Bezlotoxumab in the treatment of Clostridioides difficile infections: a real-life experience.

OBJECTIVE: Following the approval of bezlotoxumab in 2017, studies evaluating its effectiveness in prevention of Clostridioides difficile infection under "real-life" conditions are scarce. METHODS: We conducted a retrospective study developed in a large tertiary care hospital describing the use and outcomes of patients with Clostridioides difficile infection (CDI) treated with bezlotoxumab. RESULTS: A total of 16 patients were include, all of whom had an episode of CDI with high probability of recurrence and 14 of them had some kind of immunosuppression. Bezlotoxumab was effective in the prevention of CDI recurrence in 11 of the 14 cases in which follow up was possible, without significant side effects. CONCLUSIONS: Bezlotoxumab was well tolerated and the incidence of recurrent CDI in a high-risk population for recurrence was only 21.4%.

Hepatitis C virus infection and the role of a pharmaceutical care program.

PURPOSE: The design, implementation, and assessment of a comprehensive pharmaceutical care program (CPCP) for hepatitis C virus (HCV)-infected patients treated with direct-acting antivirals (DAA) are described. SUMMARY: The advent of DAA regimens has caused the evolution of the role of hospital pharmacists, leading to the development of more specialized models of pharmaceutical care. Three clinical pharmacists were incorporated into the pharmacy department of a general tertiary teaching hospital in Madrid, Spain, with the aim of developing and implementing a CPCP for HCV-infected patients. Pharmacists were responsible for proposing standards and local guidelines to physicians, monitoring adherence to guidelines, managing drug interactions and adverse drug events (ADEs), providing patient education, and evaluating health outcomes and costs. Implementation steps included (1) estimation of the healthcare demand and pharmacy resources, (2) definition of the workflow of the CPCP, (3) definition of the treatment care plan, for which tools were developed to support pharmaceutical validation, detection, and management of ADEs and drug-drug interactions, and (4) program assessment in terms of safety and cost-effectiveness. The pharmacists' interventions performed, severity of errors intercepted, and patients' satisfaction with the CPCP were also assessed. This CPCP demonstrates that the involvement of the pharmacist throughout the care plan prevents harmful medication errors in this population (0.1 per patient) and prompts significant cost savings (€1.2 million for 1,930 treated patients). CONCLUSION: The implementation of a CPCP developed by hospital pharmacists for patients treated with DAA for HCV infection is an effective approach for preventing harmful medication errors and improving cost- effectiveness.

Effect of extrapallial protein of Mytilus californianus on the process of in vitro biomineralization of chitosan scaffolds.

Biomineralization is the process by which diverse organisms have the capacity to create heterogeneous accumulations, derived from organic and inorganic compounds that induce the process of mineral formation. An example of this can be seen an extrapallial protein (EP) of Mytilus californianus, which is responsible for carrying out the biomineralization process. In order to determine their ability to perform the biomineralization process, EP protein was absorbed and mixed in chitosan scaffolds which were tested in simulated physiological fluid. The materials were analyzed by FTIR spectroscopy, field emission scanning electron microscopy-energy-dispersive electron X-ray spectroscopy andX-ray diffraction. Results confirmed that the EP protein stimulates the rapid growth of biological apatite on the chitosan scaffolds. The mixing method favored more the apatite growth as well as the formation of second nucleation sites than the immersion method.

Lesiones de arteria poplítea durante la cirugía ortopédica de rodilla / Popliteal artery injury in orthopedic knee surgery

