Tratamiento para tuberculosis resistente a rifampicina o multirresistente: análisis comparativo de indicadores programáticos entre Buenaventura y otros municipios del Valle del Cauca, Colombia / Treatment for multidrug-resistant tuberculosis: A comparative analysis of programmatic outcome indicators between Buenaventura and other municipalities of Valle del Cauca, Colombia

Resumen Introducción. El manejo adecuado de la tuberculosis multirresistente es una estrategia priorizada para el control de la tuberculosis en el mundo. Objetivo. Evaluar las diferencias entre las características demográficas y clínicas, y los indicadores programáticos de los pacientes con diagnóstico confirmado de tuberculosis pulmonar resistente a rifampicina o multirresistente en Buenaventura, frente a la cohorte de los demás municipios del Valle del Cauca entre 2013 y 2016. Materiales y métodos. Se desarrolló un estudio analítico de cohortes para comparar los registros de pacientes mayores de 15 años con tuberculosis multirresistente, del Programa de Tuberculosis de Buenaventura (con ácido paraaminosalicílico), frente a los demás municipios del Valle del Cauca (sin ácido paraaminosalicílico). Resultados. Se registraron 99 casos con una mediana de edad de 40 años (RIC = 26 - 53); en Buenaventura, el 56 % eran mujeres; en los demás municipios, predominaron los hombres (67 %); el 95 % de los evaluados tenía aseguramiento en salud. La comorbilidad más frecuente fue diabetes (14 %). Las reacciones adversas a medicamentos antituberculosos en Buenaventura fueron 1,3 veces más frecuentes que en los demás municipios (OR = 2,3; IC95 %: 0,993 - 5,568; p = 0,04). En Buenaventura falleció el 5 % de los casos frente al 15 % reportado en los demás municipios. No hubo fracasos con el tratamiento en Buenaventura, pero se reportó un 35 % de pérdida del seguimiento. El éxito del tratamiento fue mayor en Buenaventura en el 56 %. Conclusión. El programa fortalecido de Buenaventura presentó mejores resultados programáticos que los demás municipios del Valle del Cauca. El acceso a pruebas moleculares, la disponibilidad de tratamientos acortados y el seguimiento continuo para identificar reacciones adversas a medicamentos antituberculosos son un derrotero para todos los programas de control.

Abstract Introduction. Proper management of multidrug-resistant tuberculosis is a prioritized strategy for tuberculosis control worldwide. Objective. To evaluate differences concerning demographic and clinical characteristics and programmatic indicators of Buenaventura patient cohort with confirmed diagnosis of multidrug-resistant tuberculosis, compared to those of the other municipalities from Valle del Cauca, Colombia, 2013-2016. Materials and methods. We conducted an analytical cohort study to compare records of patients older than 15 years with multidrug-resistant tuberculosis included in the Programa de Tuberculosis de Buenaventura (with para-aminosalicylic acid) versus the other municipalities of Valle del Cauca (without para-aminosalicylic). Results. Ninety-nine cases were recorded with a median age of 40 years (IQR = 26 - 53); in Buenaventura, 56% of the patients were women, while in the other municipalities, men predominated with 67%; 95% had health insurance. The most common comorbidity was diabetes (14%). Adverse reactions to antituberculosis medications in Buenaventura were 1.3 times more frequent than in the other municipalities (OR = 2.3; 95% CI = 0.993 - 5.568; p = 0.04). In Buenaventura, the mortality rate was 5% compared to the 15% reported in the other municipalities. Treatment failures were not reported in Buenaventura, but 35% did not continue with the follow-up. Treatment success was higher in Buenaventura (56 %). Conclusion. A strengthened program in Buenaventura presented better programmatic results than those from the other municipalities of Valle del Cauca. Access to molecular tests, availability of shortened treatments, and continuous monitoring to identify adverse reactions to antituberculosis medications are routes for all other control programs.

Prediction of adverse drug reactions in geriatric patients admitted to intensive care units. / [Artículo traducido] Predicción de reacciones adversas a medicamentos en pacientes geriátricos ingresados en unidades de cuidados intensivos.

INTRODUCTION: Intensive Care Units (ICUs) pose challenges in managing critically-ill patients with polypharmacy, potentially leading to Adverse Drug Reactions (ADRs), particularly in the elderly. OBJECTIVE: To evaluate whether the severity and clinical prognosis scores used in ICUs correlate with the prediction of ADRs in aged patients admitted to an ICU. METHODS: A cohort study was conducted in a Brazilian University Hospital ICU. APACHE II and SAPS 3 assessed clinical prognosis, while GerontoNet ADR Risk Score and BADRI evaluated ADR risk at ICU admission. Severity of the patients' clinical conditions was evaluated daily based on the SOFA score. Adverse Drug Reaction (ADR) screening was performed daily through the identification of ADR triggers. RESULTS: 1295 triggers were identified (median 30 per patient, IQR = 28), with 15 suspected ADRs. No correlation was observed between patient severity and ADRs at admission (p=0.26), during hospitalization (p=0.91), or at follow-up (p=0.77). There was also no association between death and ADRs (p=0.28) or worse prognosis and ADRs (p>0.05). Higher BADRI scores correlated with more ADRs (p=0.001). CONCLUSIONS: The data suggest that employing the severity and clinical prognosis scores used in Intensive Care Units is not sufficient to direct active pharmacovigilance efforts, which are therefore indicated for critically ill patients.

Pharmacotherapy assessment and adverse drug reactions in older patients admitted to intensive care.

INTRODUCTION: Older patients are more susceptible to medication use, and physiological changes resulting from aging and organic dysfunctions presented by critically ill patients may alter the pharmacokinetic or pharmacodynamic behavior. Thus, critically ill older people present greater vulnerability to the occurrence of pharmacotherapeutic problems. OBJECTIVE: To evaluate pharmacotherapy and the development of potential adverse drug reactions (ADRs) in older patients admitted to an intensive care unit (ICU). METHOD: A cohort study was conducted in an ICU for adults of a Brazilian University Hospital during a 12-month period. The patients' pharmacotherapy was evaluated daily, considering the occurrence of ADRs and drug-drug interactions (DDIs), the use of potentially inappropriate medications (PIMs) for older people, and the pharmacotherapy anticholinergic burden (ACB). A trigger tool was used for active search of ADRs, with subsequent causality evaluation. PIM use was evaluated by means of the Beers criteria and the STOPP/START criteria. The ABC scale was employed to estimate ACB. The Micromedex® and Drugs.com® medication databases were employed to evaluate the DDIs. RESULTS: The sample of this study consisted of 41 patients, with a mean age of 66.8 years old (±5.2). The 22 triggers used assisted in identifying 15 potential ADRs, and 26.8% of the patients developed them. The mean estimated ACB score was 3.0 (±1.8), and the patients used 3.1 (±1.4) and 3.3 (±1.6) PIMs according to the Beers and the STOPP criteria, respectively. A total of 672 DDIs were identified, with a mean of 16.8 (±9.5) DDIs/patient during ICU hospitalization. Our findings show an association between occurrence of ADRs in the ICU and polypharmacy (p=.03) and DDIs (p=.007), corroborating efforts for rational medication use as a preventive strategy. CONCLUSIONS: Using tools to evaluate the pharmacotherapy for older people in intensive care can assist in the recognition and prevention of pharmacotherapeutic problems, with emphasis on the identification of ADRs through the observation of triggers and subsequent causality analysis.

