A high-performance liquid chromatographic method for benznidazole quantitation in plasma of patients with Chagas disease.

BACKGROUND: Chagas disease is endemic in Latin America, affecting 16-18 million people with more than 100 million exposed to risk of infection. Its etiological agent is Trypanosoma cruzi. To date, benznidazole is the only treatment of Chagas disease available in Europe. METHODS: A high-performance reversed-phase isocratic liquid chromatographic method for benznidazole analysis in human plasma is described. The mobile phase consists of 60% ultrafiltered water and 40% acetonitrile. Samples were precipitated with trichloroacetic acid (0.3 M) (1/1, v/v). The injection volume was 100 µL. Benzocaine was used as internal standard. RESULTS: The assay was linear over a benznidazole concentration range of 1.6-100 µg/mL. The method showed good agreement of results (n=15): inaccuracy (5.6%), intra- and inter-day variability (1.1% and 3.9%, respectively), recovery (94.9%), limit of detection (0.8 µg/mL), lower limit of quantitation (1.6 µg/mL) and acceptable stability over 24 h in the auto-sampler. Only 25 samples (58%) showed values within the therapeutic range. Three samples were subtherapeutic and 15 were in the toxic range. CONCLUSIONS: The method offers a fast and simple approach to determining benznidazole in human plasma which could be of use in pharmacokinetic and safety studies.

[Adverse side effects of antiretroviral therapy: relationship between patients' perception and adherence]. / Reacciones adversas del tratamiento antirretroviral: relación entre los síntomas percibidos y el cumplimiento terapéutico.

BACKGROUND AND OBJECTIVE: To evaluate the relationship between perceived adverse side effects (AE) and non-adherence associated with highly active antiretroviral therapy (HAART). PATIENTS AND METHOD: For 6 consecutive months, patients taking HAART who came to the Pharmacy Department were interviewed. In the questionnaire they had to answer if they had experienced any AE over the past 6 months, what did they do in response to AE and what was the clinical evolution. Adherence was measured by pill counts or by pharmacy records (when pill counts were not possible). RESULTS: Of 1,936 interviewed patients, 661 (34.1%) reported AE over the past 6 months. The type of antiretroviral drug regimen and starting, re-starting or changing HAART over the past 6 months were significantly associated with AE. Patients who reported AE were 1.4 times more likely to be non-adherents. The most frequently reported AE were diarrhea followed by central nervous system abnormalities and by other gastrointestinal disturbances. In patients starting HAART, 62% of AE improved or disappeared during the first 4 weeks of therapy. CONCLUSIONS: Patients who report AE have worst adherence. AE are more frequent in patients starting HAART but in most cases they improve with time and/or symptomatic therapy.

Crisis in the health sector: Impact on nurses' working conditions. / Crisis en el sector sanitario: impacto percibido en las condiciones de trabajo de las enfermeras.

In a context of economic crisis and policies to reduce the public deficit, the budgets of the Catalan Health Institute (CHI) were cut by 15.33% between 2010 and 2014. OBJECTIVE: To assess the perceived impact on nurses' work conditions of measures to contain health spending. METHOD: The study design was descriptive and transversal. A sample of 1,760 nurses from the province of Barcelona answered a questionnaire on the perceived impact of health spending containment measures implemented in their workplace during the early years of the crisis. RESULTS: Among the main aspects of the perceived impact of these measures, 86.6% of the nurses identified a pay cut and an increase in the following relevant parameters of their working conditions: number of hours worked (66.7%), final ratio of treated patients (35.2%), task complexity and workload (75.3%), rotation through various departments (31.5%), work shifts (21.4%) or work areas (23.4%), job insecurity (58.4%) and loss of employment by dismissal (6.6%) or non-renewal of contract (9%). CONCLUSIONS: The perceived impact of the crisis showed a triple negative component: Pay cut, work overload and job insecurity. As a combined effect of this multiple trend, the nurses acknowledged a deterioration in their working conditions and quality of working life.

[Antiretroviral therapy of HIV infection: duration and reasons for changing the first therapeutic regimen in 518 patients]. / Tratamiento antirretroviral de la infección por el virus de la inmunodeficiencia humana: duración y motivos de cambio del primer esquema terapéutico en 518 pacientes.

