الملخص
Introducción: Uno de cada siete pacientes hospitalizados experimenta un evento adverso relacionado con la administración de medicación. Los errores de medicación son una de las causas más importantes de mortalidad y morbilidad prevenible. Objetivo: Evaluar la eficacia de una intervención formativa sobre la población de enfermeras de turno de noche de un hospital de agudos para mejorar el cumplimiento del protocolo de administración segura de medicación. Métodos: Ensayo experimental, pre-post intervención formativa, realizado en Hospital Clínic de Barcelona, durante 2015-2016. Población: 268 enfermeras en dos turnos de noche, muestra: 177 participantes (88 Grupo Control y 89 Grupo Experimental). La intervención consistió en sesiones informativas y acceso a Procedimiento escrito. El instrumento de medida fue el Procedimiento Normalizado de Trabajo de la institución mediante check-list de cumplimiento. Se realzó estudio uni-bivariable, mediante Chi2 y test de Fisher con significancia para p < 0,05. Resultados: Se realizaron 219 observaciones en Grupo Control y 207 en Grupo Experimental. De 17 variables analizadas, solo tres mostraron diferencias significativas: en Grupo Experimental mejoró el conocimiento del Procedimiento; se incrementó el uso del agua y jabón sobre la solución hidroalcohólica; y empeoró la identificación normalizada de fármacos pendientes de administrar. Ninguna de las 14 variables restantes mostró diferencias significativas. De 426 observaciones, solo se produjeron 3 errores de medicación en Grupo control, subsanados antes de su administración, y 0 en Grupo Experimental. Conclusiones: Las intervenciones formativas clásicas con receptores pasivos pueden no ser eficaces para mejorar la práctica enfermera en administración segura de medicación(AU)
Introduction: One in seven hospitalized patients experiences an adverse event related to administration of medication. Medication errors are one of the most important causes of preventable mortality and morbidity. Objective: To assess the efficacy of a training intervention with the population of night shift nurses in an acute care hospital, in order to improve compliance with the protocol for the safe administration of medication. Methods: Experimental trial, pre-post training intervention, carried out at Hospital Clínic of Barcelona, during 2015-2016. The population consisted of 268 nurses in two night shifts. The sample consisted of 177 participants (88 from the control group and 89 from the experimental group). The intervention consisted in information sessions and access to a written procedure. The measurement instrument was the Institution's Standard Work Procedure by means of a compliance check-list. Uni-bivariate study was performed, using chi-square and Fisher's test with a significance of P < 0.05. Results: 219 observations were carried out in the control group and 207, in the experimental group. Of seventeen variables analyzed, only three showed significant differences: in the experimental group, knowledge of the procedure improved, increase in the use of soap and water over hydroalcoholic solution, and worsening of standardized identification of drugs pending from being administered. None of the fourteen remaining variables showed significant differences. Of 426 observations, only three medication errors occurred in the control group, corrected before its administration, and zero occurred in the experimental group. Conclusions: Classic training interventions with passive receptors may not be effective to improve nursing practice in safe administration of medication(AU)
الموضوعات
Humans , Drug-Related Side Effects and Adverse Reactions/etiology , Education, Nursing/methods , Shift Work Schedule/adverse effects , Medication Errors/adverse effects , Pharmaceutical Preparations , Hydroalcoholic Solutionالملخص
Abstract With the development of new cancer therapies, systemic toxicity profile and effects on survival achieved an important improvement. However, a constellation of toxicities has emerged, even more remarkably, cutaneous adverse events. This report, developed by a board of Brazilian experts in oncodermatology, aims to establish a guideline for the dermatological care of oncologic patients. When possible, evidence-based recommendations were made, but in many cases, when strong evidence was not available, a consensus was reached, based on some data supporting therapies combined with personal experiences.
