[Off-label use of intravenous immunoglobulin g in a highly complex pediatric hospital in Argentina. A prospective observational study] / Uso "off label" de inmunoglobulina g endovenosa en un hospital pediátrico de alta complejidad de Argentina.

Introduction: The World Health Organization recommends prioritizing safe and effective drugs proven by clinical or epidemiological studies. However, in population groups with little research, a drug can be used for an indication or pharmaceutical form different from that approved by the regulatory agency (off-label), extrapolating data from studies in adults and exposing pediatric patients. to develop an Adverse Drug Reaction (ADR) due to safety considerations that have not been systematically studied. Intravenous immunoglobulin (IVIg), a high-cost drug, is used with scant evidence in some low-prevalence pathologies. This paper describes and analyzes the off-label use of IVIg at the J. P. Garrahan Pediatric Hospital. Methods: Observational, descriptive, prospective study on off-label indications of IVIg. The sampling technique was non-probabilistic and for convenience during 7 months. Results: 305 IVIg infusions were studied, corresponding to 111 patients. The indication classification showed that 22% (n=67) of the infusions were off-label. In neurology there was a higher percentage of off-label indications (46%) and within them 45% corresponded to the use in neurological disorders. 81% of the doses indicated off-label were in the range 0.8-1g/kg. The off-label infusions presented 61.5% (n=8) of the ADRs. Those from the Neurology service represented 87.5%; 75% being from the "Neurological disorders" group. Conclusion: In some cases, IVIg was indicated in an off-label manner, finding a statistically significant relationship with the appearance of ADR. This finding motivates the proposition of new hypotheses to carry out more studies.

Introducción: La Organización Mundial de la Salud recomienda priorizar fármacos seguros y eficaces comprobados mediante estudios clínicos o epidemiológicos. Sin embargo, en grupos poblacionales con escasa investigación, un fármaco puede utilizarse para una indicación o, forma farmacéutica diferente a la aprobada por la agencia reguladora ("off label"), extrapolando datos provenientes de estudios en adultos y, exponiendo a los pacientes pediátricos a desarrollar una Reacción Adversa Medicamentosa (RAM) por consideraciones de seguridad no estudiadas sistemáticamente. Inmunoglobulina G endovenosa (IgG EV), medicamento de alto costo, es utilizado con escasa evidencia en algunas patologías poco prevalentes. Este trabajo describe y analiza el uso "off label" de IgG EV en el Hospital de Pediatría J. P. Garrahan. Métodos: Estudio observacional, descriptivo, prospectivo sobre indicaciones "off label" de IgG EV. La técnica de muestreo fue no probabilística y por conveniencia durante 7 meses. Resultados: Se estudiaron 305 infusiones de IgG EV que correspondieron a 111 pacientes. La clasificación de la indicación mostró que 22% (n=67) de las infusiones fueron "off label". En neurología hubo mayor porcentaje de indicaciones "off label" (46%) y dentro de ellas el 45% correspondió al uso en desórdenes neurológicos. El 81% de dosis indicadas "off label" estuvieron en rango 0,8-1g/kg. Las infusiones indicadas "off label" presentaron el 61.5% (n=8) de las RAM. Las del servicio de Neurología, representaron el 87,5 %, siendo 75% del grupo "Desórdenes neurológicos". Conclusión: En algunos casos IgG EV fue indicada en forma "off label", encontrándose una relación estadísticamente significativa con la aparición de RAM. Este hallazgo motiva al planteo de nuevas hipótesis para realizar más estudios.

Development of a Multiplexing Injector for Gas Chromatography for the Time-Resolved Analysis of Volatile Emissions from Lithium-Ion Batteries.

