[Perioperative anaemia in geriatric patients with hip fracture]. / Efectividad de distintas pautas de tratamiento de la anemia perioperatoria en pacientes ancianos con fractura de cadera.

OBJECTIVE: To describe and study the effectiveness of the perioperative anaemia treatment patterns for patients older than 64 with hip fracture. METHOD: Three groups of patients were compared: Group 1: Oral iron or without iron therapy. Group 2: low doses of intravenous iron. Group 3: treated according to a blood saving programme including intravenous iron, alpha epoetin and restrictive transfusional criteria. The homogeneity of gender, age, type of fracture, ASA, preoperative period and perisurgical bleeding affecting drug consumption within the groups was analyzed. The effectiveness of the treatments was determined by means of transfusional rate, postoperative haemoglobin levels, and postoperative length of stay and infection rate. RESULTS: 329 patients were checked. Patients were comparable. Patients included in Group 3 were transfused less than the rest (36.5 of patients in group 3 vs. 52.0% in group 1 and 67.6% in group 3, p = 0.002). Decreases in the infection rate and mean postoperative stay in group 3 were not significant. Haemoglobin levels at 48 hours post surgery were higher in group 1 but haemoglobin levels at the seventh day post surgery were similar for the three groups. CONCLUSIONS: The above mentioned blood saving programme has been observed to be effective in decreasing transfusional requirements without increasing morbidity. However, further prospective studies are needed in order to define the cost-effectiveness of this programme and to determine its role in the reduction of posttransfusional infections and postoperative length of stay.

Efectividad de distintas pautas de tratamiento de la anemia perioperatoria en pacientes ancianos con fractura de cadera / Perioperative anaemia in geriatric patients with hip fracture

Objetivo: Analizar la efectividad de distintas pautas de tratamientode la anemia perioperatoria en pacientes mayores de 64años con fractura de cadera.Método: Se compararon tres grupos de pacientes: Grupo 1:sin ferroterapia o con hierro oral. Grupo 2: con hierro intravenosoa bajas dosis. Grupo 3: tratados según protocolo de ahorro desangre con criterios transfusionales restrictivos, hierro intravenosoy epoetina alfa. Se estudió si los grupos eran homogéneos ensexo, edad, tipo de fractura, ASA, tiempo prequirúrgico y consumode fármacos que pueden afectar al sangrado. La efectividad delos tratamientos se determinó mediante el porcentaje de pacientestransfundidos, los valores de hemoglobina postoperatorios, laestancia postoperatoria y la presencia de infección hospitalaria.Resultados: Se estudiaron 329 pacientes, que se consideraroncomparables en las variables estudiadas. Los pacientes delgrupo 3 se transfundieron significativamente menos que el resto(el 36,5 de los pacientes frente al 52,0% de los del grupo 1 y el67,6% de los del grupo 2, p = 0,002). El porcentaje de pacientescon infección hospitalaria y la estancia postoperatoria media fuemenor en el grupo 3 que en el resto de grupos aunque no alcanzósignificación. Los valores de hemoglobina a las 48 h tras la intervenciónfueron mayores en el grupo 1 pero los niveles a los sietedías fueron similares en los tres grupos. Conclusiones: El protocolo de ahorro de sangre se ha mostradoefectivo en disminuir las necesidades transfusionales sinaumentar la morbilidad. Sin embargo son necesarios estudios másamplios, de carácter prospectivo, que establezcan su papel en ladisminución de las infecciones postransfusionales, en la disminuciónde la estancia hospitalaria y que definan el coste-efectividaddel programa

Objective: To describe and study the effectiveness of the perioperativeanaemia treatment patterns for patients older than 64with hip fracture.Method: Three groups of patients were compared: Group 1:Oral iron or without iron therapy. Group 2: low doses of intravenousiron. Group 3: treated according to a blood saving programmeincluding intravenous iron, alfa epoetin and restrictivetransfusional criteria. The homogeneity of gender, age, type offracture, ASA, preoperative period and perisurgical bleedingaffecting drug consumption within the groups was analyzed. Theeffectiveness of the treatments was determined by means of transfusionalrate, postoperative haemoglobin levels, and postoperativelength of stay and infection rate.Results: 329 patients were checked. Patients were comparable.Patients included in Group 3 were transfused less than the rest (36.5of patients in group 3 vs. 52.0% in group 1 and 67.6% in group 3, p= 0.002). Decreases in the infection rate and mean postoperativestay in group 3 were not significant. Haemoglobin levels at 48 hourspost surgery were higher in group 1 but haemoglobin levels at theseventh day post surgery were similar for the three groups.Conclusions: The above mentioned blood saving programmehas been observed to be effective in decreasing transfusionalrequirements without increasing morbidity. However, furtherprospective studies are needed in order to define the cost-effectivenessof this programme and to determine its role in the reduction ofpostransfusional infections and postoperative length of stay

[Proton pump inhibitors in paediatrics]. / Inhibidores de la bomba de protones en pediatría.