Exploring the impact of pharmacogenetics on personalized medicine: A systematic review. / [Artículo traducido] Exploración del impacto de la farmacogenética en la medicina personalizada: una revisión sistemática.

INTRODUCTION: Pharmacogenetics evaluates how genetic variations influence drug responses. Nowadays, genetic tests have advanced, becoming more affordable, and its integration is supported by stronger clinical evidence. Guidelines such as those from CPIC (Clinical Pharmacogenetics Implementation Consortium) and resources like PharmGKB facilitate genotype-based prescribing; and organizations like the FDA promote genetic testing before initiating certain medications. Preventive pharmacogenetic panels seem promising, but further research on biomarkers and diverse populations is needed. The aim of this review is to analyze recent evidence on the genotype-drug response relationship to examine how the genetic profile of patients influences the clinical response to treatments, and analyze the areas of research that need further study to advance towards a genetic-based precision medicine. MATERIALS AND METHODS: A systematic search was conducted on PubMed to identify articles investigating the genotype-drug response relationship. The search strategy included terms such as "pharmacogenetics", "personalized treatment", "precision medicine", "dose adjustment", "individualized dosing", "clinical routine" and "clinical practice." Clinical trials, observational studies, and meta-analyses published in English or Spanish between 2013 and 2023 were included. The initial search resulted in a total of 136 articles for analysis. RESULTS: 49 articles were included for the final analysis following review by two investigators. A relationship between genetic polymorphisms and drug response or toxicity was found for drugs such as opioids, GLP-1 agonists, tacrolimus, oral anticoagulants, antineoplastics, atypical antipsychotics, efavirenz, clopidogrel, lamotrigine, anti-TNF-α agents, voriconazole, antidepressants, or statins. However, for drugs like metformin, quetiapine, irinotecan, bisoprolol, and anti-VEGF agents, no statistically significant association between genotype and response was found. CONCLUSION: The studies analyzed in this review suggest a strong correlation between genetic variability and individual drug responses, supporting the use of pharmacogenetics for treatment optimization. However, for certain drugs like metformin or quetiapine, the influence of genotype on their response remains unclear. More studies with larger sample sizes, greater ethnic diversity, and consideration of non-genetic factors are needed. The lack of standardization in analysis methods and accessibility to genetic testing are significant challenges in this field. As a conclusion, pharmacogenetics shows immense potential in personalized medicine, but further research is required.

Prediction of adverse drug reactions in geriatric patients admitted to intensive care units.

INTRODUCTION: Intensive care units (ICUs) pose challenges in managing critically ill patients with polypharmacy, potentially leading to adverse drug reactions (ADRs), particularly in the elderly. OBJECTIVE: To evaluate whether the severity and clinical prognosis scores used in ICUs correlate with the prediction of ADRs in aged patients admitted to an ICU. METHODS: A cohort study was conducted in a Brazilian University Hospital ICU. APACHE II and SAPS 3 assessed clinical prognosis, while GerontoNet ADR Risk Score and BADRI evaluated ADR risk at ICU admission. Severity of the patients' clinical conditions was evaluated daily based on the SOFA score. ADR screening was performed daily through the identification of ADR triggers. RESULTS: 1295 triggers were identified (median 30 per patient, IQR=28), with 15 suspected ADRs. No correlation was observed between patient severity and ADRs at admission (p=0.26), during hospitalization (p=0.91), or at follow-up (p=0.77). There was also no association between death and ADRs (p=0.28) or worse prognosis and ADRs (p>0.05). Higher BADRI scores correlated with more ADRs (p=0.001). CONCLUSIONS: These data suggest that employing the severity and clinical prognosis scores used in ICUs is not sufficient to direct active pharmacovigilance efforts, which are therefore indicated for critically ill patients.

Antivirales de acción directa contra la hepatitis C: revisión narrativa / Direct acting antivirals against hepatitis C: Literature review

Desde los años ochenta se ha explorado el tratamiento para el virus de la hepatitis C, aunque en ese entonces los medicamentos disponibles eran poco toleradas y poco eficaces. En el 2011, la introducción de antivirales de acción directa transformó significativamente el curso de la enfermedad, logrando tasas de curación superiores al 90 % en los pacientes. Este avance ha permitido prevenir complicaciones futuras con efectos adversos mínimos. La presente revisión aborda la línea de tiempo del descubrimiento de los antivirales, su mecanismo de acción, sus indicaciones y potencial impacto en la salud pública.

Since the 1980s, the treatment of hepatitis C has been explored, although at that time, the available medications were poorly tolerated and ineffective. In 2011, the introduction of direct-acting antivirals significantly transformed the course of the disease, achieving cure rates of over 90% in patients. This advance has made it possible to prevent future complications with minimal adverse effects. This review addresses the timeline of the discovery of antivirals, their mechanism of action, and their impact on medicine.

Effectiveness and safety of adalimumab biosimilar in patients with inflammatory bowel disease.