Objetivos: Los traumatismos iatrogénicos de arteria poplítea asociados a cirugía ortopédica de rodilla son extremadamente raros, pero presentan una alta morbilidad. Se analiza el efecto de las lesiones ortopédicas y vasculares concomitantes en relación con la pérdida de miembros en pacientes con lesiones vasculares de extremidades inferiores y sus factores predictivos. Material y métodos: Se diseñó un estudio retrospectivo de los traumatismos de arteria poplítea asociados a cirugía ortopédica de rodilla en un único centro. Para ello se revisaron las historias clínicas entre octubre de 1979 y octubre del 2016. Se analizaron como variables principales el mecanismo de producción, el modo de reparación y las complicaciones relacionadas. Resultados: Durante ese periodo se atendieron 74 traumatismos de arteria poplítea, de los que 10 estuvieron asociados a cirugía ortopédica (13,5%). A lo largo de esos 37 años se realizaron 7.400 intervenciones ortopédicas (10/7.400, 0,1%). Los traumatismos fueron secundarios a 4 prótesis total de rodilla, 2 refracturas de fémur, 2 tibia vara, una desepifisiodesis y un osteosarcoma. La clínica fue de isquemia aguda en 5 casos, de hemorragia en 2 y falso aneurisma en 3. La mediana de edad fue 43 años, con 3 en edad pediátrica. Se realizaron 6 arteriografías y 2 angio tomografías computerizadas (TAC) ya que la señal Doppler careció de capacidad diagnóstica. La reparación fue inmediata (0-12 h) en 3 pacientes, en uno entre 12-24 h y superior a 24 h en 6 ocasiones. Todas fueron abordadas por vía medial, siendo la reparación mayoritaria la vena safena (3), interposición protésica (2), la sutura simple (2) y plastia con parche (1). Se observaron 3 síndromes compartimentales que precisaron fasciotomías. En 2 ocasiones fue necesaria una amputación, ambas en reparación tardía. La capacidad funcional quedó manifiestamente alterada en 4 pacientes: 2 por amputación mayor y 2 por lesión de nervio ciático poplíteo externo. Conclusiones: Las reparaciones tardías y con material protésico estuvieron asociadas a mayor riesgo de pérdida de la extremidad. Siempre se precisa de una prueba de imagen, ya que la señal Doppler es poco específica. El éxito de la reparación se asocia claramente a un diagnóstico y una reparación precoz. La asociación de lesiones nerviosas y venosas se acompaña de mayor discapacidad y complicaciones (AU)

Objectives: Iatrogenic popliteal artery trauma associated with knee orthopedic surgery are extremely rare, but present high morbidity. The effect of concomitant orthopedic and vascular lesions in relation to limb loss in patients with lower extremity vascular lesions and heir predictive factors is analyzed. Material and methods: A retrospective study of popliteal artery trauma associated with orthopedic knee surgery was designed in a single center. For this, the medical records were reviewed between October-1979 to October-2016. The mechanism of production, mode of repair and related complications were analyzed as main variables. Results: During this period, 74 popliteal artery injuries were treated, of which 10 were associated with orthopedic surgery (13.5%). During those 36 years, 7,400 orthopedic interventions were performed (10 / 7,400, 0.1%). The injuries were secondary to 4 total knee prosthesis, 2 femur re-fractures, 2 tibia rod, 1 de-epifisiodesis and 1 osteosarcoma. The clinic was acute ischemia in 5 cases, hemorrhage in 2 and false aneurysm in 3. The median age was 43 years, with 3 in pediatric age. Were made 6 arteriographies and 2 angio-CT was required, since Doppler signal lacked diagnostic capacity. The repair was immediate (0-12 h) in 3 patients, in 1 between 12-24 hours and over 24 hours in 6 occasions. All were medially treated, the majority of which were the saphenous vein (3), prosthetic interposition (2), simple suture (2) and plasticity with patch (1). There were 3 compartmental syndromes that required fasciotomies. On two occasions an amputation was necessary, both in late repair. The functional capacity was manifestly altered in 4 patients: 2 for major amputation and 2 for external popliteal sciatic nerve injury. Conclusions: Late repairs and with prosthetic material were associated with an increased risk of limb loss. An image test is always required, since the Doppler signal is not very specific. The success of repair is clearly associated with early diagnosis and repair. The association of nerve and venous injuries is accompanied by greater disability and complications (AU)

Aneurisma de arteria subclavia post-compresión en síndrome del estrecho torácico por costilla cervical / Cervical subclavian aneurysm in outlet syndrome due to cervical rib

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Apósitos de polímeros naturales para regeneración de piel / Natural polymers aposites for skin regeneration