Multiplex sampling, so far mainly used as a tool for S/N ratio improvement in spectroscopic applications and separation techniques, has been investigated here for its potential suitability for time-resolved monitoring where chromatograms of transient signals are recorded at intervals much shorter than the chromatographic runtime. Different designs of multiplex sample introduction were developed and utilized to analyze lithium-ion battery degradation products under normal or abuse conditions to achieve fast and efficient sample introduction. After comprehensive optimization, measurements were performed on two different GC systems, with either barrier discharge ionization detection (BID) or mass spectrometric detection (MS). Three different injector designs were examined, and modifications in the pertinent hardware components and operational conditions used. The shortest achievable sample introduction time was 50 ms with an interval of 6 s. Relative standard deviations were lower than 4% and 10% for the intra- and inter-day repeatability, respectively. The sample introduction system and column head pressure had to be carefully controlled, as this parameter most critically affects the amount of sample introduced and, thus, detector response. The newly developed sample introduction system was successfully used to monitor volatile degradation products of lithium-ion batteries and demonstrated concentration changes over the course of time of the degradation products (e.g., fluoroethane, acetaldehyde and ethane), as well as for solvents from the battery electrolyte like ethyl carbonate.

The Effect of Charging and Discharging Lithium Iron Phosphate-graphite Cells at Different Temperatures on Degradation.

The effect of charging and discharging lithium iron phosphate-graphite cells at different temperatures on their degradation is evaluated systematically. The degradation of the cells is assessed by using 10 charging and discharging temperature permutations ranging from -20 °C to 30 °C. This allows an analysis of the effect of charge and discharge temperatures on aging, and their associations. A total of 100 charge/discharge cycles were carried out. Every 25 cycles a reference cycle was performed to assess the reversible and irreversible capacity degradation. A multi-factor analysis of variance was used, and the experimental results were fitted showing: i) a quadratic relationship between the rate of degradation and the temperature of charge, ii) a linear relationship with the temperature of discharge, and iii) a correlation between the temperature of charge and discharge. It was found that the temperature combination for charging at +30 °C and discharging at -5 °C led to the highest rate of degradation. On the other hand, the cycling in a temperature range from -20 °C to 15 °C (with various combinations of temperatures of charge and discharge), led to a much lower degradation. Additionally, when the temperature of charge is 15 °C, it was found that the degradation rate is nondependent on the temperature of discharge.

[Antibiotics utilization in the Intensive Care Unit of the Hospital Dr, Guillermo Rawson-San Juan, Argentina]. / Consumo de antimicrobianos en la Unidad de Terapia Intensiva del Hospital Dr. Guillermo Rawson-San Juan, Argentina.

INTRODUCTION: To achieve rational use of antibiotics (ATB), is necessary to know its use and prescription patterns over time, Objective: To describe and analyze the characteristics of the use of ATB in the Guillermo Rawson Hospital (GRH) adult intensive care unit (ICU). MATERIAL AND METHOD: Observational, descriptive, longitudinal and retrospective study (2008-2011). Pharmacy and Statistics records were consulted, ATC code was used, the group analyzed was J01, Oral or parenteral DDD were assigned, Data was processed with Excel 2007, Unit of measure: DDD/100 bed-days, for each ATB per year and an average of use. RESULTS AND DISCUSSION: Over 4 years, 48 different medicines were dispensed (33 drugs), The average consumption of ATB was 177,07 DDD/100 bed-days and distribution per year was: 183,10, 165,90, 180,94, 178,34, The DDD/100 bed-days average for treatment groups more used were: penicillin (57.10), other ß-lactam antibacterials (48.01), other antibacterials (21.07), trimethoprim and sulfonamides (19,54), quinolones (15,64), macrolides/azalides and lincosamides (6,53), aminoglycosides (5,65) and tetracyclines (3,53), There were changes in consumption without clear pattern of increase or decrease. CONCLUSIONS: ATB used in the ICU and its variation in use between 2008-2011 were described, The ATB most used were penicillins and other ß-lactams and 2008 was the year that more ATB was dispensed. Understanding these patterns of consumption will be useful to develop a founded antibiotic policy reached by consensus and beneficial to the patients.