BACKGROUND: Adalimumab biosimilar MSB11022 (Idacio ®) has been approved for the same indications as its originator (Humira ®), based on findings from clinical trials in plaque psoriasis. Data on its efficacy and safety in inflammatory bowel disease, however, are scarce. METHODS: Retrospective, observational study of 44 patients with inflammatory bowel disease: 30 were treated with originator adalimumab, 5 were directly started on MSB11022, and 9 switched from originator to biosimilar adalimumab. To evaluate the effectiveness of the use of adalimumab in inflammatory bowel disease, both laboratory markers (fecal calprotectin and C-reactive protein) and scales that measure the activity of inflammatory bowel disease using specific scales (Harvey-Bradshaw Index (HBI) have been usEd.) for Crohn's disease and Mayo Score for Ulcerative Colitis. Efficacy was evaluated by recording the adverse effects that could occur with the administration of adalimumab (original or biosimilar). The success of the switch was determined by analyzing meaningful differences in effectiveness and safety criteria. Concomitant therapy and the need for dose intensification were also analyzed. Objective of this study was to assess the effectiveness and safety of biosimilar adalimumab in adalimumab-naïve patients and patients switched from originator adalimumab. RESULTS: No significant differences were observed in clinical disease activity (P=.317) or biochemical parameters [fecal calprotectin (P=.445) and C-reactive protein P=.661)] after the switch from the originator adalimumab to MSB11022. There was not a significant reduction in the concomitant use of corticosteroids and thiopurines (P=.157). No emergency room visits or hospitalizations were observed during the study period and none of the patients experienced serious adverse effects. CONCLUSIONS: Between originator adalimumab and biosimilar-start cohorts, no differences were observed, between originator adalimumab and switch cohorts, no significant differences were found either, and with the pre- and post-switch to biosimilar comparison, 2 of the 9 patients experienced AEs after the switch. The biosimilar showed a favorable safety profile (one patient with a serious adverse effect (rash) with biosimilar discontinued treatment) and no significant changes to clinical or biochemical parameters were observed after the switch.

As reações adversas frente ao uso de analgésicos e sedativos em cuidados intensivos pediátricos: implicações para a enfermagem / Adverse reactions to the use of analgesics and sedatives in pediatric intensive care: implications for Nursing

A pouca sedação em Unidades de Terapia Intensiva Pediátrica (UTIP) pode gerar estresse psicológico e físico desnecessário, além de extubação acidental. Em contrapartida, a super sedação pode provocar o uso da ventilação mecânica prolongada, levando ao maior tempo de internação dentro da UTIP, além de síndrome de abstinência, tolerância e delírio. Neste sentido, delimitou-se como objeto de estudo a identidade do cuidado de enfermagem frente às reações adversas do uso de analgésicos e sedativos nas crianças gravemente doentes. Os objetivos são: descrever as reações adversas do uso de sedativos e analgésicos identificadas pela equipe de enfermagem; analisar a prática do cuidado da equipe de enfermagem frente às reações adversas do uso de sedativos e analgésicos nas crianças; e discutir as implicações da prática do cuidado da enfermagem prestada à criança que apresenta reações adversas no uso de analgésicos e sedativos. Trata-se de um estudo de abordagem qualitativa. Foram entrevistados 15 membros da equipe de enfermagem que trabalhavam em uma UTIP de um hospital especializado em doenças crônicas e raras, utilizando-se a técnica de entrevista, o formulário de caracterização dos participantes, o diário de campo para observação não participante e a coleta de informações nos prontuários. Contou-se com o apoio do software Iramuteq para realizar a Análise Textual Discursiva. Obteve-se que as principais reações adversas identificadas pelos profissionais de enfermagem foram irritabilidade, choro e agitação. A prática do cuidado de enfermagem é desenvolvida de acordo com as reações adversas previamente identificadas e varia conforme profissional de enfermagem que atende a criança, não existindo um padrão institucional pré-estabelecido. Entre os cuidados descritos estão: banho momo, administração de doses fracionadas de sedação segundo a prescrição médica e acalento pelo familiar responsável ou pelo próprio profissional. No entanto, não foram observados registros no prontuário acerca dessas reações adversas, bem como desses cuidados relatados. Destaca-se que existe insegurança por parte da equipe de enfermagem no que tange os seus conhecimentos sobre as reações adversas relacionadas ao uso de sedativos e analgésicos e, como implicações para a prática, a falta de identidade no seu cuidado interferindo em sua autonomia e protagonismo profissional, sendo a figura do médico percebida como o mais atuante nessa temática. Conclui-se que a equipe de enfermagem reconhece alguns sinais e sintomas das reações adversas no uso de sedativos e analgésicos. Todavia, se faz necessário um aprimoramento e atualizações frente à utilização desses medicamentos, suas reações adversas e cuidados que devem ser prestados, de modo a reconhecer sua atuação e perceber sua posição dentro da equipe multiprofissional.

Inadequate sedation in Pediatric Intensive Care Units (PICU) can generate unnecessary psychological and physical stress, in addition to accidental extubating. On the other hand, oversedation can lead to the use of prolonged mechanical ventilation, leading to longer hospitalization in the PICU in addition to withdrawal syndrome, tolerance, and delirium. In this sense, the identity of nursing care in the face of adverse reactions from the use of analgesics and sedatives in seriously ill children was defined as the object of study. The objectives are to describe the adverse reactions caused using sedatives and analgesics identified by the nursing team; analyze the care practice of the nursing team in the face of adverse reactions from the use of sedatives and analgesics in children; and discuss the implications of nursing care practice provided to children who present adverse reactions to the use of analgesics and sedatives. This is a qualitative study. Fifteen members of the nursing team who worked in a PICU of a hospital specializing in chronic and rare diseases were interviewed, using the interview technique, the participant characterization form, the field diary for non-participant observation and data collection. information in medical records. The Iramuteq software was supported, and discursive textual analysis was used. It was found that the main adverse reactions identified by nursing professionals were irritability, crying and agitation. The practice of nursing care is developed according to previously identified adverse reactions and varies depending on the nursing professional who cares for the child, and there is no pre-established institutional standard. Among the care described are warm bath, administration of fractional doses of sedation according to medical prescription and comfort by the responsible family member or by the professional himself, however, no records were observed in the medical records regarding these adverse reactions, as well as this reported care. It is noteworthy that there is insecurity on the part of the nursing team regarding their knowledge about adverse reactions related to the use of sedatives and analgesics and, as implications for practice, the lack of identity in their care, interfering with their autonomy and protagonism professional, with the doctor being perceived as the most active on this topic. It is concluded that the nursing team recognizes some signs and symptoms of adverse reactions in the use of sedatives and analgesics, however, improvement and updates are necessary regarding the use of these medications, their adverse reactions and the care that must be provided to recognize their performance and understand their position within the multidisciplinary team.

