Negative Outcomes Associated with Medication in Neonates on Parenteral Nutrition Therapy.

OBJECTIVE: In Ecuador, studies on clinical daily practice problems focused on parenteral nutrition in neonates are scarce. Therefore, this research aimed to identify negative results associated with medications (NRAM) in neonates with parenteral nutrition (PN) in a third-level hospital in Ecuador. MATERIAL AND METHODS: An observational, prospective, descriptive study was designed in the neonatology area of a tertiary-level public hospital, where, for over four months, the medical records, PN prescriptions, and pharmacy-managed databases of 78 patients were analyzed. Drug-related problems (DRPs) as possible causes of NRAM were classified through administrative, physicochemical, and clinical validation. RESULTS: DRPs classified as follows were found: 78.81% by physicochemical, 17.62% by clinical, and 3.57% by administrative validation. The NRAM were 72% quantitatively uncertain, 16% needed, and 11% quantitatively ineffective. CONCLUSION: The NRAM associated with DRPs were statistically related to prematurity condition, APGAR score, PN time, and the number of medications administered, which suggests the need to create a nutritional therapy committee at the health facility.

Complicaciones en accesos venosos vasculares: estudio descriptivo de catéteres venosos centrales y catéteres de línea media / Complications in vascular venous access: descriptive study of central venous catheters and midline catheters

[RESUMEN]. Los accesos vasculares venosos son dispositivos elementales para el tratamiento hospitalario de diversas condiciones. Está bien documentada la tasa de complicaciones para catéteres venosos centrales (CVC) y catéteres de línea media (MD), pero existe un solo trabajo que los compara directamente. Por ello realizamos el presente trabajo con el objetivo de establecer las tasas generales y comparativas de complicaciones en ambos tipos de catéteres. Se realizo un estudio descriptivo retrospectivo donde se reclutaron 168 pacientes, los cuales recibieron 268 catéteres (120 accesos venosos centrales y 148 midline), con una media de edad de 45 años, con leve predominio del sexo femenino (51,2%). De estos, la principal comorbilidad fue neoplasia (57,1%). En el 29,8% el principal motivo de colocación fue la infusión de quimioterapia. Como resultados, la prevalencia de complicaciones fue del 19%: infecciosas en el 7,5% de los casos (con una tasa de infecciones asociadas a catéter de 4.9/1000 días catéter), 1,9% trombóticas y 9,7% mecánicas. La tasa de complicaciones fue mayor para los catéteres venosos centrales, no alcanzando una diferencia estadísticamente significativa: infecciosas (10.8% vs. 4,7%; p: 0,059; OD: 2.47; IC 95%: 0.94 - 6.34) y mecánicas (5.8% vs. 12,8%; p: 0,054; OD: 0.42; IC 95%: 0.17 ­ 1.03) para CVC y MD, respectivamente. Las complicaciones trombóticas fueron similares en ambos (1,6% en CVC y 2% en MD, p: 0,82).

[ABSTRACT]. Venous vascular accesses are fundamental devices for in hospital treatment of various conditions. Complication rates for central venous catheters (CVC) and midline catheters (MD) are well-documented, but there is only one study in wich both devices were compared. Therefore, we conducted the present study with the aim of establishing the overall and comparative complication rates of both types of catheters. We conducted a retrospective descriptive study recruiting 168 patients who received 268 catheters (120 central venous accesses and 148 midlines). The mean age was 45 years, with a slight predominance of females (51.2%). Among these, the main comorbidity was neoplasia (57.1%). In 29.8% of cases, the main reason for catheter placement was chemotherapy infusion. As a result, the prevalence of complications was 19%: infectious complications in 7.5% of cases (with a catheter-associated infection rate of 4.9/1000 catheter days), thrombotic 1,9%, and mechanical 9,7%. Complication rate were higher for central venous accesses, although the difference did not reach statistical significance: infectious (10.8% vs. 4.7%; p: 0.059; OR: 2.47; 95% CI: 0.94 - 6.34) and mechanical (5.8% vs. 12.8%; p: 0.054; OR: 0.42; 95% CI: 0.17 ­ 1.03) for CVC and MD, respectively.Thrombotic complications were similar in both (1.6% in CVC and 2% in MD, p: 0.82).

