Mesostructured lead dioxide grown on titania nanotubes for diclofenac water removal through electrocatalytic and photoelectrocatalytic processes.

Mesostructured PbO2/TiO2 materials were synthesized to perform electrocatalysis (as electrooxidation, EO) and photoelectrocatalysis for removing diclofenac (DCF), 15 ppm concentration in 0.1 M NaSO4 solutions, at different pH conditions (3.0, 6.0 and 9.0) by applying 30 mA cm-2. Titania nanotubes (TiO2NTs)-based materials were prepared to synthetize with a massive PbO2 deposit on this support to obtain TiO2NTs/PbO2 and a TiO2NTs:PbO2 material consisting in a dispersed PbO2 deposit on TiO2-NTs that allowed the formation of a heterostructured surface of combined composition (TiO2 and PbO2). Organics removal (DCF and byproducts) was monitored through UV-vis spectrophotometry and high-performance liquid chromatography (HPLC) during degradation tests. TiO2NTs/PbO2 electrode was tested in both processes, removing DCF at neutral and alkaline solution conditions in EO while an unimportant photoactivity was registered at this material. Conversely, TiO2NTs:PbO2 was used as electrocatalytic material in EO experiments, achieving more than 50% of DCF removal at pH 6.0 by applying 30 mA cm-2. Also, for first time, the synergic effect was investigated when it was exposed to UV irradiation in photoelectrocatalytic experiments, enhancing its efficacy (⁓more than 20%) to remove DCF from a solution with 15 ppm over performance removals achieved (56%) when EO was applied under similar conditions. Chemical Oxygen Demand (COD) analyses showed that significantly higher DCF degradation is reached under photoelectrocatalysis, since COD values decrease a 76% against a 42% decrease achieved with electrocatalysis. Scavenging experiments showed a significant participation on the pharmaceutical oxidation process through the generation of photoholes (h+), hydroxyl radicals and sulfate-based oxidants.

Data sources for drug utilization research in Latin American countries-A cross-national study: DASDUR-LATAM study.

PURPOSE: Drug utilization research (DUR) contributes to inform policymaking and to strengthen health systems. The availability of data sources is the first step for conducting DUR. However, documents that systematize these data sources in Latin American (LatAm) countries are not known. We compiled the potential data sources for DUR in the LatAm region. METHODS: A network of DUR experts from nine LatAm countries was assembled and experts conducted: (i) a website search of the government, academic, and private health institutions; (ii) screening of eligible data sources, and (iii) liaising with national experts in pharmacoepidemiology (via an online survey). The data sources were characterized by accessibility, geographic granularity, setting, sector of the data, sources and type of the data. Descriptive analyses were performed. RESULTS: We identified 125 data sources for DUR in nine LatAm countries. Thirty-eight (30%) of them were publicly and conveniently available; 89 (71%) were accessible with limitations, and 18 (14%) were not accessible or lacked clear rules for data access. From the 125 data sources, 76 (61%) were from the public sector only; 46 (37%) were from pharmacy records; 43 (34%) came from ambulatory settings and; 85 (68%) gave access to individual patient-level data. CONCLUSIONS: Although multiple sources for DUR are available in LatAm countries, the accessibility is a major challenge. The procedures for accessing DUR data should be transparent, feasible, affordable, and protocol-driven. This inventory could permit a comparison of drug utilization between countries identifying potential medication-related problems that need further exploration.

