Hazardous drugs (NIOSH's list-group 1) in healthcare settings: Also a hazard for the environment?

Healthcare workers can be exposed to dangerous drugs during their daily practice. The National Institute for Occupational Safety and Health (NIOSH) considers "hazardous drugs" as those that had shown one or more of the following characteristic in studies with animals, humans or in vitro systems: carcinogenicity, teratogenicity or other toxicity for development, reproductive toxicity, organ toxicity at low doses, or genotoxicity. In the actual list (draft list 2020), drugs classified in group 1 are those with carcinogenic effects. Moreover, the global human and veterinary cancer is expected to grow, so antineoplastic drug consumption may consequently grow, leading to an increase of anticancer pharmaceuticals in the environment. Not all drugs pertaining to group 1 can be classified as "antineoplastic" or "cytostatic". Since most of the research on environment presence and ecotoxicological effects of pharmaceuticals has been focused on this therapeutic class, other carcinogenic drugs belonging to different therapeutic groups may have been omitted in previous studies. In this study we aim to review the presence in the environment of the hazardous drugs (NIOSH group 1) and their possible environmental impact. Of the 90 drugs considered, there is evidence of presence in the environment for 19. Drugs with more studies reporting positive detections are: the antibiotic chloramphenicol (55), the alkylating agents cyclophosphamide (39) and ifosfamide (30), and the estrogen receptor modulator tamoxifen (18). Although the original purpose of the NIOSH list and related documents is to provide guidance to healthcare professionals in order to adequately protect them from the hazards posed by these drugs in healthcare settings, we believe they can be useful for environmentalists too. Absence of data regarding the potential of environmental risk of certain hazardous drugs might tell us which drugs ought to be prioritized in the future.

Drugs used during the COVID-19 first wave in Vitoria-Gasteiz (Spain) and their presence in the environment.

The city of Vitoria-Gasteiz was one of the probable first entrances of the SARS-CoV2 in Spain, one of the worst affected countries in the world during the first COVID 19 wave. Driven by the urgency of the situation, multiple drugs with antiviral activity were used off label. Sadly, most of these treatments were of little or no benefit and thus, the number of patients suffering from COVID-19 attended in intensive care units (ICUs) multiplied. After being administered to patients, a variable proportion of these drugs reach the environment where they may have detrimental effects, although this aspect is usually ignored by healthcare professionals. In this study we measured the patterns of hospital drug use in the city of Vitoria-Gasteiz (Spain) during the first COVID-19 wave pandemic, focusing on those with antiviral activity and those used in the ICUs. Subsequently, we measured concentrations of selected drugs in the city's wastewater treatment plant influent and effluent and estimated the potential risk for the environment. The hospital use of certain antivirals and drugs used for sedo-analgesia were dramatically increased during the first wave (cisatracurium was multiplied by 25 and lopinavir/ritonavir by 20). A mean of 1.632 daily defined doses of hydroxychloroquine were used during the period of February-May 2020. In this study we report the first positive detection of hydroxychloroquine ever in the environment. We also show the second positive report of lopinavir. Low risk was estimated for hydroxychloroquine, lopinavir and ritonavir (Risk quotients (RQ) <1), and medium risk for azithromycin (RQ 0f 0.146).

Papel del aprepitant en el manejo del prurito en un paciente con linfoma cutáneo de células T / Role of aprepitant in the management of pruritus in a patient with cutaneous T-cell lymphoma

No disponible

[Role of aprepitant in the management of pruritus in a patient with cutaneous T-cell lymphoma]. / Papel del aprepitant en el manejo del prurito en un paciente con linfoma cutáneo de células T.

