Titulación de inmunoglobulinas inespecíficas frente a citomegalovirus: alternativa a la presentación hiperinmune / Non-specific immunoglobulin titres against cytomegalovirus: An alternative to hyperimmune presentation

Objetivo La inmunoglobulina específica frente a citomegalovirus ha demostrado su eficacia en la prevención y tratamiento de la infección en el trasplante de órganos sólidos. Distintos estudios indican una eficacia similar respecto a las presentaciones de Ig inespecíficas. El objetivo de este estudio es determinar la titulación de inmunoglobulina anti-citomegalovirus de una de las presentaciones de inmunoglobulinas inespecíficas autorizadas en España. Método Estudio observacional en el que se analizó la titulación de anticuerpos anti-citomegalovirus de distintos lotes de Flebogamma® 5% 5g utilizados en el Hospital Universitari Vall d’Hebron durante los años 2008 y 2009.ResultadosSe analizaron 27 lotes, que incluyeron 18.944 viales de Flebogamma® 5%. En función del origen, la concentración mediana de inmunoglobulina anti-citomegalovirus fue de 28UPEI/ml y 22UPEI/ml para los viales de origen norteamericano y español, respectivamente (IC 95 % para la diferencia de las medianas de 5 a 6UPEI/ml; p<0 001ConclusionesLa concentración de anticuerpos anti-citomegalovirus de los lotes de inmunoglobulina inespecífica analizados es ligeramente inferior respecto a las especialidades de inmunoglobulinas específicas. Estas diferencias pueden compensarse mediante un ajuste posológico (AU)

Objective Specific immunoglobulin against cytomegalovirus has demonstrated its effectiveness in preventing and treating infections in solid organ transplantation. Several studies indicate that non-specific immunoglobulin is just as effective. This study aims to determine anti-cytomegalovirus immunoglobulin titres from one of the non-specific immunoglobulin presentations authorised in Spain. Method This was an observational study, in which we analysed the anti-cytomegalovirus antibody titres from different batches of Flebogamma® 5% 5g used at the Hospital Universitari Vall d'Hebron during 2008 and 2009.ResultsWe analysed 27 batches, which included 18,944 vials of Flebogamma® 5%. Depending on the origin, the median concentration of anti-cytomegalovirus immunoglobulin was 28PEI-U/ml and 22PEI-U/ml per vial of North American and Spanish origin, respectively (CI 95% for the difference of the medians 5 to 6PEI-U/ml; p<0 001ConclusionsThe anti-cytomegalovirus antibody concentration of the non-specific immunoglobulin batches analysed was slightly lower than in the specific immunoglobulin preparations. These differences can be compensated by adjusting the dosage (AU)

Non-specific immunoglobulin titres against cytomegalovirus: an alternative to hyperimmune presentation.

OBJECTIVE: Specific immunoglobulin against cytomegalovirus has demonstrated its effectiveness in preventing and treating infections in solid organ transplantation. Several studies indicate that non-specific immunoglobulin is just as effective. This study aims to determine anti-cytomegalovirus immunoglobulin titres from one of the non-specific immunoglobulin presentations authorised in Spain. METHOD: This was an observational study, in which we analysed the anti-cytomegalovirus antibody titres from different batches of Flebogamma(®) 5% 5g used at the Hospital Universitari Vall d'Hebron during 2008 and 2009. RESULTS: We analysed 27 batches, which included 18,944 vials of Flebogamma(®) 5%. Depending on the origin, the median concentration of anti-cytomegalovirus immunoglobulin was 28PEI-U/ml and 22PEI-U/ml per vial of North American and Spanish origin, respectively (CI 95% for the difference of the medians 5 to 6PEI-U/ml; p<0.001). CONCLUSIONS: The anti-cytomegalovirus antibody concentration of the non-specific immunoglobulin batches analysed was slightly lower than in the specific immunoglobulin preparations. These differences can be compensated by adjusting the dosage.

[Drug information management through the intranet of a hospital center]. / Original Breve Gestión de la información de medicamentos mediante la intranet de un centro hospitalario.

OBJECTIVE: This paper describes the methodology used for the implementation and validation of a network resource incorporated to the intranet of the Hospital, in order to retain and disseminate information from the Drug Information Center (DIC) of a pharmacy service in a hospital center. METHOD: A working group designed the structure, contents, memory needs, priority of access for users and a quality assessment questionnaire. RESULTS: The resource developed by the working group had a capacity of 70 Gb and its structure was based on HTML documents, including files with different format and 12 theme areas. Two levels of priority of access were established depending on the user and two persons were in charge of the resource. The questionnaire was delivered after three months of use. Sixty nine per cent of the users regarded the resource as very useful and 31%, as useful. The final structure, according to the results of the survey, had 11 theme areas. CONCLUSIONS: The use of the hospital Intranet in order to include and organize DIC information can be very simple and economic. Furthermore, the involvement of all the users in its design and structure can facilitate the practical use of this tool and improve its quality.