Prevalencia de interacciones farmacológicas en pacientes hospitalizados en el servicio de medicina interna de un hospital general de México / Prevalence of drug interactions in hospitalized patients of the internal medicine service of a general hospital of México

RESUMEN Introducción. Los medicamentos han logrado prolongar y mejorar la calidad de vida de los pacientes, pero no garantizan estar libres de riesgo. La prescripción conjunta de varios medicamentos favorece que existan interacciones farmacológicas, disminuyendo el efecto esperado del medicamento y favoreciendo la aparición de efectos secundarios inesperados que ponen en peligro la vida del paciente. Objetivo. Determinar la prevalencia de interacciones farmacológicas en pacientes hospitalizados en un servicio de medicina interna de un hospital general. Métodos. Estudio observacional, transversal y retrospectivo. Se analizaron las prescripciones farmacológicas, utilizando la herramienta "Interactions Checker" de drugs. com(r) para la detección de posibles interacciones farmacológicas encontradas en los expedientes clínicos de 118 pacientes hospitalizados en un servicio de medicina interna de un hospital público de México. Resultados. El 78% de los pacientes presentaron al menos una interacción farmacológica, se identificaron 459 interacciones en total con una media de 4 interacciones por paciente. El 75% fueron de clasificación moderada, 13,5% leves y 11,5% graves. El omeprazol presentó el mayor número de interacciones y la interacción con mayor frecuencia fue furosemide + omeprazol. Se encontró una relación significativa entre las interacciones farmacológicas y el número de fármacos prescritos (p <0,001). Conclusiones. Existe una alta prevalencia de posibles interacciones farmacológicas en nuestra muestra de estudio, éstas deben ser consideradas para realizar un proceso de prescripción racional, asegurando la relación riesgo-beneficio para obtener un impacto positivo de gran alcance en la salud de los pacientes.

ABSTRACT Introduction. The joint prescription of several medications favors the occurrence of drug interactions, reducing the expected effect of the drug, and also favors the appearance of unexpected side effects. Objective. Document the prevalence of drug interactions in patients hospitalized in an internal medicine department. Methods. Observational, cross-sectional, retrospective study. It analyzed the drug prescriptions using the drugs.com(r) "Interactions Checker" tool to detect possible drug interactions found in the clinical records of 118 patients hospitalized in an internal medicine department of a public hospital in Mexico. Results. 78% of patients presented at least one drug interaction; 459 interactions were identified in total with a mean of 4 interactions per patient. 75% were classified as moderate, 13.5% mild, and 11.5% severe. Omeprazole had the highest number of interactions, and the most frequent interaction was furosemide + omeprazole. There was a significant relationship between drug interactions and the number of drugs prescribed (p <0.001). Conclusions. There is a high prevalence of possible drug interactions in the study sample, which should be considered when performing a rational prescription process, thereby ensuring the risk-benefit ratio to obtain a far-reaching positive impact on the patients' health.

Intravenous Administration Errors Intercepted by Smart Infusion Technology in an Adult Intensive Care Unit.

OBJECTIVES: The aim of the study was to investigate the efficacy of intravenous (IV) smart pumps with drug libraries and dose error reduction system (DERS) to intercept programming errors entailing high risk for patients in an adult intensive care unit (ICU). METHODS: A 2-year retrospective study was conducted in the adult ICU of the Hospital Juárez de México in Mexico City to evaluate the impact of IV smart pump/DERS (Hospira MedNet) technology implementation. We conducted a descriptive analysis of the reports generated by the system's software from April 2014 through May 2016. Our study focused on the upper hard limit alerts and used the systems' variance reports and IV Medication Harm Index methodology to determine the severity of the averted overdoses for medications with the highest number of edits. RESULTS: The system monitored 124,229 infusion programs and averted on 36,942 deviations of the preset safe limits. Upper hard limit alerts accounted for 26.4% of pump reprogramming events. One hundred sixty-six significant administration errors were intercepted and prevented, and IV Medication Harm Index analysis identified 83 of them as highest-risk averted overdoses with insulin accounting for 51.8% of those. The rate of compliance with the safety software during the study period was 69.8%. CONCLUSIONS: Our study contributes additional evidence of the impact of IV smart pump/DERS technology. These pumps effectively intercepted severe infusion errors and significantly prevented adverse drug events related to dosing. Our results support the implementation of this technology in ICUs as a minimum safety standard and could help drive an IV infusion safety initiative in Mexico.