Resumen El presente artículo es una amplia revisión bibliográfica de algunos de los polímeros naturales más utilizados en la fabricación de apósitos para curación de heridas cutáneas y regeneración de piel en los últimos años. Asimismo, se presenta un análisis descriptivo de los polímeros de origen natural más estudiados en la ingeniería de tejidos, remarcando sus propiedades físicas, químicas y biológicas. Encontrando que las investigaciones más recientes se han centrado en la exploración de apósitos a partir de biopolímeros como una alternativa a los materiales sintéticos derivados del petróleo, debido a las propiedades que poseen, como una mayor biodegradabilidad, biocompatibilidad y sostenibilidad por ser obtenidos naturalmente. Sin embargo, aún no existe un apósito ideal que pueda ser aplicado de manera eficiente en todos los tipos de heridas; por lo que los investigadores se han enfocado en el desarrollo y la optimización de apósitos que satisfagan la mayoría de las necesidades para una etapa en particular de la herida.

Abstract This review includes the bio-polymers most used in recent years for the manufacturing of materials used as dressings in cutaneous wound healing and skin regeneration. Also, the natural polymers most studied in tissue engineering are mentioned, highlighting their physical, chemical and biological properties for skin regeneration and wound healing. Through an extensive review of the clinical and research uses different types of natural polymers were compared, as well as the results of chemical and biological tests carried out during experimental research performed internationally.

Decreased INR after acenocoumarol, ombitasvir/paritaprevir/ritonavir and dasabuvir co-administration.

WHAT IS KNOWN AND OBJECTIVE: Limited data are available on co-administration of acenocoumarol with direct-acting antiviral agents for chronic hepatitis C virus infection. CASE SUMMARY: We report a case of a patient who required a significant increase in acenocoumarol weekly dose probably due to an interaction with ombitasvir/paritaprevir/ritonavir and/or dasabuvir. A causality assessment of the drug-drug interaction leading to a reduced INR was conducted according to the Naranjo algorithm. A score of 6 suggested that the adverse drug reaction was probable. WHAT IS NEW AND CONCLUSION: Because of possible INR abnormalities during the concomitant use of acenocoumarol, ombitasvir/paritaprevir/ritonavir and dasabuvir, clinicians should closely monitor INR values.

Optimisation of antithrombotic therapy in patients with acute coronary syndrome to reduce bleeding episodes.

AIM: The aim of the study was to evaluate the effectiveness of a multidisciplinary intervention to reduce the risk of bleeding associated with antithrombotic drugs in patients with acute coronary syndrome (ACS). METHODS: We designed a pre-post quasi-experimental intervention study using retrospective cohorts. The first cohort was analysed to detect correctable measures contributing to bleeding (PRE: January-July 2010). Second, a bundle of interventions was implemented and third, a second cohort of patients was evaluated to investigate the impact of our measures in bleeding reduction (POST: September 2011-February 2012). RESULTS: A total of 677 patients were included (377 in PRE and 300 in POST). The bundle of interventions was: Overdose avoidance measures: the percentage of patients overdosed was reduced by 66.3% (p < 0.001). Institutional protocol update to include the latest recommendations regarding bleeding prevention: In POST, the percentage of patients treated with fondaparinux increased (2.4% vs. 50.7%; p < 0.001). In PRE, 11 patients were treated with the combination of abciximab and bivalirudin; whereas in POST, only one patient received the combination (p = 0.016). Mandatory measurement of body weight: the percentage of patients with unknown body weight was reduced by 35% (p = 0.0001). In POST, the total bleeding rate was reduced by 29.2% (31.6% in PRE vs. 22.4%, p < 0.05, OR: 0.62; 95% CI: 0.44-0.88). It was necessary to implement the interventions in 11 patients to prevent one bleeding episode (95% CI: 7-39). CONCLUSION: The multidisciplinary programme has been effective in reducing bleeding episodes. The interventions were effective in reducing antithrombotic drugs overdosage, incorporating the use of fondaparinux to the NSTE-ACS therapeutic arsenal, limiting the use of bivalirudin with abciximab and obtaining body weight for most patients.

[Permanence of last generation antiretroviral in daily clinical practice]. / Permanencia del tratamiento antirretroviral de última generación en la práctica clínica diaria.

