Efectos secundarios oculares de las terapias oncológicas. Revisión / Ocular side effects of oncological therapies: Review

Con el avance de la terapia contra el cáncer en los últimos años, ha aumentado el conocimiento de los mecanismos involucrados en esta enfermedad, lo que ha supuesto un aumento de la calidad de vida y de la supervivencia de los pacientes con afecciones tumorales anteriormente consideradas incurables o refractarias al tratamiento. El número de fármacos utilizados ha sufrido un aumento exponencial, y a pesar de que la toxicidad implícita es menor que la de la terapia antineoplásica convencional, conllevan la aparición de nuevos efectos adversos asociados, que el oftalmólogo debe reconocer y manejar.(AU)

With the advance of cancer therapy in recent years, the knowledge of the mechanisms involved in this disease has increased, which has meant an increase in the quality of life and survival of patients with tumor pathologies previously considered incurable or refractory to treatment. The number of drugs used has increased exponentially in number, and although the implicit toxicity is lower than that of conventional antineoplastic therapy, they lead to the appearance of new associated adverse effects that the ophthalmologist must recognize and manage.(AU)

Ocular side effects of oncological therapies: Review.

With the advance of cancer therapy in recent years, the knowledge of the mechanisms involved in this disease has increased, which has meant an increase in the quality of life and survival of patients with tumor pathologies previously considered incurable or refractory to treatment. The number of drugs used has increased exponentially in number, and although the implicit toxicity is lower than that of conventional antineoplastic therapy, they lead to the appearance of new associated adverse effects that the ophthalmologist must recognize and manage.

Consumo de ayudas ergogénicas nutricionales y farmacéuticas en personas que asisten a gimnasios del municipio de Cercado, Cochabamba

Dado el problema de salud pública que plantean los esteroides anabólicos, el consumo de ayudas ergogénicas está aumentando a nivel mundial, no es en Bolivia. Además, existe un consumo desmedido de suplementos nutricionales y farmacéuticos, así como efectos reversibles e irreversibles de los esteroides anabólicos. Objetivos: describir cómo se consumen las ayudas ergogénicas nutricionales y farmacéuticas y cómo los asistentes a gimnasios en el municipio Cercado de Cochabamba perciben sus efectos en su salud. Métodos: se realizó un estudio observacional transversal con 378 participantes mayores de 18 años, (estratificada) divididos en cuatro grupos; Amateur, Fitness, Deportista y en nueve gimnasios y dos grupos (NABBA-IFFB) y deportistas en general en el área metropolitana de Cercado Cochabamba. Resultados: se encontró que el 74,6% consume alguna sustancia que mejoran el rendimiento; el consumo de ayudas ergogénicas nutricionales fue del 57,1%(n=216) y farmacológicas el 17,4% (n=66). El tiempo dedicado a entrenamiento y dieta para el grupo amateur es estadísticamente significativo con un valor de (p<0,05). Los efectos percibidos y reportados por el consumo de ayudas ergogénicas farmacológicas (esteroides anabólicos androgénicos) son principalmente cambios de humor, alteración en la libido y acné. Entre los efectos secundarios irreversibles dos casos de hombres desarrollaron ginecomastia y dos mujeres desarrollaron clítoromegalia. Conclusiones: los usuarios de ejercicio en el gimnasio consumen grandes cantidades de sustancias nutricionales y/o farmacológica que mejoran el rendimiento.

Given the public health problem posed by anabolic steroids, the consumption of ergogenic aids is increasing worldwide, not indifferently in Bolivia. In addition, there is an excessive consumption of nutritional and pharmaceutical supplements, as well as reversible and irreversible effects of anabolic steroids. Objectives: to describe how nutritional and pharmaceutical ergogenic aids are consumed and how gym-goers in the Cercado municipality of Cochabamba perceive their effects on their health. Methods: a crosssectional observational study was conducted with 378 participants over 18 years of age, (stratified) divided into four groups; Amateur, Fitness, Athlete and in 9 gyms and 2 groups (NABBA-IFFB) and athletes in general in the metropolitan area of Cercado Cochabamba. Results: it was found that 74.6% consumed some performance-enhancing substance; the consumption of nutritional ergogenic aids was 57.1% (n=216) and pharmacological aids 17.4% (n=66). Time dedicated to training and diet for the amateur group is statistically significant with a value of (p<0.05). The perceived and reported effects of the consumption of pharmacological ergogenic aids (anabolic androgenic steroids) are mainly mood changes, libido alteration and acne. Among the irreversible side effects 2 cases of men developed gynecomastia and 2 women developed clitoromegaly. Conclusions: exercise users in the gym consume large amounts of nutritional and/or pharmacological performance enhancing substances.

The Efficacy and Safety of Different Sericin Doses for Pleurodesis.