الموضوعات
Humans , Skin Diseases/chemically induced , Drug-Related Side Effects and Adverse Reactions/etiology , Neoplasms/drug therapy , Antineoplastic Agents/adverse effects , Skin/drug effects , Risk Factors , Administration, Topical , Neoplasms/complicationsالموضوعات
Humans , Pneumonia, Viral/drug therapy , Arrhythmias, Cardiac/chemically induced , Coronavirus Infections/drug therapy , Arrhythmias, Cardiac/prevention & control , Drug-Related Side Effects and Adverse Reactions/etiology , Drug-Related Side Effects and Adverse Reactions/prevention & control , Pandemics , COVID-19 , Heart Ventricles/physiopathologyالملخص
As iatrogenias são ações decorrentes de intervenções médicas, ou de membro/s de uma equipe médica, que resultem em consequências indesejáveis ou prejudiciais à saúde de um indivíduo hospitalizado. O objetivo deste estudo foi identificar iatrogenias medicamentosas que ocorreram com pacientes idosos internados no Hospital Regional da cidade de Coari, estado de Amazonas, Brasil. Os dados foram coletados de 100 prontuários, dos quais se identificou, por meio de um instrumento criado pelos autores, que a omissão de doses foi a iatrogenia mais frequente em 83,0% dos casos, recomendando-se que se busque compreender causas, fatores de risco, consequências, e pensar em estratégias para diminuir ou minimizar essas ocorrências.
Iatrogenies are actions resulting from medical interventions or from their staff, resulting in undesirable or harmful consequences to the health of the hospitalized individual. The objective of this study was to identify the drug iatrogenies that occurred with elderly patients hospitalized at the Regional Hospital of Coari, Amazonas. The data were collected from 100 charts, which identified that through an instrument created by the authors. The absence of the dose was more frequent of iatrogeny with 83,0%.
Las iatrogenias son acciones derivadas de intervenciones médicas o de su equipo, que resulten em consecuencias indeseables o perjudiciales para la salud del individuo hospitalizado. El objetivo de este estúdio fue identificar las iatrogenias medicamentosas que ocurrieron con pacientes ancianos internados em el Hospital Regional de Coari, Amazonas. Los datos fueron recolectados de 100 prontuarios, que identifico que por medio de um instrumento creado por los autores. La omisión de dosis fu ela iatrogenia más frecuente com el 83,0%.
الموضوعات
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Drug-Related Side Effects and Adverse Reactions/etiology , Medication Errors/adverse effects , Cross-Sectional Studies , Surveys and Questionnaires , Retrospective Studies , Nurses Improving Care for Health System Elders , Inpatientsالملخص
ABSTRACT Objective: To identify in the literature the cardiovascular adverse events resulting from oral antineoplastic therapy. Method: Integrative review of the literature through the SCOPUS, Scientific Electronic Library Online (SciELO), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medical Literature Analysis and Retrieval System Online (MEDLINE) databases. The antineoplastic, cardiotoxicity, cardiovascular system and adverse reaction descriptors were used in Portuguese, English and Spanish. We selected 23 articles published between 1985 and 2015. Results: Twenty studies were related to cardiac events and eleven to peripheral vascular events. The most frequent adverse cardiac events were reduced left ventricular ejection fraction, myocardial infarction, changes in the electrocardiogram, heart failure and angina, whereas peripheral vascular events were hypertension and thromboembolism. Conclusion: Oral antineoplastic therapy is associated with different adverse events, including cardiac and peripheral vascular events.
RESUMEN Objetivo: Identificar en la literatura los eventos adversos cardiovasculares derivados de la terapia antineoplásica oral. Método: Revisión integrativa de literatura en las bases de datos SCOPUS, Scientific Electronic Library Online (SciELO), Cumulative Index to Nursing and Allied Health Literature (CINAHL) y Medical Literature Analysis and Retrieval System Online (MEDLINE). Se utilizaron descriptores antineoplásicos, cardiotoxicidad, el sistema cardiovascular y reacción adversa en Portugués, Inglés y Español. Se seleccionaron 23 artículos publicados entre 1985 y 2015. Resultados: Veinte estudios estaban relacionados con los eventos cardiacos y once con los eventos vasculares periféricos. Los eventos adversos cardiacos más frecuentes fueron la disminución de la fracción de eyección del ventrículo izquierdo, infarto de miocardio, cambios en el electrocardiograma, insuficiencia cardíaca y angina, mientras que los vasculares periféricos fueron hipertensión arterial y tromboembolismo. Conclusión: La terapia antineoplásica oral está asociada a diferentes eventos adversos, entre ellos los cardíacos y los vasculares periféricos.