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Estudio comparativo de eficacia y seguridad de dos protocolos antieméticos en quimioterapia ginecológica / No disponible

Objetivo: Evaluar la eficacia y seguridad de una actualización de un protocolo antiemético de quimioterapia en tumores ginecológicos. Método Estudio prospectivo, observacional, realizado durante 12 meses en un hospital general de 400 camas. Se evaluó la eficacia del protocolo antiemético antiguo, se implantó el protocolo nuevo, y se midió su eficacia. Se incluyeron pacientes con tumores ginecológicos que acudían al hospital de día. Tras cada ciclo de quimioterapia, en una encuesta, registraban el número y severidad de náuseas/vómitos y otros efectos adversos. Se midió la eficacia como respuesta completa (sin náuseas y sin vómitos) en la fase aguda (primeras 24h posquimioterapia) y en retardada (día 2-5 posquimioterapia). Se evaluó si la edad, el tipo de protocolo y el poder emetógeno de los esquemas podían influir en la respuesta. Resultados Se analizaron 102 ciclos de quimioterapia con el protocolo antiguo (52 pacientes) y 293 ciclos (98 pacientes) con el protocolo nuevo. Se encontraron diferencias significativas en la respuesta completa en la fase retardada con el protocolo nuevo (67,38 vs 36,27%), p < 0,0001. La probabilidad de obtener respuesta completa con el protocolo nuevo era dos veces mayor que con el antiguo en emesis aguda (OR=1,85; IC 95% = 1,05-3,24; p=0,03) y cuatro veces mayor en emesis retardada (OR=4,27; IC 95% = 2,59-7,02; p<0,0001). Conclusiones Con el nuevo protocolo se consiguió un mayor porcentaje de respuesta completa en la emesis retardada. La edad y el bajo poder emetógeno de los esquemas fueron factores predictivos de respuesta completa en la emesis aguda (AU)

Objectives: To evaluate the efficacy and safety of an update to an anti-emetic protocol in chemotherapy for gynecological tumours. Method: Prospective observational study performed over 12 months in a general hospital with400 beds. We evaluated the efficacy of the old anti-emetic protocol, a new protocol was implemented, and its efficacy was determined. We included patients with gynaecological tumours that sought treatment at the Day Hospital. After each chemotherapy cycle, patients filled out a survey that registered the number and severity of episodes of nausea/vomiting and other adverse effects. The efficacy of treatment was measured as complete response (no nausea orvomit) in the acute phase (first 24 h after chemotherapy) and late phase (2-5 days after chemotherapy). We also evaluated whether age, the type of protocol, and the emetogenous power of the different treatment schemes could influence patient response. Results: We analysed 102 chemotherapy cycles under the old protocol (52 patients) and293 cycles under the new protocol (98 patients). We observed significant differences in completeresponse rates in the late phase between old and new protocols (36.27% vs 67.38%, P<.0001).The probability of obtaining a complete response using the new protocol was twice as high as with the old protocol in acute emesis (OR = 1.85, 95% CI: 1.05-3.24, P=.03) and four times higherin late emesis (OR = 4.27, 95% CI: 2.59-7.02, P<.0001).Conclusions: A greater percentage of complete responses to late emesis was obtained using the new protocol. Age and the low emetogenous power of the treatment schemes were predictive factors for complete response in acute emesis (AU)

[Comparative study of the efficacy and safety of two anti-emetic protocols in gynecological chemotherapy]. / Estudio comparativo de eficacia y seguridad de dos protocolos antieméticos en quimioterapia ginecológica.

OBJECTIVES: To evaluate the efficacy and safety of an update to an anti-emetic protocol in chemotherapy for gynecological tumours. METHOD: Prospective observational study performed over 12 months in a general hospital with 400 beds. We evaluated the efficacy of the old anti-emetic protocol, a new protocol was implemented, and its efficacy was determined. We included patients with gynaecological tumours that sought treatment at the Day Hospital. After each chemotherapy cycle, patients filled out a survey that registered the number and severity of episodes of nausea/vomiting and other adverse effects. The efficacy of treatment was measured as complete response (no nausea or vomit) in the acute phase (first 24h after chemotherapy) and late phase (2-5 days after chemotherapy). We also evaluated whether age, the type of protocol, and the emetogenous power of the different treatment schemes could influence patient response. RESULTS: We analysed 102 chemotherapy cycles under the old protocol (52 patients) and 293 cycles under the new protocol (98 patients). We observed significant differences in complete response rates in the late phase between old and new protocols (36.27% vs 67.38%, P<.0001). The probability of obtaining a complete response using the new protocol was twice as high as with the old protocol in acute emesis (OR=1.85, 95% CI: 1.05-3.24, P=.03) and four times higher in late emesis (OR=4.27, 95% CI: 2.59-7.02, P<.0001). CONCLUSIONS: A greater percentage of complete responses to late emesis was obtained using the new protocol. Age and the low emetogenous power of the treatment schemes were predictive factors for complete response in acute emesis.