Consumo de antimicrobianos en la Unidad de Terapia Intensiva del Hospital Dr. Guillermo Rawson-San Juan, Argentina / Antibiotics utilization in the Intensive Care Unit of the Hospital Dr, Guillermo Rawson-San Juan, Argentina

Introduction: To achieve rational use of antibiotics (ATB), is necessary to know its use and prescription patterns over time, Objective: To describe and analyze the characteristics of the use of ATB in the Guillermo Rawson Hospital (GRH) adult intensive care unit (ICU). Material and Method: Observational, descriptive, longitudinal and retrospective study (2008-2011). Pharmacy and Statistics records were consulted, ATC code was used, the group analyzed was J01, Oral or parenteral DDD were assigned, Data was processed with Excel 2007, Unit of measure: DDD/100 bed-days, for each ATB per year and an average of use. Results and Discussion: Over 4 years, 48 different medicines were dispensed (33 drugs), The average consumption of ATB was 177,07 DDD/100 bed-days and distribution per year was: 183,10, 165,90, 180,94, 178,34, The DDD/100 bed-days average for treatment groups more used were: penicillin (57.10), other β-lactam antibacterials (48.01), other antibacterials (21.07), trimethoprim and sulfonamides (19,54), quinolones (15,64), macrolides/azalides and lincosamides (6,53), aminoglycosides (5,65) and tetracyclines (3,53), There were changes in consumption without clear pattern of increase or decrease. Conclusions: ATB used in the ICU and its variation in use between 2008-2011 were described, The ATB most used were penicillins and other β-lactams and 2008 was the year that more ATB was dispensed. Understanding these patterns of consumption will be useful to develop a founded antibiotic policy reached by consensus and beneficial to the patients.

Introducción: El uso racional de antibióticos (ATB) implica conocer su utilización y variaciones de prescripción en el tiempo. Objetivo: Describir y analizar el uso de ATB en la unidad de terapia intensiva (UTI) de adultos del Hospital Guillermo Rawson (HGR). Material y Método: Estudio observacional, descriptivo, longitudinal, retrospectivo 2008-2011. Se consultaron registros de Farmacia y Estadísticas. Se usó la clasificación ATC, se analizó el Grupo J01, se asignaron las DDD vía oral o parenteral. Procesamiento: Excel 2007. Unidad de medida: N° DDD/100 camas-día, para cada ATB/año y promedio de uso. Resultados y Discusión: En los cuatro años se dispensaron 48 medicamentos diferentes (33 principios activos). El consumo promedio de ATB fue 177,07 DDD/100 camas-día y la distribución por año creciente fue 183,10; 165,90; 180,94; 178,34. Promedio de DDD/100 camas-día para los grupos terapéuticos más utilizados: penicilinas (57,10), otros antibacterianos β-lactámicos (48,01), otros antibacterianos (21,07), trimetoprim y sulfonamidas (19,54), quinolonas (15,64), macrólidos/azálidas y lincosamidas (6,53), aminoglucósidos (5,65) y tetraciclinas (3,53). Hubo cambios en el consumo sin patrón claro de aumento o disminución. Conclusiones: Se describieron los ATB utilizados en UTI y su variación de uso entre 2008-2011. Los ATB más utilizados fueron penicilinas y otros β-lactámicos. En 2008 se dispensó la mayor cantidad de ATB. El conocimiento de estos patrones de consumo será de utilidad para desarrollar una política antimicrobiana consensuada y fundamentada en beneficio de los pacientes.

Intoxicación por plomo y su tratamiento farmacológico / Lead poisoning and pharmacological treatment

La intoxicación por plomo es un problema de saludpública. La evidencia de poblaciones afectadas por nivelestóxicos de plomo en sangre, confirma que hay que seguirtrabajando desde una visión pluridisciplinar. Es necesariodefinir políticas para la prevención, detección, diagnosticoy tratamiento de los efectos nocivos del plomo sobre lasalud. Los niños constituyen el segmento de la poblaciónmás vulnerable, con consecuencias de alto impactosocial, como una disminución del coeficiente intelectual ydeficiente desarrollo neurológico. En la práctica clínica, haycuatro medicamentos que se usan para el tratamiento de laintoxicación crónica, son el edetato cálcico disódico IV e IM,el dimercaprol IM, la penicilamina VO y el succímero VO.Si se tiene en cuenta que sólo penicilamina está autorizadaen nuestro país, el problema se torna mayor. Esta breverevisión pretende brindar información sobre la intoxicaciónpor exposición al plomo, los tratamientos recomendados ylos disponibles en nuestro país.(AU)

