Cholestasis induced by total parenteral nutrition: effects of the addition of Taurine (Tauramin®) on hepatic function parameters; possible synergistic action of structured lipids (SMOFlipid®).

OBJECTIVE: Assess the hepatoprotective effect of Taurine (Tau) in cases of hepatic cholestasis induced by Total Parenteral Nutrition (TPN). METHODS: We describe a retrospective series of 54 patients who received TPN, in which cholestasis was detected at an (Intermediate) point that separates the duration of TPN into 2 Phases. From this moment -Phase 2- on, and according to clinical criteria, some patients (Group A, n = 27) received amino acids with Tau (22.41 ± 3.57 mg/kg/day)(Tauramin®), while the rest (Group B, n = 27) received the standard solution without Tau. The mean TPN durations were 39.2 ± 17.1 and 36.4 ± 18.1 days respectively, with the Intermediate points on days 19.56 ± 10.51 and 17.89 ± 11.14. They all received diets that were homogeneous in terms of kcal and macronutrients. In Phase 2, 21 patients from Group A received structured lipids (SMOFlipid®); while 20 from Group B received soy MCT/LCT [ Medium Chain Triglycerides/Long Chain Triglycerides ] (physical or structured mixture). In a retrospective study, differences could not be avoided. The analytical parameters from three periods (Initial, Intermediate, and Final) were obtained from Nutridata® and Servolab®. We compared interperiod values using the Wilcoxon test SPSS® (p < 0.05). RESULTS: After introducing Taurine AST, ALT, and GGT were significantly reduced; Bilirubin was also reduced, but not significantly. The values obtained for GGT in Group A were (Mean(σ)/median): Initial 48.6 (23.1)/46; Intermediate 473.7 (276.2)/438, and Final 328.9 (190.4)/305. We stress that the mean GGT value is reduced by 30.56% after adding Taurine, while in its absence all parameters are elevated, and mean GGT increases 45.36%. CONCLUSION: These results show Taurine's hepatoprotective effect and support its use in cases of TPN-induced cholestasis. We acknowledge the possibility that the differences between SMOF and the MCT/LCT mixtures also may have influenced the results in a combined effect with taurine.

[Drug selection in hospitals. A model of reference in self-management of resources]. / Selección de medicamentos en el hospital. Un modelo de autogestión de prestaciones referencial.

The practice of medicine today must balance the optimal use of new pharmaceutical agents with the need for cost containment. Hospital policy regarding therapeutics and its historical perspective are discussed. Various aspects of the operations of Pharmacy and Therapeutics Committees are presented. The potential benefits of a formulary system are therapeutic, economic and educational and it could lead to a uniformity of drug usage throughout a district. The role of Clinical Pharmacology to provide advice to both Institution and physicians in how therapeutic practice may be optimized is also stressed.

[The impact of hospitalization on drug prescription]. / Impacto de la hospitalización sobre la prescripción de fármacos.

BACKGROUND: The aim of this study was to investigate the influence of hospitalization on drug prescription and identify the proportion of hospital admissions for "pharmacologic causes" and the incidence of side effects during hospital stay. METHODS: Five hundred four patients admitted to the internal medicine department of a community hospital over a consecutive six-month period were studied. Follow up until hospital discharge was carried out with information being collected according to a protocol established from the characteristics of the treatment administered. RESULTS: Most of the patients admitted were elderly males, with low educational and socioeconomic status, presenting multiple chronic diseases. During hospitalization the number of drugs prescribed doubled (6.0) in relation to the mean (3.3) at the time of admission. Upon discharge the mean number of drugs prescribed (4.1) was significantly higher to that at the time of patient admission. This increase in the number of drugs prescribed upon discharge reflected practically all of the therapeutic groups, specially those of antibiotics, hematologic and digestive drugs, including all the patients regardless of age or sex. The number of drugs prescribed during admission was identified as a variable independently associated to the increase in the number of drugs prescribed on discharge. Hospital admissions for pharmacologic causes were due to therapeutic non compliance (15.4%) and the presentation of side effects (7.8%). The presentation of side effects during hospitalization (8.5%), mostly gastrointestinal, cardiovascular or neurologic was related with age, and the number of drugs administered, and was associated with longer hospital stay. CONCLUSIONS: Contrary to what was expected, hospitalization leads to an increase in the number of drugs prescribed in relation with the therapeutic schedules administered prior to admission.

[Drug use pattern in an ambulatory geriatric population]. / Patrón de utilización de medicamentos en una población geriátrica ambulatoria.

AIM: To provide an update of drug utilization patterns of 500 ambulatory subjects over 60 years of age. METHODS: Subjects were asked about their prescribed and nonprescribed medications an a detailed questionnaire was fulfilled. The case records and prescription sheets, when available, were examined. RESULTS: Drug histories were obtained on 313 women and 187 men. the mean age was 71 years (range 60-96). Of these participants 1.8% were taking no medications. The average number of drugs used was 4.8 (range from 0-16) nevertheless, the mean number of pharmacological active ingredients was much higher (7.3). The mean number of nonprescribed medications was 0.11, the majority with only an active ingredient. 87% had been used for longer than three months, and were taken daily (84%). The most commonly prescribed medications in this population were paracetamol, digoxin, hydrochlorothiazide, amiloride, nifedipine and captopril. CONCLUSIONS: The elderly are, in fact, receiving an increasing number of medications with a narrow therapeutic index and chronically.