Evolución de la adherencia al tratamiento antirretoviral del 2000 al 2008 / Evolution of antiretroviral treatment adherence from 2000 to 2008

Objetivos Evaluar la adherencia al tratamiento antirretroviral en la cohorte de pacientes VIH de nuestro hospital y ver su evolución a lo largo de 9 años; así como conocer el patrón individual de la adherencia con el tiempo. Métodos Estudio descriptivo de la evolución de la adherencia media anual y el porcentaje anual de pacientes con adherencias superiores al 95%, desde el 2000 al 2008. Se analizó el patrón individual de adherencia con el tiempo y se clasificó a los pacientes en adherentes consistentes, no adherentes consistentes y fluctuantes. Resultados En el análisis de 577 pacientes, la adherencia basal fue significativamente mayor en los pacientes naive respecto a los pretratados. La adherencia media anual aumentó ligeramente y se mantuvo en valores cercanos al 95%. Al igual que el porcentaje de pacientes con adherencia superior al 95%, que aumentó desde el 64% en el 2000 al 79% en 2008.En cuanto al patrón individual de adherencia con el tiempo, de los 468 pacientes analizados, la mayoría (59%) fueron adherentes consistentes, un 4% no adherente y el resto (37%) presentaban fluctuaciones en su adherencia. Conclusiones En nuestra cohorte los valores de adherencia global se mantienen con el tiempo e incluso presentan una tendencia positiva; resultado de una monitorización sistemática de la adherencia e implantación de estrategias dirigidas a mantener la adherencia (AU)

Objectives To evaluate antiretroviral treatment adherence in the HIV patient cohort of our hospital and observe their evolution over a 9-year period; also to determine the individual pattern of adherence over time. Methods Descriptive study of the evolution of average annual adherence and the annual percentage of adherent patients greater than 95% from 2000 to 2008. We analysed the individual pattern of adherence over time and patients were classified into consistently adherent, consistently non-adherent, and fluctuating. Results In the analysis of 577 patients, baseline adherence was significantly greater in naïve patients with respect to those who were pre-treated. Average annual adherence increased slightly and stayed at values around 95%. As with the percentage of patients with adherence greater than 95%, which increased from 64% in 2000 to 79% in 2008.In terms of the individual pattern of adherence over time, of the 468 patients analysed, the majority (59%) were consistently adherent, 4% non-adherent, and the rest (37%) fluctuated in their adherence. Conclusions In our cohort the overall adherence values maintained themselves over time and even show a positive trend, likely the result of systematic monitoring of adherence and implementation strategies to maintain adherence (AU)

[Evolution of antiretroviral treatment adherence from 2000 to 2008]. / Evolución de la adherencia al tratamiento antirretoviral del 2000 al 2008.

OBJECTIVES: To evaluate antiretroviral treatment adherence in the HIV patient cohort of our hospital and observe their evolution over a 9-year period; also to determine the individual pattern of adherence over time. METHODS: Descriptive study of the evolution of average annual adherence and the annual percentage of adherent patients greater than 95% from 2000 to 2008. We analysed the individual pattern of adherence over time and patients were classified into consistently adherent, consistently non-adherent, and fluctuating. RESULTS: In the analysis of 577 patients, baseline adherence was significantly greater in naïve patients with respect to those who were pre-treated. Average annual adherence increased slightly and stayed at values around 95%. As with the percentage of patients with adherence greater than 95%, which increased from 64% in 2000 to 79% in 2008. In terms of the individual pattern of adherence over time, of the 468 patients analysed, the majority (59%) were consistently adherent, 4% non-adherent, and the rest (37%) fluctuated in their adherence. CONCLUSIONS: In our cohort the overall adherence values maintained themselves over time and even show a positive trend, likely the result of systematic monitoring of adherence and implementation strategies to maintain adherence.