Lead exposure and poisoning is a public health concern.Evidence of people with toxic level of lead in blood confirmsINTOXICACION PORPLOMO Y SU TRATAMIENTOFARMACOLOGICORecibido: 25 de Setiembrede 2012. Aprobado: 4 denoviembre de 2012Lead poisoning and pharmacological treatmentFontana Daniela,Lascano Valeria María,Solá Nancy,Martinez Samanta,Virgolini Miriam,Mazzieri Maria Rosa.Departamento de Farmacia,Facultad de Ciencias Químicas,Universidad Nacional deCórdoba.Medina Allende y Haya de laTorre, Ciudad Universitaria,(5000) Córdoba, ArgentinaTEL/FAX +54 351 535 3850(int 53351). E-mail: mrmazzie@fcq.unc.edu.ar that it is necessary to keep on working from a multidisciplinary approach. There shouldbe a well-defined policy for the prevention, detection, diagnosis and treatment of theharmful effects of lead. Children are the population at major risk, with high social impactconsequences such as lower IQ and inadequate neurological development. There arefour drugs used to treat chronic toxicity: sodium calcium edetate IV and IM, succimer(oral), dimercaprol IM, and penicillamine (oral). If we consider that the last one is theonly authorized drug in our country, the problem grows bigger. This brief review offersinformation about lead exposure and poisoning, the recommended drug treatments andtheir market availability.(AU)

Intoxicación por plomo y su tratamiento farmacológico / Lead poisoning and pharmacological treatment

La intoxicación por plomo es un problema de saludpública. La evidencia de poblaciones afectadas por nivelestóxicos de plomo en sangre, confirma que hay que seguirtrabajando desde una visión pluridisciplinar. Es necesariodefinir políticas para la prevención, detección, diagnosticoy tratamiento de los efectos nocivos del plomo sobre lasalud. Los niños constituyen el segmento de la poblaciónmás vulnerable, con consecuencias de alto impactosocial, como una disminución del coeficiente intelectual ydeficiente desarrollo neurológico. En la práctica clínica, haycuatro medicamentos que se usan para el tratamiento de laintoxicación crónica, son el edetato cálcico disódico IV e IM,el dimercaprol IM, la penicilamina VO y el succímero VO.Si se tiene en cuenta que sólo penicilamina está autorizadaen nuestro país, el problema se torna mayor. Esta breverevisión pretende brindar información sobre la intoxicaciónpor exposición al plomo, los tratamientos recomendados ylos disponibles en nuestro país.

Lead exposure and poisoning is a public health concern.Evidence of people with toxic level of lead in blood confirmsINTOXICACIÓN PORPLOMO Y SU TRATAMIENTOFARMACOLOGICORecibido: 25 de Setiembrede 2012. Aprobado: 4 denoviembre de 2012Lead poisoning and pharmacological treatmentFontana Daniela,Lascano Valeria María,Solá Nancy,Martinez Samanta,Virgolini Miriam,Mazzieri Maria Rosa.Departamento de Farmacia,Facultad de Ciencias Químicas,Universidad Nacional deCórdoba.Medina Allende y Haya de laTorre, Ciudad Universitaria,(5000) Córdoba, ArgentinaTEL/FAX +54 351 535 3850(int 53351). E-mail: mrmazzie@fcq.unc.edu.ar that it is necessary to keep on working from a multidisciplinary approach. There shouldbe a well-defined policy for the prevention, detection, diagnosis and treatment of theharmful effects of lead. Children are the population at major risk, with high social impactconsequences such as lower IQ and inadequate neurological development. There arefour drugs used to treat chronic toxicity: sodium calcium edetate IV and IM, succimer(oral), dimercaprol IM, and penicillamine (oral). If we consider that the last one is theonly authorized drug in our country, the problem grows bigger. This brief review offersinformation about lead exposure and poisoning, the recommended drug treatments andtheir market availability.