In last years the use in the pediatric area of proton pump inhibitors (omeprazole, lansoprazole, pantoprazole, rabeprazole and esomeprazole) is more often, nevertheless the clinical trials carried out are poor. The aim of this work is to analyse the bibliography published about this kind of drugs in children and to make a revision of its use in the last seven years. More studies with omeprazole and lansoprazole have been developed, to be exact omeprazole and lansoprazole is present in 122 bibliographic appointments and 34 for lansoprazole, which include studies that demonstrate a good tolerance and efficacy. The remaining proton pump inhibitors count with very few studies. The main therapeutic indications were the eradication of Helicobacter pylori, gastroesophageal reflux disease and esophagitis. The number of patients included in the reviewed studies is quite heterogeneous, from 8 to 122 and the age range between 8 days and 17 years. On the other hand, it could be highlighted the non-existence of formulations adapted to the pediatric population and the difficulty of administration specially in the youngest patients. As in many other drugs, it would be necessary to carry out clinical trials in order to determinate the pharmacologic parameters at difference ages, which will allow a safe and effective administration, and its authorization by all Health Authorities.

Inhibidores de la bomba de protones en pediatría / Proton pump inhibitors in pediatrics

En los últimos años el uso de los inhibidores de la bomba de protones(omeprazol, lansoprazol, pantoprazol, rabeprazol y esomeprazol), en pediatría es cada vez más frecuente; sin embargo los ensayos clínicos realizados son escasos. El objetivo de este trabajo es analizar la bibliografía publicada sobre este grupo de fármacos en niños y hacer una revisión de su utilización en los últimos siete años. De todos ellos, omeprazol y lansoprazol son los que cuentan con mayor número de estudios, en concreto de omeprazol se han encontrado 122 citas bibliográficas y de lansoprazol 34 citas bibliográficas, que incluyen estudios que demuestran una buena tolerancia y eficacia. El resto de fármacos de la serie cuenta con muy pocos estudios. Las patologías que motivaron la prescripción fueron principalmente erradicación de Helicobacter pylori, reflujo gastroesofágico y esofagitis. El número de pacientes incluidos en los estudios revisados es muy heterogéneo, desde 8 a 122 y las edades estaban comprendidas entre 8 días y 17 años. Por otra parte, cabe destacar la inexistencia de formulaciones adaptadas a la población pediátrica y la dificultad que supone su administración, sobre todo a los pacientes de menor edad. Como ocurre con otros muchos fármacos, sería necesario realizar ensayos clínicos que determinaran todos los parámetros farmacológicos en los distintos grupos de edad, y así permitir una administración segura y eficaz, así como su autorización por los diferentes registros sanitarios

In last years the use in the pediatric area of proton pump inhibitors (omeprazole, lansoprazole, pantoprazole, rabeprazole and esomeprazole) is more often, nevertheless the clinical trialscarried out are poor. The aim of this work is to analyse the bibliography published about this kind of drugs in children and to make a revision of its use in the last seven years. More studies with omeprazole and lansoprazole have been developed, to be exact omeprazole and lansoprazole is present in 122 bibliographic appointments and 34 for lansoprazole, which include studies that demonstrate a good tolerance and efficacy. The remaining proton pump inhibitors count with very few studies. The main therapeutic indications were the eradication of Helicobacter pylori, gastroesophageal reflux disease and esophagitis. The number of patients included in the reviewed studies is quite heterogeneous, from 8 to 122 and the age range between 8 days and 17 years. On the other hand, it could be highlighted the non-existence of formulations adapted to the pediatric population and the difficulty of administration specially in the youngest patients. As in many other drugs, it would be necessary to carry out clinical trials in order to determinate the pharmacologic parameters at difference ages, which will allow a safe and effective administration, and its authorization by all Health Authorities

[Cross-hypersensitivity syndrome between antiepileptic drugs: report of a case]. / Síndrome de hipersensibilidad cruzado entre antiepilépticos: a propósito de un caso.