BACKGROUND: The aim of present study is to compare the effectiveness, side-effect potential of different doses of sericin pleurodesis. METHODS: Adult, male, 12-week-old, Wistar-albino rats (n=52), were randomly-divided into four-groups, referred to A, B, C and D. Sericin was administrated at different doses through left thoracotomy, with 15mg sericin to Group-A, 30mg to Group-B and 45mg to Group-C. Group-D was assigned as control group. The rats were sacrificed 12 days later. Left-hemithorax, heart, liver and kidney were examined pathologically. RESULTS: No foreign body reaction in the parenchyma was observed in any of the rats, while emphysema was least common in Group-B (P<.05). Multi-layer mesothelium of both pleura was most common in Group-B, while fibrosis and fibrin organization within the visceral-pleura was more successful in all of sericin treated groups than in control group (P<.05), with neither Group-A, Group-B nor Group-C being superior to each other. In the examination of collagen fibers using Masson's trichrome, "dense collagen fibers" were found in all three sericin treated groups, and differences between Groups-A, -B, -C and the control group were significant (P<.05). The probability of observing pyknotic nucleus and balloon degeneration in liver increased with increasing sericin doses (P<.05). Glomerular degeneration in kidney and the findings of pericarditis were most common in Group-C (P<.05). CONCLUSION: The target should be to maximize efficacy while minimizing the likelihood of side-effects. The intrapleural administration of sericin 30mg performs better due to multi-layer mesothelial reaction being higher and emphysema being lower in Group-B, to the fewer side-effects affecting the kidney and heart, and liver toxicity not being higher.

Prevalencia y factores asociados al abandono del implante subdérmico de Etonogestrel, Azogues, Ecuador, 2014-2017 / Prevalence and associated factors of subdermal Etonogestrel implant discontinuation, Azogues, Ecuador, 2014-2017

INTRODUCCIÓN: El plan nacional de reducción de muerte materna y neonatal considera a la pla-nificación familiar como una de las mejores tácticas para reducir los embarazos no deseados, los abortos no terapéuticos y las muertes maternas; en este sentido el abandono precoz del implante subdérmico de Etonogestrel constituye un problema de salud pública. El objetivo de este estudio es determinar la prevalencia y factores asociados al abandono del implante subdérmico de Etonoges-trel en pacientes atendidas en el Distrito de salud 03D01 de Azogues, durante el 2014-2017. MATERIALES y MÉTODOS: Estudio observacional, descriptivo, transversal. El universo estuvo cons-tituido por todas las usuarias del implante subdérmico de Etonogestrel, la muestra incluyó 234 pacientes, seleccionada de forma aleatoria simple. Los datos se obtuvieron y se analizaron con el Software SPSS, versión 2015. La asociación significativa fue considerada con valor de p < 0.005. RESULTADOS: La edad de la población en estudio fluctuó entre 13 y 46 años, el 58.5 % eran casadas, el 49.1 % residían en el área urbana. La prevalencia de retiro precoz del implante fue del 33.3% [IC 95 % 26.98 ­ 39.02] y estuvo asociado a alteraciones del sangrado menstrual que afectan la calidad de vida [RP 3.9; IC 95 % 3.1 ­ 5.0; p < 0.001 ], incremento de peso > 10 Kg [RP 3.5; IC 95 % 2.8 ­ 4.0; p < 0.001], cefalea intensa [ RP 3.7; IC 95 % 3.0 ­ 5.0; p < 0.001], dolor en el sitio de inserción [RP 3.1; IC 95 % 2.6 - 4.0; p 0.004] y deseo de embarazo [RP 3.3; IC 95 % 2.7 ­ 4.0; p < 0.001]. CONCLUSIÓN: La prevalencia de abandono precoz del implante subdérmico de Etonogestrel en nuestro medio es del 33.3% y está asociado a la presencia de efectos no deseados del mismo.

BACKGROUND: The national plan for maternal and neonatal death reduction considers birth control as one of the best methods to reduce unwanted pregnancies, non-therapeutic abortions and maternal deaths, in this way the discontinuation of subdermal Etonorgestrel implant is a public health issue. The aim of this study is to determine the prevalence and associated factors of contraceptive discontinua-tion, of subdermal Etonorgestrel implant, in patients from Azogues (03D01 Health District), from 2014 to 2017. METHODOlOGY: Observational, descriptive, cross-sectional study. The study universe included all sub-dermal Etonorgestrel implant users, the study sample included 234 patients, selected by simple ran-dom sampling. The data was obtained and analyzed with the SPSS Software, 2015 version. Significant association was considered with a value of p < 0.005. RESUlTS:The sample age was between 13 and 46 years, 58.5 % were married, 49.1 % lived in the urban area. The prevalence of contraceptive discontinuation for Etonorgestrel implant was 33.3 % [95 % CI 26.98 - 39.02]; and it was associated with: menstrual cycle disturbances that affected quality of life [PR 3.9, 95 % CI 3 .1 ­ 5.0, p < 0.001], with weight increase> 10 kg [RP 3.5, 95 % CI 2.8 ­ 4.0,p < 0.001], severe headache [RP 3.7, 95 % CI 3.0 ­ 5.0, p < 0.001], pain at the insertion site [RP 3.1, 95 % CI 2.6 ­ 4.0, p 0.004] and pregnancy planning [RP 3.3, 95 % CI 2.7 ­ 4.0, p < 0.001]. CONClUSION: The prevalence of contraceptive discontinuation of the subdermal Etonogestrel implant in our population was 33.3% and it is associated with the drug side effects.

