 mg/kg monotherapy weekly every 28 days was prescribed for two patients (20%) both as third-line treatment and who died after 1 month of treatment. DABODEX regimen (Daratumumab 16 mg/kg, bortezomib 1.3 mg/m2, dexamethasone 20 mg) every 28 days was prescribed for three patients (30%), one as first-line treatment, one as second-line and one as third-line. Median PFS was 6 months in this group. Conclusion Prescription profile of Daratumumab for the treatment of MM in our series of patients is variable, with different scenarios of treatment and different results in terms of PFS. It is mandatory to update protocols in the use of daratumumab in our hospital to measure its use among different drug options, most importantly with promising therapeutic advances recently authorised for MM treatment. References and/or acknowledgements https://www.ema.europa.eu/documents/product-information/darzalex-epar-product-information_es.pdf No conflict of interest.

Enantioselective intramolecular Heck–Heck cascade reactions have emerged as an excellent tool for the construction of polycyclic frameworks, such as lycorane alkaloids, xestoquinone and analogues. However, it is particularly difficult to rationalize the effect of simultaneous changes in both the structure of many molecular entities and experimental conditions (temperature, time, solvent, ligand, catalyst loading, etc.) on reactivity and enantioselectivity. In this work, a computational model to predict the enantiomeric excess and the yield of Heck–Heck cascade reactions has been developed. The model combines Perturbation Theory (PT) and Quantitative Structure-Reactivity Relationships (QSRR) ideas for the prediction of two different outputs with the same equation (% ee and % yield). This model predicted 520 experimental outcomes with a correlation coefficient of R = 0.89, standard error of estimates of SEE = 1.19%, and a cross-validation correlation coefficient of q2 = 0.79. The use of the model has been illustrated with a case study, the Heck–Heck cascade reaction of a 2,3-dialkenyl pyrrole using Pd(dba)2 and (R)-BINAP. For the first time, a 2000-points simulation in ternary phase diagrams shows the effect of the concentration of the catalyst, the base, and ligand on the enantioselectivity of this reaction. The QSRR model also predicts trends in structural outcomes, such as halides vs. triflates, or the ligand structure. Therefore, the model opens the door to the design of new chiral ligands and helps to find trends to improve the experimental results in enantioselective polyene cyclisations.

Background One of the main objectives in the adequacy of HIV antiretroviral treatment is to find the drug or set of drugs that allow the best results to be obtained for the patient and to try to support this medication over time. Since the introduction of antiretroviral monotherapy in HIV there have been many studies examining the efficacy and safety of treatment, but to date, few have studied duration of monotherapy. Purpose To analyse survival after monotherapy (MT) in HIV patients and to perform a descriptive analysis for subgroups of factors associated with MT. Material and methods An observational, retrospective, analytical study was conducted in HIV patients treated with MT during 2014. Selection of patients and analysis of their antiretroviral medication were reviewed with the platform Farmatools (MT type and possible change). Clinical and demographic data (age, sex, coinfection with HCV and HBV) were obtained from the electronic health record through Mambrino XXI. We performed an analysis of survival and defined the event as ‘changing MT to double therapy (DT) or triple therapy (TT)’. We obtained data by subgroup mortality tables through the SPPS V.21 statistical programme. Results 79 patients (70.9% men) were included, mean age 51 years (44–70). With respect to antiretroviral MT: 84.4% of patients (n=67) were taking darunavir/ritonavir (DRV/r) and 15.2% (n=12) were taking liponavir/ritonavir (LPN/r). No patient was coinfected with HBV but 30 patients were HCV coinfected. Statistical analysis showed that the median survival time was: 54 months in men and 48 months in women (p=0.750). 47.27 months in HCV coinfected patients and 54 months in non-coinfected patients (p=0.315). 54 months in patients who were treated with DRV/r and 51 months with LPN/r (p=0.071). In 19 patients (24.1%) the following event occurred: 16.45% (n=13) changed to TT and 7.59% (n=6) to DT. 76% of patients who were maintained on MT (n=60) switched to DRV/cobicistat. Conclusion Median survival after MT was reasonably positive, with a tendency for better results in men not coinfected with HCV and in patients with DRV/r, although these result were not statistically significant. Further studies are required to justify the reason for change from MT to BT or TT and the benefit of a regimen against another to generalise the results. References and/or acknowledgements Special thanks to Dr Martinez Sesmero. No conflict of interest

