Papel del aprepitant en el manejo del prurito en un paciente con linfoma cutáneo de células T / Role of aprepitant in the management of pruritus in a patient with cutaneous T-cell lymphoma

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[Role of aprepitant in the management of pruritus in a patient with cutaneous T-cell lymphoma]. / Papel del aprepitant en el manejo del prurito en un paciente con linfoma cutáneo de células T.

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Estudio comparativo de eficacia y seguridad de dos protocolos antieméticos en quimioterapia ginecológica / No disponible

Objetivo: Evaluar la eficacia y seguridad de una actualización de un protocolo antiemético de quimioterapia en tumores ginecológicos. Método Estudio prospectivo, observacional, realizado durante 12 meses en un hospital general de 400 camas. Se evaluó la eficacia del protocolo antiemético antiguo, se implantó el protocolo nuevo, y se midió su eficacia. Se incluyeron pacientes con tumores ginecológicos que acudían al hospital de día. Tras cada ciclo de quimioterapia, en una encuesta, registraban el número y severidad de náuseas/vómitos y otros efectos adversos. Se midió la eficacia como respuesta completa (sin náuseas y sin vómitos) en la fase aguda (primeras 24h posquimioterapia) y en retardada (día 2-5 posquimioterapia). Se evaluó si la edad, el tipo de protocolo y el poder emetógeno de los esquemas podían influir en la respuesta. Resultados Se analizaron 102 ciclos de quimioterapia con el protocolo antiguo (52 pacientes) y 293 ciclos (98 pacientes) con el protocolo nuevo. Se encontraron diferencias significativas en la respuesta completa en la fase retardada con el protocolo nuevo (67,38 vs 36,27%), p < 0,0001. La probabilidad de obtener respuesta completa con el protocolo nuevo era dos veces mayor que con el antiguo en emesis aguda (OR=1,85; IC 95% = 1,05-3,24; p=0,03) y cuatro veces mayor en emesis retardada (OR=4,27; IC 95% = 2,59-7,02; p<0,0001). Conclusiones Con el nuevo protocolo se consiguió un mayor porcentaje de respuesta completa en la emesis retardada. La edad y el bajo poder emetógeno de los esquemas fueron factores predictivos de respuesta completa en la emesis aguda (AU)

Objectives: To evaluate the efficacy and safety of an update to an anti-emetic protocol in chemotherapy for gynecological tumours. Method: Prospective observational study performed over 12 months in a general hospital with400 beds. We evaluated the efficacy of the old anti-emetic protocol, a new protocol was implemented, and its efficacy was determined. We included patients with gynaecological tumours that sought treatment at the Day Hospital. After each chemotherapy cycle, patients filled out a survey that registered the number and severity of episodes of nausea/vomiting and other adverse effects. The efficacy of treatment was measured as complete response (no nausea orvomit) in the acute phase (first 24 h after chemotherapy) and late phase (2-5 days after chemotherapy). We also evaluated whether age, the type of protocol, and the emetogenous power of the different treatment schemes could influence patient response. Results: We analysed 102 chemotherapy cycles under the old protocol (52 patients) and293 cycles under the new protocol (98 patients). We observed significant differences in completeresponse rates in the late phase between old and new protocols (36.27% vs 67.38%, P<.0001).The probability of obtaining a complete response using the new protocol was twice as high as with the old protocol in acute emesis (OR = 1.85, 95% CI: 1.05-3.24, P=.03) and four times higherin late emesis (OR = 4.27, 95% CI: 2.59-7.02, P<.0001).Conclusions: A greater percentage of complete responses to late emesis was obtained using the new protocol. Age and the low emetogenous power of the treatment schemes were predictive factors for complete response in acute emesis (AU)

[Comparative study of the efficacy and safety of two anti-emetic protocols in gynecological chemotherapy]. / Estudio comparativo de eficacia y seguridad de dos protocolos antieméticos en quimioterapia ginecológica.

OBJECTIVES: To evaluate the efficacy and safety of an update to an anti-emetic protocol in chemotherapy for gynecological tumours. METHOD: Prospective observational study performed over 12 months in a general hospital with 400 beds. We evaluated the efficacy of the old anti-emetic protocol, a new protocol was implemented, and its efficacy was determined. We included patients with gynaecological tumours that sought treatment at the Day Hospital. After each chemotherapy cycle, patients filled out a survey that registered the number and severity of episodes of nausea/vomiting and other adverse effects. The efficacy of treatment was measured as complete response (no nausea or vomit) in the acute phase (first 24h after chemotherapy) and late phase (2-5 days after chemotherapy). We also evaluated whether age, the type of protocol, and the emetogenous power of the different treatment schemes could influence patient response. RESULTS: We analysed 102 chemotherapy cycles under the old protocol (52 patients) and 293 cycles under the new protocol (98 patients). We observed significant differences in complete response rates in the late phase between old and new protocols (36.27% vs 67.38%, P<.0001). The probability of obtaining a complete response using the new protocol was twice as high as with the old protocol in acute emesis (OR=1.85, 95% CI: 1.05-3.24, P=.03) and four times higher in late emesis (OR=4.27, 95% CI: 2.59-7.02, P<.0001). CONCLUSIONS: A greater percentage of complete responses to late emesis was obtained using the new protocol. Age and the low emetogenous power of the treatment schemes were predictive factors for complete response in acute emesis.

