Prevalence of adverse drug reactions associated with emergency department visits and risk factors for hospitalization. / [Artículo traducido] Prevalencia de reacciones adversas a medicamentos asociadas a visitas al servicio de urgencias y factores de riesgo de hospitalización.

OBJECTIVE: Adverse drug reactions increase morbidity and mortality, prolong hospital stay and increase healthcare costs. The primary objective of this study was to determine the prevalence of emergency department visits for adverse drug reactions and to describe their characteristics. The secondary objective was to determine the predictor variables of hospitalization for adverse drug reactions associated with emergency department visits. METHODS: Observational and retrospective study of adverse drug reactions registered in an emergency department, carried out from November 15th to December 15th, 2021. The demographic and clinical characteristics of the patients, the drugs involved and the adverse drug reactions were described. Logistic regression was performed to identify factors related to hospitalization for adverse drug reactions. RESULTS: 10,799 patients visited the ED and 216 (2%) patients with adverse drug reactions were included. The mean age was 70 ± 17.5 (18-98) years and 47.7% of the patients were male. A total of 54.6% of patients required hospitalization and 1.6% died from adverse drug reactions. The total number of drugs involved was 315 with 149 different drugs. The pharmacological group corresponding to the nervous system constituted the most representative group (n = 81). High-risk medications, such as antithrombotic agents (n = 53), were the subgroup of medications that caused the most emergency department visits and hospitalization. Acenocumarol (n = 20) was the main drug involved. Gastrointestinal (n = 62) disorders were the most common. Diarrhea (n = 16) was the most frequent adverse drug reaction, while gastrointestinal bleeding (n = 13) caused the highest number of hospitalizations. Charlson comorbidity index behaved as an independent risk factor for hospitalization (aOR 3.24; 95% CI: 1.47-7.13; p=0.003, in Charlson comorbidity index 4-6, and aOR 20.07; 95% CI: 6.87-58.64; p = 0.000, in Charlson comorbidity index ≥ 10). CONCLUSIONS: The prevalence of emergency department visits for adverse drug reactions continues to be a non-negligible health problem. High-risk drugs such as antithrombotic agents were the main therapeutic subgroup involved. Charlson comorbidity index was an independent factor in hospitalization, while gastrointestinal bleeding was the adverse drug reaction with the highest number of hospital admissions.

Prevalencia de reacciones adversas a medicamentos asociadas a visitas al servicio de urgencias y factores de riesgo de hospitalización / Prevalence of adverse drug reactions associated with emergency department visits and risk factors for hospitalization

Objetivos: las reacciones adversas a medicamentos aumentan la morbimortalidad, prolongan la estancia hospitalaria y aumentan los costes sanitarios. El objetivo principal de este estudio fue determinar la prevalencia de visitas por reacciones adversas a medicamentos al servicio de urgencias y describir sus características. El objetivo secundario fue determinar las variables predictoras de hospitalización por reacciones adversas a medicamentos asociadas a visitas al servicio de urgencias.Métodosestudio observacional y retrospectivo de las reacciones adversas a medicamentos registradas en un servicio de urgencias, realizado del 15 de noviembre al 15 de diciembre de 2021. Se describieron las características demográficas y clínicas de los pacientes, los medicamentos involucrados y las reacciones adversas a medicamentos. Se realizó una regresión logística para identificar los factores relacionados con la hospitalización por reacciones adversas a medicamentos.Resultados10.799 pacientes visitaron el servicio de urgencias, de los que 216 (2%) presentaban reacciones adversas a medicamentos. La edad media fue de 70 ± 17,5 (18-98) años y el 47,7% de los pacientes fueron hombres. Un 54,6% de los pacientes requirieron hospitalización y el 1,6% fallecieron a causa de una reacción adversa a medicamentos. El número total de fármacos involucrados fue de 315, con 149 fármacos diferentes. El grupo farmacológico correspondiente al sistema nervioso constituyó el grupo más representativo (n = 81). Medicamentos de alto riesgo, como los antitrombóticos (n = 53), fueron el subgrupo de medicamentos que causó más visitas a urgencias y hospitalizaciones. El acenocumarol (n = 20) fue el principal fármaco implicado. Los trastornos gastrointestinales (n = 62) fueron mayoritarios. (AU)