Una mala sedación en las Unidades de Cuidados Intensivos Pediátricos (UCIP) puede generar estrés psicológico y físico innecesario, además de extubaciones accidentales. Por otro lado, la sobresedación puede llevar al uso de ventilación mecánica prolongada, provocando una hospitalización más prolongada en la UCIP además de síndrome de abstinencia, tolerancia y dehrio. En este sentido, se definió como objeto de estudio la identidad del cuidado de enfermería ante las reacciones adversas por el uso de analgésicos y sedantes en niños gravemente enfermos. Los objetivos son: describir las reacciones adversas provocadas por el uso de sedantes y analgésicos identificadas por el equipo de enfermería; analizar la práctica de cuidados del equipo de enfermería ante las reacciones adversas por el uso de sedantes y analgésicos en niños; y discutir las implicaciones de la práctica de los cuidados de enfermería brindados a niños que presentan reacciones adversas al uso de analgésicos y sedantes. Este es un estudio cualitativo. Se entrevistó a quince miembros del equipo de enfermería que trabajaban en una UCIP de un hospital especializado en enfermedades crónicas y raras, utilizando la técnica de la entrevista, la ficha de caracterización participante, el diario de campo para la observación no parficipante y la recolección de información en historias clínicas. Se apoyó el software Iramuteq y se utiliz6 análisis textual discursivo. Se encontró que las principales reacciones adversas identificadas por los profesionales de enfermería fueron irritabilidad, llanto y agitaci6n. La práctica del cuidado de enfermería se desarrolla según reacciones adversas previamente identificadas y varía dependiendo del profesional de enfermería que atiende al niño, no existiendo un estándar institucional preestablecido. Entre los cuidados descritos se encuentran: baño tibio, administración de dosis fraccionadas de sedación según prescripción médica y confort por parte del familiar responsable o por el propio profesional, sin embargo, no se observaron registros en las historias clínicas respecto a estas reacciones adversas, así como estos ínformamn cuidados. Se destaca que existe inseguridad por parte del equipo de enfermería respecto de su conocimiento sobre las reacciones adversas relacionadas al uso de sedantes y analgésicos y, como implicaciones para la práctica, la falta de identidad en su cuidado, interfiriendo en su autonomía y protagonismo profesional, siendo el médico el más activo en este tema. Se concluye que el equipo de enfermería reconoce algunos signos y síntomas de reacciones adversas en el uso de sedantes y analgésicos, sin embargo, es necesario mejorar y actualizar respecto al uso de estos medicamentos, sus reacciones adversas y los cuidados que se deben brindar para reconocer su desempeño y comprender su posición dentro del equipo multidisciplinario.

Comparison of efficacy and safety of the new generation helixone dialyzers.

INTRODUCTION: New generation helixone dialyzers has recently been developed as part of the ongoing effort to improve dialyzer hemocompatibility and avoid adverse reactions to synthetic dialyzers. This study aimed to assess the performance and albumin loss of this new dialyzer series in hemodiafiltration and compare it with the previous generation helixone series. MATERIAL AND METHODS: A prospective study was conducted in 19 patients. Each patient underwent eight dialysis sessions with the same routine dialysis parameters; only the dialyzer varied: FX60 CorDiax, FX CorAL 60, FX600 CorDiax, FX CorAL 600, FX80 CorDiax, FX CorAL 80, FX800 CorDiax, and FX CorAL 800. The reduction ratios (RR) of urea, creatinine, ß2-microglobulin, myoglobin, kappa-free immunoglobulin light chains (κFLC), prolactin, α1-microglobulin, α1-acid glycoprotein, lambda immunoglobulin light chains (λFLC), and albumin were compared intra-individually. Dialysate albumin loss was also measured. RESULTS: All treatments were well tolerated. The mean amount of replacement fluid ranged from 31 to 34 L. Comparison of dialysis treatments showed no differences between small molecules and even up to those the size of ß2-microglobulins. Little differences were found between myoglobin, κFLC, prolactin, α1-microglobulin, and λFLC RRs, and only FX80 CorDiax was slightly superior to the others. Mean dialysate albumin losses were similar, with less than 2.5 g lost in each dialyzer. The FX80 CorDiax showed slightly higher global removal scores than the other dialyzers evaluated, except for FX CorAL 800. CONCLUSION: The new generation helixone dialyzers series has been updated to minimise the risk of adverse reactions, while maintaining the effectiveness and albumin loss achieved by the previous most advanced helixone generation.

Acute pancreatitis due to different semaglutide regimens: An updated meta-analysis.

OBJECTIVES: Some concerns persist regarding the safety of semaglutide. The objective of this updated meta-analysis is to assess the risk of acute pancreatitis with the use of semaglutide, assessing the results according to the different administration regimens. METHODS: We performed an updated meta-analysis of randomised, placebo-controlled studies of semaglutide therapy that report acute pancreatitis. This meta-analysis was performed in line with PRISMA guidelines. A global and stratified analysis according to the therapeutic scheme used was performed using the fixed-effects model. RESULTS: Twenty-one eligible trials of semaglutide, including 34,721 patients, were identified and considered eligible for the analyses. Globally, semaglutide therapy was not associated with an increased risk of acute pancreatitis (OR 0.7; 95% CI 0.5-1.2, I2 0%). When we analysed the studies according to the different schemes used, the results were similar (group with oral semaglutide: OR 0.40; 95% CI 0.10-1.60, I2 0%; group with low subcutaneous doses of semaglutide: OR 0.80; 95% CI 0.40-1.90, I2 0%; group with high subcutaneous doses of semaglutide: OR 0.70; 95% CI 0.50-1.20, I2 0%; interaction p-value=0.689). CONCLUSION: This updated meta-analysis demonstrates that the use of semaglutide is not associated with an increased risk of acute pancreatitis compared to placebo. In the stratified analysis, the results were similar with the different semaglutide regimens analysed.

Exploring the impact of pharmacogenetics on personalized medicine: A systematic review.

INTRODUCTION: Pharmacogenetics evaluates how genetic variations influence drug responses. Nowadays, genetic tests have advanced, becoming more affordable, and its integration is supported by stronger clinical evidence. Guidelines such as those from CPIC (Clinical Pharmacogenetics Implementation Consortium) and resources like PharmGKB facilitate genotype-based prescribing; and organizations like the FDA promote genetic testing before initiating certain medications. Preventive pharmacogenetic panels seem promising, but further research on biomarkers and diverse populations is needed. The aim of this review is to analyze recent evidence on the genotype-drug response relationship to examine how the genetic profile of patients influences the clinical response to treatments, and analyze the areas of research that need further study to advance towards a genetic-based precision medicine. MATERIALS AND METHODS: A systematic search was conducted on PubMed to identify articles investigating the genotype-drug response relationship. The search strategy included terms such as "pharmacogenetics", "personalized treatment", "precision medicine", "dose adjustment", "individualizing dosing", "clinical routine", and "clinical practice." Clinical trials, observational studies, and meta-analyses published in English or Spanish between 2013 and 2023 were included. The initial search resulted in a total of 136 articles for analysis. RESULTS: 49 articles were included for the final analysis following review by 2 investigators. A relationship between genetic polymorphisms and drug response or toxicity was found for drugs such as opioids, GLP-1 agonists, tacrolimus, oral anticoagulants, antineoplastics, atypical antipsychotics, efavirenz, clopidogrel, lamotrigine, anti-TNFα agents, voriconazole, antidepressants, or statins. However, for drugs like metformin, quetiapine, irinotecan, bisoprolol, and anti-VEGF agents, no statistically significant association between genotype and response was found. CONCLUSION: The studies analyzed in this review suggest a strong correlation between genetic variability and individual drug responses, supporting the use of pharmacogenetics for treatment optimization. However, for certain drugs like metformin or quetiapine, the influence of genotype on their response remains unclear. More studies with larger sample sizes, greater ethnic diversity, and consideration of non-genetic factors are needed. The lack of standardization in analysis methods and accessibility to genetic testing are significant challenges in this field. As a conclusion, pharmacogenetics shows immense potential in personalized medicine, but further research is required.