Behavior of Calcium, Phosphorus, and Parathormone Before Transplantation and in Months 1, 3, 6, 9, and 12 After Transplantation.

BACKGROUND: Bone mineral disease after transplantation persists and is an issue that must be addressed owing to the cardiovascular impact it presents. The objective of this study is to present the behavior of calcium, phosphorus, and parathormone (PTH) before renal transplantation (RT) and throughout the 12 months after transplant surgery. METHODS: A longitudinal observational study of RT patients was performed from 2013 to 2017 in 2 renal transplant units in Mexico. In total, 1009 records of patients with RT were analyzed. Calcium, phosphorus, and PTH levels were studied before transplantation and for 12 months after. Central tendency and dispersion were measured, the difference of means was established with chi square or student t tests, and the significant value of P was set at <.05. We also used the SPSS statistical package, version 25. RESULTS: Phosphorus had a median pre-RT of 5.73, which decreased to 2.8 in the first month post-transplant and then increased to 3.41 at 12 months post-RT. The median PTH, on the other hand, started at 420.60 and decreased to 67.45. Calcium began at 9.04 and hit a plateau of 9.58 during month 12 after the surgical event. CONCLUSIONS: Of the 3 biochemical parameters evaluated, phosphorus was the one that most corrected itself after transplantation. Despite a tendency toward hypophosphatemia in the first month after transplantation, it began to normalize from month 6 on. Meanwhile, calcium was the biochemical value that changed the least after transplantation.

Uncommon Complications in the First Year After Renal Transplantation.

INTRODUCTION: Classic post-transplant complications are highly studied and monitored; however, other unusual complications may occur due to immunosuppression. The objective of this study is to show these rare complications in a kidney transplant center. MATERIAL AND METHODS: Retrospective, observational, longitudinal study of renal transplants carried out from 2013 to 2017 in the Renal Transplant Unit of the National Medical Center Siglo XXI. A total of 790 transplants were performed, with surveillance for 1 year and rare events described. An analysis of frequencies and percentages of the events was performed using the statistical package SPSS version 25. RESULTS: Of the 790 patients, 110 (13.92%) experienced rare events, classified into 9 types of complications. DISCUSSION AND CONCLUSIONS: Complications exist in renal transplantation that are often ignored or minimized. A considerable number have been observed in this study, 110 events (13.92%); this result allows us to consider multiple possibilities in a kidney transplant program, especially infectious complications (34 patients) and surgical complications (29 cases). With the increase in diabetic receptor transplantation, metabolic complications will surely increase in the coming years.

Anemia and Erythrocytes: Behavior and Prevalence 1 Year After Kidney Transplant.

INTRODUCTION: Renal transplantation presents multiple complications after its completion, some of them related to the behavior of hemoglobin levels. The objective of this study is to determine the behavior and prevalence of anemia and erythrocytosis in the first year after renal transplantation. MATERIAL AND METHODS: A retrospective, observational study was conducted of a cohort of patients of the 21st Century National Medical Center in Mexico of transplants performed from January 1, 2013 to December 31, 2017. A total of 649 met the inclusion criteria. Pre-transplant hemoglobin (Hb) levels were determined, as well as levels 1 month, 3, 6, 9, and 12 months after transplantation, and the prevalence of anemia and erythrocytosis was determined in each month. Descriptive analysis was performed with measures of central tendency and measures of dispersion. The statistical program SPSS version 25 was used. RESULTS: The mean pre-transplant Hb was 10.69 g/dL (standard deviation [SD] 2.04). One year after the renal transplant, Hb averaged 14.45 g/dL (SD 2.30), which meant an increase over the first year after renal transplantation of 3.76 g/dL. Pre-transplant anemia occurred in 73.1% of patients, and erythrocytosis in 0.1%; 12.9% of patients and 5.9% in erythrocytosis continued with anemia for a year. CONCLUSIONS: Renal transplantation allows Hb levels to recover in a multifactorial way; however, the persistence of anemia and erythrocytes creates a study challenge in any transplant unit, due to their prevalence of 12.9 and 5.9% respectively.