BACKGROUND AND OBJECTIVE: Different combinations of antiretroviral drugs are used as initial HIV therapy but comparative studies between them are not frequent. The objectives of this study are to determine the median duration of different therapy combinations in naive patients between 1998-2000 and the main reasons for changing or stopping this first antiretroviral therapy (ARVT). PATIENTS AND METHOD: This study included a total of 518 naive patients who began antiretroviral therapy patients from 1998-2000. Using a Kaplan-Meier analysis the median duration of different combinations was determined. In addition, the main reasons for changing or stopping this first treatment were analysed. RESULTS: First ARVT median duration was 427 days (IQR: 114-890). 47% of patients stopped their first therapy due to adverse effects, 6% voluntarily withdrew from it, in 9% of patients the therapy was not effective and 15% of them were lost of follow up. Only 9% of them continued with the same ARVT at the end of the study but if we add 7% of treatment simplifications we can consider 16% of first ARVT successful. CONCLUSIONS: A median duration of 427 days, similar to other studies, is shorter than we would prefer for HIV, a condition that requires continuous treatment. On the other hand, the study corroborates that secondary effects are the principal problem associated with ARVT.

[Drug related problems as a cause of hospital admission]. / Problemas relacionados con la medicación como causa del ingreso hospitalario.

BACKGROUND: The goals of the present study were: a) to identify and characterize drug-related problems (adverse drug reactions, non-compliance and intentional overdose) leading to admissions to our hospital (Hospital Clínic) through the Emergency Department, b) to know the most frequently involved medications, c) to identify risk factors for hospital admissions due to drug-related problems, and d) to determine the avoidability of these admissions. PATIENTS AND METHOD: Prospective study carried out from August 1999 to November 1999 and from January 2000 to May 2000. The study included 1,800 admissions corresponding to 1,663 patients. RESULTS: Including definitive, probable and possible cases, 215 hospital admissions (11.9%) were drug-related ones. Of these cases, 108 (50.2%) corresponded to adverse drug reactions, 100 (46.5%) to dose-related therapeutic failures (mainly non-compliance) and 7 (3.3%) corresponded to intentional overdose. When 'possible' cases were excluded in order to achieve a better defined causative relationship, drug-related admissions dropped to 139 (7.7%). According to Schumock and Thornton criteria, 68.4% hospital admissions due to drug-related problems were considered 'avoidable'. Most avoidable admissions were due to non-compliance, absence of preventive therapy and inappropriate monitoring. CONCLUSIONS: Hospital admissions due to drug-related problems are frequent and often preventable.

Crisis en el sector sanitario: impacto percibido en las condiciones de trabajo de las enfermeras / Crisis in the health sector: Impact on nurses’ working conditions

En un contexto de crisis económica y de políticas de reducción del déficit público, los presupuestos del Instituto Catalán de la Salud (ICS) fueron recortados en un 15,33% entre 2010 y 2014. Objetivo: Evaluar el impacto percibido de las medidas de contención del gasto sanitario en las condiciones de trabajo de las enfermeras. Método: El diseño del estudio fue descriptivo y transversal. Una muestra de 1.760 enfermeras de la provincia de Barcelona respondió un cuestionario sobre el impacto percibido de las medidas de contención del gasto sanitario implementadas en su centro de trabajo durante los primeros años de la crisis. Resultados: Entre los aspectos principales del impacto percibido por las medidas de contención del gasto, un 86,6% de las enfermeras identificaron una reducción salarial. También percibieron un aumento en los siguientes parámetros relevantes de las condiciones de trabajo: número de horas trabajadas (66,7%), ratio definitivo de pacientes atendidos (35,2%), complejidad y presión asistencial (75,3%), rotación por diversos servicios (31,5%), cambio de turno (21,4%) o ámbito (23,4%) de trabajo, precariedad laboral (58,4%) y pérdida del empleo por despido (6,6%) o no renovación del contrato (9%). Conclusiones: El impacto percibido de la crisis mostró un triple componente de signo negativo: recorte salarial, sobrecarga de trabajo e inseguridad en el empleo. Y como efecto combinado de esta múltiple tendencia se reconoció un deterioro de las condiciones de trabajo y de la calidad de vida laboral de las enfermeras