Adherencia a los antidepresivos: reto terapéutico para mejores desenlaces clínicos en pacientes con depresión / Antidepressant adherence: therapeutic challenge for a better clinical outcome in depressive patients

La depresión es una enfermedad psiquiátrica que se manifiesta a través de un estado de ánimo bajo y síntomas somáticos como debilidad, trastornos del sueño, entre otros. Se presenta en edades tempranas principalmente, sin embargo se ha descrito en cualquier grupo etario; esta enfermedad genera alto impacto en el entorno familiar, social y laboral de la persona. La terapia antidepresiva comprende tanto el tratamiento farmacológico como las psicoterapias, siendo ambas el pilar fundamental para la remisión de esta patología. Por lo tanto, la adherencia terapéutica, definida como el cumplimiento de las dosis y tiempos indicados del medicamento prescrito y la aceptación de los cambios en el estilo de vida, se considera un reto clínico que a pesar de ser poco estudiado, se ha visto que mejora considerablemente el control de los síntomas depresivos y evitando consecuencias como la discapacidad...(AU)

Depression is a psychiatric illness that manifests itself through a low mood and somatic symptoms such weakness, sleep disorders, among others. It occurs mainly at early ages, however it has been described at any age; this disease generates high impact in the familiar, social and work environment of the person. Antidepressant therapy includes drug therapy and psychotherapy, both being essential for the remission of this pathology. Therefore, therapeutic adherence, defined as the compliance with doses and times indicated of the prescribed medication and the acceptance of changes in lifestyle, is considered a clinical challenge that despite of being low studied, significantly improves control of depressive symptoms and avoids consequences such as disability...(AU)

Validación de un cuestionario para evaluar causas administrativas de la baja notificación de reacciones adversas a los medicamentos / Validation of a questionnaire to evaluate administrative causes of low reporting of adverse drug reactions

RESUMEN Objetivo Diseñar y validar una encuesta para conocer las causas de tipo administrativo que pueden influir en la baja notificación de reacciones adversas a medicamentos (RAM). Métodos El cuestionario se diseñó a partir de una revisión bibliográfica y una tormenta de ideas. Las variables que se consideraron que pueden influir en la notificación fueron la carga de trabajo de los profesionales y su percepción del control de la actividad de farmacovigilancia. Para su validación, se encuestó a 60 profesionales de una muestra de conveniencia. La confiabilidad se calculó con la alfa de Cronbach y el coeficiente de Kuder Richardson. La validez de contenido se cuantificó con el coeficiente de Kendall y la de criterio, mediante la concordancia con el criterio establecido. Resultados El cuestionario tipo encuesta quedó constituido por 15 preguntas y estructurado en dos partes, información general y causas administrativas de la baja notificación de RAM. La alfa de Cronbach fue 0,87, el coeficiente de Kuder Richardson, 0,9033, y la validez total, 1,51, resultante de 70% de concordancia y un coeficiente de correlación por rangos de 0,81. Conclusiones La confiabilidad de la encuesta validada fue aceptable-elevada y su validez, aceptable.

ABSTRACT Objective Design and validate a survey to determine the administrative causes that can influence low reporting of adverse drug reactions. Methods The questionnaire design was based on a review of the literature and on brainstorming. The variables considered to influence reporting were professional workload and the professional perception of drug surveillance control activities. To validate the hypothesis, 60 professionals were surveyed in a convenience sample. Reliability was calculated using Cronbach’s alfa and the Kuder-Richardson coefficient. Content validity was measured using the Kendall coefficient, and criterion validity, through concordance with the established criterion. Results The survey-type questionnaire was composed of 15 questions divided into two parts: general information and administrative causes of low adverse drug reactions reporting. Cronbach’s alfa was 0.87, the Kuder-Richardson coefficient was 0.9033, and overall validity was 1.51, resulting from 70% concordance and a rank correlation coefficient of 0.81. Conclusions The reliability of the validated survey was acceptable to high and validity was acceptable.

