Eventos adversos a insulina en ancianos de UCI y prescripción inapropiada de medicamentos / Adverse insulin events in elderly ICU patients and inappropriate medication prescription

El tratamiento de la diabetes tipo 2 en el anciano representa un importante reto tanto desde el punto de vista clínico como del de la salud pública.La prescripción inapropiada es aquella donde los medicamentos prescriptos no manifiestan claros beneficios frente a los riesgos habiendo alternativas más seguras y disponibles.Objetivo: Este estudio se propone como objetivo medir la tasa de eventos adversos a insulina en ancianos diabéticos tipo II hospitalizados en una unidad de cuidados intensivos y analizar la prescripción inapropiada de medicamentos con los criterios de Beers 2015.Materiales y métodos: Estudio observacional prospectivo.Resultados: Se estudiaron 308 pacientes. El número de eventos de hipo e hiperglucemias asociadas a insulina fue de 36 (11,7%), de los cuales: 20 fueron hiperglucemias y 16 fueron hipoglucemias. Los pacientes con estos eventos han sido 30 (9,7%), de los cuales 18 han presentado criterios Beers positivos (60%). En el total de la población, 21 pacientes, es decir el 6,8% presentó criterios Beers.Conclusiones: La proporción de pacientes ancianos con eventos adversos a insulina en esta muestra de pacientes ha sido del orden del 9,7% y en un 60% han presentado criterios Beers positivos de prescripción inapropiada. (AU)

The treatment of type 2 diabetes in the elderly represents a major challenge from both a clinical and public health point of view.Inappropriate prescription is one where the prescribed drugs do not show clear benefits versus risks, with safer and more available alternatives.Objective: The objective of this study is to measure the rate of adverse events to insulin in type II diabetic elderly hospitalized in an intensive care unit and to analyze inappropriate prescription of drugs with the Beers 2015 criteria.Materials and methods: Prospective observational study.Results: 308 patients were studied. The number of events of hypo and hyperglycemia associated with insulin was 36 (11.7%), of which: 20 were hyperglycemic and 16 were hypoglycemic. There were 30 patients with these events (9.7%), of which 18 had positive Beers criteria (60%). In the total population, 21 patients, that is, 6.8% presented Beers criteria.Conclusions: The proportion of elderly patients with adverse events to insulin in this sample of patients has been of the order of 9.7% and 60% have presented positive Beers criteria of inappropriate prescription. (AU)

Incidencia de eventos adversos a quimioterapia mediante dos métodos de detección: caracterización y costos sanitarios asociados / Incidence of adverse events to chemotherapy using two detection methods: characterization and associated health costs

A pesar del avance que ha supuesto en la supervivencia de los pacientes oncológicos, la aparición de nuevos agentes quimioterápicos y nuevas combinaciones, estos han traído consigo numerosos efectos adversos que pueden llegar a comprometer el tratamiento y, por consiguiente, el pronóstico de la enfermedad.Objetivos: Conocer la incidencia de los eventos adversos asociados a quimioterapia (EA), caracterizarlos y analizar sus implicancias económicas utilizando dos herramientas de detección.Materiales y métodos: Estudio de incidencia de corte longitudinal.Resultados: Se estudiaron 350 pacientes. La media de edad: 56,9, mediana: 43,4, rango: 19-85. El número de pacientes con EA fue: 323 en los cinco años. La incidencia acumulada (IA) fue: 0,923 es decir 92,3% pacientes en 5 años y la densidad de incidencia (DI) fue 0,186 en cinco años es decir 18,6%. El número de ADES en la muestra fue 1.601 con la revisión manual, una media de 4,57 EA/paciente en el total de la muestra. Los indicadores de EA fueron: 457,42 EA/100 altas, y 118,57 EA/1.000 días paciente hospitalizados. Se detectaron 152,47 EA/1.000 dosis de oncológicos administrados. Con la revisión de GTT se hallaron 1.578 EA, una media de 4,50 EA/paciente. Los indicadores de EA fueron: 450,8 EA/100 altas, y 126,64 EA/1.000 días paciente y 141,45 EA/1.000 dosis de medicamentos oncológicos administrados. Los costos facturados con y sin eventos son USD 5.343,75 vs. 15.287,5. Las dos herramientas de detección tienen similar capacidad de detección en cuanto número de EA pero la revisión completa de historia clínica sin gatillos lleva seis veces el tiempo que lleva la herramienta de gatillos. (AU)