Gestión de la información de medicamentos mediante la intranet de un centro hospitalario / Drug information management through the intranet of a hospital center

Objetivo: En el presente trabajo se describe la metodología deimplantación y validación de un recurso de red incluido en la intranetdel Hospital, para almacenar y difundir la información delCentro de Información de Medicamentos (CIM) de un servicio defarmacia en un centro hospitalario.Método: Un grupo de trabajo diseñó la estructura, contenido,necesidades de memoria, prioridades de acceso de los usuarios yuna encuesta para evaluar la calidad.Resultados: El recurso obtenido de 70 Gb de capacidad seestructuró mediante documentos HTML incluyendo archivosde diferente formato con 12 áreas temáticas. Se establecieron2 niveles de prioridad de acceso según el usuario y dos responsablesdel recurso. La encuesta realizada tras tres meses de utilizaciónmostró que el 69% de los usuarios, consideró el recurso muyútil, y el 31% lo calificó de útil. La estructura final, según los resultadosde la encuesta fue de 11 áreas temáticas.Conclusiones: La utilización de la intranet del hospital paraincluir y estructurar la información del CIM puede realizarse deuna forma sencilla y económica. Además, la participación detodos los usuarios en su diseño y estructura, puede facilitar la utilidadpráctica de esta herramienta y aumentar su calidad

Objective: This paper describes the methodology used for theimplementation and validation of a network resource incorporatedto the intranet of the Hospital, in order to retain and disseminateinformation from the Drug Information Center (DIC) of a pharmacyservice in a hospital center.Method: A working group designed the structure, contents,memory needs, priority of access for users and a quality assessmentquestionnaire.Results: The resource developed by the working group had acapacity of 70 Gb and its structure was based on HTML documents,including files with different format and 12 theme areas.Two levels of priority of access were established depending on theuser and two persons were in charge of the resource. The questionnairewas delivered after three months of use. Sixty nine percent of the users regarded the resource as very useful and 31%, asuseful. The final structure, according to the results of the survey,had 11 theme areas.Conclusions: The use of the hospital Intranet in order toinclude and organize DIC information can be very simple and economic.Furthermore, the involvement of all the users in its designand structure can facilitate the practical use of this tool andimprove its quality

[Clinical and pharmacological databases for personal digital assistants]. / Bases de datos clínicas y farmacológicas para asistentes personales digitales.

Personal digital assistants (PDAs) are part of the new technologies applied to medicine, which could improve both access to and storage of distinct databases. The present article reviews some general technical features, as well as the utility of these devices for consulting specific pediatric, clinical and pharmacological databases. A search was performed in Medline (1999 to 2004) and of web pages that described the use of PDAs and a total of 46 useful applications were identified, including pediatric diagnostic and treatment guidelines, databases of diagnostic procedures, guidelines for antibiotic therapy in the pediatric and adult populations, databases to establish the diagnosis and treatment of patients in emergency and intensive care medicine, catalogues of general drugs with complete pharmacological data (indications, doses, adverse effects, interactions, toxicology, pregnancy, lactation), specific databases of neonatology, otorhinolaryngology and pediatric surgery, and medical calculator software. Each reference details the contents, source of the reference information, memory requirements, operating system, cost, web page for downloads and whether there is a test version. There is a wide variety of pediatrics software for PDAs. Once the quality of these databases has been assessed, each user should evaluate which application will be most useful depending on his or her needs.

Bases de datos clínicas y farmacológicas para asistentes personales digitales / Clinical and pharmacological databases for personal digital assistants

Los asistentes personales digitales (personal digital assistants, PDA) forman parte de las nuevas tecnologías aplicadas a la medicina, que pueden mejorar tanto el acceso como el almacenamiento de distintas bases de datos. En el presente trabajo se revisan algunas generalidades técnicas, así como la utilidad de estos dispositivos para la consulta de bases de datos específicas de pediatría, clínicas y farmacológicas. Se ha realizado una búsqueda en Medline (1999-2004) y de las páginas web que describen utilidades de los PDA, recopilándose un total de 46 aplicaciones útiles, del tipo: guías de diagnóstico y de tratamiento pediátricas, bases de datos de procedimientos diagnósticos, guías de terapéutica antimicrobiana en pediatría y también en el adulto, bases de datos para establecer el diagnóstico y tratamiento de pacientes en medicina de urgencia y cuidados intensivos, catálogos de medicamentos generales con fichas farmacológicas completas (indicaciones, dosis, efectos adversos, interacciones, toxicología, embarazo, lactancia), bases de datos específicas de neonatología, otorrinolaringología y cirugía pediátrica, y software calculador médico. Para cada referencia se muestra la descripción del contenido, fuente de información de referencia, necesidades de memoria, sistema operativo, coste, la página web de descarga y si hay versión de prueba. Como resultado se muestra que existe una amplia oferta de software médico especializado en pediatría para PDA, por lo que una vez contrastada la calidad de estas bases de datos, cada usuario debe valorar cuál puede ser la más útil en función de sus necesidades y de los aspectos descritos