Resumen Objetivo Determinar si existen diferencias en cuanto a seguridad oncologica tras prostatectomia radical (factores anatomonopatologicos y recidiva bioquimica) en funcion de los criterios de inclusion empleados en 2 protocolos de vigilancia activa (VA). Material y metodos Cuatrocientos cuarenta y dos pacientes con cancer de prostata (CP) localizado sometidos a prostatectomia radical laparoscopica en nuestro centro entre agosto de 2003 y diciembre de 2009. Seleccionamos pacientes con CP de bajo riesgo, potenciales candidatos a un programa de vigilancia activa. Se dividieron los pacientes en 2 grupos; grupo i : cumplian los criterios mas estrictos descritos por Epstein (dPSA ii : cumplian criterios mas laxos descritos por Klotz (PSA ≤ 10 o Resultados De los 442 pacientes un 48%(213 pacientes) habrian sido potenciales candidatos a un programa de VA. Del total de pacientes operados el 17% (76 pacientes) cumplian criterios segun Epstein y un 48%(213 pacientes) segun Klotz. Comparando los pacientes de ambos grupos no existieron diferencias estadisticamente significativas en la presencia de pT3 (7,9 vs 10,8%) p = 0,55, margenes positivos (22,4 vs 28,3%) p = 0,41, ni recidiva bioquimica a 3 anos (5,3 vs 5,6%) p = 0,86. Conclusiones En nuestra serie, en pacientes teoricamente candidatos a inclusion en un programa de vigilancia activa, no encontramos diferencias en cuanto a porcentaje de pacientes con estadio patologico pT3, margenes positivos ni recidiva bioquimica en funcion de los criterios clinicos de inclusion empleados.

Objective To determine whether there are differences in the oncological outcomes after radical prostatectomy (adverse patology and biochemical recurrence) based on clinical selection criteria used in two active surveillance (AS) protocols. Materials and methods 442 patients diagnosed with localized prostate cancer (CP) underwent radical prostatectomy at our institution between August 2003 and December 2009. We selected patients with low-risk CP, which could have been included in an AS program. Patients were divided into two groups: group i, those who met the most strict surveillance criteria described by Epstein (PSAD

Resumen Objetivos Evaluar la aceptacion del seguimiento activo por los pacientes en nuestro entorno asistencial y describir los resultados clinicos de un programa de vigilancia activa en pacientes con cancer de prostata de bajo riesgo. Material y metodos Estudio prospectivo de pacientes incluidos en programa de vigilancia activa en nuestro centro entre 2004 y 2012. Los criterios de inclusion fueron: PSA Resultados En el ano 2011, del total de pacientes potenciales candidatos, tan solo un 17% de los mismos rechazo la inclusion en un programa de vigilancia y fue tratado de forma activa. Analizamos una serie de 144 pacientes incluidos en nuestro protocolo de vigilancia activa. La media de seguimiento fue de 3,22 anos (DE: 2,08). Ciento diez pacientes (76,3%) permanecen en seguimiento activo, con una mediana estimada de supervivencia libre de tratamiento tras el diagnostico de 6,9 anos (IC 95%: 6,2-7,6%). El porcentaje de pacientes que permanecen libres de tratamiento a 2 y 5 anos fue de 96,3% (IC 95%: 92,8-99,8%) y 70,9% (IC 95%: 59,3-85,5%) respectivamente. Treinta y cuatro pacientes (23,6%) precisaron tratamiento curativo. La media de tiempo hasta el tratamiento fue de 4,6 anos (DE: 2,3). Conclusiones La vigilancia activa en pacientes altamente seleccionados con cancer de prostata de bajo riesgo es una alternativa terapeutica valida de tratamiento y aceptada por los pacientes de nuestro entorno.

Objectives To evaluate the acceptance of active monitoring by patients treated in our healthcare community and to report the clinical results of an active surveillance program in patients with low-risk prostate cancer. Materials and methods Prospective study of patients enrolled in an active surveillance program at our center between 2004 and 2012. The inclusion criteria were PSA Results In 2011, only 17% of the total number of potential candidate patients rejected their inclusion in a surveillance program and were treated actively. We analyzed a series of 144 patients included in our active surveillance protocol. The mean follow-up time was 3.22 years (SD 2.08). A total of 110 patients (76.3%) remained under active monitoring, with an estimated median treatment-free survival after diagnosis of 6.9 years (95% CI: 6.2–7.6). The percentage of patients who remained free of treatment at 2 and 5 years was 96.3% (95% CI: 92.8–99.8%) and 70.9% (95% CI: 59.3–85.5%), respectively. Thirty-four patients (23.6%) required curative treatment. The mean time to treatment was 4.6 years (SD 2.3). Conclusions Active surveillance of highly selected patients with low-risk prostate cancer is a valid alternative therapy that is accepted by patients in our community.