Objective: Adverse drug reactions increase morbidity and mortality, prolong hospital stay and increase healthcare costs. The primary objective of this study was to determine the prevalence of emergency department visits for adverse drug reactions and to describe their characteristics. The secondary objective was to determine the predictor variables of hospitalization for adverse drug reactions associated with emergency department visits.MethodsObservational and retrospective study of adverse drug reactions registered in an emergency department, carried out from November 15th to December 15th, 2021. The demographic and clinical characteristics of the patients, the drugs involved and the adverse drug reactions were described. Logistic regression was performed to identify factors related to hospitalization for adverse drug reactions.Results10,799 patients visited the ED and 216 (2%) patients with adverse drug reactions were included. The mean age was 70 ± 17.5 (18-98) years and 47.7% of the patients were male. A total of 54.6% of patients required hospitalization and 1.6% died from adverse drug reactions. The total number of drugs involved was 315 with 149 different drugs. The pharmacological group corresponding to the nervous system constituted the most representative group (n = 81). High-risk medications, such as antithrombotic agents (n = 53), were the subgroup of medications that caused the most emergency department visits and hospitalization. Acenocumarol (n = 20) was the main drug involved. Gastrointestinal (n = 62) disorders were the most common. Diarrhea (n = 16) was the most frequent adverse drug reaction, while gastrointestinal bleeding (n = 13) caused the highest number of hospitalizations. Charlson comorbidity index behaved as an independent risk factor for hospitalization (aOR 3.24; 95% CI: 1.47-7.13; p=0.003, in Charlson comorbidity index 4-6, and aOR 20.07; 95% CI: 6.87–58.64; p = 0.000, in Charlson comorbidity index ≥ 10). (AU)

Neurotoxicity associated with acyclovir and valacyclovir: A systematic review of cases.

WHAT IS KNOWN AND OBJECTIVE: Acyclovir and valacyclovir are commonly used antivirals with good general tolerance. Despite their good safety profile, they can cause systemic adverse effects, such as neurotoxicity, which are less frequent and known. The objective of this review was to collect all the reported cases of neurotoxicity associated with acyclovir and valaciclovir published in the literature and characterize their clinical course and interventions. METHODS: A systematic review of cases was carried out following the guidelines established by "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" (PRISMA). The research was carried out using the PubMed-Medline and Embase databases, between July 1984 and March 2021. RESULTS AND DISCUSSION: A total of 119 cases with neurotoxicity mainly related to acyclovir (n = 88; 73.9%), followed by valaciclovir (n = 35; 29.4%) were analysed. 49.6% (n = 59) were men with a mean age of 59.5 years ± 21.1 (0.5-88). In 83.3% of the cases, renal impairment was documented and 57.1% (n = 68) with end-stage renal disease. The administered dose was higher than the renal adjustment recommendations in 59.7% of the cases. The global mean of onset of symptoms was 3.1 days ± 4.3 (0.2-28) after the start of antivirals. The mean recovery time was 9.8 days ± 21.7 (0.2-180). 74.4% of the patients had a recovery of ≤7 days, 15.9% between 8 and 15 days and 9.8% > 15 days. WHAT IS NEW AND CONCLUSION: The neurotoxicity induced by acyclovir and its derivative valacyclovir is a poorly known and rare adverse effect that can occur mainly in patients with advanced age and impaired renal function. The most characteristic symptoms are confusion, altered level of consciousness, hallucinations, agitation and dysarthria. The basis of treatment is the discontinuation of the antiviral, and in some cases, it may require additional clearance by dialysis.

Potential drug-drug interactions in COVID 19 patients in treatment with lopinavir/ritonavir.

