ABSTRACT
Olmesartán es un potente antagonista de los receptores de la angiotensina II utilizado habitualmente en el tratamiento de la hipertensión arterial. Durante la última década se han descrito varios casos de enteropatía tipo esprúe asociados al uso de este fármaco, con afectación clínica severa que precisan hospitalización, pero afortunadamente con remisión completa tras la retirada del mismo. Se presenta el caso de una mujer de 82 años pluripatológica, con un síndrome diarreico crónico que derivó en una pérdida de 20kg de peso en los últimos tres meses. Para su hipertensión seguía doble terapia: olmesartán 40mg y lercanidipino 10mg/día. Basado en los hallazgos de la paciente presentada, se realiza una búsqueda bibliográfica de todos los casos publicados en revistas indexadas españolas (PubMed) y se comparan, intentando establecer un perfil de sospecha que promueva la suspensión de olmesartán y acelere las pruebas complementarias necesarias para descartar otros diagnósticos.(AU)
Olmesartan is a potent angiotensin II receptor antagonist commonly used in the treatment of high blood pressure. During the last decade, several cases of sprue-like enteropathy have been described associated with the use of this drug - with severe clinical involvement that requires hospitalization - but fortunately with complete remission after its discontinuation. We present the case of a multi-pathological 82-year-old woman with a chronic diarrhoeal syndrome that resulted in a weight loss of 20kg over the last three months. She was prescribed dual therapy for her hypertension: olmesartan 40mg, torasemide 10mg, and lercanidipine 10mg/day. Based on the findings of the patient presented, we conducted a literature search of all the cases published in Spanish indexed journals (PubMed) and compared them, attempting to establish a suspicion profile that would result in the suspension of olmesartan and accelerate the complementary tests necessary to rule out other diagnoses.(AU)
Subject(s)
Humans , Female , Aged, 80 and over , Olmesartan Medoxomil/adverse effects , Olmesartan Medoxomil/analysis , Hypertension , Diarrhea , Women , Aged, 80 and overABSTRACT
Olmesartan is a potent angiotensin II receptor antagonist commonly used in the treatment of high blood pressure. During the last decade, several cases of sprue-like enteropathy have been described associated with the use of this drug - with severe clinical involvement that requires hospitalization - but fortunately with complete remission after its discontinuation. We present the case of a multi-pathological 82-year-old woman with a chronic diarrhoeal syndrome that resulted in a weight loss of 20kg over the last three months. She was prescribed dual therapy for her hypertension: olmesartan 40mg, torasemide 10mg, and lercanidipine 10mg/day. Based on the findings of the patient presented, we conducted a literature search of all the cases published in Spanish indexed journals (PubMed) and compared them, attempting to establish a suspicion profile that would result in the suspension of olmesartan and accelerate the complementary tests necessary to rule out other diagnoses.
Subject(s)
Celiac Disease , Hypertension , Aged, 80 and over , Diarrhea/pathology , Female , Humans , Hypertension/drug therapy , Imidazoles/adverse effects , Tetrazoles/adverse effectsSubject(s)
Chagas Disease/epidemiology , Adult , Chagas Disease/diagnosis , Female , Humans , Male , Middle Aged , Retrospective Studies , Spain/epidemiologySubject(s)
Agammaglobulinemia/genetics , Genetic Diseases, X-Linked/genetics , Liver Abscess, Pyogenic/immunology , Mutation , Opportunistic Infections/immunology , Protein-Tyrosine Kinases/genetics , Pseudomonas Infections/immunology , Pseudomonas aeruginosa/immunology , Agammaglobulinaemia Tyrosine Kinase , Agammaglobulinemia/diagnosis , Agammaglobulinemia/drug therapy , Agammaglobulinemia/immunology , Anti-Bacterial Agents/therapeutic use , Antifungal Agents/therapeutic use , Candidiasis/drug therapy , Candidiasis/immunology , Candidiasis/microbiology , DNA Mutational Analysis , Genetic Diseases, X-Linked/diagnosis , Genetic Diseases, X-Linked/drug therapy , Genetic Diseases, X-Linked/immunology , Genetic Predisposition to Disease , Humans , Immunocompromised Host , Immunoglobulins, Intravenous/therapeutic use , Infant , Liver Abscess, Pyogenic/diagnosis , Liver Abscess, Pyogenic/drug therapy , Liver Abscess, Pyogenic/microbiology , Male , Opportunistic Infections/diagnosis , Opportunistic Infections/drug therapy , Opportunistic Infections/microbiology , Phenotype , Pseudomonas Infections/diagnosis , Pseudomonas Infections/drug therapy , Pseudomonas Infections/microbiology , Pseudomonas aeruginosa/drug effects , Treatment OutcomeABSTRACT
