Análisis de las habilidades matemáticas para el cálculo de dosis de medicamentos en estudiantes de enfermería / Analysis of mathematical skills for the calculation of medicines doses in nursing students

INTRODUCCIÓN: Los estudiantes de enfermería deben desarrollar habilidades matemáticas para una vez que sean profesionales de esta disciplina no tengan obstáculos con la dosificación de medicamentos, que es una de las funciones que deben desarrollar en el ámbito clínico, y cuya equivocación podría poner en riesgo la seguridad y vida del paciente. OBJETIVO: Analizar de qué manera las habilidades para las matemáticas básicas afecta la realización del cálculo de las dosis de medicamentos por parte de los estudiantes de enfermería en una institución universitaria. MATERIALES Y MÉTODOS: investigación descriptiva transversal realizada a través del instrumento "Habilidad matemática para el cálculo de las dosis de medicamentos" compuesto por 13 preguntas abiertas y aplicado a 256 estudiantes de los ocho semestres que componen un programa de enfermería. RESULTADOS: El estudio evidenció serias deficiencias en la resolución de situaciones que involucran distintas habilidades matemáticas básicas que debe poseer un estudiante de enfermería. Solo el 30,7% de los estudiantes pudo resolver las situaciones clínicas en las cuales tenía que realizar el cálculo de las dosis de medicamentos; también en el manejo de los porcentajes se encontró dificultades, ya que apenas el 42% logró resolver la situación planteada. La interpretación de conceptos matemáticos básicos mediante la utilización de gráficos fue interpretada adecuadamente por el 50,2%. CONCLUSIÓN: Los hallazgos de la presente investigación, mostraron que deben buscar estrategias de aprendizaje que mejoren las habilidades de los estudiantes de enfermería para la dosificación de medicamentos.

INTRODUCTION: Nursing students must develop mathematical skills so that once they are professionals in this discipline, they do not have obstacles with the dosage of medications, which is one of the functions that they must develop in the clinical field, and whose error could put at risk the safety and life of the patient. OBJECTIVE: To analyze how the skills for basic mathematics affect the calculation of medicine doses by nursing students in a university institution. MATERIALS AND METHODS: descriptive cross-sectional research, carried out through the instrument "Mathematical ability to calculate drug doses" made up of 13 open-ended questions and applied to 256 students from the eight semesters that make up a nursing program. RESULTS: The study showed serious deficiencies in the resolution of situations that involve different basic mathematical skills that a nursing student must possess. Only 30.7% of the students were able to resolve the clinical situations in which they had to perform the calculation of the drug doses; Difficulties were also found in managing the percentages, since only 42% managed to resolve the situation. The interpretation of basic mathematical concepts using graphics was adequately interpreted by 50.2%. CONCLUSION: The findings of the present investigation showed that they should seek learning strategies that improve the skills of nursing students for the dosage of medications.

Cognition of traditional Chinese medicine properties and thinking of clinical rational use of drug / 中国中药杂志

This paper discusses the rational use of traditional Chinese medicine based on chemical composition, body state and biological effect. The essence and connotations of traditional Chinese medicine are explained by modern scientific theory and technical means, and the mechanism of traditional Chinese medicine in the treatment of diseases is defined in modern medicine language, which is conducive to promoting rational and safe clinical use of drugs. Based on the chemical composition of traditional Chinese medicine,the selected genuine medicinal materials were collected and processed in a standardized way, and then used in the combination with other traditional Chinese medicines, with the aim to improve the efficacy of traditional Chinese medicine in clinical indications, increase the advantages, eliminate the disadvantages, and adapt to flexible and safe clinical drug demands. Based on the body state elements, clinical diagnosis and treatment shall be patient-centered, and doctors shall distinguish the differences of pathogenesis, symptoms and diseases, and consider the drug contraindications of special groups. According to the " dose-effect-toxicity" relationship, doctors shall select the appropriate dosage form, control the drug dosage, balance the benefits and risks of drugs, and carry out appropriate medical treatment. Based on the biological effect elements and the regulatory mechanism of traditional Chinese medicine on the target and pathway of disease, traditional Chinese medicine shall strengthen the precise positioning, provide accurate treatment; evaluate the safety of traditional Chinese medicine combination, explore the adverse reaction mechanism, strengthen the clinical safety monitoring of traditional Chinese medicine, and guide the clinical rational use of drugs, in the expectation of ensuring the safe use of traditional Chinese medicine and maximize the clinical efficacy of traditional Chinese medicine.

