[Digitalis intoxication secondary to treatment with clarithromycin]. / Original Breve Intoxicación digitálica secundaria al tratamiento con claritromicina.

OBJECTIVE: The goal of this study was to investigate the percentage of patients concurrently receiving digoxin and clarithromycin who exhibited serum digoxin concentrations above the therapeutic range because of a likely interaction between both drugs, and whether digitalis intoxication ensued. METHOD: A descriptive, retrospective study carried out from January 2002 to December 2003 in all inpatients concurrently receiving digoxin and clarithromycin whose serum digoxin concentrations were monitored by the Pharmacy Department s Pharmacokinetics Section. RESULTS: Twenty-six patients having received digoxin and clarithromycin concurrently during their hospital stay were included in the study. Of these, 12 patients (46.2%) had serum digoxin concentrations above the therapeutic range: 7 received digoxin in doses unsuited for their age and/or renal function, and 2 fell short of the mean period of time considered adequate for an interaction to occur. Therefore, only 3 patients had serum digoxin concentrations above the therapeutic range, probably because of an interaction with clarithromycin, and all three had digitalis intoxication symptoms. CONCLUSIONS: According to the results of our study, 11.5% of patients concurrently receiving digoxin and clarithromycin had serum digoxin concentrations above the therapeutic range because of a likely interaction between these two drugs, with digitalis intoxication ensuing. Thus, we deem it necessary to monitor serum digoxin concentrations in patients receiving clarithtomycin.

Intoxicación digitálica secundaria al tratamiento con claritromicina / Digitalis intoxication secondary to treatment with clarithromycin

Objetivo: El objetivo del estudio es conocer el porcentaje de pacientes en tratamiento simultáneo con digoxina y claritromicina que presentaron concentraciones séricas de digoxina superiores al rango terapéutico debido a una probable interacción entre ambos fármacos y como consecuencia si existió intoxicación digitálica. Método: Estudio descriptivo y retrospectivo realizado entre enero de 2002 y diciembre de 2003 de todos aquellos pacientes que durante su ingreso hospitalario fueron tratados simultáneamente con digoxina y claritromicina y cuyas concentraciones séricas de digoxina fueron monitorizadas por la sección de farmacocinética del servicio de farmacia. Resultados: Se incluyeron en el estudio 26 pacientes que habían recibido con comitantemente digoxina y claritromicina durante su estancia en el hospital. De ellos, 12 pacientes (46,2%) tuvieron concentraciones séricas de digoxina superiores al rango terapéutico: 7 tenían una dosis de digoxina no adecuada para su edad y/o función renal y 2 no superaban el tiempo medio considerado suficiente para que tuviera lugar la interacción. Por lo tanto, sólo 3 pacientes tuvieron concentraciones séricas de digoxina superiores al rango terapéutico debido probablemente a la interacción con claritromicina y los tres presentaron síntomas de intoxicación digitálica. Conclusiones: Según los resultados de nuestro estudio un 11,5% de los pacientes en tratamiento simultáneo con digoxina y claritromicina presentaron concentraciones séricas de digoxina superiores al rango terapéutico, debido a una probable interacción entre ambos fármacos, y como consecuencia tuvo lugar la intoxicación digitálica. Por ello consideramos necesaria la monitorización de las concentraciones séricas de digoxina en pacientes tratados con claritromicina

Objective: The goal of this study was to investigate the percentage of patients concurrently receiving digoxin and clarithromycin who exhibited serum digoxin concentrations above the therapeutic range because of a likely interaction between both drugs, and whether digitalis intoxication ensued. Method: A descriptive, retrospective study carried out from January 2002 to December 2003 in all inpatients concurrently receiving digoxin and clarithromycin whose serum digoxin concentrations were monitored by the Pharmacy Department’s Pharmacokinetics Section. Results: Twenty-six patients having received digoxin and clarithromycin concurrently during their hospital stay were included in the study. Of these, 12 patients (46.2%) had serum digoxin concentrations above the therapeutic range: 7 received digoxin indoses unsuited for their age and/or renal function, and 2 fell short of the mean period of time considered adequate for an interaction to occur. Therefore, only 3 patients had serum digoxin concentrations above the therapeutic range, probably because of an interaction with clarithromycin, and all three had digitalis intoxication symptoms. Conclusions: According to the results of our study, 11.5% of patients concurrently receiving digoxin and clarithromycin had serum digoxin concentrations above the therapeutic range because of a likely interaction between these two drugs, with digitalis intoxication ensuing. Thus, we deem it necessary to monitor serum digoxin concentrations in patients receiving clarithromycin