Fundamento: La fractura de cadera constituye la complicación clínica más grave de la osteoporosis, por su elevada morbilidad y mortalidad. Método: Hemos estudiado las características epidemiológicas y demográficas de la totalidad de fractura de cadera por fragilidad ocurridas en pacientes de ≥ 50 años de edad y recogidas en la isla de Gran Canaria durante el quinquenio 2007-2011, a partir de los Servicios de Admisión, Codificación, Urgencias y Traumatología de todos los hospitales de Gran Canaria, tanto de la red asistencial pública como privada. Resultados: Se recogieron un total de 2.222 fracturas de cadera de las cuales 1.593 (71,7%) se produjeron en mujeres y 629 (28,3%) en hombres. La relación mujer/hombre fue de 2,53. La media de la edad de producción de fracturas de cadera fue de 79 ± 9,7 años. A lo largo de los 5 años, el número total (hombres y mujeres) de fracturas de cadera anuales osciló entre 402 (año 2007) y 504 (año 2010). El número de fracturas de cadera aumentó con la edad hasta la década de los 90 años. La incidencia anual global fue de 150 casos/100.000 habitantes ≥ 50 años, siendo en las mujeres de 205,4 casos respecto a la población de este sexo y edad, y en los hombres de 89,1 casos respecto a la población de hombres ≥ 50 años. Durante los meses de invierno se produjo el 29,7% del total de fracturas, un 7,5% más de las que ocurrieron durante los meses de verano (22,2%). Conclusiones: Durante el período 2007 a 2011, la incidencia de fractura de cadera en Gran Canaria se mantuvo más o menos estable, siendo en todos los años mayor en las mujeres que en los hombres, y aumentando con la edad hasta los 90 años. El mayor número de fracturas de cadera se produjo durante los meses de invierno, siendo semejante durante la primavera, verano y otoño.

Background High-level evidence to support the use of photoselective vaporization of the prostate (PVP) is limited. Objective Assess the efficacy and safety of GreenLight HPS 120-W laser PVP compared with transurethral resection of the prostate (TURP). Design, setting, and participants A randomized clinical trial was performed with 50 patients having lower urinary tract symptoms due to benign prostatic hyperplasia in each treatment arm. Intervention Random allocation to PVP or TURP. Measurements International Prostate Symptom Score (IPSS), quality of life (QoL), and changes in maximum flow rate (Q max ) were the main end points. Patients were evaluated at a follow-up time of 2 yr. Five patients were lost to follow-up. A last observation carried forward analysis was done. Results and limitations Both laser PVP and TURP resulted in the same IPPS reduction at 2 yr (−15.7 and −14.9, respectively; p =0.48) and in the same gain in Q max (+14.5ml/s and +13.1ml/s, respectively; p =0.65). QoL was equivalent for both treatment modalities. These results were independent of prostate size, American Society of Anesthesiologists risk category, and prior indwelling catheter. No statistically significant differences were detected between arms in terms of complication rates. In the laser PVP group, three patients were readmitted to the hospital and two developed a urethral stricture. In the TURP group, two patients were readmitted, six developed a urethral stricture, and two developed bladder neck sclerosis. In-hospital stay and time to catheter removal were significantly shorter with PVP. Limitations are the potential lack of power to detect differences in the complications between groups and the lack of blindness due to the nature of the intervention. Conclusions GreenLight HPS 120-W laser PVP is as effective as TURP for symptom reduction and improvement of QoL. No differences were seen in the response of storage and voiding symptoms. Laser PVP and TURP have the same complication rate. Length of stay is shorter for laser PVP group.

The CB1 cannabinoid receptor, the main molecular target of endocannabinoids and cannabis active components, is the most abundant G protein-coupled receptor in the mammalian brain. In particular, the CB1 receptor is highly expressed in the basal ganglia, mostly on terminals of medium-sized spiny neurons, where it plays a key neuromodulatory function. The CB1 receptor also confers neuroprotection in various experimental models of striatal damage. However, the assessment of the physiological relevance and therapeutic potential of the CB1 receptor in basal ganglia-related diseases is hampered, at least in part, by the lack of knowledge of the precise mechanism of CB1 receptor neuroprotective activity. Here, by using an array of pharmacological, genetic and pharmacogenetic (designer receptor exclusively activated by designer drug) approaches, we show that (1) CB1 receptor engagement protects striatal cells from excitotoxic death via the phosphatidylinositol 3-kinase/Akt/mammalian target of rapamycin complex 1 pathway, which, in turn, (2) induces brain-derived neurotrophic factor (BDNF) expression through the selective activation of BDNF gene promoter IV, an effect that is mediated by multiple transcription factors. To assess the possible functional impact of the CB1/BDNF axis in a neurodegenerative-disease context in vivo, we conducted experiments in the R6/2 mouse, a well-established model of Huntington's disease, in which the CB1 receptor and BDNF are known to be severely downregulated in the dorsolateral striatum. Adeno-associated viral vector-enforced re-expression of the CB1 receptor in the dorsolateral striatum of R6/2 mice allowed the re-expression of BDNF and the concerted rescue of the neuropathological deficits in these animals. Collectively, these findings unravel a molecular link between CB1 receptor activation and BDNF expression, and support the relevance of the CB1/BDNF axis in promoting striatal neuron survival.

