Review of carbapenemics de-escalation in extended-spectrum b-lactamases producing enterobacteriaceae urinary tract infections in clinical practice / Revisión de la desescalada de carbapenémicos en las infecciones del tracto urinario por enterobacterias productoras de betalactamasas

The indiscriminate use of carbapenem antibiotics in urinary tract infections poses a risk of increasing antimicrobial resistance to them. The use of carbapenem antibiotics should be reserved for those urinary tract infections caused by extended-spectrum β-lactamases -producing Enterobacteriaceae. However, there is sufficient evidence of the possibility of using different therapeutic options to carbapenems in certain infections with extended-expectrum β-lactamases isolation and sensitivity data. Of the patients analysed in the study, those with urinary tract infection by extended-spectrum β-lactamases -producing Enterobacteriaceae treated with antibiotics other than carbapenemics based on susceptibility data, achieved resolution of infection in those cases where they were clinically well, so the use of these alternatives would be an appropriate optimisation and rational use of carbapenemic. (AU)

El uso indiscriminado de antibióticos carbapenémicos en infecciones del tracto urinario supone un riesgo de aumento de la resistencia antimicrobiana a los mismos. El uso de antibióticos carbapenémicos debe reservarse para aquellas infecciones del tracto urinario causadas por Enterobacterias productoras de betalactamasas de espectro extendido. Sin embargo, existe evidencia suficiente de la posibilidad de utilizar opciones terapéuticas diferentes a los carbapenémicos en determinadas infecciones con datos de sensibilidad. De los pacientes analizados en el estudio, aquellos con infección del tracto urinario por Enterobacterias productoras de betalactamasas de espectro extendido y tratados con antibióticos distintos a los carbapenémicos según datos de sensibilidad, consiguieron resolver la infección en aquellos casos en los que presentaban buen estado clínico por lo que el uso de estas alternativas supondría una adecuada optimización y uso racional de carbapenémicos. (AU)

[Effectiveness and safety of adalimumab and etanercept for rheumatoid arthritis in a third-level hospital]. / Efectividad y seguridad de adalimumab y etanercept en artritis reumatoide en un hospital de tercer nivel.

OBJECTIVE: To assess the effectiveness of adalimumab and etanercept at 6 and 12 months after therapy onset using DAS28, EULAR (European League Against Rheumatism), and ACR (American College of Rheumatology) criteria, and to analyze safety. METHOD: A prospective, 12-month, observational study of a patient cohort diagnosed with rheumatoid arthritis who were started on adalimumab or etanercept at the Rheumatology Department between January 2003 and December 2004. DAS28, EULAR, and ACR criteria were examined at 6 and 12 months. An intention-to-treat analysis was performed, and adverse reactions were quantitized. RESULTS: Ninety-nine patients were included - 50 on adalimumab and 49 on etanercept. Of these, 30 and 20%, respectively, received monotherapy. No differences in effectiveness were seen between both drugs during the studied periods of time according to DAS28. EULAR response to adalimumab at 6 and 12 months was: good 28 and 38%; moderate 40 and 36%; nil 10 and 4%; regarding etanercept at 6 and 12 months: good 29 and 43%; moderate 31 and 24%; nil 18 and 10%. As regards adalimumab at 6 and 12 months: ACR20: 64 and 62%; ACR50: 44 and 46%; ACR70: 22 and 26%; as regards etanercept at 6 and 12 months: ACR20: 61 and 65%; ACR50: 41 and 45%; ACR70: 16 and 24%. Eleven patients discontinued therapy in each group. CONCLUSIONS: Adalimumab and etanercept had a similar effectiveness in our population. Criteria of use may condition results, and thus awareness of other hospitals experience is encouraged.

Efectividad y seguridad de adalimumab y etanercept en artritis reumatoide en un hospital de tercer nivel / Effectiveness and safety of adalimumab and etanercept for rheumatoid arthritis in a third-level hospital