OBJECTIVES: To determine the prevalence of potential interactions in COVID19 patients receiving lopinavir/ritonavir (LPV/r). The secondary objective was to develop recommendations and identify the risk factors associated with presenting potential interactions with LPV/r. SUBJECTS AND METHODS: Cross-sectional and multicenter study with the participation of 2 hospitals. COVID 19 patients over 18 years of age, admitted to hospital and under treatment with LPV/r were included. A screening of potential interactions related to LPV/r and home and hospital medication was carried out. Lexicomp® (Uptodate), HIV-drug interactions and COVID-drug interactions were used as the query database. RESULTS: 361 patients with a mean age of 62.77 ±â€¯14.64 years were included, where 59.6% (n = 215) were men. 62.3% (n = 225) had 1 or more potential interactions and 26, 87% (n = 97) 2 or more. The independent variables associated with presenting ≥1 potential interactions were age (>65) (OR 1.95; 95% CI 1.06-3.59, P = .033), ICU admission (OR 9.22; CI 95% 1.98-42.93; P = .005), previous respiratory pathology (OR 2.90; 95% CI 1.15-7.36; P = .024), psychiatric (OR 4.14; 95 CI% 1.36-12.61; P = .013), dyslipidemia (OR 3.21; 95% CI 1.63-6.35; P = .001) and the number of drugs prescribed (OR 4.33; 95% CI 2.40-7.81; P = .000). CONCLUSION: The prevalence of potential interactions in COVD 19 patient undergoing treatment with LPV/r is high, with age (>65), ICU admission, previous respiratory and psychiatric pathology, dyslipidemia and the number of prescribed drugs acting as risk factors.

OBJETIVOS: Determinar la prevalencia de interacciones potenciales en pacientes COVID19 en tratamiento con lopinavir/ritonavir (LPV/r). El objetivo secundario fue elaborar recomendaciones e identificar los factores de riesgo asociados a presentar interacciones potenciales con LPV/r. SUJETOS Y MÉTODOS: Estudio transversal y multicéntrico con la participación 2 hospitales. Se incluyeron pacientes COVID 19 mayores de 18 años, con ingreso hospitalario y en tratamiento con LPV/r. Se realizó un cribado de las interacciones potenciales relacionadas con LPV/r y la medicación domiciliaria y hospitalaria. Se utilizó como base de datos de consulta Lexicomp® (Uptodate), HIV-drug interacctions y COVID-drug interacctions. RESULTADOS: Se incluyeron 361 pacientes con una media de edad de 62,77 ±â€¯14,64 años, donde el 59,6% (n = 215) fueron hombres. El 62,3% (n = 225) tuvieron 1 o más interacciones potenciales y el 26, 87% (n = 97) 2 o más. Las variables independientes asociadas a presentar ≥ 1 interacciones potenciales fueron la edad (> 65) (OR 1,95; IC 95% 1,06­3,59; P = ,033), el ingreso en UCI (OR 9,22; IC 95% 1,98­42,93; P = ,005), la patología previa respiratoria (OR 2,90; IC 95% 1,15­7,36; P = ,024), psiquiátrica (OR 4,14; IC 95% 1,36­12,61; P = ,013), la dislipemia (OR 3,21; IC 95% 1.63­6,35; P = ,001) y el número de fármacos prescrito (OR 4,33; IC 95% 2,40­7,81; P = ,000). CONCLUSIÓN: La prevalencia de interacciones potenciales en paciente COVD 19 en tratamiento con LPV/r es elevada, comportándose como factores de riesgo asociados la edad (>65), el ingreso en UCI, la patología previa respiratoria, psiquiátrica y la dislipemia y el número de fármacos prescritos.

[Potential drug-drug interactions in COVID 19 patients in treatment with lopinavir/ritonavir]. / Interacciones medicamentosas potenciales en pacientes COVID 19 en tratamiento con lopinavir/ritonavir.

OBJECTIVES: To determine the prevalence of potential interactions in COVID-19 patients receiving lopinavir/ritonavir (LPV/r). The secondary objective was to develop recommendations and identify the risk factors associated with presenting potential interactions with LPV/r. SUBJECTS AND METHODS: Cross-sectional and multicenter study with the participation of 2 hospitals. COVID-19 patients over 18 years of age, admitted to hospital and under treatment with LPV/r were included. A screening of potential interactions related to LPV/r and home and hospital medication was carried out. Lexicomp® (Uptodate), HIV-drug interactions and COVID-drug interactions were used as the query database. RESULTS: 361 patients with a mean age of 62.77 ± 14.64 years were included, where 59.6% (n = 215) were men. 62.3% (n = 225) had 1 or more potential interactions and 26, 87% (n = 97) 2 or more. The independent variables associated with presenting ≥1 potential interactions were age (> 65) (OR 1.95; 95% CI 1.06-3.59, P =.033), ICU admission (OR 9.22; CI 95% 1.98-42.93; P =.005), previous respiratory pathology (OR 2.90; 95% CI 1.15-7.36; P =.024), psychiatric (OR 4.14; 95 CI % 1.36-12.61; P =.013), dyslipidemia (OR 3.21; 95% CI 1.63-6.35; P =.001) and the number of drugs prescribed (OR 4.33; 95% CI 2.40-7.81; P =.000). CONCLUSION: The prevalence of potential interactions in COVD-19 patient undergoing treatment with LPV/r is high, with age (> 65), ICU admission, previous respiratory and psychiatric pathology, dyslipidemia and the number of prescribed drugs acting as risk factors.