Nine polymorphic microsatellite loci were isolated to investigate the effects of habitat fragmentation on gene flow and genetic variation of the peninsular kangaroo rat Dipodomys simulans peninsularis on agricultural landscape from the Baja California Peninsula. The markers had an average of 9.11 alleles per locus (range 2‐14), with mean observed and expected heterozygosities 0.646 (range 0.333‐0.900) and 0.788 (range 0.284‐0.932), respectively. No evidence of linkage disequilibrium was found across pairs of loci, and only one locus exhibited evidence of null alleles.

Ten microsatellite loci were developed for the Baja California spiny-tailed iguana Ctenosaura hemilopha, using an enriched genomic DNA library. In the Cerralvo Island population, seven loci were polymorphic and presented moderate levels of variation. Number of alleles ranged from two to eight (average 4.43), and observed heterozygosity from 0.150 to 0.857 (average 0.492). Polymorphism was detected at six loci on C. hemilopha individuals from the southern Baja California Peninsula. These markers will be useful to study familiar relationships and behaviour on the Cerralvo Island population.

Seven microsatellite loci were developed for the Baja California endemic black-tailed brush lizard Urosaurus nigricaudus, using an enriched genomic DNA library. All loci were polymorphic and overall presented high levels of variation. Number of alleles ranged from five to 16 (average 12.14), and observed heterozygosities from 0.535 to 0.923 (average 0.752). Cross-species amplification was successful and polymorphism was detected for all the loci using the congeners Urosaurus lahtelai and Urosaurus ornatus. These markers will be useful to study fragmented populations of U. nigricaudus on agricultural landscape of the Baja California Peninsula.

To evaluate the acceptance of active monitoring by patients treated in our healthcare community and to report the clinical results of an active surveillance program in patients with low-risk prostate cancer.Prospective study of patients enrolled in an active surveillance programme at our centre between 2004 and 2012. The inclusion criteria were PSA10 ng/ml, Gleason score ≤6, clinical stage T1c/T2a, ≤2 positive cores, and no more than 50% of the core being affected. Curative treatment was proposed when faced with pathological progression over the course of the monitoring.In 2011, only 17% of the total number of potential candidate patients rejected their inclusion in a surveillance programme and were treated actively. We analysed a series of 144 patients included in our active surveillance protocol. The mean follow-up time was 3.22 years (SD 2.08). A total of 110 patients (76.3%) remained under active monitoring, with an estimated median treatment-free survival after diagnosis of 6.9 years (95% CI: 6.2-7.6). The percentage of patients who remained free of treatment at 2 and 5 years was 96.3% (95% CI: 92.8%-99.8%) and 70.9% (95% CI: 59.3%-85.5%), respectively. Thirty four patients (23.6%) required curative treatment. The mean time to treatment was 4.6 years (SD 2.3).Active surveillance of highly selected patients with low-risk prostate cancer is a valid alternative therapy that is accepted by patients in our community.

To determine whether there are differences in the oncological outcomes after radical prostatectomy (adverse pathology and biochemical recurrence) based on clinical selection criteria used in two active surveillance (AS) protocols.442 patients diagnosed with localized prostate cancer (CP) underwent radical prostatectomy at our institution between August 2003 and December 2009. We selected patients with low-risk CP, which could have been included in an AS program. Patients were divided into two groups: group i, those who met the most strict surveillance criteria described by Epstein (PSAD.15; T1/T2a;2 positive core, Gleason≤6,50% involvement of the core) and group ii, those meeting the more open criteria described by Klotz (PSA≤10 or15 at age 70, Gleason≤6 or7 [3+4] in over 70 years). We compared both groups to determine differences in pathological stage, positive surgical margins and biochemical recurrence after radical prostatectomy.Of the 442 patients 48% (213 patients) had low-risk PC, and become potential candidates for an AS program. Of the patients operated on 17% (76 patients) met the criteria for AS as of Epstein's and 48% (213 patients) according to Klotz. Comparing patients in both groups there were no statistically significant differences in the presence of pT3 (7.9% vs 10.8%) P=.55, positive margins (22.4% vs. 28.3%) P=.41, nor in biochemical recurrence at 3 years (5.3% vs 5.6%) P=.86.In our series of patients theoretically candidates for inclusion in a program of active surveillance, we found no differences in the percentage of patients with pathological stage pT3, positive margins and biochemical recurrence according to clinical inclusion criteria currently used.