Personal digital assistants (PDAs) are part of the new technologies applied to medicine, which could improve both access to and storage of distinct databases. The present article reviews some general technical features, as well as the utility of these devices for consulting specific pediatric, clinical and pharmacological databases. A search was performed in Medline (1999 to 2004) and of web pages that described the use of PDAs and a total of 46 useful applications were identified, including pediatric diagnostic and treatment guidelines, databases of diagnostic procedures, guidelines for antibiotic therapy in the pediatric and adult populations, databases to establish the diagnosis and treatment of patients in emergency and intensive care medicine, catalogues of general drugs with complete pharmacological data (indications, doses, adverse effects, interactions, toxicology, pregnancy, lactation), specific databases of neonatology, otorhinolaryngology and pediatric surgery, and medical calculator software. Each reference details the contents, source of the reference information, memory requirements, operating system, cost, web page for downloads and whether there is a test version. There is a wide variety of pediatrics software for PDAs. Once the quality of these databases has been assessed, each user should evaluate which application will be most useful depending on his or her needs

[Assesing the GRDOSIS Software program as a tool to analyse drug usase by DRGs]. / Evaluación del programa informático GRDOSIS como herramienta de análisis de la utilización de medicamentos por GRD.

OBJECTIVE: To validate the GRDOSIS software program as a tool to calculate Spanish drug weights within diagnosis-related groups (DRGs), and to analyse information used in this calculation. MATERIAL AND METHODS: Information corresponding to a 7-hospital sample is analysed after exchanging data between the minimum basic data set processed by the DRG-grouping program Estación Clínica -3M and unit-dose drug consumption. Data are purged by eliminating cases with an unusual (either long or short) length of stay in each DRG, and both weights and pondered weights are calculated. Data from the 5 most prevalent DRGs are analysed by using the different options provided by the software program, with the aim of detecting intervention points in order to improve results. RESULTS: Extreme case elimination noticeably reduces mean cost per DRG. A reduced group of DRGs represents a high percentage of total cost. Similarly, a reduced number of drugs may represent a high percentage of cost within a given DRG. The use of specific therapeutic groups for specific DRGs is demonstrated, as is the correct use of first-choice drugs versus other therapeutic options within therapeutic groups. An unwarranted variability regarding drug administration dosing and frequency is, however, observed. CONCLUSIONS: The GRDOSIS software program proves itself a powerful tool for both the qualitative (drug usage profiles, dosage) and quantitative (costs) analysis of information originating in a Pharmacy Department

Inhibidores de la proteasa del vih: actualización y monitorización terapéutica de las concentraciones plásmaticas en el tratamiento antirretroviral / HIV protease inhibitors: update and therapeutic monitoring of plasma concentration during anti-retroviral therapy

La incorporación de los inhibidores de la proteasa (saquinavir, ritonavir, indinavir, nelfinavir) en la terapia antirretroviral ha supuesto un importante descenso en la morbilidad y mortalidad provocada por el SIDA. Son compuestos no peptídicos que inhiben de forma potente y selectiva la proteasa del VIH-1. Se caracterizan por tener en común un metabolismo de eliminación hepático y una semivida de eliminación corta, con diferencias en el ámbito de absorción y distribución. Excepto el indinavir, deben administrarse con comidas. Poseen distintos perfiles de toxicidad, siendo el ritonavir el que presenta una mayor incidencia de reacciones adversas. La extensa metabolización por la isoenzima CYP3A4 del citocromo P450 puede originar interacciones de interés clínico. Actualmente, la carga viral y linfocitos T CD4 son los marcadores de evolución clínica de la enfermedad. Recientes estudios sugieren que la monitorización de las concentraciones plasmáticas pueden ser de utilidad en casos de no-adherencia, interacciones farmacocinéticas y fracaso virológico (AU)

The use of peritoneal dialysis as a means of supplying nutrients.

The aim of this study is to demonstrate the possibility of using the peritoneal route for carrying out periodical dialysis (PPD) together with supplying amino acids (AA's) for nutritional purposes and, at the same time, to determine the influence of the pattern of the mixture of AA's used for this purpose. In order to carry out this study we established three different groups. The PPD technique was the same for all the patients. In the control group PPD was performed without the addition of AA's. In groups 2 and 3 PPD was carried out with the addition of AA's and two different patterns were respectively used for that purpose.