Introducción: La incidencia de las reacciones adversas a medicamentos en pediatría se ha establecido recientemente en 15,1 reacciones por 1.000 niños. Representa un 2% de las admisiones de un hospital pediátrico, similares a las del paciente adulto, y de ellas solo un pequeño porcentaje (menos del 8%) cursan con afectación hepática, que puede ir desde un ligero aumento de las transaminasas hasta una hepatitis fulminante. El objetivo de este estudio ha sido determinar la importancia (frecuencia, formas de presentación, gravedad y cronificación) de la hepatotoxicidad por fármacos o remedios naturales en la población pediátrica. Pacientes y método: Se han incluido a todos los pacientes pediátricos, neonatos y niños en los que se ha sospechado una reacción hepatotóxica, remitidos de 8 hospitales españoles participantes. Para el análisis de la causalidad de cada caso se aplica la escala de Council for International Organizations of Medical. Sciences (CIOMS). Resultados y conclusiones: Se estudian un total de 36 reacciones hepatotóxicas en 33 niños. Los grupos farmacológicos involucrados con mayor frecuencia fueron los antitinfecciosos (71%). Amoxicilina-clavulánico fue el fármaco individual responsable del mayor número de casos (31,4%). Se concluye que el registro de hepatopatías asociadas a medicamentos ha demostrado ser un instrumento útil para la creación de una red activa de especialistas motivados en la detección y comunicación de incidencias de hepatopatía tóxica, aumentando las garantías de certeza diagnóstica(AU)
Introduction: The incidence of adverse drug reactions in children has recently been established at 15.1 reactions per 1000 children. This represents 2% of admissions to a paediatric hospital, and is similar to adult patients. Only a small percentage (less than 8%) may have liver involvement, which can range from a slight increase in transaminases to fulminant hepatitis. The aim of this study was to determine the importance (frequency, types of presentation, severity and chronicity) of hepatotoxicity by drugs or natural remedies in the paediatric population. Patients and method: All paediatric patients, neonates and children who had suspected hepatotoxic reactions notified by the eight participating Spanish hospitals. The Council for International Organizations of Medical Sciences (CIOMS) scale was used for the analysis of causality in each case. Results and conclusions: We studied a total of 36 hepatotoxic reactions in 33 children. The drug classes most frequently involved were antimicrobials (71%). Amoxicillin-clavulanate was the individual drug responsible for the greatest number of cases (31.4%). We conclude that the registration of drugs associated with liver disease has proved a useful tool for creating an active network of motivated specialists in detecting and reporting incidents of toxic liver disease, ensuring increasing diagnostic accuracy(AU)
Subject(s)
Humans , Male , Female , Child , Chemical and Drug Induced Liver Injury/diagnosis , Anti-Infective Agents/adverse effects , /epidemiology , Risk Factors , Prospective StudiesABSTRACT
INTRODUCTION: The incidence of adverse drug reactions in children has recently been established at 15.1 reactions per 1000 children. This represents 2% of admissions to a paediatric hospital, and is similar to adult patients. Only a small percentage (less than 8%) may have liver involvement, which can range from a slight increase in transaminases to fulminant hepatitis. The aim of this study was to determine the importance (frequency, types of presentation, severity and chronicity) of hepatotoxicity by drugs or natural remedies in the paediatric population. PATIENTS AND METHOD: All paediatric patients, neonates and children who had suspected hepatotoxic reactions notified by the eight participating Spanish hospitals. The Council for International Organizations of Medical Sciences (CIOMS) scale was used for the analysis of causality in each case. RESULTS AND CONCLUSIONS: We studied a total of 36 hepatotoxic reactions in 33 children. The drug classes most frequently involved were antimicrobials (71%). Amoxicillin-clavulanate was the individual drug responsible for the greatest number of cases (31.4%). We conclude that the registration of drugs associated with liver disease has proved a useful tool for creating an active network of motivated specialists in detecting and reporting incidents of toxic liver disease, ensuring increasing diagnostic accuracy.