Variante de cálculo de infusión de ketamina en la TIVA manual / A Variant for calculating ketamine infusion in manual total intravenous anesthesia

Introducción: Un requisito en la conducción de la anestesia intravenosa total, en modo manual, radica en la necesidad de realizar ajustes de dosificación temporales para evitar la acumulación plasmática del fármaco. Desde hace algunos años existe el interés de emplear otros fármacos como la ketamina. Objetivos: Comparar la variación temporal de la concentración plasmática de ketamina al aplicar una variante de cálculo de decrecimiento de la velocidad de infusión (Vinf) con una velocidad de infusión invariable. Métodos: Se realizó un estudio analítico que describe el cálculo de dosificación para TIVA manual, la simulación farmacocinética del comportamiento de la concentración plasmática de la ketamina en caso de administrarse invariablemente con esos regímenes de dosificación, en un paciente virtual, de 70 Kg, según el modelo de Domino y el análisis de la variante de cálculo de decrecimiento de la Vinf del medicamento. Se estimó una significación estadística de un 95 por ciento (p<0.05). Resultados: la variante de cálculo de decrecimientode la velocidad de infusión: Vinf (tn) = Vinf (tn-1) _ [(Vinf (tn-1) x e(1 + 1/t)t)/100] = Vinf (t n-1) x 0,85 permitió valores más estables de la concentración plasmática, aproximadas a la del modelo ideal (p>0,05), por espacio de 6 h. Conclusiones: es probable que el decrecimiento de la dosis de ketamina, establecido por la variante de cálculo e infusión propuesta, posibilite una mejor estabilidad de la concentración plasmática(AU)

Introduction: A requirement in the manual conduction of total intravenous anesthesia is the need to make temporary dosage adjustments to avoid drug accumulation in plasma. For some years there has been interest in using other drugs such as ketamine. Objectives: To compare the temporal variation of ketamine concentration in plasma when applying a variant for calculating the decrease in the infusion rate (Vinf) with an invariable infusion rate. Methods: An analytical study was carried out describing the dosage calculation for manual total intravenous anesthesia, the pharmacokinetic simulation of the behavior of ketamine concentration in plasma in case of being invariably administered with these dosing regimens, in a virtual patient, of 70 kg, according to the Domino model and the analysis of the variant for calculating the decrease of ketamine infusion rate. A statistical significance of 95 percent was estimated (p<0.05). Results: The variant for calculating the decrease of the infusion rate: Vinf (tn) = Vinf (tn-1) _ [(Vinf (tn-1) x e (1+1/t) t)/100] = Vinf (tn -1) x 0.85 allowed more stable values of plasma concentration, which approximate that of the ideal model (p>0.05), for a time of 6 hours. Conclusions: Probably, the decrease of the ketamine dose, established by the proposed calculation and infusion variant, allows better stability of plasma concentration(AU)

Suitability of new drugs registered in Brazil from 2003 to 2013 for pediatric age groups / Adequação às faixas etárias pediátricas de medicamentos novos registrados no Brasil de 2003 a 2013

ABSTRACT Objective To analyze suitability of new drugs registered in Brazil from 2003 to 2013 for pediatric age groups. Methods A descriptive study of drugs with pediatric indication included in a retrospective cohort of new drugs registered in Brazil. The evaluation of drug suitability for the pediatric age group was performed using the following criteria: suitability of dosage form and capacity to deliver the recommended dose. The drugs were considered adequate for the pediatric age groups when they met both criteria. The statistical analysis included calculation of frequencies and proportions. Results Suitability due to the drug capacity to deliver the recommended dose was greater than 80% across all age groups. Regarding suitability of the dosage form, we identified that the older the age group, the greater suitability for pediatric use. Concerning the drugs presented in solid dosage form, we showed that half were classified as inadequate for one or more pediatric age groups to whom they were indicated. The adequacy of drugs to the pediatric age group was 64.3% for preschool children, 66.7% for full-term newborns, 66.7% for premature newborns, and over 70% for other age groups. Conclusion Drugs for children aged under 6 years were less often adequate, considering the dosage form and capacity to provide the recommended dose. The availability and proportional suitability of medicines for pediatric use are greater for older age groups, according to age groups the drug is registered for.