Pulmonary embolism secondary to inappropriate use of oral contraceptive therapy: a case report

Forty-one year old female admitted to the hospital because of symptoms and signs suggestive of pulmonary thromboembolism which was confirmed by CT angiography. There was no history of prior thromboembolic events, smoking, venous stasis or vascular lesion (negative lupus anticoagulant and anticardiolipins). The only documented hypercoagulability factor was the use of an oral contraceptive containing drospirenone and ethinylestradiol for the last year. The patient was treated with anticoagulants such as enoxaparin and she recovered without sequelae; she is currently under treatment with warfarin as an outpatient. It is known that the use of combined oral contraceptives in patients over 35 years old requires caution, largely due to higher risk of thromboembolic events associated with increased hepatic synthesis of several coagulation factors. Therefore, this case represents a potentially fatal and preventable severe adverse reaction(AU)

Mujer de 41 años que ingresa al hospital por cuadro clínico sugestivo de tromboembolismo pulmonar, el cual fue confirmado por AngioTAC. No había antecedentes de eventos tromboembólicos previos, tabaquismo, estasis venosa ni de lesión vascular (anticoagulante lúpico y anticardiolipinas negativo). Como único factor de hipercoagulabilidad que se documenta es el consumo de un anticonceptivo oral que contenía drospirenona y etinilestradiol desde un año atrás. La paciente fue anticoagulada con enoxaparina y se recuperó sin secuelas y actualmente se encuentra en manejo ambulatorio con warfarina. El uso de anticonceptivos orales en combinación se debe realizar con precaución en pacientes mayores de 35 años, en buena medida por el aumento del riesgo de eventos tromboembólicos asociado al incremento en la síntesis hepática de algunos factores de coagulación. Por lo tanto, éste representa un caso de reacción adversa severa, potencialmente fatal y prevenible(AU)

Severe cefepime-induced status epilepticus treated with haemofiltration.

Neurotoxicity caused by cefepime may occur predominantly in patients with impaired renal function. A case of a cefepime-induced non-convulsive status epilepticus (NCSE) is presented. A 65-year-old woman suffered a severe NCSE due to cefepime in the presence of acute renal failure, requiring coma induction with sodium thiopental. A serious interaction between valproic acid (VPA) and meropenem was also produced after changing cefepime to meropenem. Continuous veno-venous haemofiltration was employed to improve cefepime clearance, and the patient progressively regained her previous mental condition. In conclusion, the cefepime dose must be adjusted according to renal function in order to avoid toxicity in patients with renal failure. Electroencephalogram should be considered in cases of acute confusional state in patients receiving cefepime, to achieve early detection of NCSE. Continuous renal replacement therapy may be successfully employed in severe cases in order to accelerate cefepime removal. Likewise, meropenem should not be used concomitantly with VPA.

[Adherence to patients antidepressant treatment and the factors associated of non-compiance]. / Seguimiento de la adherencia al tratamiento antidepresivo en pacientes que inician su consumo.

OBJECTIVE: To know the adherence to treatment in patients who initiate antidepressant drugs and to analyze the determinant factors of non-compliance, so much clinical as sociodemographic. DESIGN: Prospective longitudinal observational study. LOCATION: Primary Health Care and Mental Health Surgeries of three Castilla-La Mancha Areas. PARTICIPANTS: 185 adults patients who were started in antidepressant treatment were evaluated. MEASUREMENTS: Treatment adherence (test Haynes-Sackett, test Morisky-Green, count of tablets and MEMS), adverse effects, intensity of depressive symptoms, sociodemographic characteristics and other characteristics related to antidepressants or participants. RESULTS: After 6months of beginning antidepressing treatment, 46.9% (95%IC: 36.5-57.3) showed an inadequate fulfilment by pill count method and 28.6% (95%IC: 19.1-38.0) with Morisky-Green's questionnaire. To 15 days the lack of adherence was 48.5% (95%IC: 40.6-56.4) and of 33.5% (95%IC: 26.1-41.0). The 38.4% (95%IC: 31.1-45.7) demonstrated some side effect during the follow-up. Using proportional risk model of Cox the variables related to compliance were: younger age, level of instruction lower than secondary studies, free medicines for pensioner, no psychotherapeutic treatment, consume a fewer antidepressants drugs and a frequency ≤ 3 visits to the family doctor 3 months previous to the study. CONCLUSIONS: The non-compliance of antidepressant treatment in primary care is high from the first weeks after initiating it. The conditioning factors are related to sociodemographic characteristics and other patient characteristics as type of financing of pharmaceutical benefit and frequentness at primary care.

