[Assessment of standard parenteral nutrition in children]. / Evaluación de nutrición parenteral estandarizada en niños.

INTRODUCTION: Nowadays, there is a stronger consensus on the proceedings of nutritional support with parenteral nutrition (PN) in paediatrics, the prescription standards, its formulation, elaboration, and nutritional requirements in order to improve the process quality and the patient's safety. The use of standardized PN solutions in children is rare due to the difficulty to adapt them to every pathophysiologic condition. In order to do so, in 2006 we designed and validated a big range of standard solutions for children weighing more than 10 kg or being older than 1 year. OBJECTIVE: To assess the use of standard PN solutions and their suitability in children from January of 2006 until June of 2008: the frequency of prescription of standard solutions by age, weight, and indication, as well as their modifications. We compared the nutrients given by individualized PN solutions versus the recommendations of the Reference Guidelines and standardised PN. RESULTS: 47 children with a mean weight of 26.6 kg (9-50) and mean age 6.8 years (1-14) received 539 units of PN. Standardized PN (437) were used in 83% of the patients. Their total energy requirements were reached within 1-3 days by using one to three types of formulas. Only 4% (22) of them were modified, with easily feasible changes: volume increase (16), glucose lowering (3), and potassium increase (3). The analysis of the individualized PN in 8 children shows the same trend, with a caloric intake lower than 33% of the recommended one. CONCLUSION: Standardized PN meet the nutritional requirements in most of the patients according to their morbid condition, highlighting their adaptability and versatility. Their use has eased the prescription-validation-preparation circuit and has improved the efficiency of the process.

[Study into the use of cetuximab in metastatic colorectal cancer in a third level hospital]. / Estudio de utilización de cetuximab en cáncer colorrectal metastásico en un hospital de tercer nivel.

OBJECTIVES: In this study we will analyse the use of cetuximab in the treatment of metastatic colorectal cancer (MCC) in a third level hospital. We will establish the usage conditions in our centre in keeping with those approved in current technical records. We will also record the treatment duration under the different usage conditions and use the information available in material that has been published to date. METHODS: An indication-prescription study of cetuximab in MCC was carried out on all patients treated with cetuximab for colorectal cancer in the period between 2004 and 2007 in our hospital. The number of prescriptions that do not fit the approved recommendations for cetuximab in MCC treatment (and why they do not fit) is determined. Descriptive statistical analysis was carried out for the different variables collected, and a Kaplan-Meier analysis was carried out for the treatment duration variable, so as to determine whether there is a difference in effectiveness for the common uses in our hospital. RESULTS: Data was recorded for 74 patients treated with cetuximab. The average cost per patient was 14,399 Euro and on average, 15.3 dosages were administered per patient. The average initial dosage was 710 mg with an average dosage of 446 mg after that. The average duration of the treatments was 15.4 weeks. cetuximab was administered to 7 patients as first-line treatment and to 32 patients who had not used Irinotecan previously. Irinotecan was not associated with cetuximab treatment in 9 patients, and it was used in 14 patients resulting in a negative outcome for the EFGR test. Treatment duration was longer in the case of its use as first-line treatment (27.7 weeks), if Irinotecan had not been used before (23.3 weeks), if Irinotecan was used (20.5 weeks) and in patients with positive EFGR results (19.6 weeks.) The median treatment duration, under the different conditions, was less than the average but with no major differences between them. 70.3 % of prescriptions did not fit with the data sheet. CONCLUSIONS: The use of cetuximab under different conditions to those approved on the technical data sheet creates an increase in the number of patients treated and a longer duration of the treatments which implies an increase in intake. The average and the mean treatment times for the usage conditions found did not present any significant statistical differences. There are a small number of patients who benefit from this treatment which can be seen by the large average, in comparison with the mean, without any of the conditions in which the analysis was carried out seeming to determine a higher response. The treatment duration in our study was similar to the durations recorded in relevant literature for these usage conditions.

