[Intermediate syndrome after organophosphate poisoning despite continuous infusion of pralidoxime]. / Síndrome intermedio en el transcurso de una intoxicación por organofosforados a pesar de una infusión continua de pralidoxima.

Acute organophosphate poisoning leads to a cholinergic crisis secondary to an acetylcholine rise, developed by an acetylcholinesterase inhibition. In some cases, after the resolution of the initial cholinergic signs and symptoms, an intermediate syndrome occurs, characterized by a delayed development of proximal and diaphragmatic muscle paralysis. We describe a case of a 67-year-old man who developed an intermediate syndrome after oxydemeton-metryl ingestion in a suicide attempt, despite a continuous pralidoxime infusion. Several hypotheses have been developed to explain the aetiology of this intermediate syndrome (neuromuscular junction dysfunction, inadequate poisoning treatment, late beginning of the oxime administration, etc). Intermediate syndrome manifestation will depend on the organophosphate's organism persistence and its chemical structure, and also on the time elapsed between the poisoning and the antidote administration.

Síndrome intermedio en el transcurso de una intoxicación por organofosforados a pesar de una infusión continua de pralidoxina / Intermediate syndroem after organophosphate poisoning despite continuous infusion of pralidoxime

En las intoxicaciones agudas por insecticidas organofosforados se produce un síndrome colinérgico debido a un aumento de la aceticolina a nivel sináptico, como consecuencia de una inhibición de la acetilcolinesterasa. En algunos casos, tras la resolución de la sintomatología colinérgica, se presenta el síndrome intermedio, caracterizado por una parálisis de la musculatura proximal y diafragmática. Describimos el caso de un paciente de 67 años que desarrolla un síndrome intermedio tras la ingestión de una cantidad desconocida de oxidemetón-metilo en un intento de autolisis, a pesar de la infusión continuada de pralidoxima a dosis altas. Diversas hipótesis tratan de explicar la etiología del síndrome intermedio (disfunción de la unión neuromuscular, instauración de un tratamiento inadecuado o de inicio tardío con oximas, entre otras). Asimismo, su manifestación se ve condicionada por la persistencia del insecticida organofosforado en el organismo, su estructura química o el tiempo transcurrido entre la ingestión del tóxico y la administración del antídoto

Acute organophosphate poisoning leads to a cholinergic crisis secondary to an acetylcholine rise, developed by an acetylcholinesterase inhibition. In some cases, after the resolution of the initial cholinergic signs and symptoms, an intermediate syndrome occurs, characterized by a delayed development of proximal and diaphragmatic muscle paralysis. We describe a case of a 67-year-old man who developed an intermediate syndrome after oxydemeton-metryl ingestion in a suicide attempt, despite a continuous pralidoxime infusion. Several hypotheses have been developed to explain the aetiology of this intermediate syndrome (neuromuscular junction dysfunction, inadequate poisoning treatment, late beginning of the oxime administration, etc). Intermediate syndrome manifestation will depend on the organophosphate’s organism persistence and its chemical structure, and also on the time elapsed between the poisoning and the antidote administration

Intoxicaciones agudas en el servicio de urgencias de un hospital universitario de nivel III: cambios producidos en los últimos 10 años / Acute poisoning in the emergency department of a level III universitary hospital: changes produced in the last 10 years

El objetivo fue evaluar los cambios epidemiológicos enlas intoxicaciones agudas (IA) entre 1994 y 2004. Para ello seestudiaron todos los casos atendidos en Urgencias con el diagnósticode intoxicación aguda, mediante un estudio transversal descriptivoanalítico desarrollado en dos períodos de un mes separados por 10 años, y comparando los resultados. Se registraron los datosdemográficos, clínicos y toxicológicos.La prevalencia de IA en Urgencias entre los períodos estudiadosaumentó significativamente (0,83 vs 1,25%) mientras que lahospitalización por esta causa pasó del 30,5% al 6,34%. La edadmedia se mantuvo entre los 32-33 años, así como la relaciónhombre/mujer, que osciló alrededor de 1. No se registraronfallecimientos.Los medicamentos fueron el tóxico más frecuente (51,3% y 62,7%respectivamente) con un aumento debido principalmente a lasbenzodiazepinas (BDZ). Asimismo, el alcohol incrementó supresencia en intoxicaciones múltiples, disminuyendo como agenteúnico. Las admisiones por drogas de abuso experimentaron unretroceso, del 26 al 19%. Los pacientes que recibieron tratamiento dealgún tipo disminuyeron aunque no de forma significativa, del 52,8 al44,4% y, a pesar del aumento de las BDZ, la utilización deflumazenilo varió de un 7% a un 8,5% de los casos. La utilización denaloxona disminuyó a la mitad.Los intentos de suicidio aumentaron el 25%, lo que supuso el 65% deltotal de la IA en el segundo período estudiado. La hospitalización, porel contrario, pasó de un 45% a un 6% en estos pacientes. Losfármacos, y entre ellos los psicotropos, fueron el tóxico másfrecuente, implicados en el 62% y 78% de los intentos de suicidio. Laasociación fármaco y alcohol aumentó de manera significativa (10% vs 22%). El registro de pacientes con antecedentes psiquiátricos seincrementó del 29% al 75%. En el intervalo de 21 a 30 años, elporcentaje de mujeres implicadas es el doble que el de hombres enambos períodos.La prevalencia de la IA experimentó un incremento significativo,paralelamente a los intentos de autolisis; sin embargo los ingresos enunidades de hospitalización, disminuyeron considerablemente tanto en el global de la IA como en los intentos de suicidio. Losmedicamentos, y entre ellos las BDZ fueron el tóxico más frecuente(AU)