Síndrome de Stevens–Johnson asociado a fenitoína en una paciente colombiana con síndrome convulsivo focal / Stevens-Johnson Syndrome associated to phenytoin in a Colombian patient with focal convulsive syndrome

Este es el reporte de un caso clínico de una paciente con diagnóstico de Síndrome de Stevens-Johnson inducido por fenitoína, quien ingresó a un hospital universitario de tercer nivel en la ciudad de Bogotá, Colombia. Trece días después del inicio del medicamento mencionado por un diagnóstico de síndrome convulsivo focal, la paciente consulta por la aparición de lesiones máculo papulares en cabeza y tronco acompañadas de úlceras orales y genitales. La presentación y distribución de las lesiones, el compromiso sistémico y la asociación temporal con el consumo de fenitoína, apoyaron el diagnóstico de Síndrome de Stevens-Johnson, el cual fue confirmado por el Servicio de Dermatología. La paciente respondió adecuadamente al tratamiento instaurado siendo dada de alta 10 días después de su ingreso sin complicaciones.

This is a case report of a female patient with a diagnosis of Stevens-Johnson Syndrome induced by Phenytoin. The patient was admitted to a third level hospital. Thirteen days after she started phenytoin use (prescribed for her focal seizure disorder), she presented some maculo-papular lesions in head and thorax, associated with oral and genital ulcers. Distribution and presentation of lesions, the systemic compromise, associated with the temporary use of Phenytoin, supported the diagnosis of SJS. The diagnosis was confirmed by Dermatology. The patient was treated successfully and she was discharged without complications ten days after her admission.

Rebound effect of drugs: fatal risk of conventional treatment and parmacological basis of homeopathic treatment / Efeito rebote das drogas: riscos fatais do tratamento convencional e bases farmacológicas do tratamento homeopático / Efecto rebote de drogas: riesgos fatales del tratamiento convencional y bases farmacológicas del tratamiento homeopático

The homeopathic model applies the secondary action or vital reaction of the organism as a therapeutic method and thus prescribes treatment by similitude, which consists in administering to ill individuals substances that cause similar symptoms in healthy individuals. The vital, homeostatic or paradoxical reaction of the organism might be explained scientifically by means of the rebound effect of modern drugs, which might cause fatal iatrogenic events after discontinuation of antipathic (a term used in alternative medicine for palliative treatment, also known as enantiopathic) treatment. Although the rebound effect is studied by modern pharmacology, it is poorly communicated to and discussed among healthcare professionals, who are thus deprived of information needed for the safe management of modern drugs. This article presents an up-to-date review on the rebound effect of modern drugs that grounds the homeopathic principle of healing and calls the attention of doctors to this type of adverse effect that is usually unnoticed. The rebound effect of modern palliative drugs, which was pointed out by Hahnemann more than two centuries ago, might cause fatal adverse events and is illustrated by the examples of acetylsalicylic acid, anti-inflammatory agents, bronchodilators, antidepressants, statins, proton-pump inhibitors, etc. Although the rebound effect is expressed by a small fraction of (susceptible) individuals and might be avoided by gradual tapering of antipathic drugs, it exhibits epidemiologic importance as a function of the massive use of such palliative drugs and the lack of knowledge in its regard.

O modelo homeopático aplica a ação secundária ou reação vital do organismo como método terapêutico. Assim, propõe o tratamento por semelhança, que consiste em administrar aos doentes substâncias que produzem sintomas similares em pessoas sadias. A reação vital, homeostática ou paradoxal do organismo pode ser explicada cientificamente com base no efeito rebote das drogas modernas. Este pode produzir eventos iatrogênicos fatais depois da suspensão do tratamento antipático (ou enantiopático, termo utilizado em medicina alternativa para se referir ao tratamento paliativo). Embora o efeito rebote é abordado pela farmacologia moderna, é pouco difundido e discutido pelos profissionais da saúde que, assim, são privados de informação necessária para o manejo seguro das drogas modernas. Este artigo apresenta uma revisão atualizada do efeito rebote das drogas modernas e que também embasa o princípio homeopático da cura. Apontado por Hahnemann mais de dois séculos atrás, o efeito rebote das drogas paliativas modernas pode causar efeitos adversos fatais, como ilustram os exemplos do ácido salicílico, anti-inflamatórios, broncodilatadores, antidepressivos, estatinas, inibidores da bomba de prótons, etc. Embora o efeito rebote seja expressado por uma pequena parte de indivíduos (suscetíveis) e possa ser evitando através da retirada gradual das drogas antipáticas, atinge importância epidemiológica devido ao uso maciço dessas drogas e do desconhecimento a seu respeito.