In a context of economic crisis and policies to reduce the public deficit, the budgets of the Catalan Health Institute (CHI) were cut by 15.33% between 2010 and 2014. Objective: To assess the perceived impact on nurses’ work conditions of measures to contain health spending. Method: The study design was descriptive and transversal. A sample of 1,760 nurses from the province of Barcelona answered a questionnaire on the perceived impact of health spending containment measures implemented in their workplace during the early years of the crisis. Results: Among the main aspects of the perceived impact of these measures, 86.6% of the nurses identified a pay cut and an increase in the following relevant parameters of their working conditions: number of hours worked (66.7%), final ratio of treated patients (35.2%), task complexity and workload (75.3%), rotation through various departments (31.5%), work shifts (21.4%) or work areas (23.4%), job insecurity (58.4%) and loss of employment by dismissal (6.6%) or non-renewal of contract (9%). Conclusions: The perceived impact of the crisis showed a triple negative component: Pay cut, work overload and job insecurity. As a combined effect of this multiple trend, the nurses acknowledged a deterioration in their working conditions and quality of working life

Teicoplanin population pharmacokinetic analysis in hospitalized patients.

The goal of this study was to build a population pharmacokinetic (PK) model to characterize the population PK parameters in our hospitalized patients. Teicoplanin serum concentrations from clinical routine were used. Antibiotic dose history and blood collection times were recorded and analyzed with NONMEM-V. Demographic and biologic data creatinine clearance (CLcr), weight (WT), and albumin (Alb) were tested for inclusion as covariates in the basic model. Intraindividual and residual variability were modeled. One hundred seven sparse samples (mainly trough levels), from 79 patients, were included. A 2-compartment PK model characterized by clearance (CL), central compartment volume of distribution (Vc), intercompartment clearance, and steady-state volume of distribution (VSS) with first-order elimination adequately described the data. CLcr and WT significantly influenced teicoplanin CL (CL = 0.57[0.15]*(1+0.0048[0.39]*(CLcr - averageCLcr)*WT) L/h). VSS was not affected by any covariate (VSS = 50.2[0.13]L). A negative trend between Alb and individual VSS estimates was observed without statistical significance. In a new data set, bias and precision resulted in mean values of -3.24% and 9.42%, respectively. In conclusion, CLcr and WT are significant covariates on teicoplanin CL. Results from predictive accuracy and precision show the usefulness of this model for implementation in a therapeutic drug monitoring program in the near future.

Are higher vancomycin doses needed in ventricle-external shunted patients?

OBJECTIVE: Hydrocephalus is usually resolved by diverting cerebrospinal fluid through a surgically implanted intra-ventricular catheter (shunt). The aim of this study was to characterize vancomycin pharmacokinetic (PK) parameters and optimal dosage in shunted patients under vancomycin treatment. SETTING: Intensive Care and Neurosurgical Units. University Hospital. METHODS: Retrospective data of vancomycin blood concentrations, demographics and biochemical parameters, from a Therapeutic Drug Monitoring (TDM) program, in ventricle-external shunted patients (Group A) and controls (Group B) were collected. In all subjects, several blood samples at steady state conditions were drawn. Individual PK parameters such as drug clearance (CL) and volume of distribution (V) were estimated by using an one-compartmental PK model and later, dosage regimens were individually adjusted by Bayesian analysis. The obtained CL and V mean +/- standard deviation were compared between both groups (A versus B). Vancomycin dosage regimens between both groups were also compared. MAIN OUTCOME MEASURES: Patients demographics, clinical records, creatinine clearance by Cockcroft-Gault, vancomycin blood levels, vancomycin pK parameters and optimal initial IV vancomycin dosage. RESULTS: Forty-five patients were included in the study: 15 patients in group A and 30 subjects in group B. Significant differences between CL(A) and CL(B) means were observed, while not between V(A) and V(B). In shunted patients, the required vancomycin daily dose to reach target concentrations was significantly higher than the dose needed in the control group (49.25 +/- 12.28 mg/kg/day vs. 31.74 +/- 6.70 mg/kg/day; P < 0.0005). CONCLUSIONS: Greater vancomycin clearance was found in our shunted patients, thus they required higher vancomycin daily doses compared to the control group. Consequently, vancomycin TDM in shunted patients should be advisable in order to guarantee antibiotic blood concentrations within the recommended therapeutic range.