Estudio de utilización de cetuximab en cáncer colorrectal metastásico en un hospital de tercer nivel / Study into the use of cetuximab in metastatic colorectal cancer in a third level hospital

Objetivos: En este trabajo se analiza la utilización de cetuximab en el tratamiento de cáncer colorrectal metastásico (CCRm) en un hospital de tercer nivel, determinando las condiciones de uso en los pacientes de nuestro centro con relación a las aprobadas en ficha técnica en el momento. También, se compara la duración del tratamiento en las distintas condiciones de uso y con los datos disponibles en la bibliografía publicada hasta la fecha de realización de este trabajo. Métodos: Se realizó un estudio de indicación-prescripción de cetuximab en CCRm para todos los pacientes tratados con cetuximab en CCR en el período 2004-2007 en nuestro hospital. Se determina el número de prescripciones que no se ajusta a la ficha técnica aprobada para cetuximab en CCRm y el motivo por el que no se adapta. Se realiza el análisis estadístico descriptivo para las distintas variables recogidas y un análisis de Kaplan-Meier para la variable duración de tratamiento para determinar si hay diferencia de efectividad para los usos habituales en nuestro hospital. Resultados: Se recogieron los datos de 74 pacientes tratados con cetuximab. El coste medio por paciente fue de 14.399 ¿ y un número medio de dosis administradas de 15,3 por paciente. La dosis media de inicio fue 710 mg y la de mantenimiento, de 446 mg. La duración media de los tratamientos fue 15,4 semanas. Cetuximab se administró a 7 pacientes en primera línea de tratamiento, y a 32 pacientes sin que previamente se hubiese utilizado irinotecan. En 9 pacientes no se asoció irinotecan al tratamiento con cetuximab y se empleó en 14 pacientes con resultado negativo para la prueba de EFGR. La duración de los tratamientos fue mayor en caso de utilización en primera línea de tratamiento (27,7 semanas), si no se empleó irinotecan previo (23,3 semanas), si se asociaba irinotecan al tratamiento (20,5 semanas) y en pacientes EFGR (..) (AU)

Objectives: In this study we will analyse the use of cetuximab in the treatment of metastatic colorectal cancer (MCC) in a third level hospital. We will establish the usage conditions in our centre in keeping with those approved in current technical records. We will also record the treatment duration under the different usage conditions and use the information available in material that has been published to date. Methods: An indication-prescription study of cetuximab in MCC was carried out on all patients treated with cetuximab for colorectal cancer in the period between 2004 and 2007 in our hospital. The number of prescriptions that do not fit the approved recommendations for cetuximab in MCC treatment (and why they do not fit) is determined. Descriptive statistical analysis was carried out for the different variables collected, and a Kaplan-Meier analysis was carried out for the treatment duration variable, so as to determine whether there is a difference in effectiveness for the common uses in our hospital. Results: Data was recorded for 74 patients treated with cetuximab. The average cost per patient was ¿14,399 and on average, 15.3 dosages were administered per patient. The average initial dosage was 710 mg with an average dosage of 446 mg after that. The average duration of the treatments was 15.4 weeks. cetuximab was administered to 7 patients as first-line treatment and to 32 patients who had not used Irinotecan previously. Irinotecan was not associated with cetuximab treatment in 9 patients, and it was used in 14 patients resulting in a negative outcome for the EFGR test. Treatment duration was longer in the case of its use as first-line treatment (27.7 weeks), if Irinotecan had not been used before (23.3 weeks), if Irinotecan was used (20.5 weeks) and in patients with positive EFGR results (19.6 weeks.) The median treatment duration, under the different conditions, was less than the average but with no major differences (..) (AU)

Desensibilización a L-asparraginasa en dos pacientes con hipersensibilidad previa / Asparraginase desensitization in two patients with previous hipersenstivity

No disponible

[Pharmacobezoar in a patient operated on for pyloric stenosis]. / Farmacobezoar en un paciente intervenido de estenosis pilórica.

Bezoars are concretions made up of a variety of partially digested materials seen in several portions of the gastrointestinal tract; they may result in gastrointestinal obstruction. Bezoar types described in the scientific literature include bezoars resulting from drugs. Their development is usually associated with some predisposing risk factor. The case of a patient is described, who was admitted to the hospitals Emergency Department because of a clinical event suggesting a gastrointestinal bleeding episode. After admission, endoscopy demonstrated the presence of a bezoar whose components included a great number of Adalat Oros tablets. A review of the drugs that induced bezoar formation is made, and associated risk factors, formation mechanisms, bezoar appearance, and treatments used are all described.

