Drug-drug interactions of telaprevir and boceprevir in HCV-monoinfected and HIV/HCV-coinfected patients can modify the adherence.

BACKGROUND & AIMS: The first generation protease inhibitors, boceprevir (BOC) and telaprevir (TVR), are both CYP3A4 inhibitors, which predispose drug-drug interactions (DDIs). The aim of this study was to evaluate the prevalence of potential DDIs, the management of outpatient medication and its impact on adherence and efficacy to antiviral treatment in hepatitis C virus (HCV)-monoinfected and human immunodeficiency virus (HIV)/HCV-coinfected patients receiving BOC and TVR. METHODS: The usual medication starting with BOC or TVR was screened by the pharmacist of the multidisciplinary support programme (MSP) for potential DDIs. Recommendations were made to avoid significant DDIs, and changes in the baseline medication were recorded. Adherence to antiviral treatment was considered as 80/80/95% of total doses. Sustained virological response was assessed at week 12 (SVR12). RESULTS: At least one potential DDI was found in 70 (64.8%) patients, 45 (54.2%) being HCV-monoinfected and 25 (100%) HIV/HCV-coinfected (P < 0.01). Baseline treatment modifications were required in 38 (35.2%) patients. Adherence and SVR12 were higher in patients without DDIs (86.8%) and (67.6%) compared to those with DDIs (62.8%) (P = 0.021) and (47.2%) (P = 0.097) respectively. CONCLUSIONS: More than half of the patients were at risk of presenting DDIs, leading to changes in the baseline medication in one-third of the patients. Drug interactions are frequent in patients with lower adherence.

The Role of OCT in Follow-Up of Fungal Keratitis Caused by Beauveria bassiana in Contact Lens Wearer.

A 25-year-old Caucasic female was referred to our clinic after suffering from infectious keratitis in the right eye for a month. The patient was a contact lens user and had no history of ocular trauma. Furthermore, the patient did not report any relevant antecedent. The main complaint was intense photophobia and pain. Infectious keratitis remains one of the main complications of contact lens wear and can become a therapeutic challenge in some patients. Although the most frequent causal agent is bacterial, other causes such as herpes virus, Acanthamoeba or fungi should be considered when antimicrobial therapy does not work as expected clinically. Fungal keratitis normally appears on previously damaged corneas, but it can also develop in contact lens wearers. Beauveria bassiana is an unusual pathogen which has been diagnosed more frequently lately per the clinical reports in the last 30 years, so it can be included in the diagnostic scheme when a fungal keratitis is suspected. In clinical management, AS-OCT may be a functional tool to assess the evolution and monitor the response to microbial agents and surgery. Although more studies are needed, some characteristic features have been described and can help to diagnose a fungal keratitis against other infections. AS-OCT can also play an important role in monitoring the corneal scarring after the keratitis episode, and it may be useful to plan post-infection therapy for visual rehabilitation.

[Atypical mycobacteria and pulmonary involvement in infectious diseases]. / Micobacterias atípicas y su implicación en patología infecciosa pulmonar.

Nontuberculous mycobacteria (NTM) are increasingly associated with infectious pulmonary disease. NTM are ubiquitous environmental pathogens with high isolation rates worldwide. The greater frequency of NTM associated with pulmonary diseases is probably due to a combination of increased exposure, improved diagnostic methods and an increase in the prevalence of risk factors predisposing individuals to infection. Difficulty may arise in determining whether an isolate from a respiratory sample is in fact a contaminant or a pathogenic organism. The ATS/IDSA guidelines highlight the importance of following microbiological and clinical criteria in making a diagnosis of NTM lung infection. These criteria may not be useful for all NTM and species-level identification is strongly recommended. Mycobacteria identification by conventional methods has been the standard in most clinical microbiology laboratories. However, conventional testing alone does not allow identification of many NTM. Newer, rapid molecular methods such as commercially available nucleic acid probes, genomic amplification and DNA sequence analysis should be used. Communication between the clinician and the laboratorian is essential to decide whether an isolate could be sent to a reference laboratory to determine the best method for species identification. Although the CLSI has recently published an approved standard for NTM susceptibility testing, there is ongoing debate about the role of in vitro susceptibility for managing patients with NTM disease. The goal of this review is to describe the mycobacteria involved in lung disease, the factors that predispose to this infection, its diagnosis with alternative procedures and the correlation between in vitro and in vivo treatment response.