RESUMO Objetivo Analisar a adequação às faixas etárias pediátricas dos medicamentos novos registrados no Brasil no período de 2003 a 2013. Métodos Estudo descritivo dos medicamentos com indicação pediátrica incluídos em uma coorte retrospectiva de medicamentos novos registrados no Brasil. A avaliação da adequação do medicamento à faixa etária pediátrica foi realizada empregando os seguintes critérios: adequação da forma farmacêutica e capacidade de fornecer a dose recomendada. Os medicamentos foram considerados adequados às faixas etárias pediátricas quando preencheram os dois critérios. A análise estatística compreendeu cálculo de frequências e proporções. Resultados A adequação devido à capacidade do medicamento fornecer a dose recomendada foi superior a 80% em todas as faixas etárias. Em relação à adequação da forma farmacêutica, identificou-se que quanto maior a faixa etária, maior a proporção de adequação para uso pediátrico. Em relação aos medicamentos que se apresentavam em formas farmacêuticas sólidas, evidenciou-se que metade foi classificada como inadequada para uma ou mais faixas etárias pediátricas para as quais estavam indicados. A adequação dos medicamentos à faixa etária pediátrica foi 64,3% para pré-escolares, 66,7% para recém-nascidos a termo, 66,7% para recém-nascidos prematuros e superior a 70% para as demais faixas etárias. Conclusão Os medicamentos destinados às crianças menores de 6 anos apresentaram menor frequência de adequação, considerando a forma farmacêutica e a capacidade de fornecer a dose recomendada. A disponibilidade e a proporção de adequação dos medicamentos para uso pediátrico aumentam com a elevação da faixa etária para a qual o medicamento é registrado.

Regimes de dosagem em patentes de segundo uso médico / Dosing regimens in second medical use patents / Regímenes de dosificación en patentes de segundo uso médico

Resumo: No campo farmacêutico, o desenvolvimento de novos fármacos exige um grau sofisticado de entendimento de mecanismos fisiopatológicos, a fim de identificar e caracterizar potenciais alvos biomoleculares e prosseguir com os estudos clínicos. Dentro desse contexto, a proteção dos resultados de Pesquisa & Desenvolvimento é uma etapa vital para garantir o retorno financeiro dos pesados investimentos na área. Uma das estratégias para atingir tal objetivo consiste na exploração de patentes de segundo uso médico, usualmente redigidas no formato "uso do composto X caracterizado pelo fato de ser empregado no preparo de medicamento para a doença Y". Considerando o possível impacto social e a ausência de diretrizes específicas no Brasil, o presente artigo revisa os principais casos relacionados a regimes de dosagem na Europa e analisa os posicionamentos do Escritório Europeu de Patentes (EPO) e judiciários alemão e do Reino Unido sobre os requisitos de patenteabilidade e escopo de proteção, visando a contribuir com o debate técnico sobre o assunto.

Abstract: In the pharmaceutical field, the development of new drugs requires sophisticated understanding of pathophysiological mechanisms in order to identify and characterize potential biomolecular targets and proceed with clinical trials. In this context, protection of research and development results is a vital stage for guaranteeing financial return on the heavy investments in the area. One strategy to achieve this objective is to exploit second-use patents, usually drafted in the format "use of compound X characterized by the fact that it is used in preparing a drug for disease Y". Considering the possible social impact and lack of specific guidelines in Brazil, this article reviews the principal cases related to dosing regimens in Europe and analyzes the positions of the European Patent Office (EPO) and German and UK judiciary systems on the requirements for patentability and scope of protection, aimed at contributing to the technical debate on the topic.