RESUMO Objetivo: Identificar na literatura os eventos adversos cardiovasculares decorrentes da terapia antineoplásica oral. Método: Revisão integrativa de literatura nas bases de dados SCOPUS, Scientific Electronic Library Online (SciELO), Cumulative Index to Nursing and Allied Health Literature (CINAHL) e Medical Literature Analysis and Retrieval System Online (MEDLINE). Utilizaram-se os descritores antineoplásicos, cardiotoxicidade, sistema cardiovascular e reação adversa, em português, inglês e espanhol. Foram selecionados 23 artigos publicados entre 1985 e 2015. Resultados: Vinte estudos estavam relacionados aos eventos cardíacos e onze aos eventos vasculares periféricos. Os eventos adversos cardíacos mais frequentes foram diminuição da fração de ejeção do ventrículo esquerdo, infarto do miocárdio, alterações no eletrocardiograma, insuficiência cardíaca e angina, enquanto que os vasculares periféricos foram hipertensão arterial e tromboembolismo. Conclusão: A terapia antineoplásica oral está associada a diferentes eventos adversos, dentre eles os cardíacos e os vasculares periféricos.
الموضوعات
Humans , Cardiovascular Diseases/etiology , Antineoplastic Agents/adverse effects , Administration, Oral , Anticarcinogenic Agents/adverse effects , Anticarcinogenic Agents/therapeutic use , Drug-Related Side Effects and Adverse Reactions , Drug-Related Side Effects and Adverse Reactions/etiology , Antineoplastic Agents/therapeutic useالملخص
Resumo Reações adversas a medicamentos (RAM) podem ser causa de enfermidades, incapacidades ou óbitos, principalmente em idosos. Realizou-se busca ativa de suspeitas de RAM que motivaram a procura de idosos por cuidados em pronto socorro (PS) utilizando rastreadores e discutindo seu uso nessa unidade de atendimento. Tratou-se de um estudo transversal e retrospectivo que utilizou adaptação dos rastreadores do "Institute of Healthcare Improvement". Foram analisados 287 prontuários, nos quais foram encontrados 38 rastreadores que identificaram 7 suspeitas de RAM. Uma foi encontrada sem uso dos rastreadores. Assim, no total, foram encontradas 8 reações (2,79%). Os medicamentos mais implicados foram os para trato alimentar e metabolismo e sistema cardiovascular. Dos rastreadores testados, alguns são essenciais para uso em PS, como os que indicam problemas com anticoagulantes, hipoglicemiantes e anti-hipertensivos, medicamentos bastante utilizados por idosos. Outros são adequados a estudos prospectivos, por necessitarem avaliação detalhada para confirmar da suspeita de RAM. Os rastreadores devem ser adaptados para cada instituição, mas se mostraram úteis para a detecção das suspeitas de RAM, identificando problemas ocorridos fora do ambiente hospitalar e sinalizando medicamentos que envolvem maior risco ao paciente idoso.
Abstract Adverse drug reactions (ADRs) can cause illness, disability or death, especially in the elderly. An active search for suspected ADRs was carried out using triggers, which motivated the search of elderly people under care in adult emergency departments (ED). It was a cross-sectional and retrospective study that used an adaptation of the Institute of Health Care Improvement triggers. A total of 287 medical records were analyzed and 38 triggers were found, identifying 7 suspected ADRs. One was found without the use of triggers. Thus, in total, 8 ADRs (2.79%) were found, of which 6 were considered serious. There was a higher prevalence of ADRs in females (62.5%) and in those over 80 years of age (50%). The medications most implicated were those for alimentary tract and metabolism and cardiovascular system. Of the triggers tested, some are essential for use at EDs, such as those that indicate problems with anticoagulants, hypoglycemic agents and antihypertensives. Triggers have proved useful for an active search for suspected ADRs at EDs, including severe ones, identifying problems occurring outside hospital settings and signaling medications that pose an increased risk to the elderly .
