An individual patient data meta-analysis on factors associated with adverse drug events in surgical and non-surgical inpatients.

AIM: The incidence of adverse drug events (ADEs) in surgical and non-surgical patients may differ. This individual patient data meta-analysis (IPDMA) identifies patient characteristics and types of medication most associated with patients experiencing ADEs and suggests target areas for reducing harm and implementing focused interventions. METHODS: Authors of eligible studies on preventable ADEs (pADEs) were approached for collaboration. For assessment of differences among (non-)surgical patients and identification of associated factors descriptive statistics, Pearson chi-square, Poisson and logistic regression analyses were performed. For identification of high risk drugs (HRDs), a model was developed based on frequency, severity and preventability of medication related to ADEs. RESULTS: Included were 5367 patients from four studies. Patients aged ≥ 77 years experienced more ADEs and pADEs compared with patients aged ≤ 52 years (odds ratios (OR) 2.12 (95% CI 1.70, 2.65) and 2.55 (95% CI 1.70, 3.84), respectively, both P < 0.05). Polypharmacy on admission also increased the risk of ADEs (OR 1.21 (95% CI 1.03, 1.44), P < 0.05) and pADEs (OR 1.85 (95% CI 1.34, 2.56), P < 0.05). pADEs were associated with more severe harm than non-preventable ADEs (54% vs. 32%, P < 0.05). The top five HRDs were antibiotics, sedatives, anticoagulants, diuretics and antihypertensives. Events associated with HRDs included diarrhoea or constipation, abnormal liver function test and central nervous system events. Most pADEs resulted from prescribing errors (90%). CONCLUSION: Elderly patients with polypharmacy on admission and receiving antibiotics, sedatives, anticoagulants, diuretics or antihypertensives were more prone to experiencing ADEs. Efficiency in prevention of ADEs may be improved by targeted vigilance systems for alertness of physicians and pharmacists.

Expression pattern of osteopontin and αvß3 integrin during the implantation window in infertile patients with early stages of endometriosis.

BACKGROUND: To study endometrial receptivity in terms of osteopontin (OPN) and αvß3 integrin expression and co-expression in infertile women with early stages of endometriosis. METHODS: We investigated the immunohistochemical expression and co-expression of OPN and αvß3 integrin in the endometrium of 20 infertile patients with Stage I or II endometriosis as the only detectable cause of infertility, 20 infertile patients with unexplained infertility and 20 fertile women undergoing tubal sterilization. Two endometrial biopsies were performed during a single menstrual cycle (postovulatory Day +7 to +8 and 4 days later) in each subject. RESULTS: No statistically significant differences regarding OPN and αvß3 integrin expression were found between infertile patients with endometriosis and the two control groups. There was no significant correlation between OPN and αvß3 integrin staining intensity in the mid-luteal phase biopsies in any of the groups studied. CONCLUSIONS: Endometrial OPN and αvß3 integrin expression or co-expression is not impaired during the window of implantation in patients with Stage I-II endometriosis. Further studies are needed to determine whether these results imply normal endometrial receptivity in such patients or add to the increasing uncertainty about the clinical value of assessing the endometrium with these markers of implantation.

Pharmaceutical care in hospitalized patients. (Management of the COVID-19 pandemic crisis. A new challenge for pharmacy services).

During the pandemic caused by the SARS-CoV-2 virus, pharmacy services have  had to adapt their service portfolio, and yet ensure efficient, equitable and  quality pharmaceutical care. Given the limited scientific evidence available, most drugs have been used off-label or in the context of clinical trials, which should be the preferred option in order to create new evidence. Among kind different  situations we have faced are the increase in workload, the expansion of  coverage to new wards and ICUs and shortages, which have caused the use of  alternative drugs and even other routes of administration. Given that covid-19  affects elderly population with greater severity and many of them are  polymedicated, great effort have been focused on monitoring interactions, both  pharmacokinetic and pharmacodynamic (specially prolongation of the QT  interval), monitoring correct concentrations of electrolytes, nutritional support,  adaptation of chemotherapy treatment protocols and anticoagulant  management, among others. The use of personal protective equipment added  difficulty for nursing work and some measures had been taken to minimize the  number of entries into the rooms. Eventually, team's split to guarantee care, the challenge of teleworking, remote validation, telemedicine and telepharmacy for  communication between professionals and patients, as well as training in this pandemic situation have been a challenge for our profession. These  difficulties have risen up new learning opportunities we hope will be useful to us  in the event we have to face similar situations in the future.

La pandemia ocasionada por el virus SARS-CoV-2 ha hecho que los servicios de  farmacia hayan tenido que adaptar su cartera de servicios, y sin embargo  asegurar una atención farmacéutica eficiente, equitativa y de calidad. Dada la  escasa evidencia científica disponible, la mayoría de los medicamentos se han  empleado fuera de indicación o en el contexto de ensayos clínicos, que debería  ser la opción preferente para generar nueva evidencia. Entre las diversas  situaciones que se han tenido que afrontar se encuentran el incremento de  trabajo asistencial, la ampliación de la cobertura a nuevas salas y unidades de  cuidados intensivos y los desabastecimientos, que han ocasionado el uso de  fármacos alternativos e incluso otras vías de administración. Dado que la  COVID-19 afecta con mayor gravedad a población de edad avanzada, muchos de ellos polimedicados, se ha tenido que dedicar un gran esfuerzo al seguimiento de interacciones, tanto farmacocinéticas como farmacodinámicas (en especial,  prolongación del intervalo QT), monitorización de concentraciones correctas de  electrolitos, soporte nutricional, adaptación de pautas de quimioterapia y manejo e los anticoagulantes, entre otros. La dificultad adicional para enfermería de la  administración de medicamentos con equipos de protección individual ha  supuesto la adaptación de formas de administración para minimizar el número  de entradas en las habitaciones. Por último, el fraccionamiento del equipo para  garantizar la atención, el reto del teletrabajo, la validación en remoto, la  telemedicina y la telefarmacia para la comunicación entre profesionales y  pacientes, así como la formación en esta situación de pandemia, han supuesto  un reto para nuestra profesión. Estos desafíos han creado nuevas oportunidades  de aprendizaje que esperemos nos puedan ser de utilidad en el caso de que  tuviéramos que afrontar situaciones semejantes en el futuro.

[Pharmacokinetics and interactions of raltegravir]. / Farmacocinética e interacciones del raltegravir.

Raltegravir is the first integrase inhibitor approved for the treatment of HIV-1 infection in pretreated adults with evidence of viral replication despite receiving antiretroviral therapy. Raltegravir is administered orally at a dose of 400 mg every 12 hours, with or without food. This drug is mainly eliminated through UGT1A1-mediated glucuronidation and is not an inhibitor or inducer of the main liver cytochrome P450 isoenzymes; consequently there is virtually no risk of pharmacological interactions with most commonly used drugs such as methadone, azole antifungal agents or drugs used to treat erectile dysfunction. Studies of interaction with other antiretroviral agents show that raltegravir can be used in combination with tenofovir, efavirenz, atazanavir, ritonavir or tipranavir/ritonavir without the need for dose adjustments. When combined with rifampicin, the dose of raltegravir should be increased to 800 mg/12 h. Proton pump inhibitors increase plasma levels of raltegravir (a 3-fold increase in exposure or AUC levels), and consequently their combined use should be avoided as far as posible. Raltegravir is well tolerated and does not require dose adjustments in patients with severe renal impairment or mild-to-moderate liver impairment. There are no studies in patients with severe liver impairment.