Esteroides asociados a inmunoglobulina intravenosa en el tratamiento del Síndrome de Stevens-Johnson y necrólisis epidérmica tóxica / Steroids associated with intravenous immunoglobulin in the treatment of Stevens-Johnson syndrome and toxic epidermal necrolysis

Introducción: La necrólisis epidérmica tóxica (NET) y el síndrome de Stevens-Johnson (SSJ) son reacciones cutáneas raras, graves y potencialmente mortales asociadas principalmente al uso de medicamentos; sin embargo, se ha señalado la posible relación entre el SSJ con la infección por Mycoplasma pneumoniae o herpes. El tratamiento consiste en la suspensión del fármaco y cuidados de soporte. No existe tratamiento específico que haya demostrado eficacia. Se ha propuesto el uso de inmunoglobulina intravenosa debido a su potencial anti-Fas in vitro, aunque sus efectos reportados no son concluyentes. Objetivo: Describir la respuesta a inmunoglobulina intravenosa en el tratamiento del SSJ/NET en el Hospital de Especialidades Centro Médico Nacional Siglo XXI. Material y métodos: Se realizó un estudio descriptivo retrospectivo en pacientes con SSJ/NET del servicio de Medicina Interna que recibieron inmunoglobulina intravenosa (IV) en el período de marzo de 2008 y abril de 2014. Resultados: Siete pacientes recibieron de 1-3 g/kg de inmunoglobulina IV, 5 mujeres (87.7%) y 1 hombre (14.2%). Todos se relacionaron con ingesta de fármacos, trimetoprim/sulfametoxazol en el 28.5% de los casos. El 71.4% presentó fiebre, 85.7% presentó afección mayor al 10% de la superficie corporal, 100% presentó afección de 2 o más mucosas y 42.8% requirió manejo avanzado de la vía aérea. La estancia hospitalaria promedio fue de 32 días. No ocurrieron defunciones. Una mujer presentó hipertensión asociada a la infusión de inmunoglobulina, así como cefalea, y otra paciente desarrolló neumonía nosocomial. Conclusiones: La respuesta a inmunoglobulina IV fue satisfactoria logrando abortar la progresión del cuadro en 5 pacientes, 85.7% de los casos, sin efectos adversos relevantes(AU)

Background: Toxic epidermal necrolysis (TEN) and Stevens -Johnson syndrome (SJS) are rare but serious and potentially lifethreatening adverse cutaneous drug reactions. However, a possible relationship between SJS with Mycoplasma pneumoniae infection or herpes has been noted. Treatment consists of drug discontinuation and supportive care as there is no specific therapy that has shown efficacy. Intravenous immunoglobulins have been tested as a consequence of the anti-Fas in vitro potential, although its reported effects are inconclusive. Objective: To describe the response to intravenous immunoglobulin in the management of SJS / TEN in Hospital de Especialidades Centro Médico Nacional SXXI. Material and methods: A retrospective descriptive study was conducted in patients with SJS / TEN in the service of Internal Medicine who received intravenous immunoglobulin (IVIG) from March 2008 until April 2014. Results: Seven patients received 1-3 g/ kg IV immunoglobulin, 5 females (87.7 %) and 1 male (14.2 %), all related to ingestion of drugs, trimethoprim/ sulfamethoxazole in 28.5 % of cases. 71.4% had fever, 85.7 % had skin involvement of greater than 10% of the body surface , 100 % had involvement of 2 or more mucous and 42.8 % required advanced airway management . The average hospital stay was 32 days. No deaths occurred. A woman has hypertension associated with immunoglobulin infusion and headache, and another patient developed nosocomial pneumonia Conclusions: Response to IV immunoglobulin was satisfactory as it was associated with cessation of skin and mucosal detachment in 85.7 % of cases without significant adverse effects.