Impact of Implementing Smart Infusion Pumps in an Intensive Care Unit in Mexico: A Pre-Post Cost Analysis Based on Intravenous Solutions Consumption.

Background: The use of smart pump technology has shown to be profitable in the intensive care unit (ICU) because it avoids costs from prevented medication errors and allows for savings on disposables and medications by establishing standardized concentrations and dosing units. Objective: The objective of the study is to evaluate the economic impact of the implementation of smart infusion pumps in the consumption of intravenous (IV) solutions in an ICU. Methods: A retrospective observational study was conducted with a pre-post design. The study occurred in the adult ICU of the Hospital Juárez de México. The pattern of consumption of IV solutions (sodium chloride 9%, Hartmann's solution, dextrose 5% and 10%, sodium chloride 0.9% with dextrose 5%) was analyzed preimplementation and postimplementation of 50 Plum A+™ pumps with Hospira MedNet™ security software. Using the TreeAge Pro 2016 software, deterministic and probabilistic analyses were carried out (10 000 Monte Carlo simulations) to confirm the robustness of the annual consumption comparison and the associated expenses before and after implementing smart technology. Results: The implementation of the smart pumps reduced the annual consumption of IV solutions to 8994 units (18%) and 3649 liters (22.3%). In the first year, MXN$55 850.97 were saved. From an institutional perspective and with a probability of 0.63, the use of MedNet™ technology proved to be a lower cost alternative (17.1% saved) with respect to the conventional infusion systems. Conclusion: The implementation of smart infusion pumps allows savings, specifically for the IV solutions used in ICU.

Nutritional support and cardioprotection with L-carnitine: prescription appropriateness and safety concerns in Mexican neonates.

Medication errors are probably more common in neonates than is generally appreciated. In Mexican pediatric hospitals, L-carnitine is mainly used for nutritional support and to treat cardiomyopathy secondary to neonatal asphyxia. Using a longitudinal-retrospective approach we assessed the appropriateness of all L-carnitine prescriptions written during a 12-month period at a NICU of a second-level hospital located in Toluca, Mexico. Reports of adverse reactions possibly related to L-carnitine therapy were collected and characterized. Overall, administration of L-carnitine was considered justified and appropriate only in 18% of patients. 60.7% of L-carnitine prescriptions were rated as inappropriate because the prescribed doses fell outside the recommendations. The overall rate of ADRs calculated from the patient population was 18.03%. All of them were of gastrointestinal type: abdominal cramps (8 cases, 61.54%) and vomiting (5 cases, 38.46%). Our results supported the establishment of an L-carnitine rational use policy at the NICU of the hospital under study.

Improving pediatric drug safety: need for more efficient clinical translation of pharmacovigilance knowledge.

There is an urgency to improve the evaluation of pediatric drug safety in the pre-market and post-market phases of drug evaluation. The need to improve pharmacovigilance methods concerns not only new drugs but also existing drugs that have been used for many years in an off-label manner in children. Effective methods for early detection of adverse drug reactions (ADRs) and drug safety epidemiologic studies are a pressing need in pediatrics. Moreover, the nature and severity of an ADR as well as the extent to which the suspected drug is being used, will determine how quickly the information about risk needs to be made available to users and what would be the most appropriate method of communication. Based on our experience through the Genotype-specific Approaches to Therapy in Children study, an active ADR surveillance network of pediatric hospitals across Canada, we present five strategic elements that should be included in pharmacovigilance initiatives in pediatrics: active ADR surveillance; drug or ADR targeted pharmacovigilance; trained surveillance clinicians; case-control methodology and standardized procedures for recognition; reporting and evaluating drug-induced harm. In addition, linking pharmacovigilance with pharmacogenomics to find drug safety solutions is presented as a promising strategy for knowledge generation. Finally, we discuss the importance of an efficient translation of the pharmacovigilance knowledge into clinical practice to achieve safer drug therapy in children.

