Prescription profile in patients with SARS-CoV-2 infection hospitalised in Aragon, Spain.

INTRODUCTION: On 14 March 2020, a state of alarm was declared in Spain because of the pandemic of coronavirus disease (COVID-19). After 12 weeks from the beginning of the pandemic, the number of confirmed cases stoods at 5781 in Aragon: 46% hospitalised, 5% admitted to intensive care unit, and 15% died. The absence of controlled trials in SARS-CoV-2 infection and the fast progression of the disease has promoted the use of treatments with unproven potential benefit. The objective of this study is to define the prescription profile in patients with SARS-CoV-2 infection hospitalised in Aragon, Spain during the pandemic and its adaptation to the official recommendations. PATIENTS AND METHODS: Descriptive retrospective study of the consumption and inpatient dispensation of drugs in a sample of COVID-19 infected inpatients (with positive PCR test result) admitted to hospitals of Aragon, between 1 March and 8 May 2020. Data were collected by an inpatient dispensation software program. RESULTS: 1482 positive COVID-19 patients were analysed: 54.9% male, median age 75 years (IQR 62-85); 12% were admitted to the intensive care unit. Median prescription: 13 active ingredients per patient (IQR 9-19). 73% (1093 patients) received hydroxychloroquine, lopinavir/ritonavir, or azithromycin, 81% as combination therapy. 4.3% (52) received other antivirals. 46% received corticosteroids (84% methylprednisolone, 8.7% dexamethasone) and 2.2% tocilizumab. DISCUSSION: At the time of the study period there was not enough quality evidence to issue a recommendation on any treatment. There are several clinical trials ongoing to clarify what is the best treatment for patient with SARS-CoV-2 infection.

Sofosbuvir plus simeprevir for the treatment of genotype 1 chronic hepatitis C: a review of evidence.

INTRODUCTION: Sofosbuvir (SOF) with simeprevir (SIM) combination was the first interferon-free regimen that reached optimal results in terms of sustained viral response (SVR). Areas covered: A systematic review of the scientific literature concerning the effects that the SOF/SIM combination had on hepatitis C genotype 1 patients yielded 771 references. After the revision process, four clinical trials and 15 observational studies met the inclusion criteria; in total, these studies involved 5,766 patients. The SVR ranged from 67% to 100% depending on the patients' viral subtype and cirrhosis status. Adverse effects were common, but treatment discontinuation related to drug toxicity occurred in less than 5% of cases. Expert commentary: The SOF/SIM combination exhibits efficacy and tolerability profiles that are similar to those of the other available interferon-free combinations used for non-cirrhotic genotype 1b patients. Meanwhile, for patients with advanced cirrhosis or genotype 1a, this approach cannot be considered a routine treatment option due to the unsatisfactory results.

Treatment of subclinical hypothyroidism in pregnancy using fixed thyroxine daily doses of 75 µg.

BACKGROUND AND OBJECTIVES: Treatment of hypothyroid pregnant women is usually calculated based on weight (1 µg/kg/day) and TSH levels. This study assessed the usefulness of treating these women with a fixed dose of 75 µg/day. PATIENTS AND METHODS: All women with pregnancy diagnosed from January to August 2012 in the Vigo Health Area (Spain) without previous diagnosis of thyroid disease or thyroxine treatment and with TSH levels over 4,5 mUI/ml were enrolled by consecutive sampling. All 116 women in the sample were treated with a fixed daily dose of thyroxine 75 µg-thyroxine levels were measured at two, four, and six months, and thyroxine dose was modified if TSH level was lower than 0.3 or higher than 4.5 mUI/ml. RESULTS: A woman had a TSH level less than 0.3 mUI/ml in a test; reduction of thyroxine dose to 50 µg/day allowed for maintaining TSH level within the desired range until delivery. Six women had TSH levels over 4.5 mUI/ml in one test; in all of them, increase in thyroxine dose to 100 µg/day allowed for maintaining the level within the desired range until delivery. CONCLUSIONS: Fixed daily doses of thyroxine 75 µg allowed for achieving goal TSH levels in most of our pregnant women with subclinical hypothyroidism, irrespective of their weight and baseline TSH level.

Tratamiento del hipotiroidismo subclínico en gestantes con una dosis fija diaria de 75 µg de tiroxina / Treatment of subclinical hypothyroidism in pregnancy using fixed thyroxine daily doses of 75 microgram

ANTECEDENTES Y OBJETIVOS: Los métodos habituales de cálculo de la dosis inicial de tiroxina en el tratamiento de gestantes hipotiroideas usan el peso de las pacientes (1 microgramo/kg/día) o la concentración plasmática de TSH. Este estudio analiza la idoneidad de tratar a estas mujeres con una dosis fija de 75 microgramo/día de la hormona. PACIENTES Y MÉTODOS: Se seleccionaron mediante un muestreo consecutivo a todas aquellas mujeres diagnosticadas de gestación en el área sanitaria de Vigo entre enero y agosto de 2012, sin antecedentes de tiroidopatía y con una concentración de TSH superior a 4,5 mUI/ml y T4L normal. Las 116 gestantes de la muestra resultante recibieron tratamiento con 75 microgramo/día de tiroxina, y se les hizo un análisis a los 2, 4 y 6 meses tras la instauración del tratamiento, modificándose la dosis de la hormona si la concentración de TSH era inferior a 0,3 o superior a 4,5 mUI/ml. RESULTADOS: Una de las pacientes tuvo, en un análisis, una concentración de TSH inferior a 0,3 mUI/ml; el descenso de la dosis de tiroxina a 50 microgramo/día permitió mantener dicha concentración en el rango deseado hasta el parto. Seis tuvieron en un análisis una concentración de TSH superior a 4,5 mUI/ml; en todas ellas el aumento de la dosis de tiroxina a 100 microgramo/día permitió mantener dicha concentración en el rango deseado hasta el parto. CONCLUSIONES: Una dosis de tiroxina 75 microgramo/día permitió conseguir los objetivos de concentración de TSH de nuestro estudio en la mayoría de las gestantes con hipotiroidismo subclínico, independientemente de su peso y de su concentración inicial de TSH