Resumen: En el campo farmacéutico, el desarrollo de nuevos fármacos exige un grado de sofisticación en la comprensión de los mecanismos fisiopatológicos, con el fin de identificar y caracterizar potenciales objetivos biomoleculares y proseguir con los estudios clínicos. Dentro de este contexto, la protección de los resultados de Investigación y Desarrollo es una etapa vital para garantizar el retorno financiero de las costosas inversiones en este área. Una de las estrategias para alcanzar tal objetivo consiste en la explotación de patentes de segundo uso médico, habitualmente redactadas en el formato "uso del compuesto X, caracterizado por el hecho de ser empleado en la preparación del medicamento para la enfermedad Y". Considerando el posible impacto social, y la ausencia de directrices específicas en Brasil, el presente artículo revisa los principales casos relacionados con los regímenes de dosificación en Europa y analiza las posiciones adoptadas por la Oficina Europea de Patentes (EPO) y los sistemas judiciales alemanes y del Reino Unido sobre los requisitos de patentabilidad y alcance de la protección, con el objetivo de contribuir al debate técnico sobre este asunto.

Retrospective analysis of the financial break-even point for intrathecal morphine pump use in Korea

BACKGROUND: The high cost of intrathecal morphine pump (ITMP) implantation may be the main obstacle to its use. Since July 2014, the Korean national health insurance (NHI) program began paying 50% of the ITMP implantation cost in select refractory chronic pain patients. The aims of this study were to investigate the financial break-even point and patients' satisfaction in patients with ITMP treatment after the initiation of the NHI reimbursement. METHODS: We collected data retrospectively or via direct phone calls to patients who underwent ITMP implantation at a single university-based tertiary hospital between July 2014 and May 2016. Pain severity, changes in the morphine equivalent daily dosage (MEDD), any adverse events, and patients' satisfaction were determined. We calculated the financial break-even point of ITMP implantation via investigating the patient's actual medical costs and insurance information. RESULTS: During the studied period, 23 patients received ITMP implantation, and 20 patients were included in our study. Scores on an 11-point numeric rating scale (NRS) for pain were significantly reduced compared to the baseline value (P < 0.001). The MEDD before ITMP implantation was 0.59 [IQR: 0.55–0.82]. The total MEDD increased steadily to 0.77 [IQR: 0.53–1.08] at 1 year, which was 126% of the baseline (P < 0.001). More than a half (60%) responded that the ITMP therapy was somewhat satisfying. The financial break-even point was 28 months for ITMP treatment after the NHI reimbursement policy. CONCLUSIONS: ITMP provided effective chronic pain management with improved satisfaction and reasonable financial break-even point of 28 months with 50% financial coverage by NHI program.

Risk factor analysis of additional administration of sedative agent and patient dissatisfaction in intravenous conscious sedation using midazolam for third molar extraction

OBJECTIVES: The primary purpose of this study was to investigate the factors related with additional administration of sedative agent during intravenous conscious sedation (IVS) using midazolam (MDZ). The secondary purpose was to analyze the factors affecting patient satisfaction. MATERIALS AND METHODS: Clinical data for 124 patients who had undergone surgical extraction of mandibular third molar under IVS using MDZ were retrospectively investigated in this case-control study. The initial dose of MDZ was determined by body mass index (BMI) and weight. In the case of insufficient sedation at the beginning of surgery, additional doses were injected. During surgery, peripheral oxygen saturation, bispectral index score (BIS), heart rate, and blood pressure were monitored and recorded. The predictor variables were sex, age, BMI, sleeping time ratio, dental anxiety, Pederson scale, and initial dose of MDZ. The outcome variables were additional administration of MDZ, observer's assessment of alertness/sedation, intraoperative amnesia, and patient satisfaction. Descriptive statistics were computed, and the P-value was set at 0.05. RESULTS: Most patients had an adequate level of sedation with only the initial dose of MDZ and were satisfied with the treatment under sedation; however, 19 patients needed additional administration, and 13 patients were unsatisfied. In multivariable logistic analysis, lower age (odds ratio [OR], 0.825; P=0.005) and higher dental anxiety (OR, 5.744; P=0.003) were related to additional administration; lower intraoperative amnesia (OR, 0.228; P=0.002) and higher BIS right before MDZ administration (OR, 1.379; P=0.029) had relevance to patient dissatisfaction. CONCLUSION: The preoperative consideration of age and dental anxiety is necessary for appropriate dose determination of MDZ in the minor oral surgery under IVS. The amnesia about the procedure affects patient satisfaction positively.