Percepção dos profissionais de enfermagem sobre manejo de reação infusional a antineoplásicos: estudo qualitativo / Perception of nursing professionals on the management of infusion reactions to antineoplastics: qualitative study

Identificar a percepção dos profissionais de enfermagem sobre o manejo de reação infusional imediata a antineoplásicos. Método: Trata-se de um estudo descritivo de caráter exploratório com abordagem qualitativa realizado em um hospital no Rio Grande do Sul. Resultados: Todos os participantes afirmaram saber identificar uma reação infusional. Após a identificação da reação, nota-se que a maioria obedeceu a uma ordem de condutas a serem realizadas. Quanto aos cuidados para prevenção das reações infusionais, a maioria dos participantes mencionou a administração de medicamentos pré-quimioterápicos, como antialérgicos e antieméticos. Conclusão: Os achados demonstram que a maioria dos profissionais sabe reconhecer e manejar, porém há a necessidade de treinamentos e padronização das ações.(AU)

To identify the perception of nursing professionals about the management of immediate infusion reactions to antineoplastic drugs. Method: This is a descriptive, exploratory study with a qualitative approach carried out in a hospital in Rio Grande do Sul. Results: All the participants said they knew how to identify an infusion reaction. After identifying the reaction, it was noted that the majority followed an order of conduct to be carried out. As for precautions to prevent infusion reactions, most of the participants mentioned the administration of pre-chemotherapy drugs, such as anti-allergic and anti-emetic drugs. Conclusion: The findings show that most professionals know how to recognize and manage them, but there is a need for training and standardization of actions.(AU)

Identificar la percepción de los profesionales de enfermería sobre el manejo de las reacciones infusionales inmediatas a medicamentos antineoplásicos. Método: Se trata de un estudio descriptivo, exploratorio, con abordaje cualitativo, realizado en un hospital de Rio Grande do Sul. Resultados: Todos los participantes afirmaron saber identificar una reacción a la infusión. Después de identificar la reacción, la mayoría siguió un orden de conducta. En cuanto a las precauciones para prevenir las reacciones a la infusión, la mayoría de los participantes mencionó la administración de fármacos prequimioterápicos, como antialérgicos y antieméticos. Conclusión: Los hallazgos muestran que la mayoría de los profesionales saben reconocerlas y manejarlas, pero es necesaria la formación y la estandarización de actuaciones.(AU)

Análisis de reacciones adversas a medicamentos por fármacos antipsicóticos en un instituto de salud mexicano / Analysis of adverse drug reactions caused by antipsychotic drugs in a mexican health institute

RESUMEN Introducción: Las reacciones adversas a medicamentos (RAM) son manifestaciones clínicas o de laboratorio no deseadas que se relacionan con el consumo de medicamentos. Las RAM se asocian con un riesgo significativo de morbimortalidad e ingresos hospitalarios. Los antipsicóticos poseen una reducida ventana terapéutica y se han relacionado con la manifestación de una diversidad de RAM. Objetivo: Evaluar el patrón de las RAM debido a fármacos antipsicóticos, detectadas en pacientes atendidos en el Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz entre diciembre de 2021 y mayo de 2022. Métodos: Estudio observacional, descriptivo, prospectivo y transversal de una serie de casos. La gravedad, la severidad y la calidad de la información de la notificación de las RAM se definieron conforme a la NOM-220-SSA1-2016, instalación y operación de la farmacovigilancia, mientras que la causalidad se determinó mediante el algoritmo de Naranjo. Resultados: La incidencia de las RAM fue del 59% y se detectó una o más RAM en 52 de los 88 pacientes que estaban en tratamiento antipsicótico durante el periodo de estudio. El 45% de las RAM tuvo una causalidad probable y el 55%, posible; únicamente tres RAM se clasificaron como graves, debido a que prolongaron la estancia hospitalaria y pusieron en peligro la vida del paciente. Conclusiones: Las RAM de los sistemas gastrointestinal y endocrino fueron las más incidentes, y la hiperprolactinemia fue la más frecuente. La olanzapina y clozapina fueron los medicamentos que más RAM provocaron. Se recomienda fomentar la cultura de notificación y seguimiento de RAM causadas por fármacos antipsicóticos.

ABSTRACT Introduction: Adverse Drug Reactions (ADR) are unwanted clinical or laboratory manifestations that are related to drug use. ADR are common and are associated with significant risk of morbidity, mortality and hospital admissions. Antipsychotics have a reduced therapeutic window, and have been related to the manifestation of a variety of ADR. Objetive: To evaluate the pattern of ADRs due to antipsychotic drugs detected in patients treated at the Ramón de la Fuente Muñiz National Institute of Psychiatry between December 2021 and May 2022. Methods: Observational, descriptive, prospective and cross-sectional study of a series of cases. The seriousness, severity, and quality of the information in the notification of the ADR were defined in accordance with NOM-220-SSA1-2016, Installation and Operation of Pharmacovigilance, while causality was determined using the Naranjo algorithm. Results: The incidence of ADRs was 59%, with one or more ADR detected in 52 of the 88 patients who were receiving antipsychotic treatment during the study period. Forty-five percent of the ADR had probable causality and 55% possible; only three ADR were classified as serious as they prolonged the hospital stay and endangered the patient's life. Conclusions: The ADR of the gastrointestinal and endocrine systems were the most incidental, with hyperprolactinemia being the most frequent. Olanzapine and clozapine were the medications that caused the most ADR. It is recommended to promote the culture of notification and follow-up of ADR caused by antipsychotic drugs.