Despite the progress it has made in the survival of cancer patients, the appearance of new chemotherapeutic agents and new combinations, these have brought with them numerous adverse effects that can compromise treatment and, consequently, the prognosis of the disease.Objectives: To know the incidence of adverse events associated with chemotherapy (AE), characterize them and analyze their economic implications using two detection tools.Materials and methods: Longitudinal cut incidence study.Results: 350 patients were studied. Mean age: 56.9, median: 43.4, range: 19-85. The number of patients with AD was: 323 in the five years. The cumulative incidence (AI) was: 0.923 that is 92.3% patients in 5 years and the incidence density (DI) was 0.186 in five years that is 18.6%. The number of ADES in the sample was 1,601 with manual review, a mean of 4.57 EA/patient in the total sample. The AE indicators were: 457.42 AE/100 discharges, and 118.57 AE/1,000 hospitalized patient days. 152.47 EA/1,000 doses of oncology administered were detected. With the GTT review, 1,578 AE were found, a mean of 4.50 AE/patient. The AE indicators were: 450.8 AE/100 discharges, and 126.64 AE/1,000 patient days and 141.45 AE/1,000 doses of oncological drugs administered. The costs invoiced with and without events are USD 5,343.75 vs. 15,287.5. The two detection tools have a similar detection capacity in terms of number of AE, but the complete medical history review without triggers takes six times the time that the trigger tool takes.Conclusions: The incidence of adverse cancer events is high, the GTT tool is useful compared to the complete review of medical records to find AE, the costs of hospitalization with events in relation to without events are significantly higher. The most frequent reactions are dermatological, and those that affect the blood system, among others. (AU)

Impact of intensity and timing of integrated home palliative cancer care on end-of-life hospitalization in Northern Italy.

PURPOSE: The Veneto Region implemented a novel integrated home-based palliative cancer care (HPCC) program embedded in primary care. We examined the impact of timing and intensity of this program on the quality of end-of-life (EOL) care. METHODS: We selected adult cancer patients died in the Veneto Region between March and December 2013, excluding those died from haematological malignancies as well as the very elderly (85+ years). We retrieved the claim-based data on hospitalization and homecare visits, and defined two observation windows: 90 to 16 days before death to examine intensity of HPCC exposure, and the last 15 days of life to examine EOL outcomes, including hospital death, any hospital stay for medical reasons and hospital stay ≥7 days for medical reasons. Multivariate analysis was conducted using a Poisson model. RESULTS: Among the 2211 adults who died of solid tumours and received 1+ homecare visits during the exposure period, 1077 (48.7%), 552 (25.0%) and 582 (26.3%) had 0.1-1.9, 2-3.9 and 4+ homecare visits/week, respectively. The median duration between an HPCC home visit and death was 92 days (IQR 42-257 days). Hospital death occurred in 856 (38.7%) patients, while 1087 (49.2%) and 556 (25.1%) had a hospital stay and a hospital stay ≥7 days during the exposure period, respectively. In the multivariate analysis, a greater intensity of integrated HPCC (4+ visits/week) was significantly associated with a lower risk of hospital death (relative risk [RR] = 0.67, 0.59-0.76), any hospital stay (RR = 0.69, 0.62-0.77) and hospital stay ≥7 days for medical reasons (RR = 0.59, 0.49-0.71). A late activation (≤30 days before death) of HPCC was also associated with increased both hospital stay (RR = 1.26, 0.11-1.42) and hospital stay ≥7 days (RR = 1.25, 1.01-1.54). CONCLUSIONS: A greater HPCC program intensity reduces the risk of hospital death and hospital stay in the end-of-life. An early activation of this program can contribute to improve these EOL outcomes.

High speed optical holography of retinal blood flow.

We performed noninvasive video imaging of retinal blood flow in a pigmented rat by holographic interferometry of near-infrared laser light backscattered by retinal tissue, beating against an off-axis reference beam sampled at a frame rate of 39 kHz with a high throughput camera. Local Doppler contrasts emerged from the envelopes of short-time Fourier transforms and the phase of autocorrelation functions of holograms rendered by Fresnel transformation. This approach permitted imaging of blood flow in large retinal vessels (∼30 microns diameter) over 400×400 pixels with a spatial resolution of ∼8 microns and a temporal resolution of ∼6.5 ms.

Specific intra-tissue responses to manganese in the floating lamina of Trapa natans L.

Plant tolerance to heavy metals requires morpho-physiological mechanisms that are still poorly understood, especially in hydrophytes. This study focuses on the young floating lamina of the rhyzophyte Trapa natans exposed for 10 d to 130 microM Mn. The lamina has the ability to bioaccumulate Mn (> 3000 microg g(-1)). X-ray microanalysis of Mn cellular distribution revealed accumulation in the upper epidermis, in the first palisade layer, and in the idioblasts of the spongy tissue, which were shown with electron microscopy to contain osmiophilic vacuolar deposits, also observed to a minor extent in the control leaves. On the basis of biochemical and histochemical tests, these deposits were attributed to phenolic compounds that were probably able to chelate Mn. Net photosynthesis, photosynthetic pigments, room temperature microspectrofluorimetric analyses, and ultrastructural studies of plastids were performed to evaluate the status of the photosynthetic apparatus. A greater development of thylakoid membranes was observed in plastids of the second palisade and spongy tissue, which, however, did not accumulate Mn. Only the spongy tissue experienced inadequate assembly of PS II, but this did not significantly influence the photosynthetic yield of the whole lamina. It was concluded that T. natans can optimise productivity in the presence of Mn by means of specific intra-tissue responses within the framework of the floating lamina.