To perform an external validation of the EORTC risk tables and to evaluate their applicability in the patients of our institution by comparing the actual risk of recurrence and progression in our series to those obtained through the application of the EORTC tables.Retrospective study, based on a prospective cohort of 417 patients in follow-up with primary TaT1 bladder tumors, operated on in our center between 1998 and 2008 and collected in our database. Risk scores were assigned depending on the tumor characteristics to divide our series into four risk groups according to these ratings. An analysis of survival was carried out to calculate the probability of recurrence by the method of Kaplan-Meier.A total of 417 patients with a median follow-up of 59 months were studied. The overall recurrence and progression rates of our series were 25.95% (21.97-30.49) and 4.86% (3.16-7.43) at 1 year and 53.46% (48.06-59.05) and 8.43% (5.95-11.86) at 5 years, respectively. When we compare our rates of recurrence and progression by groups with the corresponding values from Sylvester's publication, an overlapping of the confidence intervals between both populations is detected.In terms of the applicability of the EORTC risk tables in our patients' population, we conclude that these tables predict accurately the clinical course of patients with NMIBC. Due to the sample size of our study, we can only validate the recurrence model of the EORTC tables.

Paratesticular tumours are rare but generally benign neoplasms, usually treated by local excission. Adenomatoid tumours of epididymis are the most common of these tumours.Analyze paratesticular tumours treated in our center and describe dyagnosis and treatment of adenomatoid tumours of epididymis.We retrospectively review 8 patients with paratesticular tumours treated from July 1997 to July 2007. We analyze clinical presentation, dyagnostic suspicion given by image technique, treatment followed and final dyagnosis.Patients median age was 44.1 years (22-69), presenting most of them subacute scrotal tumour with median size by ultrasound of 2.8 cm (1.5-7). All of them were locally extirpated except one with suspicion of a malignant polyorchidism and another one with an apparently intratesticular lesion of great size. Just in two cases peroperatory biopsy was performed. Dyagnosis was in 4 cases adenomatoid tumour of epididymis, in two cases fibrous pseudotumour of epididymis, in one case leiomyoma of epididymis and in one case angiolipoma of spermatic cord. Just in one case diagnosed of adenomatoid tumour of epididymis ultrasound confirmed solid tumour suggesting the final dyagnosis.Adenomatoid tumors of epididymis are rare tumours which may present at any age. Ultrasound may help in dyagnosis, but its capacity to distinguish this lesions is low. Benignity of adenomatoid tumour of epididymis as well as most of the other paratesticular tumours should make local excission the treatment of choice and, when any doubt existed, peroperatory biopsy should be performed.

PARATESTICULARES Introduccion: Los tumores paratesticulares son neoplasias poco frecuentes aunque habitualmente benignas que suelen ser tributarias de extirpacion local. Dentro de ellos se considera que los tumores adenomatoides de epididimo constituyen el subgrupo mas frecuente. Objetivos: Analizar los casos de tumores paratesticulares intervenidos en nuestro centro, asi como el diagnostico y tratamiento de los tumores adenomatoides de epididimo. Material y metodos: Se revisan de forma retrospectiva 8 pacientes con tumores paratesticulares intervenidos entre julio de 1997 y julio 2007. Se analiza en cada caso la forma de presentacion, la orientacion diagnostica que aportaba la prueba de imagen, el tratamiento indicado para cada paciente y el diagnostico definitivo. Resultados: La edad media de los pacientes fue de 44,1 anos (22-69), consultando la mayoria de ellos por tumoracion escrotal de aparicion subaguda que presentaban en la ecografia un tamano medio de 2,8 cm (1,5-7). Se practico la extirpacion local en todos los casos a excepcion de un paciente con sospecha de un teste accesorio malignizado y otro con una lesion aparentemente intratesticular de gran tamano. Solo en dos casos se practico una biopsia peroperatoria. El diagnostico fue en 4 casos de tumor adenomatoide de epididimo, en dos casos de pseudotumor fibroso de epididimo, en un caso de leiomioma de epididimo y en otro de angiolipoma de cordon espermatico. Solo en un caso diagnosticado de tumor adenomatoide de epididimo la ecografia informaba de tumoracion solida sugestiva del diagnostico definitivo. Conclusiones: Los tumores adenomatoides de epididimo son tumores poco frecuentes que se pueden diagnosticar a cualquier edad. La ecografia puede orientar el diagnostico pero su capacidad para diferenciarlos es baja. La naturaleza habitualmente benigna tanto del tumor adenomatoide de epididimo como del resto de tumores paratesticulares obligaria a practicar como primera opcion la extirpacion local de los mismos y, ante cualquier duda, deberia practicarse una biopsia peroperatoria.