Eficacia y seguridad del uso extendido de anticonceptivos orales combinados / Efficacy and safety of extended use of combined oral contraceptives

Los anticonceptivos orales combinados constituyen hoy en día uno de los métodos anticonceptivos más populares a nivel mundial. Su composición consiste en una combinación de análogos de hormonas sexuales femeninas que se administran en bajas dosis diarias, manteniendo constante su concentración sanguínea y evitando de esta forma los cambios en el eje endócrino que estimulan la ovulación. Con el objetivo de recrear los procesos fisiológicos, la mayoría de las formulaciones comprenden un intervalo de 4 a 7 días libres de hormonas en el cual se genera el sangrado por deprivación.A partir de una viñeta clínica en la que una paciente sana desea posponer su hemorragia por deprivación, y tras realizar una búsqueda bibliográfica que prioriza las investigaciones más recientes y de mejor calidad, la autora revisa la evidencia sobre el uso de hormonas sin intervalo libre, especialmente su efectos sobre la eficacia y la incidencia de efectos adversos. (AU)

Nowadays, combined oral contraceptives are one of the most popular contraceptive methods worldwide. Its composition consists of a combination of similar female sex hormones administered in low daily doses, keeping their blood concentration constant and thus avoiding changes in the endocrine axis that stimulate ovulation. In order to recreate physiological processes, most formulations include an interval of 4 to 7 hormone-free days in which withdrawal bleeding occurs.Starting from a clinical vignette in which a healthy patient desires to postpone her withdrawal bleeding, and after conducting a bibliographic search that prioritizes the most recent and best-quality research, the author reviews the evidence about the use of hormones without free interval, especially their effects on efficacy and the incidence of adverse effects. (AU)

Eventos adversos pós-vacina contra o papilomavírus humano em adolescentes: revisão sistemática da literatura / Adverse events following human papillomavirus vaccine in adolescents: systematic review of the literature / Eventos adversos tras la vacuna contra el virus del papiloma humano en adolescentes: revisión sistemática de la literatura

Objetivo: O objetivo desse estudo foi investigar a ocorrência de Eventos Supostamente Atribuídos a Vacinação e/ou Imunização associados à vacina Papilomavírus Humano entre adolescentes de ambos os sexos. Métodos:Trata-se de uma revisão sistemática, realizada segundo os preceitos do Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Resultados: Inicialmente, foram identificados 11.016 artigos e, após a remoção de duplicidades, restaram 6.824. Destes, 59 foram selecionados para leitura na íntegra. Ao final, nove estudos compuseram a amostra. Os resultados indicam que a maioria dos Eventos Supostamente Atribuídos a Vacinação e/ou Imunização foram leves e moderados, prevalecendo eventos no local da injeção, como a dor e edema. Os Eventos Supostamente Atribuídos a Vacinação e/ou Imunização sistêmicos mais frequentes foram a febre, cefaleia, fadiga e tontura. Conclusão: A vacina contra o Papilomavírus Humano para os adolescentes é segura, reforçando-se sua importância como estratégia para diminuir as taxas de incidência dos cânceres associados ao Papilomavírus Humano.

Objective: The objective of this study was to investigate the occurrence of Events Supposedly Attributable to Vaccination and/or Immunization associated with the Human Papillomavirus vaccine among adolescents of both sexes. Methods: This is a systematic review carried out according to the principles of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Results: Initially, 11,016 articles were identified, of which 6,824 remained after removing duplicates, and 59 of these were selected for full reading. The sample comprised nine studies. The results indicate that most Events Supposedly Attributable to Vaccination and/or Immunization were mild and moderate, and events at the injection site, such as pain and edema, prevailed. The most common systemic Events Supposedly Attributable to Vaccination and/or Immunization were fever, headache, fatigue and dizziness. Conclusion: The Human Papillomavirus vaccine for adolescents is safe, reinforcing its importance as a strategy to reduce the incidence rates of Human Papillomavirus associated cancers

Objetivo: El objetivo de este estudio fue investigar la ocurrencia de Eventos Supuestamente Atribuibles a la Vacunación o Inmunización asociados a la Vacuna contra el Virus del Papiloma Humano entre adolescentes de ambos sexos. Métodos: Se trata de una revisión sistemática realizada según la declaración Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Resultados:Se identificaron 11.016 artículos y, tras eliminar duplicados, quedaron 6.824. De ellos, 59 fueron seleccionados para lectura completa. La muestra estuvo compuesta por nueve estudios. Los resultados indican que la mayoría de los Eventos Supuestamente Atribuibles a la Vacunación o Inmunización fueron leves y moderados, prevaleciendo los eventos en el lugar de la inyección, como dolor y edema. Los Eventos Supuestamente Atribuibles a la Vacunación o Inmunización sistémicos más comunes fueron fiebre, dolor de cabeza, fatiga y mareos. Conclusión: La vacuna contra el Virus del Papiloma Humano para adolescentes es segura, lo que refuerza su importancia como estrategia para reducir las tasas de incidencia de cánceres asociados al Virus del Papiloma Humano.

Predicción de toxicidad de la quimioterapia y radioterapia en el paciente oncológico quirúrgico

Fundamento la toxicidad asociada a los tratamientos de quimioterapia y radioterapia eleva la morbilidad y la mortalidad en los pacientes oncológicos. Objetivo diseñar un modelo predictivo de toxicidad de la quimioterapia y la radioterapia en el paciente oncológico quirúrgico. Métodos estudio analítico, de casos y controles, en pacientes oncológicos quirúrgicos que cumplieron los criterios de inclusión para la predicción de toxicidad preoperatoria, en el periodo enero a diciembre de 2022, en el Hospital Provincial Docente Oncológico María Curie, de Camagüey. Mediante el paquete estadístico Statistical Package for the Social Sciences, se seleccionó una muestra aleatoria de 334 pacientes, 197 sin toxicidad (grupo control) y 137 con toxicidad (grupo de estudio). Se realizó estimación de predictores de toxicidad mediante regresión logística binaria. Se seleccionó el modelo de mejor ajuste. Resultados el modelo en el paso tres predice un porcentaje global de 83,5 % con respecto a los valores observados. La sensibilidad resultó ser de 81,8; y la especificidad, 84,8. El modelo presentó buen poder discriminativo. Las variables en la ecuación fueron: hipertensión arterial, fracción de eyección del ventrículo izquierdo y anemia. La comparación de la predicción con la realidad, mediante curva Receiver Operating Characteristic determinó un área bajo la curva de 0,901. Conclusión se obtuvo una función de regresión logística que permitió la estimación de la probabilidad de toxicidad en pacientes oncológicos quirúrgicos electivos, la cual proporcionó una herramienta para su predicción desde el preoperatorio.