Prospective validation of a novel dosing scheme for intravenous busulfan in adult patients undergoing hematopoietic stem cell transplantation

The objective of this study was to externally validate a new dosing scheme for busulfan. Thirty-seven adult patients who received busulfan as conditioning therapy for hematopoietic stem cell transplantation (HCT) participated in this prospective study. Patients were randomized to receive intravenous busulfan, either as the conventional dosage (3.2 mg/kg daily) or according to the new dosing scheme based on their actual body weight (ABW) (23×ABW(0.5) mg daily) targeting an area under the concentration-time curve (AUC) of 5924 µM·min. Pharmacokinetic profiles were collected using a limited sampling strategy by randomly selecting 2 time points at 3.5, 5, 6, 7 or 22 hours after starting busulfan administration. Using an established population pharmacokinetic model with NONMEM software, busulfan concentrations at the available blood sampling times were predicted from dosage history and demographic data. The predicted and measured concentrations were compared by a visual predictive check (VPC). Maximum a posteriori Bayesian estimators were estimated to calculate the predicted AUC (AUC(PRED)). The accuracy and precision of the AUC(PRED) values were assessed by calculating the mean prediction error (MPE) and root mean squared prediction error (RMSE), and compared with the target AUC of 5924 µM·min. VPC showed that most data fell within the 95% prediction interval. MPE and RMSE of AUCPRED were -5.8% and 20.6%, respectively, in the conventional dosing group and −2.1% and 14.0%, respectively, in the new dosing scheme group. These fi ndings demonstrated the validity of a new dosing scheme for daily intravenous busulfan used as conditioning therapy for HCT.

Evaluation on dosage-based efficacy-toxicity correlation of Tripterygium wilfordii against immune inflammation in mice / 中国中药杂志

<p><b>OBJECTIVE</b>To study the anti-immune inflammation efficacy and toxicity of Tripterygium wilfordii decoction, in order to provide experimental basis for studies on its "efficacy-toxicity" correlation.</p><p><b>METHOD</b>The delayed hypersensitivity model was established by dinitrofluorobenzene in mice. Different doses of T. wilfordii decoction was administered for 5 consecutive days. The ear swelling inhibition ratio and the toxic action were observed. After the final administration, the biochemical indexes of PGE2, TNF-α, IL-2, ALT, AST, PA, TBA, TBIL in serum were detected, and the visceral indexes of heart, liver, spleen and kidney were measured.</p><p><b>RESULT</b>The DNFB-induced ear swelling could be notably inhibited by multiple oral administration of T. wilfordii decoction, with the ED50 and its 95% confidence limit of 0.34 (0.21-0.42) g x kg(-1). The contents of PGE2, TNF-α, IL-2 in serum decreased in a dose-dependent manner. The activities of serum AST, ALT, TBA, TBIL and the PA content reduced.</p><p><b>CONCLUSION</b>T. wilfordii decoction shows a significant anti-immune inflammation efficacy within the dosage range between 0.59 and 2.34 g x kg(-1) in a dose-dependent manner. With a certain hepatotoxicity, high dose (2.34-4.68 g x kg(-1)) of T. wilfordii decoction can cause substantial liver injury, with a dose dependence in liver function index. Therefore, the efficacy and toxicity of T. wilfordii is dose dependent, which provides reference for preventing adverse drug reactions in clinic and developing early-warning schemes and ensure the clinical medication safety of T. wilfordii.</p>

Study on multi-target optimization of prescription dose of Mahuang decoction / 中国中药杂志