[Reflections on betalactam antibiotics administered by continuous infusion]. / Algunas reflexiones acerca de la administración de antibióticos betalactámicos en infusión continua.

Numerous studies on continuous intravenous infusion of betalactam antibiotics have indicated that this could be a useful strategy for treating nosocomial infections as well as exacerbations of pulmonary infections in patients with cystic fibrosis and episodes of febrile neutropenia. From the pharmacodynamic viewpoint, betalactam antibiotics have a time-dependent behavior. Thus, the pharmacokinetic/pharmacodynamic index that best correlates with therapeutic efficacy appears to be the time during which free antibiotic concentrations remain above the minimum inhibitory concentration (MIC) of the infecting microorganism. Continuous infusion of betalactams successfully optimizes this pharmacokinetic/ pharmacodynamic index. Furthermore, some studies have shown that this therapeutic strategy may be favorable economically.

El Capitalismo Organizacional como factor de riesgo Psicosocial:: Efectos psicológicos colaterales de las nuevas condiciones de trabajo en hospitales y universidades de naturaleza pública. Resultados Santander, Colombia / The Organizacional Capitalism as a Psychosocial risk factor: psychological collateral effects of the new working conditions in hospitals and universities of public nature. Results in Santander, Colombial

En esta investigación se analiza la subjetivación laboral del capitalismo organizacional a partir de las construcciones de significado de los trabajadores de hospitales y universidades públicas desarrolladas según: a) percepciones del entorno laboral, b) experiencia y sentido del trabajo, c) impacto psicosocial percibido en la calidad de vida laboral y el bienestar psicológico, y d) estrategias y prácticas de afrontamiento individual y colectivo de las demandas organizacionales. El estudio se desarrolló a través de una investigación de tipo cualitativo en la que se utilizó el análisis del discurso. Paralelamente, se aplicaron técnicas cuantitativas a efectos de realizar una triangulación de métodos como estrategia de investigación. Se desarrollaron entrevistas sobre las experiencias laborales actuales de los profesionales, acompañadas de la aplicación del Cuestionario de calidad de vida laboral (Blanch, 2008). Algunos resultados destacan como aspectos positivos: el compañerismo y mejoramiento de materiales; y entre los aspectos negativos, la sobrecarga laboral, el tipo de contratación, inestabilidad laboral y baja remuneración salarial.

This research analyzes the labor subjectification of organizational capitalism, considering the construction of meaning of workers in hospitals and universities in the public sector, developed according to: a) perceptions of the working environment, b) experience and meaning of work, c) perceived psychosocial impact on the quality of working life and psychological well-being, and d) strategies and practices of facing collective and individual organizational requirements. The study was developed through a qualitative research, by using discourse analysis. In parallel, we applied quantitative techniques, performing a triangulation of the methods as a research strategy. We conducted interviews in-depth, about current work experiences of professionals, along with the application of the questionnaire entitled Calidad de Vida Laboral (Blanch, 2008). Some of the results point out positive aspects like fellowship and the improvement of materials, and, as negative aspects, the excessive workload, the type of contract, job instability and wage compensation.

Tirofiban and eptifibatide treatment of patients presenting with acute coronary syndrome with non-ST segment elevation.

OBJECTIVE: This retrospective study was conducted to determine the usage patterns and tolerability of tirofiban and eptifibatide during the first year of their use. METHODS: We have assessed the appropriate use of these drugs according to the criteria implemented by the Clinical Institute of Cardiovascular Disease as part of a protocol for treating acute coronary syndrome with non-ST segment elevation. RESULTS: 37 patients received tirofiban and 19 patients received eptifibatide. These patients were at high risk of poor outcomes such as myocardial infarction or death. Tirofiban and eptifibatide were used according to the indication criteria: only one case fell outside them. Dosing, time for drug initiation (from last chest pain) and time of infusion were considered appropriate. Tirofiban was involved in two cases of minor bleeding complications and eptifibatide in one case of thrombocytopenia (80,000 platelets per millimeter). These mild adverse drug reactions were reversible with the early withdrawal of the drugs. CONCLUSIONS: This study shows that tirofiban and eptifibatide have been used optimally, with a close adherence to the pre-established protocol. Both drugs have shown a good level of tolerability.

