Atención farmacéutica en pacientes con inmunodeficiencia adquirida y/o tuberculosis en el área ambulatoria de un hospital pediátrico / Pharmacovigilance in patients with acquired immunodeficiency and/or tuberculosis in the outpatient area of a pediatric hospital

La Atención farmacéutica (AF) ayuda a los pacientes a alcanzar objetivos terapéuticos reduciendo los problemas relacionados al medicamento (PRM). Objetivos: analizar los PRM en la práctica de la AF a pacientes con inmunodeficiencia adquirida (IDA) y/o tuberculosis (TBC) y evaluar su impacto. Método: estudio, descriptivo, observacional, en el área ambulatoria de Farmacia. Se incluyeron pacientes con IDA y/o TBC con: inicio de tratamiento, polifarmacia, reinternaciones frecuentes, regular/mala adherencia, reacciones adversas a medicamentos (RAM) previas y/o comorbilidades. Se entrevistaron pacientes o cuidadores y se registraron PRM, errores, grados de adherencia y conocimiento farmacoterapéutico, retiro oportuno de medicamentos y parámetros clínicos. Se registró la intervención farmacéutica y entregó material educativo. Se repitieron las mediciones en una segunda entrevista. Resultados: Se estudiaron 54 pacientes (28 con IDA y 26 con TBC). Se realizaron 93 intervenciones (29.9% dirigidas al prescriptor, 27.8% a otros profesionales) y se detectaron 8 RAM y 53 errores (28 IDA y 25 TBC), el principal PRM fue la mala/regular adherencia con bajo porcentaje de conocimiento farmacoterapéutico completo. Después de la AF, en IDA el grado de adherencia tuvo una mejora estadísticamente significativa (p= 0.012), también fue significativa la mejora en el retiro oportuno de la medicación (28.6% a 71.4% p=0.005 IDA). Se obtuvieron resultados favorables de carga viral (CV) en 72% pacientes con IDA y aumento de peso en 92% pacientes con TBC, aunque no fueron estadísticamente significativos. Conclusiones: mediante AF se mejoró la adherencia y la comunicación en pacientes pediátricos con IDA y/o TBC (AU)

Pharmacovigilance (PV) helps patients achieve therapeutic goals by reducing drug-related problems (DRP). Objectives: to analyze DRPs in the practice of PV in patients with acquired immunodeficiency (AIDS) and/or tuberculosis (TB) and to evaluate its impact. Methods: A descriptive, observational study was conducted in the outpatient pharmacy area. Patients with AIDS and/or TB with: treatment initiation, polypharmacy, frequent readmissions, regular/poor adherence, previous adverse drug reactions (ADR) and/or comorbidities were included. Patients or caregivers were interviewed, and DRP, errors, adherence and pharmacotherapeutic knowledge, timely drug withdrawal, and clinical parameters were recorded. The pharmaceutical intervention was recorded and educational material was delivered. Measurements were repeated in a second interview. Results: We studied 54 patients (28 with AIDS and 26 with TB). Ninety-three interventions were performed (29.9% addressed to the drug prescriber, 27.8% to other professionals) and 8 ADRs and 53 errors were detected (28 AIDS and 25 TB). The main DRP was poor/regular adherence together with a low level of complete pharmacotherapeutic knowledge. After PV, in patients with AIDS the degree of adherence statistically significantly improved (p= 0.012). The improvement in timely medication withdrawal was also significant (28.6% vs. 71.4% p=0.005 AID). Favorable viral load results were obtained in 72% of patients with AIDS and weight gain in 92% of patients with TB, although they were not statistically significant. Conclusions: PV improved adherence and communication in pediatric patients with AIDS and/or TB (AU)

Farmacoepidemiología del rituximab en un hospital pediátrico de alta complejidad / Rituximab pharmacoepidemiology in a tertiary-care pediatric hospital

Objetivo: Estudiar el perfil farmacoepidemiológico de rituximab en un hospital pediátrico de alta complejidad. Métodos: Diseño: Estudio de utilización de medicamentos: Prescripción ­ Indicación. Lugar: Hospital de Pediatría Juan P. Garrahan, Buenos Aires, Argentina. Participantes: pacientes que recibieron rituximab, de enero 2012 a junio 2014, comprendió 58 pacientes con 17 patologías distintas. Mediciones principales: se analizó la efectividad como: positiva, negativa e incierta. Se estudiaron las reacciones adversas al medicamento, que fueron procesadas y notificadas. Se evaluó también la manera de premedicar la administración del fármaco. Resultados: treinta y dos pacientes (55%) presentaron un resultado positivo luego del tratamiento,16 pacientes (29%) presentaron un resultado negativo y 9 (16%) tuvieron un resultado incierto. Los mejores resultados se obtuvieron en el tratamiento de pacientes con trasplante de médula ósea con infección por virus de Epstein Barr y en linfoma de Burkitt. Se hallaron 41 reacciones adversas en a 22 pacientes, la mayoría estuvieron relacionadas a la infusión. Se premedicó de 8 formas distintas a los pacientes. Conclusiones: Las patologías con mejores resultados son similares a lo esperado según la literatura consultada. El perfil de seguridad del rituximab lo ubica como un medicamento riesgoso. Es necesario mejorar el registro para ejecutar programas de farmacoepidemiología (AU)

