Manejo del dolor en el paciente oncológico pediátrico y factores que influyen en su percepción / Pain management in the pediatric oncological patient and factors influencing its perception

El dolor es una característica subjetiva que presentan muchos pacientes durante su estancia hospitalaria. La población pediátrica presenta unas características fisiológicas y psicológicas diferentes a la de los adultos, si a esto se le suma un proceso oncológico en el cuál son sometidos a numerosas experiencias dolorosas durante su diagnóstico y tratamiento, se hace de vital importancia un adecuado manejo del dolor. El objetivo del presente trabajo es revisar los principales factores que influyen en la percepción del dolor oncológico en el paciente pediátrico y las medidas, tanto farmacológicas no, que son necesarias tener en cuenta para un correcto manejo del dolor. Para ello se realizó una revisión de publicaciones científicas en la base de datos MEDLINE durante los últimos 25 años. Se concluye que la percepción del dolor oncológico en pediatría tiene una componente multifactorial, por otro lado, además de un uso adecuado de las medidas farmacológicas, las medidas no farmacológicas son muy importantes para el abordaje integral del dolor(AU)

Pain is a subjective characteristic found in many patients during their hospital stay. Pediatric population presents physiological and psychological characteristics different from those of the adults. Added to this, if a cancer process is present, for which they are subjected to numerous painful experiences during their diagnosis and treatment, adequate pain management is vital. The objective of this paper was to review the main factors that influence the perception of cancer pain in the pediatric patient and both non-pharmacological and pharmacological measures that are necessary to take into account for proper pain management. To this end, a literature review was made in MEDLINE database, which covered the scientific publications of the last 25 years. It can be concluded that oncological pain perception has a multifactoral component. Furthermore, in addition to appropriate use of pharmacologic measures, non-pharmacological actions are very important for a comprehensive approach to pain(AU)

Experiencia en el manejo de inmunosupresores con los fármacos inhibidores de proteasa frente al virus de la hepatitis C / Experience in the management of immunosuppressant treatment with hepatitis C virus protease inhibitors

INTRODUCCIÓN: Los fármacos antivirales frente al virus de la hepatitis C (VHC) presentan un número importante de interacciones. El objetivo de este estudio es describir la interacción de telaprevir, boceprevir y sofosbuvir con los fármacos inmunosupresores en pacientes trasplantados. Métodos :Estudio observacional retrospectivo de pacientes trasplantados hepáticos con infección por VHC que iniciaron tratamiento con telaprevir, boceprevir o sofosbuvir. Se recogieron las dosis, pautas posológicas y niveles plasmáticos de tacrolimus, ciclosporina y sirolimus previas y posteriores al inicio del tratamiento antiviral. Se calculó la variación media de dosis e intervalo de dosificación, así como la modificación de los niveles de inmunosupresor tras iniciar el tratamiento. RESULTADOS: Se incluyeron 35 pacientes. En pacientes tratados con telaprevir (n = 18), la dosis de ciclosporina se redujo una media de 59,1% (SD = 14,6%), obteniéndose una reducción media de 14,6% (18,8%) en los niveles plasmáticos. En cuanto a tacrolimus, la dosis se redujo en un 34,3% (31,7%) aumentando el intervalo de dosificación una media de 73,4 (38,2) horas. Con ello, los niveles se incrementaron un 59,7% (89,6%). En los pacientes tratados con boceprevir (n = 4), tacrolimus se inició con una reducción del 18,1% (9,8%) de la dosis inicial y un aumento medio en el intervalo de dosificación de 12,0 (16,9) horas, observándose una reducción media del 37,7% (21,8%) en los niveles plasmáticos. El tratamiento con sofosbuvir (n = 13) no mostró variaciones importantes en los niveles de inmunosupresores. CONCLUSIONES: La interacción de telaprevir y boceprevir con los fármacos inmunosupresores requiere un ajuste de la dosis previa de los mismos al inicio del tratamiento, así como una monitorización rigurosa de sus niveles plasmáticos

INTRODUCTION: Antiviral drugs for the treatment of hepatitis C virus (HCV) infections have a large number of interactions. The aim of this study was to describe the interactions of telaprevir, boceprevir and sofosbuvir with immunosuppressive drugs in liver transplant recipients. METHODS: A retrospective observational study was performed in liver transplant patients with HCV infection who started treatment with telaprevir, boceprevir or sofosbuvir. Dose, regimens and plasma levels of tacrolimus, cyclosporine and sirolimus before and after antiviral treatment initiation were collected. Average variations in dose, dosing interval and immunosuppressive plasma levels after the start of treatment were calculated. RESULTS: Thirty-five patients were included. In patients treated with telaprevir (n = 18), the cyclosporine dose was reduced by an average of 59.1% (SD = 14.6%), yielding an average reduction of 14.6% (18.8%) in plasma levels. The dose of tacrolimus was reduced by 34.3% (31.7%), increasing the dosing interval by a mean of 73.4 (38.2) hours. After this variation, tacrolimus levels were increased by an average of 59.7% (89.6%). In patients treated with boceprevir (n = 4), tacrolimus started with a reduction of 18.1% (9.8%) of the initial dose and an average increase in the dosing interval of 12.0 (16.9) hours, showing a mean reduction in plasma levels of 37.7% (21.8%). Sofosbuvir therapy (n = 13) showed no significant variations in immunosuppressive drug levels. CONCLUSIONS: The interaction of telaprevir and boceprevir with immunosuppressive drugs requires a substantial dose reduction at the beginning of treatment and close monitoring of plasma levels

[Experience in the management of immunosuppressant treatment with hepatitis C virus protease inhibitors]. / Experiencia en el manejo de inmunosupresores con los fármacos inhibidores de proteasa frente al virus de la hepatitis C.

INTRODUCTION: Antiviral drugs for the treatment of hepatitis C virus (HCV) infections have a large number of interactions. The aim of this study was to describe the interactions of telaprevir, boceprevir and sofosbuvir with immunosuppressive drugs in liver transplant recipients. METHODS: A retrospective observational study was performed in liver transplant patients with HCV infection who started treatment with telaprevir, boceprevir or sofosbuvir. Dose, regimens and plasma levels of tacrolimus, cyclosporine and sirolimus before and after antiviral treatment initiation were collected. Average variations in dose, dosing interval and immunosuppressive plasma levels after the start of treatment were calculated. RESULTS: Thirty-five patients were included. In patients treated with telaprevir (n = 18), the cyclosporine dose was reduced by an average of 59.1% (SD = 14.6%), yielding an average reduction of 14.6% (18.8%) in plasma levels. The dose of tacrolimus was reduced by 34.3% (31.7%), increasing the dosing interval by a mean of 73.4 (38.2) hours. After this variation, tacrolimus levels were increased by an average of 59.7% (89.6%). In patients treated with boceprevir (n = 4), tacrolimus started with a reduction of 18.1% (9.8%) of the initial dose and an average increase in the dosing interval of 12.0 (16.9) hours, showing a mean reduction in plasma levels of 37.7% (21.8%). Sofosbuvir therapy (n = 13) showed no significant variations in immunosuppressive drug levels. CONCLUSIONS: The interaction of telaprevir and boceprevir with immunosuppressive drugs requires a substantial dose reduction at the beginning of treatment and close monitoring of plasma levels.