Un paciente con dolor en el metatarso

Agrupamos la patología del antepié en cuatro grandes apartados. Denominamos al primero alteración estática, donde se describen las enfermedades que asientan en el metatarso, como consecuencia de una mala posición u otra alteración, considerada una variante de la normal. Estas enfermedades pueden ser sintomáticas por sí mismas o presentar sintomatología con el paso del tiempo, como producto de degeneraciones artrósicas. En el segundo apartado se inclulyen las enfermedades óseas y degenerativas que asientan en el antepié, que pueden aparecer de forma primaria o secundaria a otras enfermedades e ir asociadas a una alteración estática o no. En la tercera parte, se incluyen las enfermedades de partes blandas, que constituyen un motivo muy frecuente de consulta y, habitualmente, tienen fácil solución. En general, son consecuencia de una alteración estática. Aquí también tienen cabida las enfermedades dermatológicas, vasculares, infecciosas, etc. Po último, comentaremos las enfermedades reumáticas inflamtorias que tienen una especial repercusión en el antepié (AU)

[Analysis of experience in an integrated program of hospital rheumatological service and primary care]. / Análisis de la experiencia de un programa integrado de asistencia hospitalaria reumatológica en Atención Primaria.

BACKGROUND: In order to improve the health quality at the Primary care level, the Catalonian Health Authority (Servei Catala de la Salut) has begun a reform of the medical and surgical specialties. In this reform process the Hospital del Mar, Barcelona, Spain, has taken part in the incorporation of several medical and surgical hospital specialists to primary care within its influence area. In this study, we describe the results of the collaboration between Hospital health care and Primary care on rheumatic complaints during one year. METHODS: We carried out a descriptive study of some clinical and epidemiological variables of the population visited during one year (1995), at the Primary care level by the Rheumatologist. Our area has a population of 90,612 people, and its located in Barcelona City, Ciutat Vella Variables of study were collected during the period of time between January and December 1995. The following variables were recorded: age, gender, referral cause, rheumatologic diagnosis, intra-articular and peri-articular corticosteroid injections perform, techniques used for the diagnosis of rheumatic disease, follow-up level Data were statistically analyzed. RESULTS: Visits performed were 2,668 on 1,384 patients. Fifty-two percent were first visits, 48% were follow-up visits (Ratio first visits Nolfow-up visits: 0.57). Fifty-one percent of the patients were > 65 years old. Unspecific polyarthralgias, chronic low back pain, gonalgia and pathology of the shoulder were the most frequent complaints (> 50%). Osteoarthritis and soft-tissue diseases were the most frequent diagnosis with a percentage of 41% and 30.7%, respectively. Connective tissue diseases and spondyloarthropathies had account for 3.8% of global diagnosis. X-ray film has been the commonest technique used for the diagnosis of rheumatic diseases (80.5%). The waiting list for first visit initially has been 5 weeks, and at the end of study it has been 3 weeks. Ten percent of patients had been referred to the Hospital. CONCLUSIONS: Collaboration between Hospital care rheumatology and Primary care, improves the diagnostic quality, as well as it decreases the waiting list and allows the patients' control at the most appropriate care level.

[Favorable response to corticoid therapy in a patient with transverse myelitis in systemic lupus erythematosus]. / Respuesta favorable a la corticoterapia en una paciente afecta de mielitis transversa en el curso de lupus eritematoso sistémico.

Transverse myelitis is one of the most unusual neurologic complications of systemic lupus erythematosus. Its pathogenetic mechanisms are controversial. Several therapeutic regimens have been attempted with contradictory results. Corticotherapy appears to improve prognosis, although some authors question its beneficial effects. The case of a patient with systemic lupus erythematosus and transverse myelitis, who presented a favourable clinical course following early treatment with high-dose corticoids, is reported.