Evaluación de la dosificación de voriconazol intravenoso tres veces al día vs dos veces al día para el tratamiento de aspergilosis invasora en niños inmunocomprometidos: monitorización terapéutica y seguridad / Evaluation dosing intravenous voriconazole three times a day vs twice daily for the treatment of invasive aspergillosis in immunocompromised children: therapeutic drugs monitoring and safety

INTRODUCCIÓN: Voriconazol es el antifúngico de elección para el tratamiento de la aspergilosis invasora (AI). Concentraciones plasmáticas (CPs) > 1 μg/mL se han asociado a mejores resultados terapéuticos, las que no siempre se alcanzan durante el tratamiento en niños inmunocomprometidos. Dada la necesidad de iniciar una terapia precoz y efectiva de la infección, es relevante establecer el régimen de administración de voriconazol que se asocie con CPs óptimas en esta población. OBJETIVO: Comparar las CPs y seguridad de voriconazol intravenoso (IV), dosificado BID y TID en niños inmunocomprometidos con indicación de tratamiento antifúngico. MÉTODO: Estudio observacional retrospectivo de enero de 2015 a julio de 2018 en un hospital pediátrico de alta complejidad de Santiago de Chile, en pacientes de 0 a 17 años que recibieron tratamiento con voriconazol IV. Se excluyeron aquellos con terapia de reemplazo renal, falla hepática y/o falla renal. Se compararon las CPs valles entre un grupo con régimen de dosificación BID y otro grupo con administración TID. Se evaluaron las reacciones adversas en ambos grupos. RESULTADOS: Se obtuvieron 137 CPs valles en 76 niños, con una mediana de edad de 9 años (0-17 años) en el grupo BID y 9 años (0-16 años) en el grupo TID, con una mediana de peso de 27 kg (6-83 kg) y 28 kg (9,3-60 kg), respectivamente. Resultados: Pacientes 1 gg/mL en comparación con la administración BID (p = 0,001). Se reportaron ocho reacciones adversas, principalmente fotofobia, sin encontrarse diferencias significativas entre grupo BID y TID. CONCLUSIÓN: Dosificaciones TID están asociadas a una mayor probabilidad de obtener una adecuada exposición a voriconazol en pacientes < 12 años en comparación a dosificaciones BID, con baja frecuencia de reacciones adversas.

BACKGROUND: Voriconazole is the antifungal of choice for the treatment of invasive aspergillosis (IA). Plasma concentrations (PCs) > 1 μg / mL llave been associated with better therapeutic results which have not always been achieved during treatment in immunocompromised children. In the necessity to initiate early and effective therapy for the infection, it is relevant to establish the voriconazole administration regimen that is associated with optimal PCs in this population. AIM: To compare the PC and safety of intravenous (IV) voriconazole, dosed BID and TID in immunocompromised children with indication of antifungal treatment. METHOD: Retrospective observational study since January 2015 until July 2018 in a highly complex pediatric hospital in Santiago of Chile, in patients aged 0 to 17 years who received treatment with IV voriconazole. Those with renal replacement therapy, liver failure and / or renal failure were excluded. Trough PCs were compared between a group with BID dosing regimen versus another group with TID administration. Adverse reactions were evaluated in both groups. RESULTS: 137 trough PCs were obtained in 76 children, with a median age of 9 years (0-17 years) in the BID group and 9 years (0-16) in the TID group with a median weight of 27 kg (6-83 kg) and 28 kg (9.3-60 kg), respectively. Patients 1 gg/mL compared to BID administration (p = 0.001). Eight adverse reactions were reported, mainly photophobia, with no significant difference found between the BID and TID groups. CONCLUSION: TID dosages are associated with a greater probability of obtaining adequate exposure to voriconazole in patients < 12 years old compared to BID dosages, with a low frequency of adverse reactions.

Daño asociado al uso de medicamentos en hospitales chilenos: análisis de prevalencia 2010-2017 / Drug related harm in Chilean hospitals: prevalence analysis 2010-2017

Background: Medication related adverse events are an important cause of hospital admission or prolonged stay. Aim: To assess medication related adverse events in a hospital discharge database. Material and Methods: Revision of the Chilean hospital discharge database from 2010 to 2017 searching for ICD- 10 diagnostic codes corresponding to medication related adverse events. Results: The number of medication related adverse events was stable across the studied time lapse, but admission length increased. Between 34 and 111 people died every year due to medication related adverse events. Lactating babies, toddlers, adolescents and people over 80 years of age are at greater risk of experiencing these events. Conclusions: Medication related adverse events are more common than expected.

Pseudoaneurisma e CIV pós-IAM concomitantes: apresentação grave e rara / Pseudoaneurysm and VSD concomitant after AMI: severe and rare presentation

Relata-se caso raro de dupla-complicação mecânicapós-IAM anterior: pseudoaneurisma e comunicação interventricular (CIV). Paciente do sexo feminino,66 anos, tendo apresentado quadro de dor torácica típica, foi submetida à cineangiocoronariografia, que demonstrou oclusão total em terço médio de artéria descendente anterior (DA), com angioplastia realizada10 dias após o início do quadro. Evoluiu após três semanas com recidiva de dor precordial, dispneia,sopro sistólico novo, estável hemodinamicamente. Diagnóstico à cineangiocoronariografia e ao ecocardiograma de pseudoaneurisma de parede anterior de ventrículo esquerdo e CIV apical. Realizada correção cirúrgica, com ressecção do aneurisma e correção da CIV, obtendo-se ótimo resultado, apesar da gravidade do caso.

We report a rare case of double mechanical complication after anterior myocardial infarction:pseudoaneurysm and ventricular septal defect (VSD). Female patient, 66 years old, presented with typical chest pain and under went coronary angiography,which showed total occlusion in the middle third ofleft anterior descending artery (DA) with angioplasty performed 10 days after on set of symptoms. Evolved after three weeks with recurrence of chest pain, dyspnea, systolic murmur new, hemodynamically stable. Diagnostic coronary angiography and echocardiography pseudoaneurysm of the anterior wall of the left ventricle and apical VSD. Performed surgical repair with resection of the aneurysm and VSD correction, obtaining excellent results despite the gravity of the case.