Foundation the toxicity associated with chemotherapy and radiotherapy treatments increases morbidity and mortality in cancer patients. Objective to design a predictive model of chemotherapy and radiotherapy toxicity in surgical cancer patients. Methods analytical, case-control study, in surgical oncology patients who met the inclusion criteria for the prediction of preoperative toxicity, from January to December 2022, at the María Curie Provincial Teaching Oncology Hospital in Camagüey. Using the Statistical Package for the Social Sciences, a random sample of 334 patients was selected, 197 without toxicity (control group) and 137 with toxicity (study group). Toxicity predictors were estimated using binary logistic regression. The model with the best fit was selected. Results the model in step three predicts an overall percentage of 83.5% with respect to the observed values. The sensitivity turned out to be 81.8; and the specificity, 84.8. The model presented good discriminative power. The variables in the equation were: arterial hypertension, left ventricular ejection fraction, and anemia. The comparison of the prediction with reality, using the Receiver Operating Characteristic curve, determined an area under the curve of 0.901. Conclusion a logistic regression function was obtained that allowed the estimation of the toxicity probability elective surgical cancer patients, which provided a tool for its prediction from the preoperative period.

Design and validity of the Spanish version of two questionnaires related to adverse reactions to foodstuffs.

Introduction: Introduction: there is an emerging current necessity of valid questionnaires, encompassing most of food, beverages, diseases, signs and symptoms currently related to the pathogenesis of adverse reactions to foodstuffs (ARFS) in the Spanish population. Objectives: this study aimed to design and validate two questionnaires to assess ARFS in the Spanish population, Food and Beverages Frequency Consumption Questionnaire to Identify Adverse Reactions to Foodstuffs (FBFC-ARFSQ-18); and Pathologies and Symptomatology Questionnaire associated with Adverse Reactions to Foodstuffs (PSIMP-ARFSQ-10). Methods: both questionnaires were designed adapting questionnaires from the literature; and validated, using the expert judgment method, in five phases: questionnaires development, pilot test and reliability, content validity, face validity, and ethical considerations. Questionnaires were developed using the REDCap™ tool hosted at the Universidad Politécnica de Madrid. A total of 20 Spanish experts evaluated the questionnaires. Cronbach's alpha reliability coefficients were calculated using SPSS version 25.0 (IBM Corp., Armonk, NY-USA) and Aiken's V coefficient values were calculated using ICaiken.exe (Visual Basic 6.0, Lima-Perú). Results: a final construct of questions was designed, ensuring no overlap, for FBFC-ARFSQ-18 and PSIMP-ARFSQ-10. Cronbach's alpha reliability coefficients were 0.93 and 0.94; and Aiken's V coefficient values were 0.90 (0.78-0.96 CI) and 0.93 (0.81-0.98 CI) for FBFC-ARFSQ-18 and PSIMP-ARFSQ-10, respectively. Conclusions: both validated questionnaires could be used to analyze the association between certain food and beverages consumption with ARFS, such as food allergies and food intolerances; also, to investigate the link between some specific diseases, signs and symptoms with ARFS.

Introducción: Introducción: actualmente, existe una necesidad emergente de cuestionarios validados que abarquen la mayor parte de los alimentos, bebidas, enfermedades, signos y síntomas relacionados con la patogénesis de las reacciones adversas a los alimentos (RAA). Objetivos: diseñar y validar dos cuestionarios para evaluar las RAA en población española, el Cuestionario de Frecuencia de Consumo de Alimentos y Bebidas para Identificar Reacciones Adversas de Origen Alimentario (CFCAB-RAA-18); y el Cuestionario de Patologías y Sintomatología Asociadas a Reacciones Adversas a Alimentos (PSIMP-RAA-10). Métodos: ambos cuestionarios se diseñaron adaptando cuestionarios de la literatura y se validaron, utilizando el método de juicio de expertos, en cinco fases: desarrollo de cuestionarios, prueba piloto y confiabilidad, validez de contenido, validez aparente y consideraciones éticas. Los cuestionarios se desarrollaron utilizando la herramienta REDCap™. Un total de 20 expertos evaluaron los cuestionarios. Se calcularon coeficientes de confiabilidad alfa de Cronbach con SPSS versión 25.0 (IBM Corp., Armonk, NY-Estados Unidos) y valores del coeficiente V de Aiken con ICaiken.exe (Visual Basic 6.0, Lima-Perú). Resultados: se diseñó una construcción final de preguntas, evitando solapamiento entre ambas herramientas. Los coeficientes de confiabilidad alfa de Cronbach fueron 0,93 y 0,94, y los valores del coeficiente V de Aiken fueron 0,90 (IC: 0,78-0,96) y 0,93 (IC: 0,81-0,98) (CFCAB-RAA-18 y PSIMP-RAA-10, respectivamente). Conclusiones: ambos cuestionarios fueron validados y podrían utilizarse para analizar la asociación entre el consumo de determinados alimentos y bebidas con las RAA, como alergias e intolerancias alimentarias, así como para investigar el vínculo entre algunas enfermedades, signos y síntomas específicos con las RAA.

Prevalencia nacional de Eventos Adversos Medicamentosos en pacientes hospitalizados / Adverse Drug Events in Hospitalized Patients in Chile: Prevalence & Implications

OBJETIVO: El propósito de este trabajo es estudiar la prevalencia de eventos adversos medicamentosos (EAM) en pacientes hospitalizados durante el período 2019-2020 en Chile. Además, como parte de la investigación, se realizó una validación del método que etiqueta la ocurrencia de EAM en base a los diagnósticos de egreso de los casos analizados. Diseño: La prevalencia de EAM fue estudiada para cerca de 1,7 millones de pacientes, para los cuales se analizó, además de los diagnósticos CIE10 de egreso, información sociodemográfica e indicadores de resultado sanitario de la atención, tales como el peso GRD, largo de estadía y mortalidad. Para la validación del método de identificación de EAM, se seleccionó una muestra aleatoria representativa estratificada por sexo y especialidad médica del año 2019 en un hospital público de Chile, cuyos resúmenes de egreso fueron analizados por un grupo de expertos de forma retrospectiva. Resultados: Los resultados muestran una prevalencia de EAM u otras sustancias de 2,7% y 3,1% en los egresos hospitalarios de los años 2019 y 2020 a nivel nacional y una precisión del instrumento de al menos un 83,3% (IC 90%). Conclusiones: Este estudio permite describir un fenómeno por medio de la estimación basada en datos reales, el cual es esencial para el diseño de políticas públicas en salud y estudios que apunten a enriquecer la calidad y seguridad del paciente.