Shock séptico secundario a Elizabethkingia meningoseptica: descripción de un caso / Septic shock secondary to Elizabethkingia meningoseptica: a case report

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Neuropatía óptica asociada a linezolid: revisión sistemática de casos / Optic neuropathy associated with linezolid: systematic review of cases

Objetivo: Recoger y analizar todos los casos descritos de neuropatía óptica asociada a linezolid. Método: Se realizó una revisión sistemática de casos mediante una búsqueda en PubMed-Medline, Embase y ScienceDirect, entre septiembre de 2002 y abril de 2018. Se evaluaron las características demográficas, clínicas y oftalmológicas de cada paciente. Resultados: Se analizaron un total de 33 casos procedentes de 26 artículos independientes. La media de edad fue de 44,97 ± 21,40 años (rango: 6-79) y 16 (50%) de los 32 casos fueron mujeres. La duración del tratamiento con linezolid hasta el comienzo de los síntomas fue superior a 28 días en 29 (90,6%) de los 32 casos documentados. El tiempo medio de exposición hasta el comienzo de los síntomas fue de 8,5 ± 8,6 meses (rango: 0,33-50). Un total de 12 de 26 pacientes adultos recibieron linezolid 600 mg/24 h de inicio. En 30 (90,9%) pacientes se documentó pérdida de la agudeza visual. Se retiró linezolid en todos los casos una vez confirmado el diagnóstico, con mejoría clínica en 31 (93,9%) casos. Conclusiones: La neuropatía óptica es una complicación reversible relacionada con el uso prolongado de linezolid e independiente de la dosis. Recomendamos realizar un seguimiento a los pacientes con tratamientos largos (> 28 días) y exploración oftalmológica en aquellos con alteraciones visuales para el diagnóstico temprano de la neuropatía y la retirada precoz de linezolid

Objective: Collect and analyze all the described cases of optic neuropathy associated with linezolid. Method: A systematic review of cases was carried out through a search in PubMed-Medline, Embase and ScienceDirect, between September 2002 and April 2018. The demographic, clinical and ophthalmology characteristics of each patient were evaluated. Results: A total of 33 cases from 26 independent articles were analyzed. The mean age was 44.97 ± 21.40 years (range: 6-79) and 16 (50%) of 32 cases were women. The duration of treatment with linezolid until onset of symptoms was greater than 28 days in 29 (90.6%) of 32 documented cases. The mean time of exposure to onset of symptoms was 8.5 ± 8.6 months (range: 0.33-50). A total of 12 of 26 adult patients received linezolid 600 mg/24 h, starting. In 30 (90.9%) patients loss of visual acuity was documented. Linezolid was withdrawn in all cases once the diagnosis was confirmed, with clinical improvement in 31 (93.9%) cases. Conclusions: Optic neuropathy is a reversible complication related to the prolonged use of linezolid and regardless of the dose. We recommend follow-up in patients with long treatments (> 28 days) and ophthalmological exploration in those with visual alterations for the early diagnosis of neuropathy and early withdrawal of linezolid

Optic neuropathy associated with linezolid: systematic review of cases.