الموضوعات
Humans , Male , Female , Aged , Aged, 80 and over , Drug-Related Side Effects and Adverse Reactions , Emergency Service, Hospital/statistics & numerical data , Hospitalization/statistics & numerical data , Sex Factors , Prevalence , Cross-Sectional Studies , Retrospective Studies , Risk Factors , Age Factors , Drug-Related Side Effects and Adverse Reactions/etiology , Middle Agedالملخص
Resumo: O objetivo deste estudo foi propor um conjunto de rastreadores para a pesquisa de eventos adversos em odontologia ambulatorial no Brasil. O instrumento foi elaborado em duas etapas: (i) para construir um conjunto preliminar de rastreadores foi realizada uma revisão da literatura, a fim de identificar a composição das ferramentas de rastreamento utilizadas nas demais áreas da saúde e os principais eventos adversos encontrados em odontologia; (ii) para validar os rastreadores preliminarmente construídos foi organizado um painel de especialistas empregando o método Delphi modificado. Foram elaborados quatorze rastreadores para compor um instrumento com critérios explícitos para identificar potenciais eventos adversos no cuidado odontológico, essenciais para os estudos de revisão retrospectiva de prontuários. Pesquisas relacionadas à segurança do paciente em odontologia ainda são bastante incipientes em relação às demais áreas da saúde. Este trabalho pretendeu contribuir para a investigação nesse campo. O aporte da literatura e a ajuda da expertise do painel de especialistas permitiram a elaboração de um conjunto de rastreadores para a detecção de eventos adversos odontológicos, no entanto, são necessários estudos adicionais para testar a validade do instrumento.
Resumen: El objetivo de este estudio fue proponer un conjunto de marcadores para la investigación de eventos adversos en odontología ambulatoria en Brasil. El instrumento se elaboró en dos etapas: (i) para construir un conjunto preliminar de marcadores se realizó una revisión de la literatura, a fin de identificar la composición de las herramientas de rastreo utilizadas en las demás áreas de la salud, y los principales eventos adversos encontrados en odontología; (ii) para validar los marcadores preliminarmente construidos se organizó un panel de especialistas, empleando el método Delphi modificado. Se elaboraron catorce marcadores para componer un instrumento con criterios explícitos, con el fin de identificar potenciales eventos adversos en el cuidado odontológico, esenciales para los estudios de revisión retrospectiva de registros médicos. Las investigaciones relacionadas con la seguridad del paciente en odontología todavía son bastante incipientes, en relación con las demás áreas de salud. Este trabajo pretendió contribuir a la investigación en ese campo. El aporte de la literatura y la ayuda de la pericia del panel de especialistas permitieron la elaboración de un conjunto de marcadores para la detección de eventos adversos odontológicos, sin embargo, se necesitan estudios adicionales para probar la validez del instrumento.
Abstract: The aim of this study was to propose a trigger tool for research of adverse events in outpatient dentistry in Brazil. The tool was elaborated in two stages: (i) to build a preliminary set of triggers, a literature review was conducted to identify the composition of trigger tools used in other areas of health and the principal adverse events found in dentistry; (ii) to validate the preliminarily constructed triggers a panel of experts was organized using the modified Delphi method. Fourteen triggers were elaborated in a tool with explicit criteria to identify potential adverse events in dental care, essential for retrospective patient chart reviews. Studies on patient safety in dental care are still incipient when compared to other areas of health care. This study intended to contribute to the research in this field. The contribution by the literature and guidance from the expert panel allowed elaborating a set of triggers to detect adverse events in dental care, but additional studies are needed to test the instrument's validity.
الموضوعات
Humans , Dental Records , Dental Care/adverse effects , Patient Safety , Brazil , Delphi Technique , Dental Care/methods , Medical Errors/prevention & control , Consensus , Drug-Related Side Effects and Adverse Reactions/diagnosis , Drug-Related Side Effects and Adverse Reactions/etiologyالملخص
Objective: To update information about drug interactions in patients with HIV/AIDS. Methods: Comprehensive literature review in MEDLINE/PubMed database from May of 2009 to December of 2014, using the Mesh terms: Anti-retroviral agents and drug interactions or herb-drug interactions or food-drug interactions. Publications with drug interactions in humans, in English or Spanish, and with full text were retrieved. Additionally, citation lists from identified articles were reviewed. The study inclusion was assessed by three independent researchers and by consensus among them when was necessary. Clinical relevance of drug interaction was grouped into four levels according to seriously and probability of occurrence. Results: Global, 546 different references were retrieved and 243 were selected. In addition 11 further manuscripts were identified in the references of the included articles. Overall, 935 pairs of drug interactions were identified, 95.7% pharmacokinetic (823 by enzyme induction or inhibition and 67 by changes in bioavailability). Of the 935 pairs of drug interactions, 402(43%) were classified as levels 1 or 2. Conclusions: The most clinically relevant antiretroviral drug interactions are due to pharmacokinetic mechanism, mainly induction or enzyme inhibition, according to previous reviews, the protease inhibitors remain as the antiretrovirals with the highest number of clinical relevant interactions.