[Treatment of pulmonary hypertension]. / Tratamiento de la hipertensión pulmonar.

Pulmonary hypertension is a difficult-to-diagnose, poor-prognosis disease that may be primary or secondary to other conditions. It is characterized by pulmonary vasoconstriction, in situ thrombosis, and altered endothelial function, which clinically manifests with dyspnea and other disabling symptoms for the patient. Conventional treatment includes oral anticoagulants together with oxygen supplementation, diuretics, and digoxin --according to concurrent conditions-- as well as vasodilators, traditionally calcium antagonists. In recent years novel vasodilators have been developed for use in the treatment of pulmonary hypertension-prostaglandins (epoprostenol, iloprost), endothelin-1 receptor antagonists (bosentan), nitric oxide, and sildenafil, among other drugs under study. However, question marks remain on the management of this disease, and further studies are needed to find a truly effective therapeutic option.

Tratamiento de la hipertensión pulmonar / Treatment of pulmonary hypertension

La hipertensión pulmonar es una enfermedad de difícil diagnóstico y mal pronóstico, que puede ser primaria o secundaria a otras patologías. Está caracterizada por vasoconstricción pulmonar, trombosis in situ y alteración de la función endotelial; lo que clínicamente se manifiesta con disnea y otros síntomas incapacitantes para el paciente. El tratamiento convencional consiste en anticoagulantes orales, junto con suplementos de oxígeno, diuréticos y digoxina según otras patologías concomitantes, así como un vasodilatador, tradicionalmente un antagonista del calcio. En los últimos años se han desarrollado nuevos fármacos vasodilatadores para ser utilizados en el tratamiento de la hipertensión pulmonar, como prostaglandinas (epoprostenol e iloprost), antagonistas del receptor de endotelina I (bosentan), óxido nítrico y sildenafilo, entre otros fármacos en estudio. Sin embargo, todavía son muchas las incógnitas que rodean al tratamiento de esta enfermedad, por lo que son necesarios muchos más estudios que ayuden a encontrar la opción terapéutica más eficiente (AU)

[Simplification to lamivudine, zidovudine, and abacavir therapy: impact on adherence, clinical outcome, and economic issues]. / Simplificación con lamivudina, zidovudina y abacavir: repercusión sobre la adhrencia, resultados clínicos e impacto económico.

OBJECTIVES: To analyze the influence on adherence and clinical outcome of the replacement of a previous antiretroviral therapy to a simplified approach using zidovudine, lamivudine, and abacavir (Trizivir) and to assess its economic impact. METHODS: A retrospective study of 75 pretreated, HIV-infected adult patients who received Trizivir from May 2001 to December 2002. Adherence was assessed by dispensation records or medication counting, CD4 lymphocyte counts, and viral load before and six months after medication change was analyzed; finally, the cost of each therapy was assessed in order to calculate the economic impact of medication change. RESULTS: Mean adherence significantly increased a 2.5% after medication change; 16 more patients reached optimal adherence, with an NNT (number of patients requiring therapy change in order to obtain one more adherent) of 4.7. The number of patients with undetectable viral load remained almost similar, and mean CD4 cell counts stayed above 500 cells/mm3 in both periods of time. A great variability in incremental costs was seen, due to the varying costs of the previous treatments, and the influence of five intensification therapies using Trizivir. However, when only simplification regimens were analyzed such variability was reduced, and even became favorable in selected cases. CONCLUSIONS: Changing to a simplification therapy using Trizivir resulted in improved adherence, similar clinical outcomes, and a varying economic impact depending on previous antiretroviral therapy costs.

Monitorización por el sf de pacientes con potasio sérico alterado / Monitoring patients with altered serum potassium by a Pharmacy Department connecting it to renal function and potassium altering drugs administration

Objetivos: Realizar una revisión sistemática de los pacientes con potasio sérico alterado, relacionándolo con su función renal y con la toma de fármacos que alteran su homeostasis. Método: El laboratorio de bioquímica envía a Farmacia, por correo electrónico, valores de potasio y creatinina séricos de cada paciente. El Servicio de Farmacia realiza un informe para el médico/a sobre aquellos pacientes que presentan un potasio sérico fuera de rango habitual (5,2 mEq/L) y que además, estén recibiendo fármacos o fluidos con capacidad para alterar el potasio en sangre. Resultados: Se enviaron 302 informes (282 sobre hiperpotasemia). La media de medicamentos por informe enviado fue 4,2 ñ 1,8. En el 40 per cent de los informes de hiperpotasemia, los pacientes estaban recibiendo suplementos de potasio (oral o intravenoso).Conclusiones: El acceso a datos de laboratorio y de tratamiento farmacológico permite al Servicio de Farmacia detectar y corregir problemas relacionados con los medicamentos de forma sistemática (AU)