Rebound effect of drugs: fatal risk of conventional treatment and parmacological basis of homeopathic treatment / Efeito rebote das drogas: riscos fatais do tratamento convencional e bases farmacológicas do tratamento homeopático / Efecto rebote de drogas: riesgos fatales del tratamiento convencional y bases farmacológicas del tratamiento homeopático

The homeopathic model applies the secondary action or vital reaction of the organism as a therapeutic method and thus prescribes treatment by similitude, which consists in administering to ill individuals substances that cause similar symptoms in healthy individuals. The vital, homeostatic or paradoxical reaction of the organism might be explained scientifically by means of the rebound effect of modern drugs, which might cause fatal iatrogenic events after discontinuation of antipathic (a term used in alternative medicine for palliative treatment, also known as enantiopathic) treatment. Although the rebound effect is studied by modern pharmacology, it is poorly communicated to and discussed among healthcare professionals, who are thus deprived of information needed for the safe management of modern drugs. This article presents an up-to-date review on the rebound effect of modern drugs that grounds the homeopathic principle of healing and calls the attention of doctors to this type of adverse effect that is usually unnoticed. The rebound effect of modern palliative drugs, which was pointed out by Hahnemann more than two centuries ago, might cause fatal adverse events and is illustrated by the examples of acetylsalicylic acid, anti-inflammatory agents, bronchodilators, antidepressants, statins, proton-pump inhibitors, etc. Although the rebound effect is expressed by a small fraction of (susceptible) individuals and might be avoided by gradual tapering of antipathic drugs, it exhibits epidemiologic importance as a function of the massive use of such palliative drugs and the lack of knowledge in its regard.(AU)

O modelo homeopático aplica a ação secundária ou reação vital do organismo como método terapêutico. Assim, propõe o tratamento por semelhança, que consiste em administrar aos doentes substâncias que produzem sintomas similares em pessoas sadias. A reação vital, homeostática ou paradoxal do organismo pode ser explicada cientificamente com base no efeito rebote das drogas modernas. Este pode produzir eventos iatrogênicos fatais depois da suspensão do tratamento antipático (ou enantiopático, termo utilizado em medicina alternativa para se referir ao tratamento paliativo). Embora o efeito rebote é abordado pela farmacologia moderna, é pouco difundido e discutido pelos profissionais da saúde que, assim, são privados de informação necessária para o manejo seguro das drogas modernas. Este artigo apresenta uma revisão atualizada do efeito rebote das drogas modernas e que também embasa o princípio homeopático da cura. Apontado por Hahnemann mais de dois séculos atrás, o efeito rebote das drogas paliativas modernas pode causar efeitos adversos fatais, como ilustram os exemplos do ácido salicílico, anti-inflamatórios, broncodilatadores, antidepressivos, estatinas, inibidores da bomba de prótons, etc. Embora o efeito rebote seja expressado por uma pequena parte de indivíduos (suscetíveis) e possa ser evitando através da retirada gradual das drogas antipáticas, atinge importância epidemiológica devido ao uso maciço dessas drogas e do desconhecimento a seu respeito.(AU)

La Farmacovigilancia en los últimos 10 años: actualización de conceptos y clasificaciones. Logros y retos para el futuro en Colombia / Pharmacovigilance in the last 10 years: update of concepts and classifi cations. Achievements and challenges for the future in Colombia

Introducción: la farmacovigilancia es la disciplina encargada de la detección, evaluación, entendimiento y prevención de los efectos adversos y de cualquier otro problema relacionado con medicamentos. Desde la creación del Programa nacional de farmacovigilancia en cabeza del Instituto Nacional de Vigilancia de Medicamentos y Alimentos en 1998, han ocurrido avances importantes por ejemplo en la existencia de experiencias colombianas de investigación en relación al tema. Así mismo, han sido actualizados algunos conceptos importantes y clasificaciones para el ejercicio de la disciplina. Objetivos: exponer los estudios publicados sobre reacciones adversas/eventos adversos a medicamentos en pacientes colombianos. Presentar una reseña sobre la historia de la Farmacovigilancia en Colombia y actualizar las definiciones y clasificaciones más importantes. Métodos: se utilizaron las bases de datos Medline, SciELO, LILACS, EMBASE, para la búsqueda de información. Resultados: se encontraron 13 estudios publicados dirigidos a detectar reacciones adversas/eventos adversos en pacientes colombianos realizados entre 1998 y el 2007. La frecuencia de reacciones adversas/eventos adversos en los hospitalizados estuvo entre el 1,2 y el 45% mientras que la misma frecuencia como motivo de consulta u hospitalización estuvo entre el 0,03% y el 6,8%. Estas cifras coinciden parcialmente con las de la literatura internacional y las diferencias de frecuencias encontradas se explican principalmente por el método de detección de reacciones adversas/eventos adversos empleado. Las nuevas clasificaciones clínicas y mecanísticas (DoTS y EIDOS) de las RAM parecen tener gran utilidad en la práctica y una de ellas fue empleada exitosamente en un estudio colombiano. Conclusiones: la farmacovigilancia ha avanzado significativamente en Colombia en la última década. Sin embargo es necesario mejorar la articulación de funciones entre todos los actores participantes y hacer de la detección y el reporte de RAM/EAM una práctica sistemática por parte de todos los profesionales de la salud, en especial de los medicamentos que han sido recientemente comercializados...