OBJECTIVE: Collect and analyze all the described cases of optic neuropathy associated with linezolid. METHOD: A systematic review of cases was carried out through a search in PubMed-Medline, Embase and ScienceDirect, between September 2002 and April 2018. The demographic, clinical and ophthalmology  characteristics of each patient were evaluated. RESULTS: A total of 33 cases from 26 independent articles were analyzed. The mean age was 44.97 ± 21.40 years (range: 6-79) and 16  (50%) of 32 cases were women. The duration of treatment with linezolid  until onset of symptoms was greater than 28 days in 29 (90.6%) of 32  documented cases. The mean time of exposure to onset of symptoms was 8.5 ± 8.6 months (range: 0.33-50). A total of 12 of 26 adult patients  received linezolid 600 mg/24 h, starting. In 30 (90.9%) patients loss of  visual acuity was documented. Linezolid was withdrawn in all cases once the diagnosis was confirmed, with clinical improvement in 31 (93.9%) cases. Conclusions: Optic neuropathy is a reversible complication related to the  prolonged use of linezolid and regardless of the dose. We recommend follow- up in patients with long treatments (> 28 days) and ophthalmological exploration in those with visual alterations for the early  diagnosis of neuropathy and early withdrawal of linezolid.

Objetivo: Recoger y analizar todos los casos descritos de neuropatía óptica  asociada a linezolid.Método: Se realizó una revisión sistemática de casos mediante una  búsqueda en PubMed-Medline, Embase y ScienceDirect, entre septiembre de 2002 y abril de 2018. Se evaluaron las características demográficas,  clínicas y oftalmológicas de cada paciente.Resultados: Se analizaron un total de 33 casos procedentes de 26 artículos independientes. La media de edad fue de 44,97 ± 21,40 años (rango: 6-79) y 16 (50%) de los 32 casos fueron mujeres. La duración  del tratamiento con linezolid hasta el comienzo de los síntomas fue superior  a 28 días en 29 (90,6%) de los 32 casos documentados. El tiempo medio de  exposición hasta el comienzo de los síntomas fue de 8,5 ± 8,6 meses (rango: 0,33-50). Un total de 12 de 26 pacientes adultos recibieron  linezolid 600 mg/24 h de inicio. En 30 (90,9%) pacientes se documentó pérdida de la agudeza visual. Se retiró linezolid en todos los  casos una vez confirmado el diagnóstico, con mejoría clínica en 31 (93,9%)  casos.Conclusiones: La neuropatía óptica es una complicación reversible  relacionada con el uso prolongado de linezolid e independiente de la dosis. Recomendamos realizar un seguimiento a los pacientes con  tratamientos largos (> 28 días) y exploración oftalmológica en aquellos con  alteraciones visuales para el diagnóstico temprano de la neuropatía y la  retirada precoz de linezolid.

Pancitopenia inducida por vancomicina: descripción de un caso / Pancitopenia induced by vancomicina: case report

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Evaluation of the efficiency under current use of human fibrinogen concentrate in trauma patients with life-threatening hemorrhagic disorders.

The aim of the study was to assess the influence of fibrinogen concentrate on survival when it is used in trauma patients with life-threatening hemorrhagic disorders. Secondly, to evaluate when the fibrinogen concentrate administration maximizes its efficacy, and to describe what other concomitant treatment the patients received in order to control their life-threatening hemorrhage. Retrospective, observational, and multicenter study was carried out in three trauma areas between June 2012 and June 2014. The totality of trauma patients with a documented life-threatening hemorrhage who received a fibrinogen concentrate prescription was included in the study. Demographic and analytical data, admission diagnosis, treatment indication, fibrinogen concentrate dose, survival after 1 and 7 days, hospitalization time, and concomitant blood product treatment were collected. One hundred and twenty-three patients were finally included. The mean dose of fibrinogen concentrate administered was 2.87 g. The mean initial fibrinogen plasma level was 1.49 g/l, which rose to 2.26 g/l. The number of patients who survived after 24 h was 80.49%, and 69.11% after 7 days. Lower fibrinogen plasma levels are statistically associated with a higher probability of death after 7 days (P = 0.004). The most suitable threshold to recommend the fibrinogen concentrate administration has been found to be 1.5 g/dl (P = 0006, after 24 h; P = 0.032, after 7 days). Finally, the most common concomitant treatment was the erythrocytes concentrate. A statistically significant relationship between lower fibrinogen plasma levels and a higher probability of death after 7 days has been found. Our data support the threshold of 1.5 g/l as the recommended level to administer fibrinogen concentrate in trauma patients.