[Tumor necrosis factor blocking agents: a review. Part I: Clinical efficacy evaluation]. / Lugar en terapéutica de los medicamentos antagonistas del factor de necrosis tumoral. Parte I: evaluación clínica.

Blockade of tumor necrosis factor with monoclonal antibodies, has emerged as one of the most promising therapies in some autoimmune conditions as rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis and Crohn s disease. They have shown effectiveness on reducing symptoms and modifying the progression of the disease. However, they disrupt the balance of inflammatory and immune responses and some risks associated with TNF-blockers have become apparent. The purpose of this article is to review the evidence about benefits and risk associated with the use of TNF-blockers in approved indications and to provide practical recommendations for its use in the management of these conditions.

[Tumor necrosis factor blocking agents: a review. Part II: safety and recommendations]. / Lugar en terapéutica de los medicamentos antagonistas del factor de necrosis tumoral. (2da de dos partes): de los efectos indeseados y recomendaciones.

Blockade of tumor necrosis factor with monoclonal antibodies, has emerged as one of the most promising therapies in some autoimmune conditions as rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis and Crohn's disease. They have shown effectiveness on reducing symptoms and modifying the progression of the disease. However, they disrupt the balance of inflammatory and immune responses and some risks associated with TNF-blockers have become apparent. The purpose of this article is to review the evidence about benefits and risk associated with the use of TNF-blockers in approved indications and to provide practical recommendations for its use in the management of this conditions.

[Drug interactions in the prescription of medical patients at hospital discharge]. / Interacciones entre medicamentos prescritos al alta en un Servicio de Medicina Interna.

OBJECTIVES: To detect and evaluate the clinical significance of drugs interactions in patients discharged from hospital. MATERIAL AND METHODS: We retrospectively screened the medication for potential drug interactions of 412 patients discharged. Interactions were catalogued according to clinical importance following the Hansten and Horn's classification. RESULTS: Three hundred twenty-nine potential interactions were detected. The 39.9% of the patients had at least one potentially interacting drug combination. The 52.6% of the interactions were catalogued as Class 3, bearing in mind minimizing the risk of the interaction. We did not find any Class 1 or 2 interactions, which have potentially major severity. Oral anticoagulants and digoxin were the most frequently implicated drugs. The patient monitoring was well done in the 100% of the interactions of Oral anticoagulants with other drug, but in the interactions of digoxin with another, this control was not done adequately. One patient was rehospitalised due to high levels of digoxin, he had been discharged with two potential interactions. CONCLUSIONS: The frequently of potential drug interactions in medical patients at hospital discharged was high, but the clinical significance appear to be low.

[Oral anticoagulation]. / Anticoagulación oral.

The use of oral anticoagulants in the prevention of thrombotics processes, has experienced a considerable increase. In addition, there are a growing experience on the medical and socials consequences of the use of this drug. This has originated a much more pragmatic vision of the daily handling of the anticoagulated patient. In this article, we made are vision about the indications and the practical use, including some useful advices and criteria for the concomitant drug selection.

[Use of beta-blockers for treatment of cardiac failure]. / Utilización de betabloqueadores en el tratamiento de la insuficiencia cardiaca.

The rationale for betablocker use in heart failure, based on neurohormonal physiology, has been established over the past 20 years. Recent trials have shown the unequivocal benefits of betablockers in patients with chronic systolic heart failure. The benefits include improve survival (35%) reduced need for hospitalization and improve of left ventricular function. However, betablockers may also make a patient with heart failure worse, especially when treatment begins and there is reluctance to use betablockade therapy. Complications can generally be avoided by starting with extremely low doses and increasing the dose very slowly. Despite this, further questions remain regarding the use of these agents in cardiac failure, including the role in the progression of the disease, the selection of individual betablocker, and the use in very severe disease or very old patients.