Carotenoids are important as pigments for bright coloration of animals, and as physiologically active compounds with a wide array of health-related benefits. However, the causes of variation in carotenoid acquisition and physiology among species are poorly known. We measured the concentration of carotenoids in the blood of 80 wild bird species differing in diet, body size and the extent of carotenoid-based traits. Preliminary analyses showed that diet significantly explains interspecific variability in plasma carotenoids. However, dietary influences were apparently overridden by phylogenetic relationships among species, which explained most (65%) of this variability. This phylogenetic effect could be due partly to its covariation with diet, but may also be caused by interspecific differences in carotenoid absorption from food to the blood stream, mediated, for example by endothelial carriers or gut parasites. Carotenoid concentrations also decreased with body size (which may be explained by the allometric relationship between ingestion rate and body mass), and correlated positively with the extent of carotenoid-dependent coloration of plumage and bare parts. Therefore, the acquisition of carotenoids from the diet and their use for both health and display functions seem to be constrained by ecological and physiological aspects linked to the phylogeny and size of the species.

Background Drugs returned by patients have to be managed properly. Purpose To analyse drugs returned by patients and the associated financial impact after the implementation of a quality system (corrective action to ensure traceability of these drugs). Materials and methods Retrospective descriptive study of returns recorded after implementation of the improved procedure for ‘return of drugs for the patient’, from March 2011 to June 2013. The auxiliary records the return in formalised form indicating date, name of the patient, drug, number of units, batch and expiry date. The pharmacist validates the return based on a decision algorithm allowing the acceptance or rejection of the drug, taking into account whether it is in date, the physical appearance of the product and the storage conditions at home. If the drug is accepted, it is recorded back in the APD-Prism software and is labelled with ‘Return accepted drug’ so it can be traced to the patient to whom the returned medicine is dispensed. WE analysed the number of patients who returned drugs, units of returned drugs, therapeutic group of returned drugs (according to ATC classification), causes of the return and the financial impact associated with returned drugs. Results During the study period, 132 patients out of 1811 returned 77 different drugs corresponding to 400 lines of returns and 10,377 returned units. The main therapeutic groups and amounts of returned units were: J05 antivirals (44.7%), L01 antineoplastics (23%), J01 anti-infectives for systemic use (5.7%), C02 antihypertensives (4.4%), L04 immunosuppressants (4.3%), L03 immunomodulators (3.8%) and L02 endocrine drugs (3.3%). Returned drugs were accepted for the following reasons: end of treatment (31%), change of treatment (21.8%), death (12%), less than the expected treatment duration (11.8%), change of dose (11.3%), adverse reactions (10.3%), did not start the treatment (1.3%) and patient transfer (0.5%). The total value of returns was 188,862 € (0.77% of total), of which 4.6% were not accepted due to being expired (30%), defective (30%), badly stored (20%) and to opening of the primary multi-dose container (abiraterone) (20%). Conclusions A standard procedure for return of drugs facilitates the traceability of drugs and optimises the use of resources allocated to the budget line of drugs. It should inform patients of the importance of returning drugs no longer needed and their proper storage. The cost opportunity in the repackaging of drugs dispensed in the outpatient area should be discussed. No conflict of interest.