The aim was to evaluate the epidemiological changes in the acutepoisonings (AP) between 1994 and 2004. For this purpose, all thecases attended at the Emergency Service with the diagnosis of acutepoisoning were studied, by means of a transverse descriptiveanalytical study developed in two periods of one month separated for 10 years, and comparing the results. The demographic, clinical andtoxicological data were recorded.The acute poisoning's prevalence in the Emergency Service increasedsignificantly (0,83 vs. 1,25%) whereas the hospitalization for thisreason decreased from 30,5% to 6,34%. The average age of our serieswere unchanged, (between 32-33 years) as well as the relation man /woman,that it ranged about 1. No deaths were recorded.Drugs were the most frequent poisoning agent (51,3% and 62,7%respectively) with an increase due principally to the benzodiazepines.Likewise, the alcohol increased its presence in multiple poisonings, diminishing as the only agent. The admissions for drugs of abuseexperienced a setback, from 26 to 19%. The patients who receivedany type of treatment diminished but not in a significant form, from 52,8 to 44,4% and, in spite of the benzodiazepines increase, theutilization of flumazenil changed from 7% to 8,5% of the cases. Theutilization of naloxone diminished to the half.The attempts of suicide increased 25%, which supposed 65% of thewhole of the IA in the second studied period. The hospitalization, onthe contrary, descended from 45% to 6% in these patients. Drugs, andamong them the psychotropes, were the most frequent poisoningagent, implied in 62% and 78% of the suicide attempts. Theassociation drug and alcohol increased in a significant way (10% vs.22%). The patients' record with psychiatric precedents was increasedfrom 29% to 75%. In the age interval from 21 to 30, the percentage ofwomen is twice than that of men in both periods.The prevalencia of the IA experienced a significant increase, parallelto the attempts of autolisis; nevertheless the admission inhospitalization units, diminished both in the global of the IA and inthe suicide attempts. Drugs, and among them the benzodiacepineswere the toxic agent most frequently involved(AU)

Profilaxis y tratamiento del angioedema hereditario y adquirido en el HUB; utilización del inhibidor de la C1-esterasa / Profhylaxis and treatment of hereditary and acquired angioedema at HUB; use of the C1-esterase inhibitor

Introducción: El angioedema hereditario o adquirido está producido por el déficit del inhibidor de la esterasa del primer componente del complemento (C1-INH). Se caracteriza por síntomas transitorios de hinchazón de tejidos subcutáneos, pared intestinal y vías respiratorias superiores, que puede derivar en muerte por asfixia. Se presenta la fisiopatología, clasificación, diagnóstico y tratamiento, así como un seguimiento de los pacientes diagnosticados, a los que se les entrega 1 vial de concentrado de C1-INH (Berinert®), valorando la aportación del Servicio de Farmacia en el circuito de dispensación y control de dicho fármaco. Material y métodos: Se realizó una búsqueda a través de PubMed y otras fuentes relevantes. Mediante las recetas controladas se tomaron los datos del paciente y de las dispensaciones e indicación de Berinert®; se completó el seguimiento mediante la historia clínica, los datos de laboratorio y la entrevista al paciente cuando fue preciso. Resultados: Del total de 9 casos, 8 fueron angioedema hereditario y 1 adquirido. El danazol se utilizó como profilaxis a largo plazo en 8 casos, pero sus efectos secundarios obligaron a discontinuarlo en alguno de ellos. El concentrado de C1-INH fue efectivo en los 6 brotes agudos detectados en el estudio, así como en las 3 profilaxis quirúrgicas (consumo global de 6.500 U).Conclusión: El danazol fue un fármaco eficaz como profilaxis, pero con efectos secundarios importantes. El concentrado de C1-INH ha sido eficaz tanto en la profilaxis como en el tratamiento de los brotes agudos. El Servicio de Farmacia dispondrá de un stock suficiente de producto (AU)

[Profhylaxis and treatment of hereditary and acquired angioedema at HUB; use of the C1-esterase inhibitor]. / Profilaxis y tratamiento del angioedema hereditario y adquirido en el HUB; utilización del inhibidor de la C1-esterasa.