BACKGROUND AND OBJECTIVES: Treatment of hypothyroid pregnant women is usually calculated based on weight (1 microgram/kg/day) and TSH levels. This study assessed the usefulness of treating these women with a fixed dose of 75 microgram/day. PATIENTS AND METHODS: All women with pregnancy diagnosed from January to August 2012 in the Vigo Health Area (Spain) without previous diagnosis of thyroid disease or thyroxine treatment and with TSH levels over 4.5 mUI/mL were enrolled by consecutive sampling. All 116 women in the sample were treated with a fixed daily dose of thyroxine 75 microgram-thyroxine levels were measured at two, four, and six months, and thyroxine dose was modified if TSH level was lower than 0.3 or higher than 4.5 mUI/mL. RESULTS: A woman had a TSH level less than 0.3 mUI/mL in a test; reduction of thyroxine dose to 50 microgram/day allowed for maintaining TSH level within the desired range until delivery. Six women had TSH levels over 4.5 mUI/mL in one test; in all of them, increase in thyroxine dose to 100 microgram/day allowed for maintaining the level within the desired range until delivery. CONCLUSIONS: Fixed daily doses of thyroxine 75 microgram allowed for achieving goal TSH levels in most of our pregnant women with subclinical hypothyroidism, irrespective of their weight and baseline TSH level

Influencia de la glucemia venosa en ayunas en el cálculo de la glucemia media estimada / Influence of venous blood glucose during fasting in the calculation of estimated average glucose

INTRODUCCIÓN: La glucosa media estimada (eAG) es una aproximación en mg/dl de la concentración plasmática media de glucosa durante los 60-90 días previos. OBJETIVO: Conocer el papel de la glucemia venosa en ayunas y las glucemias posprandiales en el cálculo de eAG. MATERIAL Y MÉTODOS: Se incluyó a 413 pacientes con diabetes mellitus atendidos entre enero y julio de 2012, usando como criterios de exclusión las condiciones que pueden modificar los valores de A1c. Se recogieron las glucemias venosas en ayunas y A1c pertenecientes a una misma extracción. Se calculó el valor de eAG perteneciente a cada determinación de A1c, y la diferencia entre cada glucemia venosa y la eAG de 909 parejas de valores. RESULTADOS: Edad de 64 ± 13,5 años. El 53% eran varones, y en el 95% de los casos diabéticos tipo 2. La media de A1c en la muestra analizada fue de 8,1 ± 1,6%. El valor de eAG de este porcentaje es de 186 mg/dl. La glucemia venosa en ayunas fue de 172 ± 69 mg/dl. La diferencia entre la eAG y la media de las glucemias venosas en ayunas fue de 14 mg/dl, significativa con una p < 0,01. CONCLUSIÓN: La eAG es significativamente superior a la media de las glucemias en ayunas en los pacientes con diabetes. Podemos suponer que esta diferencia es consecuencia de la influencia de las glucemias posprandiales en el cálculo de eAG, y que la contribución de la glucemia en ayunas a dicho cálculo es aproximadamente del 92%, y la de la glucemia posprandial, del 8%

INTRODUCTION: The estimated average glucose (eAG) level is an approximate calculation in mg/dL of the plasma concentration of glucose over the previous 60-90 days. OBJECTIVE: To determine the role of venous blood glucose during fasting and post-prandial levels in the calculation of eAG. MATERIAL AND METHODS: We included 413 patients with diabetes mellitus that were being treated between January and July 2012. We considered any condition that could modify the values of A1c as exclusion criteria. We measured the fasting venous blood glucose levels and A1c in the same samples. We calculated the eAG level of each A1c measurement, and the difference between each venous blood glucose level and the eAG of 909 pairs of values. RESULTS: The mean age of the patients was 64 ± 13.5 years old. From our sample, 53% were male, and 95% of these cases were suffering from type 2 diabetes. The average A1c in the sample was 8.1% ± 1.6%. The eAG level for this percentage was 186 mg/dL. The fasting venous blood glucose was 172 ± 69 mg/dL. The difference between the eAG and the average of the fasting venous glucose levels was 14 mg/dL. This was found to be significant with P < 0.01. CONCLUSION: The eAG level is significantly higher than the mean of the levels in fasting in patients with diabetes. We can assume that this difference is due to the influence of the post-prandial glucose levels in the calculation of eAG; and that the contribution of fasting blood glucose to this calculation is approximately 92%, and that of post-prandial blood glucose only 8%