Subject(s)
Biological Products/adverse effects , Chemical and Drug Induced Liver Injury/etiology , Prescription Drugs/adverse effects , Adolescent , Chemical and Drug Induced Liver Injury/diagnosis , Chemical and Drug Induced Liver Injury/epidemiology , Child , Child, Preschool , Female , Humans , Infant , Male , Pharmaceutical Preparations , Prospective Studies , RecordsSubject(s)
Humans , Male , Female , Triage/methods , Triage , Critical Care/legislation & jurisprudence , Critical Care/methods , Critical Care/organization & administration , 34661/methods , Post Disaster Resettlement , Triage/organization & administration , Triage/supply & distribution , Triage/trends , 35158ABSTRACT
The intensive care units must be prepared for a possible disaster, whether internal or external, in case it becomes necessary to evacuate the in-patients. They must have an Emergency and Self-protection Plan that includes the patient evacuation criteria and this must be known by all the personnel who work in the service. For that reason, the patients must be triaged, based on their attention priorities, according to their survival possibilities. Having an evacuation, known by all the personnel and updated by means of the performance of periodic drills, should be included as a quality indicator that must be met, since this would achieve better attention to the patient in case of a disaster situation requiring the evacuation of the ICU.
Subject(s)
Emergencies , Intensive Care Units/standards , Quality Indicators, Health CareABSTRACT
Las unidades de cuidados intensivos deben estar preparadas para un eventual desastre, bien sea de índole interno o externo, donde sea necesario evacuar a los pacientes ingresados. Deben disponer de un Plan de Emergencia y Autoprotección donde estén recogidos los criterios de evacuación de los pacientes, que debe conocer todo el personal que trabaja en el servicio. Para esto, habrá que hacer un triaje a los pacientes basándose en las prioridades de atención y según las posibilidades de supervivencia. El disponer de un plan de evacuación, conocido por todo el personal y actualizado mediante la realización de simulacros periódicos, debería incluirse como un indicador de calidad que se debería cumplir, ya que con esto se conseguiría una mejor atención al paciente en caso de presentarse una situación de desastre donde hubiere que evacuar la unidad de cuidados intensivos (AU)
The intensive care units must be prepared for a possible disaster, whether internal or external, in case it becomes necessary to evacuate the in-patients. They must have an Emergency and Self-protection Plan that includes the patient evacuation criteria and this must be known by all the personnel who work in the service. For that reason, the patients must be triaged, based on their attention priorities, according to their survival possibilities. Having an evacuation, known by all the personnel and updated by means of the performance of periodic drills, should be included as a quality indicator that must be met, since this would achieve better attention to the patient in case of a disaster situation requiring the evacuation of the ICU (AU)
Subject(s)
Emergencies , Intensive Care Units/standards , Quality Indicators, Health CareABSTRACT
No disponible
Subject(s)
Humans , Primary Health Care/methods , Hypertension/diagnosis , Emergency Medical Services/methods , Hypertension/therapy , Antihypertensive Agents/therapeutic useABSTRACT
No disponible
Subject(s)
Male , Child, Preschool , Humans , Hypertension/complications , Hypertension/diagnosis , Hypertension/therapy , Cafe-au-Lait Spots/complications , Cafe-au-Lait Spots/diagnosis , Respiration, Artificial/methods , Echocardiography, Doppler/methods , Angiography/methods , Genes, Neurofibromatosis 1/physiology , Neurofibromatosis 1/diagnosis , Heart Failure/complications , Aortic Valve Stenosis/complications , Aortic Valve Stenosis/diagnosisABSTRACT
Objetivo. Conocer el grado y los motivos de adecuación del tratamiento antihipertensivo inicial, globalmente y por grupos de riesgo cardiovascular. Diseño. Estudio descriptivo retrospectivo. Emplazamiento. Centro de salud urbano del área metropolitana de Barcelona. Pacientes. Todos los pacientes con hipertensión arterial (HTA) y edad > 60 años que entre enero de 1998 y diciembre de 1999 iniciaron la toma de medicación antihipertensiva (n = 205).Intervenciones. Revisión de historias clínicas y valoración según recomendaciones definidas en el VI Informe del Joint National Committee (JNC-VI).Resultados. Edad media 70,4 ñ 7,5 años y 56 por ciento mujeres. De los 205 hipertensos estudiados: 52 (25,4 por ciento) estratificados en el grupo de riesgo cardiovascular B (riesgo medio) y 153 (74,6 por ciento) en el grupo C (riesgo alto). El tratamiento farmacológico