[Characteristics of antiviral drugs]. / Características de los fármacos antivirales.

This article summarizes the principal characteristics of the drugs used to treat viral infections, with the exception of human immunodeficiency virus infection. It includes antiviral agents active against herpes virus, cytomegalovirus, hepatitis B and C virus, and respiratory viruses, such as influenza and respiratory syncytial virus. Dosage according to the indication, dose adjustment in the case of renal or hepatic insufficiency, significant pharmacokinetic characteristics, and the main adverse effects and interactions are described.

[Comparison of three methods to calculate adherence in patients receiving antiretroviral treatment]. / Comparación de tres métodos de cálculo de adherencia en pacientes con tratamiento antirretroviral.

INTRODUCTION: Knowledge of the patient's adherence to antiretroviral treatment is extremely useful for monitoring HIV infection. Several methods have been proposed to calculate adherence, but they all have certain problems at application. The aim of this study was to compare three of the available methods for assessing medication adherence in order to determine their accuracy for this purpose. PATIENTS AND METHODS: Three methods for evaluating medication adherence were prospectively studied: 1. Remaining pill count (RPC), 2. Structured interview (SI), and 3. Pharmacy registry of drug refills (DR). The RPC was considered the gold standard and sensitivity and specificity of the other methods was calculated according to the RPC. The study included 100 consecutive patients and had a follow-up of one year. RESULTS: We were able to assess all three methods in 69 cases. The percentages of patients taking 95% or more of the prescribed dose according to the three methods were 72.5% (RPC), 85.5% (SI) and 81.2% (DR). Taking the RPC as gold standard, there was 75.1% concordance with the DR and 75.1% with the SI method. The sensitivities of the DM and SI were 52.6 % and 42.1 %, respectively. After one year of follow-up, patients with > 90% adherence (RPC) had a 1.29-times higher probability of achieving good virological response (CI 95% 1.04-1.62, p 5 0.0138). CONCLUSION: Although concordance among the methods was acceptable, the SI and DR overestimated adherence as compared to the RPC. Since there is currently no ideal method for determining treatment adherence, it is important to combine several methods to minimize errors and provide results that are as close to the true situation as possible.

Calidad de vida laboral en centros asistenciales de salud catalanes / Quality of wor king life in Catalan health care centers

Objetivo. Evaluar la calidad de vida laboral en centros asistenciales de salud catalanes atendiendo a las valoraciones porel personal de las condiciones de trabajo y del clima sociolaboral en su centro.Método. Se aplicó un cuestionario incluyendo escalas de condiciones de trabajo y de clima sociolaboral en tres estudiostransversales independientes a personal empleado en centros asistenciales de salud catalanes. En el primero (2003) y el tercero(2008), la investigación fue realizada en un mismo centro hospitalario. En el segundo (2006), la encuesta se pasó a otros18 centros (hospitalarios y sociosanitarios) pertenecientes, como el anterior, a la XHUP (Red Hospitalaria de UtilizaciónPública de Cataluña). En conjunto, respondieron el cuestionario 2033 personas. El muestreo del primer estudio fue aleatorioy estratificado y el de los otros dos de conveniencia. Las muestras primera y tercera fueron homogéneas en cuanto a característicaspersonales y laborales generales. La segunda incluyó un mayor porcentaje de mujeres-enfermeras, más presentesen centros sociosanitarios.Resultados. En una escala de 0 a 10, la muestra total valoró con una media de 6 las condiciones de trabajo y de 6,5 elclima sociolaboral. Del primer estudio al tercero, las puntuaciones medias en ambas escalas tendieron a bajar y la presiónasistencial percibida a subir.Conclusiones. La calidad de vida laboral en los centros de salud evaluados mantuvo un nivel moderadamente aceptablepero tendiendo al empeoramiento en los años evaluados, posiblemente por el crecimiento de la presión asistencial percibida(AU)