INTRODUCTION: Time of permanence is a useful measure of success in last generation antiretroviral (LGA) therapy: raltegravir, darunavir, etravirine and maraviroc. The aim of our study was to analyze the permanence of antiretroviral therapy (ART) containing at least one LGA, and to compare it with other ART used in experienced patients. METHODS: Observational case-control study. It included adult outpatients whose ART was switched between 01/05/2008 and 01/09/2009. Cases (patients with at least one LGA) were matched (1:1) with pretreated patients who switched to an ART without any LGA (controls). The primary endpoint was the permanence of ART. The follow-up was conducted from the modification of ART to a year after the closure of the inclusion period. Results were adjusted for confounding variables: CD4 and viral load (VL) at baseline, MDR HIV infection and time from the first ART. RESULTS: 112 patients were included in each group. The permanence of ART was 16.7 months (cases) vs 16.8 months (controls), although statistically significant differences were not found after adjusting for confounding variables. Toxicity was the main reason of discontinuation (53.3% in cases vs 45.2% in controls, p = 0.70). The mean decrease in the logarithm of the VL was 0.89 in cases and 0.58 in controls (p = 0.223). The increase of CD4/microL was 77 and 73 respectively (p = 0.480). CONCLUSION: The permanence of ART in patients whose treatment contains a LGA is similar to those without any LGA.

Introducción: La permanencia es una medida útil del éxito de los tratamientos antirretrovirales de última generación (AUG): raltegravir, darunavir, etravirina y maraviroc. El objetivo de nuestro estudio fue analizar la permanencia de los tratamientos antirretrovirales (TAR) que contenían al menos un AUG, y compararla con otros TAR utilizados en pacientes experimentados. Métodos: Estudio observacional, de casos y controles, de pacientes adultos externos cuyo TAR fue modificado entre 01/05/2008 y 01/09/2009. Los casos (pacientes con al menos un AUG) fueron emparejados (relación 1:1) con pacientes pretratados que cambiaron a un TAR sin AUG (controles). La variable principal fue la permanencia del TAR. El seguimiento se realizó desde la modificación del TAR hasta un año después del cierre del período de inclusión. Los resultados se ajustaron por las variables de confusión: CD4 y carga viral (CV) basales, infección VIH multirresistente y tiempo desde el primer TAR. Resultados: Se incluyeron 112 pacientes en cada grupo. El tiempo de permanencia del TAR fue 16,7 meses (casos) vs 16,8 meses (controles), sin encontrarse diferencias estadísticamente significativas ajustando por las variables de confusión. La toxicidad fue el principal motivo de discontinuación (53,3% en casos vs 45,2% en controles, p = 0,70). La media en la disminución del logaritmo de la CV fue 0,89 en los casos y 0,58 en los controles (p = 0,223). El incremento de CD4/microL fue 77 y 73 respectivamente (p = 0,480). Conclusión: La permanencia del TAR en los pacientes cuyo tratamiento contiene algún AUG es similar a la de los pacientes que no lo contienen.

Permanencia del tratamiento antirretroviral de última generación en la práctica clínica diaria / Permanence of last generation antiretroviral in daily clinical practica

Introducción: La permanencia es una medida útil del éxito de los tratamientos antirretrovirales de última generación (AUG): raltegravir, darunavir, etravirina y maraviroc. El objetivo de nuestro estudio fue analizar la permanencia de los tratamientos antirretrovirales (TAR) que contenían al menos un AUG, y compararla con otros TAR utilizados en pacientes experimentados. Métodos: Estudio observacional, de casos y controles, de pacientes adultos externos cuyo TAR fue modificado entre 01/05/2008 y 01/09/2009. Los casos (pacientes con al menos un AUG) fueron emparejados (relación 1:1) con pacientes pretratados que cambiaron a un TAR sin AUG (controles). La variable principal fue la permanencia del TAR. El seguimiento se realizó desde la modificación del TAR hasta un año después del cierre del período de inclusión. Los resultados se ajustaron por las variables de confusión: CD4 y carga viral (CV) basales, infección VIH multirresistente y tiempo desde el primer TAR. Resultados: Se incluyeron 112 pacientes en cada grupo. El tiempo de permanencia del TAR fue 16,7 meses (casos) vs 16,8 meses (controles), sin encontrarse diferencias estadísticamente significativas ajustando por las variables de confusión. La toxicidad fue el principal motivo de discontinuación (53,3% en casos vs 45,2% en controles, p =0,70). La media en la disminución del logaritmo de la CV fue 0,89 en los casos y 0,58 en los controles (p =0,223). El incremento de CD4/microL fue 77 y 73 respectivamente (p =0,480). Conclusión: La permanencia del TAR en los pacientes cuyo tratamiento contiene algún AUG es similar a la de los pacientes que no lo contienen (AU)