Antiepileptic hypersensitivity syndrome (SHA) is a rare (1/1.000 to 1/10.000 in new exposures) but potentially life-threatening syndrome that occurs after exposure to an anticonvulsant, most commonly the aromatic ones such as phenytoin, carbamazepine or phenobarbital. Clinical features of this syndrome include cutaneous reactions, fever, lymphadenopaties, eosinophilia and internal organ involvement (mainly liver, but also kidney, CNS, heart or lung). We present a case report of a 61-year-old woman treated with phenobarbital who developed a cutaneous eruption attributed to this drug. Treatment was changed to phenytoin and after 17 days the patient developed cutaneous rash, eosinophilia and an increase in transaminase levels. The high rate of cross-sensitivity between aromatic anticonvulsants (40-80%) suggests a link between a hypersensitivity reaction to phenytoin and the previous reaction to phenobarbital.

Síndrome de hipersensibilidad cruzado entre antiepilépticos: a propósito de un caso / Cross-hypersensivity syndrome between antiepileptic drugs: report of a case

El síndrome de hipersensibilidad a antiepilépticos (SHA) es un síndrome raro (1/1.000 a 1/10.000 nuevos casos) que potencialmente amenaza la vida del paciente y ocurre tras exposición a un antiepiléptico, más frecuentemente un aromático como fenitoína, carbamazepina o fenobarbital. Las características clínicas del síndrome son reacciones cutáneas, fiebre, linfadenopatías, eosinofilia, y afectación sistémica (principalmente el hígado pero también el riñón, el sistema nervioso central y el corazón o el pulmón).Se describe un caso de una mujer de 61 años en tratamiento con fenobarbital que sufrió una erupción cutánea atribuida al tratamiento con este fármaco. Se cambió a fenitoína y después de 17 días la paciente desarrolló erupción cutánea, eosinofilia y aumento en las transaminasas. La alta tasa de reactividad cruzada entre antiepilépticos aromáticos (40-80 por ciento) sugiere la relación entre la reacción a la fenitoína y la anterior a fenobarbital (AU)

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[Intravenous inmunoglobulins in pediatrics]. / Inmunoglobulinas intravenosas en pediatría.

The use of intravenous immunoglobulins remains controversial after their introduction in therapeutics during the 80s. Their mechanism of action remains unexplained for certain pathologies, but their application to new indications and their economical impact makes them a target of many studies and protocols of use. Intravenous immunoglobulins are administred as substitution therapy in primary and secondary immunodeficiencies. On the other hand, their immunomodulating effect is the basis of their use on a great variety of autoimmune diseases and inflammatory processes, although not always following the authorised indications. This study reviews the use of intravenous immunoglobulins in pediatric population, making the distinction between the indications authorised by the regulatory authorities, and those non-authorised but supported by scientific publications.

[Drug use in neonatology units of 6 Spanish hospitals]. / Utilización de medicamentos en Unidades de Neonatología de 6 hospitales españoles.

OBJECTIVE: To determine the status of drug use in Neonatology units regarding: 1. Frequency of use for drugs unauthorised by DirecciA(3)n General de Farmacia y Productos Sanitarios. 2. Suitability of commercial presentations regarding actual needs of patients. METHOD: Two cut-off points were established for 100% of patients admitted to Neonatology Units in 6 Spanish hospitals. Data on demography and therapeutic drug profile were collected, as well as on whether doses were or not prepared by Pharmacy departments. Approval for each drug regarding indication, age range, dosage and administration route was assessed. RESULTS: The number of patients included was 346. In all, 17.6% of patients were under treatment with unauthorised drugs, the reason being age in 78.7% and indication in 21.3%. Master formula preparation was needed for 22% of patients because of a lack of commercial preparations suited for paediatric age. Pharmacy departments prepared 25% of prescribed drugs. CONCLUSIONS: The use of unauthorised drugs in Neonatology is a common fact. Pharmacy departments are actively involved in Neonatology-related drug therapies: counselling and/or processing for compassionate unauthorised drug use, master formula preparation, intravenous mixtures, etc. Therapeutics in Neonatology benefits from specialised pharmaceutical involvement.

[A possible hypersensitivity reaction to total parenteral nutrition]. / Posible reacción de hipersensibilidad a una nutrición parenteral total.

We present a possible case of a hypersensitivity reaction to parenteral nutrition in a surgical patient of 61 years, weighing 49 kg, who presented facial, thoracic, and underarm erythema, proximal to the peripheral line, accompanied by pruritus: the symptoms disappeared after discontinuing the nutrition and after administration of dexchlorpheniramine. Analysis of the possible causes of this manifestation takes place, as well as of the components of the parenteral nutrition, route of administration, and concomitant medication.