Objective. To assess the quality of working life in Catalan health care centers as self-reported by staff through their evaluationof working conditions and social climate at work.Method. A questionnaire that included scales assessing working conditions and social climate was administered in threeseparate cross-sectional waves to personnel employed in Catalan health care centers. In the first (2003) and third (2008) waves, the survey was conducted in the same hospital. The second survey (2006) was conducted in 18 health centers ofthe XHUP (Public Use Hospital Network of Catalonia). Overall, 2033 people answered the questionnaire. The first studysample was random and stratified and the other two were convenience samples. The first and third samples were homogenouswith respect to general census characteristics. The second sample included a higher percentage of women-nurses, anda greater presence of social-health care centers.Results. Overall, on a scale of 0 to 10, the average scores for working conditions and social climate at work were 6 and6.5, respectively. From the first to the third study, mean scores on both scales showed a decreasing trend, while perceivedworkload tended to increase.Conclusions. The quality of working life in participating health centers shows a moderately acceptable level, but seemsto be decreasing over the study time period, possibly related to the perceived increase in workload(AU)

Violencia hacia profesionales de la salud en su lugar de trabajo. Incidentes violentos notifi cados por internet en Catalunya entre 2005 y 2007: resultados de un estudio piloto / Workplace violece against healthcare workers. Internet-based reporting of violence incidents in catalonia, 2005 - 2007. Results of a pilot study

Objetivo: Presentar el diseño y los resultados preliminares de la aplicación del sistema informatizado de Notifi cación de Incidente Violento (NIV) en el ámbito sanitario. Método: A lo largo del bienio 2005-2006, el sistema NIV se ha implementado la web www.violenciaocupacional.net en 38 centros sanitarios de Catalunya que participan voluntariamente en el proyecto. Esta web, que incluye el Cuestionario de Violencia Ocupacional, permite un registro integrado de incidentes violentos contra profesionales de la salud en tiempo real y de modo confi dencial. Una sola persona notifi ca on-line los incidentes de cada centro. El notifi cador pertenece a los departamentos de Recursos Humanos o de Prevención de Riesgos Laborales y ha sido especialmente designado por su propia institución para esta función. Resultados: En el período comprendido entre el 01-01-2005 y el 31-03-07 han sido notifi cados 501 incidentes violentos desde 38 centros en los que trabajan unas 18.000 personas. En el 35% de los casos se da cuenta de agresión física y en el 83 % de la de tipo verbal (que a menudo acompaña a la anterior). Los incidentes afectan a personal de enfermería (42%), médico (35%), técnico y administrativo (16%) y de otros sectores (7%). Conclusión: El sistema NIV constituye una técnica novedosa de recogida de información sobre la violencia ocupacional en el sector sanitario. Los resultados preliminares de su aplicación piloto reafi rman la importancia del problema investigado, ratifi can tendencias observadas por otros estudios locales e internacionales y señalan elementos clave para la agenda de la investigación y la intervención en este campo

Objective: To present the design and preliminary results of application of the computerised Violent Incident Notifi cation (NIV) system in the healthcare sector. Methods: In the 2005-2006 biennium, the www.violenciaocupacional.net website was launched in 38 healthcare centres in Catalonia, all of whom participate voluntarily in this project. This website features a Workplace Violence Questionnaire that allows confi dential, real-time, integrated reporting of violent incidents against health care workers. Each centre has a single designated individual, employed in either the human resources or occupational health departments, charged with submitting the online reports. Results: From January 1 2005 through March 31 2007, a total of 501 violent incidents were reported from the 38 healthcare centers, which collectively employ nearly 18,000 persons. Physical assaults accounted for 35% of the cases and verbal aggression (which may occur together with physical assaults) were reported in 83% of cases. These incidents primarily affected nursing (42%), medical (35%), technical and administrative (16%), and other (7%) personnel. Conclusion: The NIV system is a new technique for collecting information on workplace violence in the healthcare sector. Preliminary results of its pilot application underscore the importance of the problem investigated, confi rm previously described trends in other local and international studies, and identify some key elements for further investigation and intervention

Reacciones adversas del tratamiento antirretroviral: relación entre los síntomas percibidos y el cumplimiento terapéutico / Adverse side effects of antiretroviral therapy: relationship between patients perception and adherence