Background Satisfaction surveys are an important tool for ascertaining patient opinions. Purpose To evaluate the degree of satisfaction with interferon beta-1a pre-filled pens and patient preferences. Materials and methods We conducted a survey of patients who were treated with interferon beta-1a after the change from syringe to pre-filled pen. The survey, conducted by the pharmacist after the second device had been dispensed in the Outpatient department, picked up the following aspects: a) self-administration (yes or no), b) ease of use (preparation and injection), rated from 0 (more difficult) to 10 (easier), c) adverse effects (pain, hematoma, induration, redness and swelling and flu-like symptoms), d) preference for syringe or pre-filled pen and reason, e) overall satisfaction, rated from 0 (lowest) to 10 (highest). The assessment of pain at the injection site was measured by a visual analogue scale (VAS). Results All patients (44) completed the survey. 84% self-administered with the pen. The average score received both for ease of preparation and injection was 9. 9% did not like the pen because they had difficulty with device preparation and 2.3% because the safety lock release had failed. Adverse effects experienced: hematoma (13.6%), induration (13.6%), redness and swelling (6.8%) and flu-like symptoms (6.8%). Pain at the injection site obtained an average of 2.14. 88.7% preferred the pen, the main reason was ease of injection (56.4%) and other reasons were: the need to spend less time (25.7%), ease of preparation (7.7%), reduced pain (5.1%) and less anxiety due to the injection (5.1%). The overall patient satisfaction was 8.7. Conclusions The degree of satisfaction was high; some patients did prefer the syringe but weren’t given the option of continuing to use it. The majority preferred the pre-filled pen because of the ease of use. They agreed with the goal of changing the presentation in the Pharmacy Service. The change did not cause an increase in the perception of adverse reactions associated with the device. No conflict of interest.

he study of the role of carotenoids on the physiology and evolutionary ecology of birds demands methods for their quantification in the bloodstream. We compared color‐chart scores of plasma hue with the actual concentration of plasma carot‐enoids obtained by spectrophotometry in 356 wild birds from 26 species. Repeatability of chart scores between three independent observers was high. However, color scores did not correlate with the spectrophotometric results in interspecific analyses. Within species ( ), one showed no relationship and two showed weak but significant positive correlations. Hemoglobin, and probably other substances, may mask the color of carotenoids, making the accurate use of color charts difficult. Spectrophotometry should be the method of choice as it permits precise quantifications of total plasma carotenoids and objective comparisons among studies.

Identification of factors associated with suffering Acute Respiratory Infections (ARI).A descriptive study using a direct survey."El Naranjo" Primary Care team, Area 9 Madrid.362 patients between 0 and 14.362 interviews were carried out, covering items connected with personal background, living conditions, situation and quality of life and activities, 180 patients attending with clinical symptoms of ARI were interviewed, as well as 182 who attended during the same period for other reasons. The profile of the patients interviewed was mainly: females between 6 and 10, with more history of catarrh than any other pathology, and who had taken aspirin to treat symptoms and mainly Penicillin as an aetiological treatment. They lived in homes measuring 100 square metres, with three bed-rooms which were shared in the main by two people, and had one brother aged between 1 and 9.No protective factors against ARI were found in the group of children studied.

An evaluation was made of the appropriateness of hospital admissions in the ear, nose, and throat surgery department of a teaching hospital. One hundred fifty-two clinical histories were studied. Elective surgery admissions were reviewed using the new Appropriateness Evaluation Protocol (AEP) for elective surgery. Non-elective admissions and the duration of the hospital stay were reviewed with the adult medical-surgical AEP. In the patients who underwent elective surgery, admission was inappropriate in 6.2% (95% confidence interval: 2.9-12.2%). Name of the non-elective admissions (95% confidence interval: 0-17.8%) was inappropriate. Nineteen per cent of hospital days were inactive (95% confidence interval: 13.3-26.4%).

Background Hepatitis C virus (HCV) infection is a major health problem in the western world. Current treatment with interferon (IFN) and ribavirin (RBV) is able to produce a sustained virological response in approximately 50% of patients with genotype-1. Telaprevir (TPV) represents a change in the treatment of HCV. Purpose To describe the proportion of patients who had undetectable plasma HCV-RNA at week 4 and 12 of treatment, the haemoglobin and platelets level during treatment and the most frequently reported adverse events. Materials and Methods We conducted a retrospective study of all patients who started triple therapy in 2012. We collected demographics (age and sex), genotype, pre-treatment response, haemoglobin, platelets, plasma HCV-RNA at weeks 0, 4 and 12 and reported adverse events. Results Since January 2012, 9 patients began treatment with RBV+IFN+TPV with a mean of age of 49 (SD:6.2). 89% were male. Genotype-1a was predominant (95%). Five patients were previous non-responders, three were relapsers and one was missing. The mean haemoglobin at weeks 0, 4 and 12 was 15.5 (SD:1.2), 13.0 (SD:1.7), and 11.3.(SD:1.9) mg/dl respectively and the mean platelets at week 0, 4 and 12 were 217 (SD:142.4), 132 (SD:46.2) and 121 (SD:33.9) respectively. The mean of plasma HCV-RNA at the beginning was log 6.55 (SD:0.39). At week 4, 8 patients (88.9%) had undetectable plasma HCV-RNA and 1 had to discontinue treatment (HCV-RNA: log5.63). At week 12, 7 patients had undetectable plasma HCV-RNA. One patient had to discontinue treatment due to severe anaemia. The most frequent adverse event was anaemia (89%); in two cases it was even necessary to administer erythropoietin. Other adverse events were rash, fatigue and haemorrhoids. Conclusions Our rate of undetectable plasma HCV-RNA at week 4 is high (89%) which allowed TPV to be suspended at week 12 and RBV+IFN treatment to be shortened to 24 weeks. Anaemia was the major serious adverse event reported. No conflict of interest.