Suspensión de talco para efusión pleural maligna / Talc suspension to treat malignant pleural effusion

El talco es uno de los agentes esclerosantes más efectivos de los que se dispone actualmente para el tratamiento de la efusión pleural maligna. Al no existir como preparado comercial es necesario proceder a su formulación, siendo el aspecto más problemático la esterilización.En el presente trabajo se describe la preparación de una suspensión de talco, usando como método de esterilización el calor húmedo. La fórmula que se propone es segura, de fácil elaboración, efectiva y de bajo coste. Asimismo se valora la efectividad de dicha fórmula en un total de 10 pacientes, obteniendo un porcentaje de efectividad del 80 por ciento. La incidencia de efectos adversos fue baja y concordante con los datos publicados en la literatura (AU)

[Use of enteral nutrition products in a general hospital]. / Utilización de productos de nutrición enteral en un hospital general.

The present work aims to study the use of enteral nutrition (EN) products during the period between October 1996 and January 1997, in a general hospital with a nutrition unit. The EN expenditure ascended to 3,343,475 Pesetas, with the supplements representing the greatest cost percentage (39.1%). An indication-prescription study was carried out by reviewing 120 clinical histories of patients who had received EN during that period. The patients originated in different departments of the hospital, excluding the ICU, chronic patients, pediatrics, and palliative care. Data regarding sex, age, diagnosis, diet used, calories/day given, route of administration, and selection criterion for the diet were analysed. The average age of the patients was 64.59 years. The most common diagnoses were solid tumors (32.5% of the cases), followed by cerebrovascular accidents (16.7% of the cases). The most commonly used EN preparation was the Pentadrink hypercaloric diet (36.7% of the cases), followed by the standard diet (25.8%). The route of administration used most frequently was the oral route in 63.3% of the cases. The calories/day given varied per diet, with this being 886 cal for the hypercaloric diet, and 1,839 cal for the standard diet. Among the criteria for selecting an EN diet 50% of the patients had abnormal protein metabolism and a normal digestive capacity with slight or moderate stress, 12.5% were diabetic; and the remainder presented other criteria that influenced the choice for a specific type of EN diet. From the analysis of the results it is clear that Pentadrink is used as a supplement, and that there are patients with a sometimes insufficient caloric supply.

Allergy to natural honeys and camomile tea.

Precipitation of food allergy reactions is well known in some patients with pollinosis when they consume natural food, such as honey or camomile tea. We present 9 patients with hay fever, with or without asthma, who experienced systemic allergic reactions after ingestion of natural honeys from two local areas (Andujar and Granada) and/or camomile tea. Pollen analysis showed a high level in sunflower pollen (23.6% of pollen grains) in the honey from Andujar but not in that from Granada. The diagnosis of food and respiratory allergy was based on history, skin prick tests and specific IgE activity against pollen from Compositae. Conjunctival challenge with camomile extract also gave positive results. The above allergological tests and the inhibition studies carried out, suggest that pollen of Compositae may be responsible for allergic reactions to certain natural foods and that the reactions are mediated by an IgE-related mechanism.

Hypersensitivity to ketoconazole.

We report a patient who experienced generalized urticaria and facial angioedema following oral administration of ketoconazole. Skin prick tests with ketoconazole and oral challenge were positive. Conjugates of ketoconazole with human serum albumin were used for the in vitro study, obtaining a positive result in the histamine release test. No significant levels of IgE antibodies to ketoconazole were found by RAST. Controls did not react to any of these tests. These results suggest that the patient developed a type I hypersensitivity reaction to ketoconazole. In this case, skin prick tests with ketoconazole and histamine release test with a conjugate of ketoconazole with human serum albumin were useful in ketoconazole hypersensitivity diagnosis. Finally, skin tests with other imidazole agents were carried out, including metronidazole, ornidazole, and fluconazole that were negative.