Pelviperitonitis gonocócica. A propósito de un caso / Gonococcal pelviperitonitis. A case report

Neisseria gonorrhoeae se considera uno de los agentes causales más importantes de la enfermedad pélvica inflamatoria (EPI) produciendo síntomas leves e inespecíficos, lo cual la convierte en un desafío diagnóstico. Se presenta un caso de una pelviperitonitis gonocócica aguda con dolor difuso, distensión abdominal, fiebre. El único hallazgo destacable fue un líquido peritoneal y endocervical purulento con reactantes de fase aguda elevados. El cultivo del líquido endocervical y peritoneal fue positivo para N. gonorrhoeae. En mujeres sexualmente activas y con sospecha de EPI es importante descartar enfermedades de transmisión sexual.

Neisseria gonorrhoeae is considered one of the most important causal agents of pelvic inflammatory disease, producing mild and nonspecific symptoms, which makes it a diagnostic challenge. A case of acute gonococcal pelviperitonitis with abdominal distension, fever and diffuse pain is presented. The only noteworthy finding was purulent peritoneal and endocervical fluid with elevated acute-phase reactants. Endocervical and peritoneal fluid culture showed infection with N. gonorrhoeae. Therefore, in sexually active women with suspected PID, it is important to rule out sexually transmitted diseases.

Patient risk factors for developing a drug-related problem in a cardiology ward.

BACKGROUND: Because of the high incidence of drug-related problems (DRPs) among hospitalized patients with cardiovascular diseases and their potential impact on morbidity and mortality, it is important to identify the most susceptible patients, who therefore require closer monitoring of drug therapy. PURPOSE: To identify the profile of patients at higher risk of developing at least one DRP during hospitalization in a cardiology ward. METHOD: We consecutively included all patients hospitalized in the cardiology ward of a teaching hospital in 2009. DRPs were identified through a computerized warning system designed by the pharmacy department and integrated into the electronic medical record. RESULTS: A total of 964 admissions were included, and at least one DRP was detected in 29.8%. The variables associated with a higher risk of these events were polypharmacy (odds ratio [OR]=1.228; 95% confidence interval [CI]=1.153-1.308), female sex (OR=1.496; 95% CI=1.026-2.180), and first admission (OR=1.494; 95% CI=1.005-2.221). CONCLUSION: Monitoring patients through a computerized warning system allowed the detection of at least one DRP in one-third of the patients. Knowledge of the risk factors for developing these problems in patients admitted to hospital for cardiovascular problems helps in identifying the most susceptible patients.

Increased early atherogenesis in young versus old hypercholesterolemic rabbits by a mechanism independent of arterial cell proliferation.

We sought to determine the relative importance of aging and hypercholesterolemia on atherosclerosis. Although plasma cholesterol levels increased similarly in young and old rabbits fed an atherogenic diet for 2 months, aortic atherosclerotic lesions were more prominent in young animals. This finding was associated with an age-dependent reduction in the DNA-binding activity of the proinflammatory nuclear factor kappaB (NF-kappaB) in aortic tissue. Atherosclerotic lesions consisted mostly of macrophages, which displayed a similar proliferative response in both age groups. Independently of the age, medial cell proliferation was low and increased as a function of intimal lesion size. Thus, higher atherogenicity in young rabbits exposed to extreme hypercholesterolemia compared to old counterparts is associated with higher activity of NF-kappaB in the juvenile vessel wall without apparent age-dependent changes in arterial cell proliferation.