Objetivo: Actualizar información sobre interacciones medicamentosas en pacientes con VIH/SIDA. Métodos: Revisión estructurada en MEDLINE/PubMed utilizando los términos Mesh: Anti-retroviral agents and drug interactions or herb-drug interactions or food-drug interactions, entre mayo de 2009 y diciembre de 2014. Publicaciones sobre interacciones medicamentosas, en humanos, en inglés o español y con acceso a texto completo fueron seleccionadas. Además, se incluyeron referencias de artículos considerados relevantes. La inclusión de los artículos fue evaluada por tres investigadores independientes y, en caso de requerirlo, por consenso entre ellos. La relevancia clínica se estableció en cuatro niveles, acorde con la gravedad y probabilidad de ocurrencia de la interacción. Resultados: Se identificaron 546 artículos, de los cuales se seleccionaron 273; además, se incluyeron 11 referencias relevantes. Se identificaron 935 parejas de interacciones medicamentosas, 95,7% farmacocinéticas. De este grupo, 823 mediadas por inducción o inhibición enzimática y 67 por cambios en la biodisponibilidad. De las 935 parejas de interacciones, 402 (43%) fueron relevantes clínicamente (niveles 1 o 2). Conclusiones: Las interacciones medicamentosas con anti-retrovirales de mayor relevancia clínica se deben a mecanismos farmacocinéticos, principalmente inducción o inhibición enzimática. Acorde con revisiones previas, los inhibidores de proteasa continúan siendo los anti-retrovirales con mayor número de interacciones relevantes.
الموضوعات
Humans , Acquired Immunodeficiency Syndrome/drug therapy , Anti-Retroviral Agents/pharmacokinetics , Drug-Related Side Effects and Adverse Reactions/etiology , Protease Inhibitors/pharmacokinetics , Risk Factors , Drug Interactionsالملخص
Las reacciones adversas medicamentosas (RAMs) representan la principal causa de cambio de la terapia antiretroviral de gran actividad (TARGA) de primera línea y, por tanto, el principal limitante en el seguimiento a largo plazo de los pacientes con el virus de la inmunodeficiencia humana (VIH) en tratamiento. Se realizó un estudio retrospectivo en un Centro Especializado del estado Lara-Venezuela incluyéndose 99 pacientes mayores de 18 años que presentaron cambio de la TARGA de primera línea debido a RAMs en el período 2010-2013. Se describieron variables sociodemográficas y clínicas así como también la frecuencia de RAMs que condicionaron el cambio de la TARGA, la duración del primer régimen, los fármacos asociados y los factores condicionantes. Se encontró que las RAMs representaron el 47,5% de todas las causas de cambio durante este período. La mediana de duración global en TARGA de primera línea fue 1,08±0,28 años; las RAMs más frecuentes fueron la anemia en 34,3%, reacciones de hipersensibilidad en 20,2% y la intolerancia gastrointestinal en 13,1%. Los regímenes antirretrovirales más prescritos fueron los basados en inhibidores de proteasas en 59,6%, la zidovudina se utilizó en 41,4% de los casos siendo el fármaco más relacionado con las RAMs. El estudio de regresión permitió determinar aumento del riesgo de RAMs en solteros y estudiantes en el análisis univariante, en heterosexuales y homosexuales en el análisis multivariante, así como reducción del riesgo de RAMs en trabajadores activos. Este estudio permitió evidenciar la alta prevalencia de RAMs en la población evaluada y representa la primera casuística que describe la farmacoepidemiología de un grupo de pacientes VIH positivos tratados en el país.