Cutaneous adverse drug reactions in children: an analysis of reports from the Canadian Pharmacogenomics Network for Drug Safety (CPNDS).

Cutaneous adverse drug reactions (CADRs) are the most prevalent adverse drug reactions (ADRs) in hospitalized children, with an estimated rate of 2-3%. The Canadian Pharmacogenomics Network for Drug Safety (CPNDS) is a pan-Canadian active surveillance network identifying genomic biomarkers of risk for serious ADRs. The purpose of this paper is to describe the characteristics of paediatric CADR cases reported to the CPNDS from February 2005 to December 2008. The CPNDS database was mined and details of CADRs and key clinical data from cases were extracted. Reports were individually analyzed and classified in two main groups: severe and non-severe CADRs, with subcategories. In total, 326 CADR cases were included in the study; 214 (65.6%) severe and 112 (34.4%) non-severe CADRs. Overall L-asparaginase (n=56, 16%), amoxicillin (n=29, 8.3%), cotrimoxazole (n=25, 7.2%), carbamazepine (n=17, 4.9%) and lamotrigine (n=13, 3.7%) accounted for 40% of all suspected medications. We have demonstrated the ability to comprehensively collect clinical data on a wide range of severe and non-severe CADRs to drugs commonly used in the care of children. Our study provides additional real world evidence to promote the proactive detection, collection, reporting and assessment of CADRs in children.

A systematic review of treatment of drug-induced Stevens-Johnson syndrome and toxic epidermal necrolysis in children.

Stevens-Johnson (SJS) and Toxic Epidermal Necrolysis (TEN) are two uncommon mucocutaneous diseases usually considered as severe drug reactions and are characterized by different grades of epidermal necrosis. Several treatment modalities have been proposed with variable results but the lack of controlled studies makes difficult to analyze them objectively especially in children. All publications describing management for SJS and TEN in children were searched in MEDLINE, EMBASE, and the Cochrane Library. Reports included were divided in two categories: A, studies with 5 or more patients and observational studies; and B, reports with less than 5 patients. A formal meta-analysis was not feasible. Description was made using central tendency measures. From 1389 references only 31 references with a total of 128 cases were included, 88 category A and 40 category B. The 4 main treatment modalities were: intravenous immunoglobulin (IVIG), steroids (prednisolone, methylprednisolone, dexamethasone), dressings with or without surgical debridement, and support treatment alone. Miscellaneous treatments: Of 12 patients, 3 received ulinastatin, 4 patients plasmapheresis, 2 patients IV pentoxifylline and the last three patients received different treatment each (cyclosporine, methylprednisone/G-CSF and methylprednisolone/IVIG). Patients receiving IVIG and steroids showed similar findings while patients treated with dressing and support treatment alone, reported both longer time to achieve remission and hospitalization stays and appear to be associated with more complications and deaths. There is scant quality literature about management of SJS and TEN in children. Steroids and IVIG seem to improve the outcome of SJS and TEN patients but results from different reports are variable. Patients treated only with care support seem to have higher morbidity and mortality. Further studies are necessary to define optimal management.

Pharmacogenomics of serious adverse drug reactions in pediatric oncology.

Adverse drug reactions (ADRs) rank as one of the top ten leading causes of death and illness in the developed world. In cancer therapy, more patients are surviving cancer than ever before, but 40% of cancer survivors suffer life-threatening or permanently disabling severe ADRs and are left with long-term sequelae. ADRs are often more frequent and more severe in children, and the consequences for children who experience a severe ADR can be catastrophic. Pharmacogenomics has the potential to improve the safety of these drugs. This review highlights severe ADRs that can occur in cancer therapy that are more frequent and more severe in children, and the pharmacogenomics research that aims to understand, predict, and ultimately prevent these severe reactions.