<p><b>OBJECTIVE</b>To optimize the prescription dose of Mahuang decoction in a multi-target manner, in order to provide reference for the quantitative optimization of the prescription dose of the traditional Chinese medicine compound.</p><p><b>METHOD</b>The number of diaphoretic spots in rats, the tracheal antispasmodic rate in guinea pigs and the writhing times by acetic acid in mice were taken as the indexes for evaluating the diaphoretic, antispasmodic and analgesic effects. According to the experimental results of the 16 orthogonal combination prescriptions, a mathematical dose-effect model was built by support vector regression (SVR) and quadratic response surface regression (RSR) respectively. The multi-target optimization was achieved by elitist non-dominated sorting genetic algorithm (NSGA-II) and entropy weight TOPSIS method.</p><p><b>RESULT</b>The optimal dose of Mahuang decoction after being optimized by SVR modeling contained 17.71 g of Ephedrae Herba, 9.57 g of Cinnamomi Ramulus, 11.75 g of Armeniacae Semen Amarum and 4.39 g of Glycyrrhizae Radix et Rhizoma Praeparata Cum Melle. The optimized result by RSR modeling contained 13.37 g of Ephedrae Herba, 11.61 g of Cinnamomi Ramulus, 11.98 g of Armeniacae Semen Amarum and 5.67 g of Glycyrrhizae Radix et Rhizoma Praeparate Cum Melle. SVR was superior to RSR in both of the forecast capacity and optimization results.</p><p><b>CONCLUSION</b>SVR-NSGA-II-TOPSIS method could be adopted for the multi-target optimization for the dose of Mahuang decoction and other traditional Chinese medicine compounds. It is proved to be the optimal prescription with the best efficacy, and could provide scientific quantitative basis for determining the dose of traditional Chinese medicine compound prescriptions and developing new traditional Chinese medicines.</p>

Analysis on dosage of traditional Chinese medicine decoction pieces stipulated in Chinese pharmacopoeia / 中国中药杂志

Chinese Pharmacopoeia I (2010 edition) covers dosage and usage of traditional Chinese medicinal herbs and decoction pieces, and provides dosage ranges of most of decoction pieces. By using the descriptive statistical method, the article discusses the distribution of maximum dosage, minimum dosage and dosage range of decoction pieces set forth in Chinese Pharmacopoeia, and compares toxic drugs and non-toxic drugs. Altogether 617 drugs are included into the study. Except for 16 decoction pieces whose dosages are not clear, all of the remaining decoction pieces are covered by Chinese Pharmacopoeia, with the maximum common dosage, minimum common dosage and dosage range of 3, 10 and 6 g. Upon comparison, we discovered that Chinese Pharmacopoeia sets stricter standards for toxic drugs than non-toxic drugs. Compared with dosages in classical prescriptions and actual clinical usages, dosage ranges described in Chinese Pharmacopoeia are much narrower. There is no significant difference between drugs that can be used as foods or healthcare foods and other drugs according to Chinese Pharmacopoeia.

Pharmaceutical study on multi-component traditional Chinese medicines / 中国中药杂志

Due to the limitation of science and technology in ancient times, traditional Chinese medicines (TCMs) could have prepared only in traditional dosage forms, such as pills, powders, ointments and pellets. Though studies on multi-component TCMs have become one of major development orientations of TCM, the druggability of their preparations has always been neglected. On the basis of two key difficulties--the integration of studies on multi-component TCMs and TCM theory as well as the evaluation on their druggability, the essay proposes methods and technologies that can be adopted in studies on multi-component TCM preparations, including the characteristic physicochemical property of multi-component TCMs and its correlation with forming process, the release-modified micro pill preparation technology based on prescription-symptom-dosage, and the evaluation technology on release of release-modified micro pill components based on mathematical set model.

Consumo neto de sevoflurane en la primera hora de cirugía y su relación con el IMC en pacientes sometidos a Colelap en el Hospital Dos de Mayo. Lima, Febrero - Abril 2013 / Net consumption of sevoflurane in the first hour of surgery and its relationship with BMI in patients submitted laparoscopic cholecystectomy at the Hospital Dos de Mayo. Lima, February-April 2013