Fundamento y objetivo: Evaluar la relación entre las reacciones adversas percibidas (RA) y la falta de cumplimiento del tratamiento antirretroviral de gran actividad (TARGA). Pacientes y método: Durante 6 meses consecutivos se realizó una encuesta a los pacientes con TARGA atendidos en la Unidad de Farmacia Ambulatoria. En el cuestionario debían indicar si habían experimentado alguna RA durante los 6 meses anteriores, cómo actuaron y cuál fue la evolución clínica. El cumplimiento terapéutico se calculó mediante el recuento de medicación sobrante o por registro de dispensaciones (en los casos en que no fue posible realizar recuento). Resultados: De 1.936 pacientes encuestados, 661 (34,1%) refirieron RA durante los 6 meses anteriores. La aparición de RA mostró una relación estadísticamente significativa con el tipo de tratamiento y con el hecho de haber iniciado, reiniciado o cambiado de TARGA durante los 6 meses anteriores. Los pacientes que refirieron RA presentaron un riesgo 1,4 veces superior de falta de cumplimiento del TARGA. Las RA más frecuentes fueron diarrea, toxicidad en el sistema nervioso central y otras alteraciones digestivas. En los pacientes que habían iniciado TARGA, el 62% de las RA mejoraron o desaparecieron durante las 4 primeras semanas de tratamiento. Conclusiones: Los pacientes que refieren RA presentan un peor cumplimiento terapéutico. Las RA son mucho más frecuentes en los pacientes que inician TARGA, pero en muchos casos mejoran con el tiempo y/o tratamiento sintomático

Background and objective: To evaluate the relationship between perceived adverse side effects (AE) and non-adherence associated with highly active antiretroviral therapy (HAART). Patients and method: For 6 consecutive months, patients taking HAART who came to the Pharmacy Department were interviewed. In the questionnaire they had to answer if they had experienced any AE over the past 6 months, what did they do in response to AE and what was the clinical evolution. Adherence was measured by pill counts or by pharmacy records (when pill counts were not possible). Results: Of 1,936 interviewed patients, 661 (34.1%) reported AE over the past 6 months. The type of antiretroviral drug regimen and starting, re-starting or changing HAART over the past 6 months were significantly associated with AE. Patients who reported AE were 1.4 times more likely to be no adherents. The most frequently reported AE were diarrhea followed by central nervous system abnormalities and by other gastrointestinal disturbances. In patients starting HAART, 62% of AE improved or disappeared during the first 4 weeks of therapy. Conclusions: Patients who report AE have worst adherence. AE are more frequent in patients starting HAART but in most cases they improve with time and/or symptomatic therapy

Algunas reflexiones acerca de la administración de antibióticos betalactámicos en infusión continua / Reflections on betalactam antibiotics administered by continuous infusion

Son numerosos los trabajos de investigación que se han publicado acerca de la administración de antibióticos betalactámicos en infusión continua. Los resultados obtenidos indican que podría tratarse de una estrategia terapéutica de gran utilidad en el tratamiento de la infección nosocomial, las agudizaciones de las infecciones pulmonares de pacientes con fibrosis quística y el tratamiento de la neutropenia febril. Desde el punto de vista farmacodinámico, los antibióticos betalactámicos tienen un patrón de actividad dependiente del tiempo y es el tiempo durante el cual la concentración de antibiótico libre supera la concentración inhibitoria mínima del microorganismo responsable de la infección, el índice farmacocinético/farmacodinámico que mejor se correlaciona con la eficacia clínica. La administración de betalactámicos en infusión continua logra maximizar el citado índice, y además algunos estudios indican que podría resultar también ventajosa en términos económicos (AU)

Numerous studies on continuous intravenous infusion of betalactam antibiotics have indicated that this could be a useful strategy for treating nosocomial infections as well as exacerbations of pulmonary infections in patients with cystic fibrosis and episodes of febrile neutropenia. From the pharmacodynamic viewpoint, betalactam antibiotics have a time-dependent behavior. Thus, the pharmacokinetic/pharmacodynamic index that best correlates with therapeutic efficacy appears to be the time during which free antibiotic concentrations remain above the minimum inhibitory concentration (MIC) of the infecting microorganism. Continuous infusion of betalactams successfully optimizes this pharmacokinetic/ pharmacodynamic index. Furthermore, some studies have shown that this therapeutic strategy may be favorable economically (AU)