OBJETIVE: To study the prevalence of adverse drug events (ADE) in hospitalized patients in Chile. As part of our research, we also assessed the validity of the method used to identify the occurrence of an ADE based on the discharge diagnoses of the patient. Design: The study included 1,7 million patients hospitalized during 2019-2020. We analyzed the following variables for each patient: ICD-10 discharge diagnoses, sociodemographic information, and clinical outcome indicators, i.e., diagnosis-related group (DRG) weight, length of stay, and mortality. To validate the method for the identification of ADEs, first, we generated a random representative sample of patients, stratified by sex and medical specialty, hospitalized in a Chilean public hospital in 2019, and then we compared the outcome of the method with the opinion of a group of clinical experts that reviewed each patient's discharge summary retrospectively. Results: The prevalence of ADEs in hospitalized patients in Chile during 2019 and 2020 was 2,7% and 3,1%, respectively. The precision of the method used to identify ADEs was 83,3% or higher (CI 90%). Conclusions: This paper uses nationwide data to describe the prevalence of ADEs and their correlation with different factors associated with the patient, the patient's disease, and the health service. These studies are essential to designing public health policies that effectively address healthcare quality and patient safety.

Reacciones adversas a múltiples antibióticos / Adverse drug reactions to multiple antibiotics

Resumen La información sobre reacciones adversas es fundamental para conocer la seguridad real de los medicamentos comercializados. Existen casos de pacientes con síndrome de intolerancia a múl tiples drogas, una entidad poco reportada, la que puede presentarse cuando en un mismo paciente ocurren reacciones adversas a más de dos medicamentos no relacionados farmacológicamente. Se describe el caso de una mujer con diagnóstico de endocarditis por Staphylococcus aureus multisensible, que cursó con reacciones adversas a cinco antibióticos estructuralmente no relacionados y con mecanismos de acción diferentes, en dos internaciones consecutivas. Las reacciones fueron secundarias a cefazolina (tricitopenia), vancomicina (injuria renal), daptomicina (elevación de creatina fosfoquinasa) y linezolid (hepatotoxicidad) en la primera internación, y a cotrimoxazol (plaquetopenia) en la segunda. En todos los casos se observó daño transitorio en diferentes sistemas de órganos. Finalmente, se otorgó alta hospitalaria con clindamicina sin nuevas intercurrencias hasta finalizar tratamiento. Este caso podría corresponder al síndrome antes mencionado o a una entidad aún no caracterizada.

Abstract Adverse reaction reporting is essential to understand the actual safety of marketed medicines. There are cases of patients with multidrug intolerance syndrome, an under-reported entity, which can occur when adverse reactions to more than two pharmacologically unrelated drugs occur in the same patient. We describe the case of a woman diagnosed with multisensitive Staphylococcus aureus endocarditis who experienced adverse reactions to five structurally unrelated antibiotics with different mechanisms of action in two consecutive hospitalisations. The reactions were secondary to cefazolin (tricytopenia), vancomycin (renal injury), daptomycin (elevated creatine phosphokinase) and linezolid (hepatotoxicity) in the first hospitalization, and to cotrimoxazole (thrombocytopenia) in the second. Transient damage to different organ systems was observed in all cases. Finally, hospital discharge was granted with clindamycin without further intercurrences until treatment was completed. This case could cor respond to the aforementioned syndrome or to an as yet uncharacterized entity.

DRESS, una reacción alérgica no mediada por IgE / DRESS, a Non-IgE Mediated Allergic Reaction

Resumen El síndrome de reacción a medicamentos con eosinofilia y síntomas sistémicos (DRESS, por sus siglas en inglés) es una respuesta de hipersensibilidad multisistémica poco frecuente inducida por uno o varios medicamentos que puede inducir una reacción adversa cutánea grave, la cual es difícil de diagnosticar y pone en peligro la vida del paciente si no es identificada y no se recibe tratamiento. Frecuentemente, se manifiesta como una erupción cutánea amplia, linfadenopatía, signos de afectación de órganos viscerales y alteraciones hematológicas, como leucocitosis, eosinofilia y, en ocasiones, linfocitosis atípica que se presentan de 2 a 8 semanas posterior a la administración del fármaco responsable. Los medicamentos responsables con mayor número de reportes son la fenitoína, la carbamazepina, el alopurinol y el abacavir. Se han identificado algunos alelos específicos del antígeno leucocitario humano (HLA) que se asocian a la hipersensibilidad de estos fármacos. La fisiopatología del síndrome de DRESS aún no se conoce por completo, generalmente se trata de una respuesta de hipersensibilidad mediada por células T, al interactuar con el receptor del complejo principal de histocompatibilidad en individuos con factores de susceptibilidad genética, como ocurre en otros cuadros de reacciones graves secundarias a la ingesta de fármacos. Los criterios del European Registry of Severe Cutaneous Adverse Reactions to Drugs (RegiSCAR) son los más utilizados para su diagnóstico. El síndrome de hipersensibilidad inducido por fármacos (DiHS), el síndrome de Stevens-Johnson (SSJ), la necrólisis epidérmica tóxica (NET), y la pustulosis exantemática generalizada aguda (PEGA) deben considerarse ante cualquier exantema que aparezca posterior a la administración de cualquier fármaco. La terapia incluye la eliminación del agente causal lo antes posible, así como los corticosteroides sistémicos, los cuales son los pilares del tratamiento.. Los agentes ahorradores de esteroides, como la ciclosporina, las inmunoglobulinas intravenosas (IVIGs) y otros agentes inmunosupresores, se han utilizado con éxito para contribuir al tratamiento.

Abstract DRESS (drug reaction syndrome with eosinophilia and systemic symptoms) is a rare drug-induced multisystemic hypersensitivity response that can induce a severe cutaneous adverse reaction that is difficult to diagnose and treat. It frequently manifests as an extensive skin rash, systemic symptoms, lymphadenopathy, visceral organ involvement, and hematological alterations, mainly leukocytosis, eosinophilia, and sometimes atypical lymphocytosis that manifest 2 to 8 weeks after continuous administration of the responsible drug. The most prevalent drugs related with this syndrome are phenytoin, carbamazepine, allopurinol, and abacavir. Some specific human leukocyte antigen (HLA) alleles have been identified that are associated with hypersensitivity to these drugs. The pathophysiology of DRESS syndrome is not yet fully understood; the main hypothesis is a T-cell mediated hypersensitivity response when interacting with the major histocompatibility complex receptor in individuals with genetic susceptibility factors. The criteria of the European Registry of Severe Cutaneous Adverse Reactions to Drugs (RegiSCAR) are the most commonly used for the diagnosis of DRESS syndrome. Drug-induced hypersensitivity syndrome (DiHS), Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and acute generalized exanthematous pustulosis (AGEP) should be considered for any rash that appears following the administration of any drug. Therapy of DRESS includes the elimination of the causative agent as soon as possible, as well as systemic corticosteroids which are the cornerstones of treatment. Steroid-sparing agents such as cyclosporine, intravenous immunoglobulins (IVIGs), and other immunosuppressive agents have been used successfully to contribute to treatment.