El presente estudio se realizó en el HNDM, entre los meses de Febrero-Abril 2013 en, 30 pacientes, 18 mujeres y 12 varones, entre los 18 a 50 años de edad. Es un estudio longitudinal donde se relaciona el consumo neto de sevoflurano con el IMC en el paciente, sometido a Colelap. El consumo de sevoflurano se obtuvo de la diferencia entre el valor de sevoflurano de ingreso menos el valor de sevoflurano de salida. Se ha observado que el valor de consumo neto de sevoflurano no se diferencia tanto entre mujeres como varones. Se observa que existe una relación directa entre el consumo neto de sevoflurano y el índice de masa corporal; lo cual nos indica que a mayor IMC, mayor consumo de sevoflurano. Se recomienda hacer trabajos similares con un mayor muestreo para evitar sesgos por muestra insuficiente. OBJETIVO: Determinar el consumo neto del sevoflurano en pacientes sometidas a Colelap en el Hospital Nacional Dos de mayo durante el periodo de Febrero-Abril 2013. DISEÑO: Se realizó un estudio: Observacional, analítico prospectivo. MATERIALES Y METODOS: En pacientes programados para colecistectomía laparoscópica en el Hospital Nacional Dos de Mayo entre Febrero y Abril de 2013. Quienes cumplen los criterios de inclusión y exclusión. Se registraron el índice de masa corporal y el valor del sevoflurano al ingreso y salida vía respiratoria del paciente y el CAM. RESULTADOS: El índice de masa corporal varía entre 21.51 y 43.25 y el consumo de sevoflurano varia entre 0.26 por ciento a 0.80 por ciento y los valores del CAM está entre los rangos de 0.65 y 1.30. CONCLUSION: Existe mayor consumo de relativo de sevoflurano en varones que en mujeres. Con respecto al IMC existe una relación directa, a mayor IMC mayor consumo de sevoflurano.

This study was conducted in the HNDM, between the months of February to April 2013 in 30 patients, 18 females and 12 males, between 18-50 years old. Where a longitudinal study is relates sevoflurane net consumption BMI in the patient undergoing colelap. Sevoflurane consumption was obtained from the difference between the value of sevoflurane income less the value of output sevoflurane. It has been observed that the net consumption value does not differ much sevoflurane among females and males. It is observed that there is a direct relationship between the sevoflurane consumption and the net body mass index, which indicates that the higher the BMI, the greater consumption of sevoflurane. Similar work is recommended with a larger sample to avoid bias by insufficient sample. OBJECTIVE: Determine the net consumption of sevoflurane in patients undergoing Colelap National Hospital Two May during the period February to April 2013. DESIGN: We conducted a study: Observational, prospective analytical. MATERIALS AND METHODS: In patients scheduled for laparoscopic cholecystectomy at the National Hospital Dos de Mayo between February and April of 2013. Those who meet the inclusion and exclusion criteria. We recorded body mass index and the value of the entry and exit sevoflurane patient's airway and CAM. RESULTS: The body mass index varies between 21.51 and 43.25 and sevoflurane consumption varies between 0.26 per cent to 0.80 per cent and the values of CAM ranges are between 0.65 and 1.30. CONCLUSION: There is increased relative consumption of sevoflurane in men than in women. For BMI there is a direct, higher BMI greater consumption of sevoflurane.

How Should Azathioprine Be Dosed in Crohn's Disease? A Novel Strategy of Maximum Dose-titration Based on the Lower Limit of Leukocyte Count and Tolerability / 대한소화기학회지

BACKGROUND/AIMS: Although general guidelines have suggested weight-based dosing of azathioprine (AZA, 2.5 mg/kg/day) for Crohn's disease (CD), a substantial number of patients develop bone marrow suppression. The aim of this study was to evaluate the maximum dose of AZA not based on weight but titrated according to the lower limit of leukocyte count for maintaining remission in patients with CD. METHODS: Among a total of seventy-eight patients with CD, who had been followed-up at Kosin University Gospel Hospital (Busan, Korea) from 2010 to 2011, those treated with the maximum dose of AZA meeting both drug-tolerability and leukocytes count of more than 4,000/mm3 for steroid-free maintaining remission were enrolled. The titrated maximum AZA dose and its relationship with weight were evaluated. RESULTS: A total of 42 patients (male, 32 patients; mean age, 31 years) were enrolled. The maximum dose of AZA was 49.1 mg/day. The dose per weight was 0.87 mg/kg/day and negatively correlated with body weight (gamma=-0.51, p=0.01) and BMI (gamma=-0.33, p=0.034). AZA dose per weight in the below 40 years old group was significantly higher than that in the above 40 years old group (p=0.039). CONCLUSIONS: Dose decision of AZA based only on weight could put the patients to inappropriately low or high dose resulting in need of additional therapy or serious side effect, respectively. Therefore, the maximum dose-titration based on the lower limit of leukocyte count and tolerability is a novel and a valuable strategy in deciding the dose of thiopurines.