Introduction: The science and activities relating to the detection, assessment, understanding and prevention of adverse effects or any other drug related problem. Since the creation of the Colombian Pharmacovigilance Program led by INVIMA (National Institute of Drug and Food Surveillance) in 1998, there have been significant progress and there are numerous research Colombian experiences regarding this topic. They have also been updated some important concepts and classifications for the practice of the discipline. Objectives: To published studies on adverse drug reactions/adverse drug events (ADR/ADE) in Colombian patients. Also, to describe the history of Pharmacovigilance in Colombia in briefly, and update the most important definitions and classifications. Methods: The databases reviewed were Medline, SciELO, LILACS and EMBASE. Results: There were 13 published studies aimed at detecting ADR/ADE in Colombian patients, conducted between 1998 and 2007. The frequency of ADR/ADE in hospitalized patients was between 1.2 and 45% while the same frequency as the reason for consultation or hospitalization was between 0.03% and 6.8%. These figures overlap with the international literature and differences between frequencies are mainly explained by the detection system that was used. The new classifications clinical and mechanistic (DoTS and EIDOS) of ADR seem to be very useful in practice, one of which was used successfully in a Colombian study. Conclusions: The Pharmacovigilance in Colombia has made significant progress in the last decade. However, it is necessary to improve the articulation of responsibilities between all actors involved and make the detection and reporting of ADR/ADE a routine practice by all health professionals, especially for those drugs that have recently been marketed...

Nefrotoxicidad inducida por medicamentos / Drug-induced nephrotoxicity

La presente revisión incluye la descripción de los diferentes tipos de nefrotoxicidad inducida por medicamentos de acuerdo a su clasificación histopatológica, mecanismo de generación, presentación clínica y medicamentos más frecuentemente implicados. Para esta revisión fue realizada una búsqueda sistemática en el Index Medicus de artículos relacionados publicados a partir de 1999, los cuales fueron seleccionados de acuerdo a su pertinencia. La nefrotoxicidad inducida por medicamentos es un hallazgo de gran importancia clínica, debido a su alta frecuencia y potencial severidad, así como al desconocimiento de medidas preventivas en muchos casos. Las principales alteraciones renales producidas por medicamentos se pueden clasificar histopatológicamente, según la función renal alterada. De este modo, se encuentra la necrosis tubular aguda, la nefritis intersticial, la lesión glomerular y las alteraciones vasculares, que a su vez incluyen la microangiopatía trombótica, la aterosclerosis y la vasculitis. Finalmente, se hace una revisión de algunos medicamentos de uso habitual con alto potencial de nefrotoxicidad, haciendo énfasis en las recomendaciones de uso clínico dirigidas a optimizar la seguridad renal de estos productos...

This review includes a description of the different types of drug-induced nephrotoxicity (DIN) according to histopathologic classification, generation mechanism, clinical presentation and drugs most frequently involved. For this review, a systematic search was conducted in the Index Medicus for articles published since 1999, which were selected according to their relevance. The DIN is a finding of major clinical importance due to their high frequency and potential severity, and the lack of preventive measures in many cases. The main renal impairments caused by drugs can be classifi ed histopathologically according to altered renal function. Thus, there is the acute tubular necrosis, interstitial nephritis, glomerular injury and vascular changes that in turn include thrombotic microangiopathy, atherosclerosis and vasculitis. Finally, some commonly used drugs with high potential for nephrotoxicity are reviewed, with emphasis on recommendations for clinical use to optimize the renal safety of these products...

Skin eruption and thrombocytopaenia in a woman with glaucoma: a case report / Erupción cutánea y trombocitopenia en una mujer con glaucoma: reporte de un caso

Antibiotic and non-antibiotic sulphonamides are often prescribed. Although chemical differences make cross-reactivity rare, reactions may be severe in patients allergic to sulphur. Adverse reactions are common with sulphonamides but low platelets and skin changes are rarely associated with eye-drops for glaucoma. A woman treated with dorzolamide and timolol presented with disseminated eruption. On admission, her physical examination was unremarkable except for the skin changes and severe thrombocytopaenia was detected. Skin biopsy showed hyperkeratosis, acanthosis, perivascular and periadnexal infiltrates with no vasculitis. After discontinuation of eye-drops, the eruption improved but low platelets persisted. Skin changes reappeared with use of dapsone which suggested sulphonamide cross-reactivity.