Aim: To study the pharmacoepidemiological profile of rituximab in a pediatric tertiary-care hospital. Methods: Study design: Evaluation of medication use: Prescription ­ Indication. Place: Hospital de Pediatría Juan P. Garrahan, Buenos Aires, Argentina. Participants: patients receiving rituximab between January 2012 and June 2014, including 58 patients with 15 different conditions. Main measurements: effectivity was defined as: positive, negative, and uncertain. Adverse events associated with rituximab were studied, processed, and notified. Premedication for administration of the drug was also studied. Results: Thirty-two patients (55%) had a positive response,16 patients (29%) had a negative response , and 9 (16%) had an uncertain response to the treatment. The best results were obtained in patients undergoing bone marrow transplantation with Epstein Barr virus and in those with Burkitt's lymphoma. Forty-one adverse events were observed in 22 patients, related to drug-infusion in the majority of cases. Pre-medication was administered in the patients in 8 different ways. Conclusions: The conditions in which the best results were achieved were similar to those reported in the literature. The safety profile of rituximab places it among risk drugs. Registration needs to be improved to run pharmacoepidemiology programs (AU)

Conciliación farmacoterapéutica en las áreas de transición en la atención del paciente en un hospital pediátrico de alta complejidad / Medication reconciliation at areas of transition in the patient care at a tertiary pediatric hospital

Introducción: La Conciliación Farmacoterapéutica garantiza el tratamiento medicamentoso correcto (dosis, vía y frecuencia) en relación a la situación actual del paciente. Objetivos: Determinar el grado de seguridad farmacoterapéutica en todas las transiciones del cuidado del paciente. Métodos: estudio descriptivo, transversal. Se realizó conciliación en las primeras 24 hs del ingreso en CIM (salas de internación de cuidados intermedios o moderados), Emergencia o UCI. Se incluyeron pacientes crónicos, que recibían más de 4 medicamentos, con readmisiones frecuentes y/o fármacos de bajo índice terapéutico. Se entrevistó a los pacientes/cuidadores, con previa firma del consentimiento informado y se recolectaron datos de la HCE para comparar el "mejor listado de medicación" obtenido con la indicación médica actual para analizar las discrepancias encontradas y resolverlas. Resultados: Se conciliaron en total 320 pacientes, encontrándose 1343 discrepancias totales, de las cuales 220 (16%) fueron errores de medicación. Se conciliaron 105 pacientes en la etapa emergencia (donde hubo más errores) 101 en la etapa CIM y 92 en la etapa UCI. El 42% de los pacientes sufrió al menos 1 error de medicación (omisión de indicación, el más frecuente). La mayoría de los errores no llegaron al paciente, esto fue evitado en el 52% por el padre y en el 39% por el farmacéutico. El 7% de los errores que llegaron al paciente causaron daños. En la conciliación al alta se halló que no se asienta en la HC la farmacoterapia de base. Conclusiones: La magnitud de los errores hallados es considerable, por lo que debería implementarse en forma rutinaria un programa de conciliación terapéutica, con énfasis en Emergencia (AU)

Introduction: Medication reconciliation guarantees adequate drug treatment (dose, route, and frequency) according to the current state of the patient. Aims: To determine the degree of medication safety in all transitions of patient care. Methods: A descriptive cross-sectional study. Reconciliation was carried out in the first 24 hours after admission to the ward (intermediate or moderate care wards), emergency department, or ICU. Chronic patients receiving more than 4 different drugs, with frequent readmissions, and/or narrow therapeutic index medications were included. Patients/caregivers were interviewed after signing informed consent and data were collected from the medical chart to compare the "best list of medications" obtained with the current medical indications to analyze discrepancies and resolve them. Results: Overall, reconciliation was carried out in 320 patients and 1343 discrepancies were observed, of which 220 (16%) were found to be medication errors. Reconciliation was carried out in 105 patients at the emergency department (where most errors were made), in 101 on the wards, and in 92 in the ICU. In 42% of the patients at least one medication error was observed (being omission of the indication the most common). The majority of errors did not affect the patient; they were avoided by the parent in 52% and by the pharmacist in 39%. Seven percent of the errors that did affect the patient caused damage. At reconciliation at discharge we found that in the medical chart baseline pharmacotherapy was not recorded. Conclusions: The magnitude of errors found was considerable and therefore a program of medication reconciliation should be routinely implemented, with emphasis on the emergency department (AU)

[Treatment of vancomycin-resistant Enterococcus with linezolid in paediatric hospitals]. / Tratamiento de infecciones por Enterococcus resistente a vancomicina con linezolid en un hospital pediátrico.