Objetivo: Valorar la efectividad de adalimumab y etanercept alos 6 y 12 meses de tratamiento mediante DAS28, criteriosEULAR (European League Against Rheumatism) y ACR (AmericanCollege of Rheumatology) y analizar la seguridad.Método: Estudio observacional, prospectivo, durante 12meses, de una cohorte de pacientes diagnosticados de artritis reumatoide,que iniciaron tratamiento con adalimumab o etanercepten el servicio de reumatología entre enero de 2003 y diciembrede 2004. Se determinaron criterios DAS28, EULAR y ACR a los6 y 12 meses. Se analizó por intención de tratar y se cuantificaronlas reacciones adversas.Resultados: Se incluyeron 99 pacientes, 50 con adalimumaby 49 con etanercept, de ellos el 30 y 20% en monoterapia. Nohubo diferencia de efectividad según DAS28 entre ambos fármacosen los periodos estudiados. La respuesta EULAR para adalimumaba los 6 y 12 meses fue: buena 28 y 38%, moderada 40 y36%, y ninguna 10 y 4% y para etanercept: buena 29 y 43%,moderada 31 y 24% y ninguna 18 y 10%. Para adalimumab a los6 y 12 meses: ACR20: 64 y 62%; ACR50: 44 y 46%; ACR70:22 y 26% y para etanercept a los 6 y 12 meses: ACR20: 61 y65%; ACR50: 41 y 45%; ACR70: 16 y 24%. Cesaron tratamientoen cada grupo 11 pacientes.Conclusiones: Adalimumab y etanercept presentan similarefectividad en nuestra población. Los criterios de utilización puedencondicionar los resultados, por ello es interesante conocer laexperiencia de otros hospitales

Objective: To assess the effectiveness of adalimumab and etanerceptat 6 and 12 months after therapy onset using DAS28,EULAR (European League Against Rheumatism), and ACR (AmericanCollege of Rheumatology) criteria, and to analyze safety.Method: A prospective, 12-month, observational study of apatient cohort diagnosed with rheumatoid arthritis who were startedon adalimumab or etanercept at the Rheumatology Departmentbetween January 2003 and December 2004. DAS28,EULAR, and ACR criteria were examined at 6 and 12 months.An intention-to-treat analysis was performed, and adverse reactionswere quantitized.Results: Ninety-nine patients were included – 50 on adalimumaband 49 on etanercept. Of these, 30 and 20%, respectively,received monotherapy. No differences in effectiveness were seenbetween both drugs during the studied periods of time according toDAS28. EULAR response to adalimumab at 6 and 12 months was:good 28 and 38%; moderate 40 and 36%; nil 10 and 4%; regardingetanercept at 6 and 12 months: good 29 and 43%; moderate31 and 24%; nil 18 and 10%. As regards adalimumab at 6 and 12months: ACR20: 64 and 62%; ACR50: 44 and 46%; ACR70: 22and 26%; as regards etanercept at 6 and 12 months: ACR20: 61and 65%; ACR50: 41 and 45%; ACR70: 16 and 24%. Elevenpatients discontinued therapy in each group.Conclusions: Adalimumab and etanercept had a similar effectivenessin our population. Criteria of use may condition results, andthus awareness of other hospitals experience is encouraged

[Use of MBDS as a tool for the detection of drug-related adverse events]. / Utilización del CMBD como herramienta para la detección de acontecimientos adversos a medicamentos.

OBJECTIVE: To analyze drug-related adverse events (DRAE) as noted in hospital discharge reports, as well as their severity and drugs involved, and to assess potential avoidability. MATERIAL AND METHODS: A retrospective study for the September-December 2002 period of time in which patients with discharge reports including an ICD-9-CM code E930-E949.9 were selected using the minimum basic data set (MBDS). RESULTS: DRAEs were detected in 2.15% of all discharge reports, and 229 were retrospectively assessed. In all, 62.45% (n = 143) were DRAEs detected at the Emergency Department, and 37.55% (n = 86) were DRAEs detected during hospitalization. Of these, 57.20% are considered potentially avoidable. Drugs most commonly involved in the outpatient DRAE sample studied included: digoxin (24.47%, avoidable 97.14%) and NSAIDs-opioids (13.98%, avoidable 75%). Inpatient DRAEs included: anticoagulants (30.23%, avoidable 57.69%) and antimicrobials (17.44%, avoidable 26.67%). CONCLUSIONS: The study revealed a high proportion of preventable DRAEs around a small number of drugs. Information to prescribing doctors and procedures for treatment follow-up using a unit dose drug dispensing system may be useful to reduce this.

Formation of copper oxychloride and reactive oxygen species as causes of uterine injury during copper oxidation of Cu-IUD.

The lining of the uterus and cervix might be injured by a variety of oxidation products of Cu in a Cu-IUD, including cuprous ions, dissolved and precipitated cupric ions, and reactive oxygen species such as superoxide radicals, hydrogen peroxide, and hydroxyl radicals. In this study, the human amnious WISH cell line was employed as a model of uterine cells in the presence of copper. The cell viability was decreased by elemental copper, which was alleviated up to 70% by the addition of catalase. The addition of copper oxychloride caused cell death in a dose-dependent manner. Hydroxyl radicals in the presence of copper were determined by the formation of malondialdehyde. Soluble cuprous chloride complexes are formed in the uterus by slowly entering oxygen. The complexes are partly oxidized to insoluble copper oxychloride. which damages the endometrium. Unoxidized cuprous ions migrate to the oxygen-rich cervix and are oxidized to copper oxychloride, causing cervix damage.