Introduction: Time of permanence is a useful measure of success in last generation antiretroviral (LGA) therapy: raltegravir, darunavir, etravirine and maraviroc. The aim of our study was to analyze the permanence of antiretroviral therapy (ART) containing at least one LGA, and to compare it with other ART used in experienced patients. Methods: Observational case-control study. It included adult outpatients whose ART was switched between 01/05/2008 and 01/09/2009. Cases (patients with at least one LGA) were matched (1:1) with pretreated patients who switched to an ART without any LGA (controls). The primary endpoint was the permanence of ART. The follow-up was conducted from the modification of ART to a year after the closure of the inclusion period. Results were adjusted for confounding variables: CD4 and viral load (VL) at baseline, MDR HIV infection and time from the first ART. Results: 112 patients were included in each group. The permanence of ART was 16.7 months (cases) vs 16.8 months (controls), although statistically significant differences were not found after adjusting for confounding variables. Toxicity was the main reason of discontinuation (53.3% in cases vs 45.2% in controls, p = 0.70). The mean decrease in the logarithm of the VL was 0.89 in cases and 0.58 in controls (p = 0.223). The increase of CD4/microL was 77 and 73 respectively (p = 0.480). Conclusion: The permanence of ART in patients whose treatment contains a LGA is similar to those without any LGA (AU)

[Prevalence of Helicobacter pylori infection in primary health care]. / Prevalencia de la infección por Helicobacter pylori en atención primaria de salud.

OBJECTIVES: To find the prevalence of Helicobacter pylori (Hp) infection in the population as a whole. To assess its relationship with the associated factors described in other studies. DESIGN: Transversal study of an urban population of 20,000. PARTICIPANTS: Between 14 and 80 years old. Randomised sampling of the computerised records (640 clinical histories). Necessary sample n = 384 (alpha = 0.05, prior prevalence = 50%, precision 0.05). MEASUREMENTS: Breath test with urea marked (13C), age, sex, alcohol and tobacco consumption, social class and dyspepsia and/or gastro-duodenal pathology. RESULTS: 123 exclusions. 122 losses (23%). 397 people screened, 43.6% male. Average age: 42.6. 41.6% consumed alcohol. 30.5% smoked. Prevalence of dyspepsia, gastritis, gastric ulcer and duodenal ulcer, 14%, 2.8%, 2.8% and 2.0%, respectively. Hp prevalence: 56.1% (95% CI, 51.2-60.1). There were no significant differences between prevalence of Hp+ and sex, dyspepsia, peptic ulcer history, gastritis, alcohol consumption and tobacco consumption. Greatest prevalence of Hp+ in over-70s (73%). Significant linear tendency between presence of Hp+ and age (p < 0.05) and low social class (p < 0.05). The logistic regression analysis found a statistically significant relationship only between the presence of H. pylori and age and social class. CONCLUSIONS: Prevalence was similar to that in other studies. The relationship between low social class and age and greater Hp prevalence was confirmed. Dyspepsia is not a justification for empirical treatment of Hp. Patients with and without the infection must be followed to evaluate morbidity longitudinally.

Prevalencia de la infección por Helicobacter pylori en atención primaria de salud / Prevalence of helicobacter pylori infection in primary health care