A menudo se prescriben sulfonamidas antibióticas y no-antibióticas. Aunque las diferencias químicas hacen que la reactividad cruzada sea algo raro, las reacciones pueden ser severas en los pacientes alérgicos al azufre. Las reacciones adversas son comunes con las sulfonamidas pero las plaquetas bajas y los cambios en la piel raramente se asocian con las gotas oculares para el glaucoma. A una mujer a quien se le hizo un tratamiento con dorzolamida y timolol, se le presentó una erupción diseminada. En el momento del ingreso, su examen físico fue común y corriente excepto por los cambios en la piel. Además se le detectó una trombocitopenia severa. La biopsia de la piel reveló hiperqueratosis, acanthosis, infiltrados perivasculares y periadnexales sin vasculitis. Tras descontinuar las gotas oculares, la erupción mejoró pero las plaquetas bajas persistieron. Los cambios de la piel reaparecieron con el uso de dapsona, lo que hizo pensar en una reactividad cruzada de la sulfonamida.

Ocurrencia de efectos adversos a medicamentos entre el 20 de septiembre y el 2 de octubre de 2004 en el Centro de Atención Ambulatoria Central de la ESE Luis Carlos Sarmiento de Bogotá, Colombia / Adverse drug reactions ocurrence between september 20 and october 2 in 2004 in Centro de Atención Ambulatoria Central ESE Luis Carlos Galán Sarmiento in Bogotá, Colombia

Introducción: las reacciones adversas a medicamentos representan un problema de salud pública importante. Sin embargo, se desconoce la magnitud de éste en población ambulatoria en Colombia. Objetivo: establecer la prevalencia de reacciones adversas a medicamentos como motivo de consulta en un servicio de atención prioritaria. Materiales y métodos: el estudio se llevó a cabo en el servicio de atención prioritaria del Centro de Atención Ambulatoria Central de la Empresa Social del Estado Luis Carlos Sarmiento en Bogotá del 20 de septiembre al 2 de octubre de 2004. Las reacciones adversas medicamentosas fueron identificadas por un evaluador independiente quien revisó la totalidad de historias clínicas y cada vez que los médicos señalaron la sospecha de una reacción, posteriormente los pacientes fueron contactados. La evaluación de la causalidad, previsibilidad, y mecanismo de generación fue realizada por dos evaluadores. Resultados: la prevalencia de reacciones adversas medicamentosas fue de 45 en 1395 consultas, en dos semanas (2,8%). El reporte espontáneo modificado detectó 26,7% de las reacciones detectadas por búsqueda activa. De las reacciones adversas medicamentosas identificadas 73,3% ocurrieron en mujeres y 64,9% en mayores de 60 años; 75,6% fueron posibles (evaluación de causalidad), 95,6% fueron no serias, 44,4% fueron de tipo A (mecanismo de generación), y el 22,2% fueron prevenibles. Conclusiones: las reacciones adversas medicamentosas motivan una proporción importante de consultas, y el sistema de reporte espontáneo modificado detectó una cuarta parte de éstas. La distribución y tipo de reacciones adversas medicamentosas fueron similares a los descritos en otras series. No hubo diferencias en cuanto a la frecuencia de reacciones adversas medicamentosas y el género, y éstas fueron más frecuentes en ancianos. Dos de cada 10 reacciones adversas medicamentosas pudieron haberse prevenido...

Introduction: the adverse drug reactions represent an important public health problem. However, the importance of this problema in ambulatory care in Colombia is unknown. Objective: establishing the prevalence of adverse drug reactions as the reason for visiting an emergency department. Materials and methods: the study took place at the “Luis Carlos Galán Sarmiento Empresa Social del Estado” Emergency Department’s Central Outpatient Centre in Bogotá. It was carried out between September 20th and October 2nd 2004. The adverse drug reactions were identified by an evaluator who reviewed all clinical histories, noting when physicians had indicated that a reaction had occurred. The patients were contacted. Two people evaluated causality, the degree of preventability and the mechanism producing the adverse drug reactions. Results: 45 adverse drug reactions were recorded in 1,395 visits made during a two-week period (2.8%). Modified spontaneous report detected 26.7% of adverses drug reactions identifi ed by active search. 73.3% of all identifi ed adverses drug reactions occurred in females, 64.9% in people older than 60; 75,6% were posible (causality assessment), 95,6% were non serious, 44,4% were of A type (mechanism producing the adverses drug reactions), and 22,2% were preventable. Conclusions: adverses drug reactions represent an important proportion of the reasons for outpatient consultation; the modified spontaneous report system detected a fourth part of those. There were no statistically significant differences between gender and adverse effects frequency. Adverse drug reactions occurred more frequently in elderly patients. Two out of each 10 adverses drug reactions could have been prevented...