OBJECTIVE: To describe the use of linezolid in vancomycin-resistant Enterococcus infections in a paediatric hospital. METHOD: Retrospective, observational study of hospitalised patients at the "Juan P. Garrahan" paediatric hospital receiving linezolid for the treatment of vancomycin-resistant Enterococcus, during the period between January 2002 and July 2004. RESULTS: During 18 months, linezolid was prescribed 17 times for a total of 15 seriously ill patients. The median age was 7 years old (range: 1 month-15 years) and the median length of the treatment was 15 days, with an average hospital stay of 74 days. Infection with vancomycin-resistant Enterococcus was microbiologically documented in 11 (73.3%) patients; they all responded to treatment with linezolid with the exception of two, who died while receiving treatment. The most frequently reported adverse reactions were of a haematological nature (55.5%). CONCLUSIONS: Linezolid was effective and moderately well tolerated for the treatment of vancomycin-resistant Enterococcus in children with life-threatening infections.

Thirteen years of culture-positive M. bovis-BCG infection in an IL-12Rbeta1 deficient patient: treatment and outcome.

Patients with mutations in the IFNgamma/IL-12 pathway show an exquisite susceptibility to mycobacterial diseases. An IL-12Rbeta1 deficient patient with impaired intestinal absorption suffered from a 13 year culture-positive Mycobacterium bovis-BCG infection with acquired multidrug resistance. A combined parenteral and enteral anti-mycobacterial treatment, including recombinant IFNgamma, helped to clear his infection.

Cervical coinfection with human papillomavirus (HPV) types as a predictor of acquisition and persistence of HPV infection.

Interest in coinfection with multiple types of human papillomavirus (HPV) has increased in response to the possibility of vaccination and the discovery that the host immune response appears to be mainly type specific. This study attempts to document the occurrence of coinfection with multiple HPV types and to determine whether these coinfections predicted acquisition or persistence of other HPV types in a prospective cohort of women in Brazil. Multiple HPV types were detected at the same visit in one-fifth of all women who tested positive for HPV at any time. Acquisition of an HPV infection was more likely among women with any HPV type detected on study entry. Persistence of HPV infection, the true precursor of cervical abnormalities, was independent of coinfection with other HPV types. Given the increasing prominence of HPV vaccination as a potential preventive approach, it is imperative that additional insights on cross-type protection be obtained from longer-term longitudinal investigations.

Impacts of solar ultraviolet-B radiation on terrestrial ecosystems of Tierra del Fuego (southern Argentina). An overview of recent progress.

The southern part of Tierra del Fuego, in the southernmost tip of South America, is covered by dense Nothofagus spp. forests and Sphagnum-dominated peat bogs, which are subjected to the influence of ozone depletion and to increased levels of solar ultraviolet-B radiation (UV-B). Over the last 5 years we have studied some of the biological impacts of solar UV-B on natural ecosystems of this region. We have addressed two general problems: (i) do the fluctuations in UV-B levels under the influence of the Antarctic ozone 'hole' have any measurable biological impact, and (ii) what are the long-term effects of solar (ambient) UV-B on the Tierra del Fuego ecosystems? In this paper, we provide an overview of the progress made during the first 4 years of the project. We highlight and discuss the following results: (1) ambient UV-B has subtle but significant inhibitory effects on the growth of herbaceous and graminoid species of this region (growth reduction < or = 12%), whereas no consistent inhibitory effects could be detected in woody perennials; (2) in the species investigated in greatest detail, Gunnera magellanica, the inhibitory effect of solar UV-B is accompanied by increased levels of DNA damage in leaf tissue, and the DNA damage density in the early spring is clearly correlated with the dose of weighted UV-B measured at ground level; (3) the herbaceous species investigated thus far show little or no acclimation responses to ambient UV-B such as increased sunscreen levels and DNA repair capacity; and (4) ambient UV-B has significant effects on heterotrophic organisms, included marked inhibitory effects on insect herbivory. The results from the experiments summarized in this review clearly indicate that UV-B influences several potentially important processes and ecological interactions in the terrestrial ecosystems of Tierra del Fuego.

Epidemiology of acquisition and clearance of cervical human papillomavirus infection in women from a high-risk area for cervical cancer.

Acquisition and clearance of cervical human papillomavirus (HPV) infection were analyzed among 1425 low-income women attending a maternal and child health program in São Paulo, Brazil. Specimens collected every 4 months were tested by a polymerase chain reaction protocol (MY09/11). In all, 357 subjects were positive at least once. There were 1.3% new infections per month, with 38% cumulative positivity after 18 months. Of 177 positive subjects at enrollment, only 35% remained infected after 12 months. The monthly clearance rate was higher for nononcogenic types (12.2%; 95% confidence interval [CI], 9.6-15.4) than for oncogenic HPV infections (9.5%; 95% CI, 7.5-11.9). Median retention times were 8.1 months (95% CI, 7.8-8.3) for oncogenic types and 4.8 months (95% CI, 3.9-5.6) for nononcogenic HPV infections. The mean infection durations were 8.2 and 13.5 months for nononcogenic and oncogenic types, respectively. Although a woman's age did not affect mean duration for oncogenic types (13-14 months), nononcogenic-type infections lasted longer (10. 2 months) among younger (<35 years old) than in older women (5.6 months).