Objetivos. Conocer la prevalencia de infección por Helicobacter pylori (Hp) en población general. Valorar la relación con los factores asociados descritos en otros ámbitos. Diseño y ámbito. Estudio transversal. Población urbana: 20.000 personas. Sujetos. Edad de 14-80 años. Muestreo aleatorio del registro informatizado (640 historias clínicas). Muestra necesaria, 384 (alfa, 0,05; prevalencia previa, 50 por ciento; precisión, 0,05). Mediciones. Prueba del aliento con urea marcada (13C), edad, sexo, consumo de alcohol y tabaco, clase social y dispepsia y/o patología gastroduodenal. Resultados. Exclusiones, 123; pérdidas, 122 (23 por ciento); cribados, 397; varones, 43,6 por ciento; edad media, 42,6 años; consumía alcohol, 41,6 por ciento; fumaba, 30,5 por ciento. Prevalencia de dispepsia, gastritis, ulcus gástrico y duodenal, respectivamente, 14, 2,8, 2,8 y 2,0 por ciento. Prevalencia Hp, 56,1 por ciento (IC del 95 por ciento, 51,2-60,1). No hay diferencias significativas entre prevalencia de Hp+ y sexo, dispepsia, antecedentes de ulcus péptico, gastritis, consumo de alcohol y consumo de tabaco. Máxima prevalencia de Hp+ en mayores de 70 años (73 por ciento). Tendencia lineal significativa entre presencia de Hp+ y edad (p < 0,05) y clase social baja (p < 0,05). El análisis de regresión logística sólo encuentra relación estadísticamente significativa entre presencia de Hp y edad y clase social. Conclusiones. La prevalencia es similar a la de otros estudios. Se confirma la relación entre clase social baja y edad y mayor prevalencia de Hp. La dispepsia no justificaría el tratamiento empírico de Hp. Es necesario el seguimiento de los pacientes con y sin infección para evaluar la morbilidad longitudinalmente (AU)

Alcohol intake in a rural village: physical signs and biological markers predicting excessive consumption in apparently healthy people.

Four hundred and ninety-two (232 males and 260 females) randomly selected inhabitants older than 15 years of La Esperanza, a rural village of Tenerife, have been inquired about their daily alcohol intake, analyzing the relationship between this parameter and sex, age, marital status, educational level, job and smoking habit, physical signs, and biological markers of excessive ethanol consumption. One hundred and seventy-four out of them (35.4%) were teetotalers, while 318 (64.6%) consumed alcoholic beverages; 18.2% (34.1% of the males and 4.2% of the females) referred excessive ethanol consumption (more than 80 g/day and 40 g/day, respectively). Men consumed 62.3 +/- 4 g/day ethanol and women, 8 +/- 1 g/day. The distribution of the population according to the amount of ethanol consumed fits into Lederman's curve, most of the individuals being consumers of small amounts of ethanol. Male sex, middle age, married or separated status, unskilled job, sometimes unemployed, low educational level, daily drinking (mainly wine), and smoking, were all related to a higher ethanol consumption. When assessed by logistic regression, only liver enlargement, parotid swelling, retches and tremor in the morning, and hoarseness, out of the physical signs, showed independent predictive value as indicators of excessive consumption as well as serum GGT, ASAT, MCV, and urate levels out the biological markers. When all those physical and analytical signs that had previously shown predictive independent value are analyzed together, all the five physical signs (liver enlargement, parotid swelling, retches and tremor in the morning, and hoarseness) but only urate, out of the biochemical markers, showed independent predictive value.

The effect of early experience on the exploratory behaviour, learning ability and on the synaptosomes of the mice brain.

This study deals with the effects that are produced by an enriched early experience on the mitochondrial fraction on the mice brain. The total content of lipids and proteins in mitochondrial fraction, the morphology of the mitochondries and the density of synaptosomes were investigated. A significant difference in the total quantity of lipids of the mitochondrial fraction and the density of synaptosomes was observed between mice subjected to an enriched environment and others subjected to an impoverished environment. These mice, which were subjected to a psychological study before proceeding to the extraction of the mitochondrial fraction, displayed distinct characteristics. The enriched group displayed a greater exploratory behaviour and a greater capacity to learn than the mice raised in the impoverished environment.

Histochemical study of mucopolysaccharides in the subthalamic region of rats.

Histological sections of the Subthalamic region of rats were treated with solutions of: Toluidin Blue, Thionin, Alcian Blue and Colloidal Iron. The microscopic observation of the histological sections treated with those histochemic reactions showed the existence in the Subthalamic region of three neuronal types, differentiated between them because of the morphologic and histochemic points of view. In the LUY's Subthalamic nucleus was observed only one neuronal type, while in the nucleus of the FOREL's field and in the Zona incerta were found two very special types of neurons (alpha and beta) differentiated between them because of their reaction before the Collidal Iron. It is suggested the possibility that those different types of neurons have different functional characteristics.