inicial se distribuyó así: 40 por ciento diuréticos, 38 por ciento inhibidores de la enzima conversora de la angiotensina (IECA), 7,3 por ciento betabloqueantes, 5,3 por ciento calcioantagonistas, 4 por ciento antagonistas receptores de angiotensina II y 5,4 por ciento asociaciones. La adecuación correcta o aceptable del tratamiento inicial fue, en conjunto, del 53,2 por ciento. Por grupos de riesgo cardiovascular, adecuación correcta del 63,5 por ciento en el grupo B y del 45,1 por ciento en el C, diferencias estadísticamente significativas (p = 0,022).Como fármaco inicial, los diuréticos se emplean más en el grupo B que en el C (57,7 por ciento frente a 34 por ciento; p = 0,002) y los IECA se utilizan más en el grupo C que en el B (43 por ciento frente a 23 por ciento; p = 0,01).Conclusiones. Pese a la directrices restrictivas del JNCVI, valoramos positivamente el grado de adecuación obtenido. Los diuréticos se usan más en los pacientes de riesgo cardiovascular medio y los IECA en los de riesgo alto. El motivo principal de adecuación incorrecta es el uso de IECA en situaciones no indicadas por el JNC-VI, sobre todo en diabéticos tipo 2 sin proteinuria. Objetivo. El trabajo intenta evaluar la incidencia de la hipertensión arterial (HTA) en los pacientes con aneurismas extraparenquimatosos de arteria renal y su evolución después de la cirugía. Material y métodos. Desde enero de 1978 a diciembre de 1999 se han intervenido en nuestro servicio, de forma consecutiva, 19 pacientes con 23 aneurismas extraparenquimatosos de arteria renal. Diecisiete pacientes (89,5 por ciento) tenían HTA.i Resultados. En 12 de 16 pacientes hipertensos se demostró HTA vasculorrenal. Veinte aneurismas estaban permeables, 1 obstruido crónicamente y un paciente comenzó clínicamente con trombosis aguda de aneurisma de aorta abdominal y arteria renal bilateral. En 11 de los 20 casos permeables existía estenosis significativa en la arteriografía preoparatoria. Diecisiete aneurismas (74 por ciento) estaban localizados en el tronco principal de la arteria renal. En todos ellos se practicaron técnicas revascularizadoras. No hubo fallecimientos postoperatorios y la permeabilidad inicial de las técnicas de revascularización fue del 100 por ciento. La tasa de mejoría/curación de la HTA a largo plazo fue del 65 por ciento (el 91 por ciento de estos pacientes tenían HTA renovascular y estenosis de la arteria renal). La permeabilidad acumulada durante el seguimiento fue del 89,2 por ciento. Conclusiones. La incidencia de HTA fue del 89,5 por ciento y la presión arterial descendió significativamente después de la cirugía. Doce pacientes (63,1 por ciento) tenían HTA vasculorrenal, que es una de nuestras 3 principales indicaciones quirúrgicas. Las otras 2 indicaciones básicas que consideramos son la prevención de rotura y la conservación de función renal. La cirugía ofrece buenas tasas de permeabilidad a largo plazo (AU)
Subject(s)
Aged , Female , Male , Middle Aged , Aged, 80 and over , Humans , Cardiovascular Diseases/prevention & control , Hypertension/drug therapy , Primary Health Care , Cardiovascular Diseases/etiology , Hypertension/complications , Risk Groups , Retrospective StudiesABSTRACT
It seems clear that the pineal hormone, melatonin (N-acetyl-5-methoxytryptamine), is involved in the reproductive behavior of several animal species including humans. Moreover, several data also support a role for 5-methoxytryptophol (ML), another pineal hormone, in the control of sexual processes. To test the role of ML in human reproductive axis, 128 healthy children, 68 boys and 60 girls, were studied. Each of these groups was divided in three age subgroups of 6, 11, and 14 years. A single blood sample (0900 hours) was obtained from each subject to determine melatonin, ML, FSH, LH, estradiol (girls), and testoterone (boys) by RIA. Statistical analysis of the data included ANOVA-II (factor I: age, factor II: sex) and an analysis of covariance with age as covariate. A similar plasma melatonin concentration, with a significant decrease between 6 and 11 years, was found in boys and girls. Melatonin concentrations correlate well with initiation of the pubertal development in these children, although no sex differences were found. Concentrations of ML are approximately 50% of those of melatonin. In contrast to melatonin, ML levels show significant age and sex differences. Plasma ML concentration significantly increased in boys (P < 0.001) and decreased in girls (P < 0.001) after 8 years of age. These results support the hypothesis that, besides melatonin, other pineal compounds such as ML may be involved in the maturation process in humans. The pineal indole ML may also be used as a marker of the different chronobiology in the pubertal development in boys and girls.
