Administración de amoxicilina a un paciente con mononucleosis infecciosa. Reporte de un caso de reacción adversa / Amoxicillin administration to a patient with infectious mononucleosis. Report of an adverse reaction case

Objetivo: Describir un caso clínico de un paciente tratado con amoxicilina (AMX) mientras cursaba una infección viral, en el que se detectaron errores de medicación (EM) y reacciones adversas a medicamentos (RAM). Descripción del caso clínico: Paciente masculino de 7 años y 23 kg concurrió a la guardia del hospital presentando fatiga, fiebre y ganglios linfáticos inflamados. Se diagnosticó faringitis bacteriana y se indicó AMX 50 mg/kg/día vía oral/8 h. Al día siguiente, el paciente fue nuevamente al hospital presentando rash cutáneo en todo el cuerpo. Se advirtió evento adverso (EA) por diagnóstico erróneo y se diagnosticó mononucleosis infecciosa (MI). Se suspendió la AMX y hubo remisión del rash. Un farmacéutico hospitalario realizó la imputación utilizando el algoritmo de Naranjo (puntaje 5-8) y notificó al Sistema Unificado de Farmacovigilancia de Córdoba. Discusión: Es fundamental el diagnóstico adecuado de la MI para evitar el uso inapropiado de antibióticos ante una infección viral. En el caso descripto ocurrió un EM en la etapa de prescripción, debido al diagnóstico incorrecto, y una RAM por el uso de AMX. El puntaje obtenido permitió catalogar a esta RAM como probable, no pudiendo ser considerada definida/probada por no haber reexposición; aunque el EA apareció luego de la administración de un fármaco sospechoso y no existieron causas alternativas para explicar esta reacción. Además, el EA desapareció tras suspender la AMX. Esto enfatiza el rol protagónico del farmacéutico para promover la seguridad de pacientes y la importancia de las notificaciones. (AU)

Goal: To describe a clinical case of a patient treated with amoxicillin (AMX) while he had a viral infection. In this case, medication error (ME) as well as adverse drug reaction (ADR) were detected. Description of the clinical case: A 7-year-old, 23-kg male patient attended to the hospital with the following symptoms: fatigue, fever and swollen lymph nodes. Pharyngitis caused by bacteria was diagnosed and orally administration of AMX 50 mg/kg/day each 8 h was indicated. One day later, the patient returned to the hospital with skin rash throughout the body. An adverse event (AE) was noticed due to an error in the diagnosis, which was corrected and infectious mononucleosis (MI) was detected. AMX was suspended and remission of the rash was observed. A hospital pharmacist performed the imputation using the Naranjo algorithm (score 5-8) and notified to the Sistema Unificado de Farmacovigilancia of Cordoba. Discussion: Proper diagnosis of IM is essential to avoid inappropriate use of antibiotics when the patients present viral infections. In this clinical case, a ME occurred at the prescription, due to the incorrect diagnosis, and an ADR because of the use of AMX. The score obtained allowed us to classify this ADR as probable, and it could not be considered definite/proven because there was no re-exposure. However, the AE occurred after the administration of a suspected drug and there were no alternative causes to explain this reaction. In addition, the AE disappeared after suspending the AMX. This emphasizes the leading role of the pharmacist in promoting patient safety and the relevance of notifications. (AU)

Clinical significance and in vitro cellular regulation of hypoxia mimicry on HIF-1α and downstream genes in canine appendicular osteosarcoma.

Cellular adaptation to a hypoxic microenvironment is essential for tumour progression and is largely mediated by HIF-1α and hypoxia-regulated factors, including CXCR4, VEGF-A and GLUT-1. In human osteosarcoma, hypoxia is associated with resistance to chemotherapy as well as with metastasis and poor survival, whereas little is known about its role in canine osteosarcoma (cOSA). This study aimed primarily to evaluate the prognostic value of several known hypoxic markers in cOSA. Immunohistochemical analysis for HIF-1α, CXCR4, VEGF-A and GLUT-1 was performed on 56 appendicular OSA samples; correlations with clinicopathological features and outcome was investigated. The second aim was to investigate the in vitro regulation of markers under chemically induced hypoxia (CoCl2). Two primary canine osteosarcoma cell lines were selected, and Western blotting, immunofluorescence and qRT-PCR were used to study protein and gene expression. Dogs with high-grade OSA (35.7%) were more susceptible to the development of metastases (P = 0.047) and showed high HIF-1α protein expression (P = 0.007). Moreover, HIF-1α overexpression (56%) was correlated with a shorter disease-free interval (DFI; P = 0.01), indicating that it is a reliable negative prognostic marker. The in vitro experiments identified an accumulation of HIF-1α in cOSA cells after chemically induced hypoxia, leading to a significant increase in GLUT-1 transcript (P = 0.02). HIF-1α might be a promising prognostic marker, highlighting opportunities for the use of therapeutic strategies targeting the hypoxic microenvironment in cOSA. These results reinforce the role of the dog as a comparative animal model since similar hypoxic mechanisms are reported in human osteosarcoma.