Based on hospital information system data, analysis of effects of different doses of shenmai injection on renal function / 中国中药杂志

<p><b>OBJECTIVE</b>To assess whether the dosage of Shenmai injection influences renal function.</p><p><b>METHOD</b>Analysis of hospital information system (HIS) data from 18 national hospitals using Shenmai injections. Patients were aged between 18 to 80 years old. Blood analysis of creatinine and serum urea nitrogen was undertaken 7 days before and after exceeding the maximum recommended dose of 100 mL of Shenmai injection. Propensity score method was used to compare the differences between the two groups of renal function scores.</p><p><b>RESULT</b>The differences in abnormal changes in creatinine and serum urea nitrogen levels between the groups before and after exceeding the recommended dose was not statistically significant, but abnormal changes were detected.</p><p><b>CONCLUSION</b>Based on the available data we did not find that exceeding the recommended dose of Shenmai injection had a significantly deleterious effect on renal function. However, caution should be applied in its clinical use.</p>

Vancomycin serum concentrations in pediatric oncologic/hematologic intensive care patients

BACKGROUND: Usual treatment regimens with vancomycin often fail to provide adequate serum levels in patients with severe infections. METHODS: Retrospective analysis of vancomycin trough serum measurements. The following parameters were calculated by Bayesian analysis: vancomycin clearance, distribution volume, and peak estimated concentrations. The area under the concentration curve (AUC) (total daily dose/24 h clearance of vancomycin) was used to determine the effectiveness of treatment through the ratio of AUC/minimum inhibitory concentration (MIC) above 400, using MIC = 1 µg/mL, based on isolates of Staphylococci in cultures. RESULTS: Sixty-one vancomycin trough measurements were analyzed in 31 patients. AUC/MIC > 400 was obtained in 34 out of 61 dosages (55.7%), but the mean vancomycin dose required to achieve these levels was 81 mg/kg/day. In cases where the usual doses were administered (40-60 mg/kg/day), AUC/MIC > 400 was obtained in nine out of 18 dosages (50%), in 13 patients. Trough serum concentrations above 15 mg/L presented a positive predictive value of 100% and a negative predictive value of 71% for AUC/MIC > 400. CONCLUSION: Higher than usual vancomycin doses may be required to treat staphylococcal infections in children with oncologic/hematologic diseases. Since the best known predictor of efficacy is the AUC/MIC ratio, serum trough concentrations must be analyzed in conjunction with MICs of prevalent Staphylococci and pharmacokinetic tools such as Bayesian analysis.

Gemcitabine in brief versus prolonged low-dose infusion, both combined with carboplatin for advanced non-small cell lung cancer.

Purpose: Gemcitabine in low-dose prolonged infusion is a treatment with documented activity against a variety of tumors. The present study was conducted to evaluate the efficacy and safety of the combination of gemcitabine at a low-dose prolonged infusion in comparison with standard dose gemcitabine with carboplatin in chemonaive patients with advanced non-small cell lung cancer (NSCLC). Materials and Methods: Sixty chemonaive patients with stage IIIB or IV NSCLC were included. Patients were randomly assigned 1:1 to receive 350mg/m 2 gemcitabine in a 6-h infusion on days 1 and 8 and carboplatin area under the serum concentration time curve (AUC) 5 on day 1 versus gemcitabine 1000mg/m 2 on days 1 and 8 and carboplatin AUC 5 on day 1 (3-week cycle both). A total of 118 chemotherapy cycles, with a median of 4 cycles per patient (range 2-6), and 134 chemotherapy cycles, with a median of 4.47 cycles per patient (range 3-6) were administered in standard and low infusional dose arm, respectively. Results: Among patients in the standard arm, 40% had overall response rate (ORR), 33.3% had stable disease and 26.6% had progressive disease, while in low-dose infusional arm, 36.6% had ORR, 36.3% had stable disease and 26.6% had progressive disease (P = 0.992). Median progression-free survival was 5.5 months and 5.4 months, median overall survival was 9.7 months and 10.7 months, and 1-year survival was 33.7% and 36.6% in standard arm and low-dose infusion arm, respectively. Grade 3/4 toxicity was rare. Conclusion: In NSCLC, gemcitabine low-dose prolonged infusion with carboplatin has low toxicity, especially thrombocytopenia, and has an activity comparable with gemcitabine given in higher dose in standard infusion.