INTRODUCTION: Hereditary and acquired angioedema result from a deficiency in first complement component esterase (C1-esterase) inhibitor. It is characterized by transient subcutaneous tissue, intestinal wall, and upper airway swelling, which may lead to asphyxia and death. The pathophysiology, classification, diagnosis, and treatment of this condition are discussed, as is the follow-up of patients diagnosed with angioedema who received 1 vial of concentrated C1-INH (Berinert); the contribution of the Pharmacy Department in the dispensation and control of said drug is also assessed. MATERIAL AND METHODS: PubMed and other relevant sources were searched. Patient, dispensation, and Berinert(R) indication data were collected from controlled prescriptions; follow-up was completed by performing a medical history, collecting laboratory data, and patient interview when needed. RESULTS: Eight out of 9 cases were of hereditary angioedema, and 1 case was of acquired angioedema. Danazol was used as long-term prophylaxis in 8 patients, but side effects forced discontinuation in some of them. The C1-INH concentrate was effective in 6 acute episodes that were detected during the study, as well as in 3 surgical prophylaxis cases (overall use 6,500 U). CONCLUSION: Danazol was effective as prophylactic treatment, but had severe side effects. The C1-INH concentrate was effective both as prophylactic therapy and treatment for acute episodes. An adequate stock of this product will be available at the Pharmacy Department.

[Incidence and risk factors of mechanical complications in parenteral nutrition]. / Incidencia y factores de riesgo en las complicaciones mecánicas en nutrición parenteral.

The objective of the present study is to determine the incidence of mechanical complications in patients with parenteral nutrition in our hospital, and to study which factors associated with catheterization in these patients are related to the appearance of different types of mechanical complications. All the central venous catheters registered during the time period between 1988-1994 were included. For the statistical treatment 5 logistic multiple regression models were designed in function of the different types of mechanical complications studied (dependent variable) and in relation to the defined risk factors (independent variables). The difference was considered to be statistically significant when, for each variable, this is not 1 for the confidence interval. The understanding of the different risk factors associated with the appearance of mechanical complications allows a better level of clinical action in the prevention of these types of complications.

[The epidemiology of central venous catheterization (CVC) in parenteral nutrition. The clinical implications and factors that determine the selection of germs]. / Epidemiología de la cateterización venosa central (CVC) en nutrición parenteral. Implicaciones clínicas y factores que determinan la selección de gérmenes.

The objective of the study is, on one hand, to determine the etiology and the clinical implications as a function of the isolated germ, of central venous catheterization in patients with parenteral nutrition in our hospital, and on the other hand, to determine which factors are associated with the selection of germs of central venous catheterization in parenteral nutrition. For this we included venous catheters, colonized for 5 years, and with a study of the different segments (connection, insertion point, and tip). As a function of the appearance of associated clinical symptoms, of the results of the blood culture, and of the clinical evolution of the patient, the variables which determine the level of pathogenicity of the different groups of germs in the central venous catheterization, are defined; for the study of the factors associated with the selection of the different groups of germs, 8 variables were chosen. The data obtained are statistically treated, and the results are considered to be significant if p < 0.05. The understanding of the different factors associated with the selection of germs, and the level of clinical pathogenesis of the different groups, allows a better level of the clinical action in the prevention of the infection associated with the catheter.

[Description of the computer program used at the Hospital de Bellvitge for monitoring and control in the Parenteral Nutrition Unit]. / Descripción del programa informático utilizado en el Hospital de Bellvitge para el seguimiento y control de la Unidad de Nutrición Parenteral.

The purpose of this paper is to introduce a computer program to control the Pharmacy Service Parenteral Nutrition Unit. The program's main feature is a broad menu of possibilities for the clinical monitoring of patients receiving PN. We explain its operation, potential and applications and give some practical examples of some of those applications.

[Artificial nutrition in bone marrow transplantation]. / Nutrición artificial en el trasplante de médula ósea.

The issue of nutritional support in oncologic patients is reviewed. Special reference is made in relation to patients undergoing bone marrow transplant and their possible digestive tract and nutritional changes induced by the different therapies available in these situations. Nutritional evaluation and caloric and nitrogen requirement calculations have been proposed. Likewise, several possibilities have been considered regarding the route of administration, timing and quality of the nutriments to be administered, both to adult and pediatric patients.