Adverse drug reactions (ADRs) represent the first cause of change of the first-line highly active antiretroviral therapy (HAART) regimen, therefore, they constitute the main limiting factor in the long-term follow up of HIV patients in treatment. A retrospective study was carried out in a specialized center in Lara State, Venezuela, including 99 patients over 18 years of age who had change of first-line HAART regimen due to ADRs, between 2010 and 2013. The aims of this research were to describe the sociodemographic and clinical variables, frequency of ADRs related to change of HAART, duration of the first-line HAART regimen, to determine the drugs associated with ARVs and to identify the risk factors. The ADRs constituted 47.5% of all causes of change of first-line HAART regimen, the median duration was 1.08±0.28 years. The most frequent ADRs were anemia (34.3%), hypersensitivity reactions (20.2%) and gastrointestinal intolerance (13.1%). The most frequent ARV regimen type was the protease inhibitors-based regimen (59.6%), but zidovudine was the ARV most linked to ADRs (41.4%). The regression analysis showed increased risk of ADRs in singles and students in the univariate analysis and heterosexuals and homosexuals in multivariate analysis; and decreased risk in active workers. The present work shows the high prevalence of ADRs in the studied population and represents the first case-based study that describes the pharmacoepidemiology of a cohort of HIV-positive patients treated in Venezuela.
الموضوعات
Adolescent , Adult , Female , Humans , Male , Middle Aged , HIV Infections/drug therapy , Antiretroviral Therapy, Highly Active/adverse effects , Drug-Related Side Effects and Adverse Reactions/etiology , Venezuela , Retrospective Studiesالموضوعات
Adult , Drug-Related Side Effects and Adverse Reactions/epidemiology , Drug-Related Side Effects and Adverse Reactions/etiology , Female , Humans , Immunoconjugates/administration & dosage , Immunoconjugates/adverse effects , Male , Middle Aged , Psoriasis/chemically induced , Psoriasis/epidemiology , Psoriasis/etiologyالملخص
Background & objectives: Several studies have reported adverse drug events ranging from 5 to 35 per cent in all age group from outpatient setting. However, adverse drug reactions (ADRs) particularly among a large sample of ambulatory elderly patients in India has not been reported. This study has attempted to identify ADRs and assessed their causality, preventability and severity, and also their risk factors in Indian ambulatory elderly patients. Methods: A 2 year long term prospective study included 4005 ambulatory elderly patients (60 yr or above; either sex) at a public teaching hospital. Suspected ADRs were assessed for causality, preventability and severity using Naranjo's probability scale, modified Schumock and Thornton's criteria, and modified Hartwig's criteria, respectively. Results: Of the total 4005 prescriptions, 406 were identified with ADRs, giving the occurrence of 10 per cent ADRs in elderly. The total number of ADRs was 422 in 406 prescriptions. Type A ADRs accounted for 46 per cent of the total ADRs. Majority of the ADRs (88.6%) were classified as ‘probable’. The definitely preventable reactions were 22 per cent. The percentage of moderate reaction was 16 per cent. Only 1.6 per cent ADRs was severe in nature. The most common type of ADR was peripheral oedema. The most commonly offending class of drug was cardiovascular drugs (57.6%). Using logistic regression analysis, the risk factors which contributed to ADRs were age above 80 yr (OR=1.7), prescription of multiple drugs (OR=1.8), longer duration of treatment (OR=2.28) and multiple diagnoses (OR=1.8). Interpretation & conclusions: In this study, 10 per cent ambulatory elderly patients were found to have ADRs. This indicates that the elderly patients should be closely monitored for ADRs, to avoid clinically significant harmful consequences. The awareness of risk factors of ADRs would help physicians to identify elderly patients with greater risk of ADRs and, therefore, might benefit from ADRs monitoring and reporting programme.
