Background Infectious skin disorders (ISDs) are commonly seen in pediatric emergency departments (PED), however the exact frequency is unknown. We provide an accurate evaluation of the incidence and characteristics of ISDs diagnosed in a PED from Buenos Aires, Argentina, over a 1-year period.Methods Prospectively, descriptive study of children evaluated in the PED with ISDs during 2016. ISDs were analyzed on the basis of their incidence, patient demographics, seasonal variations, and hospitalization rates.Results ISDs were diagnosed in 1680 (67.9%) of the skin consultations (M/F: 1.1; mean age: 4.4 AE 3.7 years). Bacterial infections were observed in 932 (55.5%) cases. Viral infections were seen in 604 patients (35.9%). Fungal and parasite skin infections were diagnosed in 33 (2%) and 111 (6.6%) children, respectively. The most frequent ISDs according to the etiology group were impetigo 377 (22.4%), varicella 397 (23.6%), tinea capitis 10 (0.6%), and scabies 109 (6.5%). A higher frequency of ISDs were reported during the summer (38.4%) and spring (38.2%) months. Bacterial skin infections were more frequent during the summer months, while viral skin infections were more prevalent during spring. Parasitic skin infections were diagnosed more frequently during the winter months. No differences were seen for mycotic skin infections. Hospitalization rate was 1% (all for bacterial skin infections).Conclusion Our data reveal the extremely high frequency of ISDs seen at the PED, underlying the need for closer cooperation between dermatologists and pediatricians.

BackgroundThe extended use of rituximab for off-label indications accentuates the need for creating standardised protocols to speed up both the administrative processes and the supply to the patient.PurposeTo analyse rituximab’s off-label indications as well as the treatment schedule used to evaluate the degree of compliance with the Royal Decree which regulates the use of medicines under special circumstances.Material and methodsAn observational retrospective study was carried out in 2015, in which all patients treated with rituximab, both exclusively or in combination with other drugs, were included. For data collection, the oncologic treatment management tool, Onconfarm, and the electronic clinic history programme, Selene, were used: age, gender, diagnosis, treatment schedule received, off-label indication or not, and, if affirmative, whether it was processed and authorised by the medical board at the hospital.Results74 patients were included, 38 women and 36 men, with an average age of 69 years (20–90). A total of 103 treatments were applied, the following being the most frequent: follicular lymphoma (23%), giant cell lymphoma (13.5%) and chronic lymphocytic leukaemia (CLL) (12%). The most used treatment schedules were: R-CHOP (22%), rituximab every 2 months (13.5%) and rituximab quarterly (12.5). Of all treatments applied, 48 (47%) did not comply with the indications in the technical data sheet. The most frequent indications were: membranous glomerular nephropathy (14.5%), CLL as maintenance treatment (12.5%) and Mantle cell lymphoma and Waldenström’s macroglobulinaemia (10.5%). Of all the off-label treatments, 58% were processed following the procedures related to the use of medicines under special circumstances and authorised to be applied, while the remaining 42% were applied without being administratively processed.ConclusionPrescribing Rituximab for off-label indications is very frequent in hospitals. These situations should be registered under some therapeutic protocols, mandatory for physicians, and in which regulation by the Pharmaceutical and Therapeutical Commission should be actively engaged and involved.References and/or acknowledgementsGarcía-Sabina A, Rabunal Rey R, Martínez-Pacheco R. Review of use of drugs for conditions not included in product characteristics. Farmhosp (Internet). 2016 (mentioned 10 Oct 2016); 2011;35:264–77. Available at European Assessment Report, de la European Medicines Agency. Procedure No. EMEA/H/C/165/II/0060. Available at , mentioned 10 Oct 2016No conflict of interest

Sleep disturbances are a common yet often overlooked symptom of psychosis that can drastically affect the quality of life and well-being of those living with the condition. Sleep disorders are common in people diagnosed with schizophrenia and have significant negative effects on the clinical course of the illness and the functional outcomes and quality of life of patients. There is a limited number of studies addressing this question in first-episode psychosis (FEP). In this narrative review, we aimed to provide an overview of sleep disorders in populations with FEP and at-risk mental states (ARMS). The review was focused on the various treatments currently used for sleep disorders, including both non-pharmacological and pharmacological treatments. A total of 48 studies were included. We found that sleep disturbances are associated with attenuated psychotic symptoms and other psychopathological symptoms in ARMSs. The association of sleep disturbances with the transition to psychosis has been poorly investigated. Sleep disturbances have an impact on the quality of life and the psychopathological symptoms of people suffering from FEP. The non-pharmacological treatments include cognitive behavioral therapy for insomnia, bright light therapy, cognitive restructuring techniques, sleep restriction therapy, basic sleep hygiene education, and the provision of portable sleep trackers. Other treatments include antipsychotics in acute phases and melatonin. The early intervention in sleep disturbances may improve overall prognosis in emerging psychosis populations.

BackgroundIn order to improve the quality of assistance and to promote rational use of drugs in patients who come to the emergency department (ED), a new drug kit dispensation programme was launched.PurposeTo assess the viability of the drug kit dispensation programme in ED patients after discharge. To analyse the impact on the prescription of these drugs.Material and methodsA retrospective experimental observational study was conducted from June to December 2015. 5 kits (ibuprofen, omeprazole, metamizol, paracetamol and butylscopolamine) were dispensed for the most common diagnoses in ED, containing the right medication to treat them. The kits were properly identified, packed and contained written information. All dispensations were registered by the ED physician in charge through the computer tool Selene, and the kits were given to the patients together with the discharge report. The registered variables were: number of patients, number and type of dispensed kits, prescriptions given by the correspondent ED, direct costs, percentage difference in expenditure compared with previous year, bearing in mind the trend in the first semester of 2015.ResultsOver the period of this study, 4320 kits (710 omeprazole, 1620 ibuprofen, 930 metamizole, 820 paracetamol and 240 butylscopolamine) were dispensed. Only 20% of the dispensations were registered, and therefore it was impossible to monitor these patients and analyse the results. In terms of expenditure on prescriptions, there was a drop in paracetamol (5.17%), in metamizole (18.64%) and in ibuprofen (9.14%); and there was an increase in omeprazole (2.97%). Butylscopolamine was not taken into consideration due to its erratic fluctuation. The cost of the kits, passed on to the hospital pharmacy service, was €287.82 for paracetamol, €184.14 for metamizole, €112.32 for butylscopolamine, €70.30 for omeprazole and €335.34 for ibuprofen. The estimated potential savings were: €4743 for paracetamol, €1485 for metamizol, €139 for butylscopolamine, €4509 for omeprazole and €3133 for ibuprofen.ConclusionMedication kits after discharge can be a good strategy to ensure compliance with the treatment, to promote rational use of drugs and to reduce the costs in ED as far as traceability can be totally ensured.No conflict of interest