Background The increase in drug spending and the decrease in resources make it necessary to look for strategies for minimising costs. Purpose To describe the strategy for administering high-consumption intravenous drugs (IVd) directly and estimating the associated resources saved in an Intensive Care Unit (ICU). Materials and Methods We obtained a list of drugs whose consumption in the ICU was more than 1,000 units/year. After a literature review, we selected those that could be safely administered via IVd but are usually administered in intermittent intravenous infusion. We prepared a table containing instructions for their reconstitution and administration. For four weeks two nurses administered the medicines that had been prescribed and were included in the table via IVd, recording: drug, time spent in preparation & administration and adverse reactions related to the route of administration. After collecting data We estimated the direct cost savings in fluids if all drugs consumed by the unit and included in the table had been administered by IVd during 2010. We compared the time spent on the preparation and administration of drug doses used in routine practise versus time used to implement this strategy. Results The ICU used more than 1,000 units/year of each of 39 intravenous drugs, of which 12 were included in the table: metoclopramide, colistimethate, hydrocortisone, phytonadione, pantoprazole, amoxicillin/clavulanic acid, dexamethasone, piperacillin/tazobactam, furosemide, methylprednisolone, meropenem and ranitidine. The nurses made 117 administrations via IVd (following the usual procedure) of these drugs. The average time was 6.5 minutes for preparation and administration of each dose and no adverse reactions were detected related to the route of administration. We estimate the ICU can save 28,000€/year. Conclusions Direct IV administration can be safe and efficient. The extension of a programme of this type throughout the Hospital could increase efficiency and rational use of medicines significantly. No conflict of interest.

Hemobilia is the term which describes the presence of blood in the biliary tract. We describe a case of symptomatic hemobilia after percutaneous liver biopsy which resolved spontaneously. We review the physiopathology of this complication and we highlight the role of abdominal ultrasonography not only in the diagnosis but also in the follow-up of hemobilia. In our case, abdominal ultrasonography was able to identify the probable point of bleeding.

Background A growing body of evidence suggests that proton pump inhibitors (PPIs) may adversely interact with clopidogrel, diminishing the antiplatelet effect. The potential for increased risk of thrombotic complications warrants cautious use of this drug combination. When concomitant clopidogrel and PPI treatment is considered necessary, pantoprazole or ranitidine may offer a safe choice. Purpose To analyse the prescription profile and financial impact of an alert that was added to the assisted electronic prescription program (EPP) and is triggered by a prescription for concomitant clopidogrel and omeprazole treatment. A safer choice that is pantoprazole or ranitidine is suggested to assist health professionals. Materials and methods Retrospective cohort study. Period A (before this alert was added) April–June 2010: pantoprazole was the only PPI included in the hospital9s formulary and Period B (after this alert was introduced) April–June 2011: omeprazole and pantoprazole as the low cost and the alternative options respectively for prescribing PPIs. The authors looked at all the clopidogrel prescriptions in both periods of study. Patient code, age (years), gastric protector drug (none, omeprazole, pantoprazole, ranitidine), dose (mg/day) and treatment cost/day data were collected from the EPP. Main outcome and measures: number of patient with PPIs as the treatment for gastric protection and average treatment cost/day. Statistical analysis: OR with its 95% CI and t-test were used to compare the two periods. Results A total of 360 patients were included in Period A (70% men) with a mean age of 72.2 (IC 95% 70.8 to 73.5) and 327 in Period B (68.9% men) with a mean age of 72.5 (IC 95% 71.2 to 73.8). The change from Period A to Period B was: the percentage of patients treated with a PPI fell from 68.9% to 24.7% (OR=0.15; IC 95% 0.11 to 0.21; p Conclusions The prescription profile for PPIs was modified by the introduction of the alert. Fewer patients taking clopidogrel are now being prescribed a PPI and a safer drug is used more often. The cost per patient is now lower.