الموضوعات
Adverse Drug Reaction Reporting Systems , Aged , Aged, 80 and over , Ambulatory Care/statistics & numerical data , Drug-Related Side Effects and Adverse Reactions/epidemiology , Drug-Related Side Effects and Adverse Reactions/etiology , Female , Humans , India/epidemiology , Male , Nonprescription Drugs/adverse effects , Prescription Drugs/adverse effects , Risk Factorsالملخص
Existen riesgos inherentes a la terapia con fármacos, tanto conocidos como desconocidos, asociados con el uso terapéutico de drogas, prescriptas y no prescriptas. Se realizó un estudio experimental de intervención educativa en personas con VIH/sida (PVS) del Policlínico Giraldo Aponte Fonseca del municipio Guamá de la provincia Santiago de Cuba en el período de Septiembre a Diciembre del 2009, con el objetivo de fortalecer los conocimientos de las personas con VIH/sida con tratamiento antirretroviral de las Reacciones Adversas Medicamentosas. El universo-muestra estuvo constituido por la totalidad de las personas con VIH (14) que tienen tratamiento antirretroviral. Para la investigación se dividió el estudio en tres etapas: Diagnóstico, Intervención y Evaluación, además se analizaron variables de interés como: edad, sexo, conocimientos de las Reacciones Adversas Medicamentosas, cómo tomar los medicamentos y reacciones adversas y efectos indeseables al tomar los antirretrovirales. Los datos obtenidos se procesaron por el método manual utilizando una calculadora y los resultados se exponen en tablas estadísticas utilizando el porciento como unidad de resumen. Obteniéndose como resultado el predominio del grupo de edades entre los 35 39 años y el sexo femenino. Se concluyo planteando que se logro fortalecer los conocimientos en las reacciones adversas medicamentosas que se presentan al administrarse los medicamentos antirretrovirales, así como, sus efectos indeseables(AU)
There are risks inherent in the pharmacotherapy, well-known or not, associated with the therapeutic use of drugs, prescribed or not. An experimental study was conducted on educational intervention in HIV/AIDS persons from the Giraldo Aponte Fonseca Polyclinic of the Guamá municipality, Santiago de Cuba province from September to December, 2009 to strength the knowledges of this type of patients under antiretroviral treatment on Drug Adverse Reactions. The universe-sample included all the HIV-persons (14) under antiretroviral treatment. For research, study was divided into three stages: diagnosis, intervention and assessment, also interesting variables were analyzed including: age, sex, knowledges of Drugs Adverse Reactions, how to take drugs and adverse reactions and undesirable effects when they take the antiretroviral drugs. Data obtained were processed by manual method using a calculator and results are showed in statistical tables using the percentage as summary unit. There was predominance of 35-30 age group and female sex. We conclude proposing that it was possible to strength the knowledges in drug adverse reactions present at moment of antiretroviral administration, as well as its undesirable effects(AU)
الموضوعات
Humans , HIV/drug effects , Drug-Related Side Effects and Adverse Reactions/etiology , Antiretroviral Therapy, Highly Active/adverse effectsالملخص
En este trabajo presentamos nuestra experiencia en el manejo de pacientes con toxidad hepática en un período de 4 años en dos instituciones de Santafé de Bogotá. Presentamos dos grupos de pacientes, uno toxicidad hepática aguda y el otro crónica, su forma de presentación, evolución y morbimortalidad asociadas. Encontramos que la toxicidad hepática por fármacos y otros hepatotóxicos, algunos no identificados, continúa siendo una causa importante y poco diagnosticada de consulta y hospitalización
الموضوعات
Humans , Drug-Related Side Effects and Adverse Reactions/etiology , Liver Cirrhosis/etiology , Hepatitis/complications , Hepatitis/etiologyالملخص
La hepatitis tóxica por nimesulida es una patología rara. Para su diagnóstico se requiere un alto grado de sospecha clínica y la confirmación por biopsia hepática. Se presenta el caso de una mujer de 70 años que ingresó al servicio de Clínica Quirúrgica por dolor epigástrico irradiado a ambos hipocondrios e ictericia. Antecedentes: Ingesta 200 mg. de nimesulida durante 1 mes. Laboratorio TGO 526 UI/1(VN:O-31), TGP 414 UI/1 (VN: 0-37), FA 537 UI (VN: 98-276), bilirrubina total 12,9 mg/dl, bilirrubina directa 9,8 mg/dl (VN:0-0,4), el resto de los análisis fueron normales. Ecografía: vesícula aumentada de tamaño con paredes engrosadas y un cálculo de 20 mm en su interior. Se trató con antibióticos y medidas de sostén con mejoría del estado general, al tercer día se le practicó colecistectomía y biopsia hepática. Al cuarto día disminuyó el ritmo diurético y fue trasladada a UTI donde se diagnosticó IRA oligoanúrica que se trató con hemodiálisis. Al décimo día de postoperatorio presentó cuadro de Sepsis severa causada por klebsiella sp. que a pesar de tratamiento intensivo tuvo una evolución sumamente tórpida falleciendo a los 26 días del postoperatorio. El estudio anatomopatológico de la vesícula demostró la presencia de un proceso inflamatorio crónico con pouse aguda y el de la muestra hapática lesiones compatibles con hepatopatía tóxica. Conclusiones: La lesión hepática por nimesulida, aunque rara, debe ser considerada en todo enfermo con necrosis hepatocelular de causa no evidente y el antecedente de haber sido tratado con esa droga