Barriers to pharmaceutical care in Argentina.

OBJECTIVE: To identify the perceived barriers to implementing pharmaceutical care in Argentina. METHOD: A semi-structured questionnaire was designed to carry out a cross-sectional descriptive study. The questionnaires were distributed in different continuing professional development events for pharmacists during November-December 2005. RESULTS: Ninety completed questionnaires were collected with the following distribution: 16.7% at the national congress of hospital pharmacy, 18.9% after a conference, 64.4% during two courses related to pharmaceutical care. The surveyed pharmacists work for community pharmacies (76.7%), hospital/institutional pharmacies (20.0%) and primary care centers (2.2%). The most important barriers mentioned were lack of time, lack of specific training and lack of communication skills. CONCLUSION: The opinions of Argentinian pharmacists from different places and professional practice settings were obtained. In all work settings, "lack of time" is the main barrier to overcome for implementing pharmaceutical care.

Iron-mediated microbial oxidation and abiotic reduction of organic contaminants under anoxic conditions.

In anoxic environments, the oxidation of organic compounds, such as BTEX fuel components, by dissimilatory Fe(III) reduction can generate reactive mineral-bound Fe(II) species, which in turn are able to reduce other classes of organic and inorganic groundwater contaminants. In this study, we designed and evaluated an anaerobic batch reactor that mimicks iron-reducing conditions to investigate the factors that favor the coupling of microbial toluene oxidation and abiotic reduction of nitroaromatic contaminants. We investigated the influence of different Fe(III)-bearing minerals and combinations thereof on the coupling of these two processes. Results from laboratory model systems show that complete oxidation of toluene to CO2 by Geobacter metallireducens in the presence of Fe(III)-bearing minerals leads to the formation of mineral-bound Fe(II) species capable of the reduction of 4-nitroacetophenone. Whereas significant microbial toluene oxidation was only observed in the presence of amorphous Fe(III) phases, reduction of nitroaromatic compounds only proceeded with Fe(II) species bound to crystalline Fe(III) oxides. Our results suggest that in anoxic soils and sediments containing amorphous and crystalline iron phases simultaneously, coupling of microbial oxidation and abiotic reduction of organic compounds may allow for concurrent natural attenuation of different contaminant classes.

La prevención de los PRM y el Segundo Consenso de Granada / No disponible

Con el objeto de evitar que se presenten los Problemas Relacionados con Medicamentos (PRM) se hace necesario implementar medidas de tipo preventivas en el ámbito dela salud pública. Es importante el papel que el farmacéutico puede desarrollar en esta área, para actuar antes de que los PRM se manifiesten y provoquen la morbimortalidad relacionada con medicamentos. Por ello, los PRM potenciales, no manifestados o riesgo de PRM deben ser considerados en las actividades cotidianas del farmacéutico. Se analiza el artículo sobre el Segundo Consenso de Granada, considerando los alcances teóricos del concepto de PRM, la utilidad práctica de los mismos y su clasificación. Se aconseja que, conjuntamente con la definición de PRM, se contemple el concepto de los PRM potenciales, no manifestados o riesgo de PRM como aquellos que «pueden conducir a la no consecución del objetivo terapéutico o a la aparición de efectos no deseados». Además, y dada su importancia, se debería presentar a cada uno de los PRM en forma potencial (AU)

Avoiding the appearance of Drug Related Problems (DRP) to implement preventive measures in the field of public health is necessary. The role of pharmacist acting beforethe DRP arise provoking drug related morbidity is important. Therefore the risk of DRP, also known as potential or not manifested DRP, should be considered between the daily activities of the pharmacist. The article about the Second Consensus of Granada is analyzed taking into account the theoretical scope of the concept of DRP as well as their practical usefulness and classification. The potential or not manifested DRP or the risk of DRP should be contemplated as those that «can conduct not to reach the therapeutic aim or to the appearance of undesirable effects». In addition and because of their importance, each one of the DRP should be introduced in the potential way too (AU)