Cases of leprosy notified in the municipality of Parnaíba, state of Piauí, Brazil, 2007-2016

This study aimed to describe the epidemiological and clinical characteristics of leprosy cases reported in the municipality of Parnaíba, State of Piauí. This was a cross-sectional study of leprosy cases, living in Parnaíba, State of Piauí, reported to the National System of Notifiable Diseases (SINAN), from 2007 to 2016. There were 582 cases of leprosy with hyperendemic detection in the general population in 2008, 2009 and 2016; and under < 15 years of age in 2008, 2014 and 2016, with a predominance of females (53.1%), brown (62.2%), aged 20-64 years (74.7%), complete and incomplete elementary school (56.4%), housewives (20.7%), living in the urban area (87.1%), reported by primary care (69.2%). The most frequent clinical and therapeutic findings were: multibacillary operational classification (53.8%); clinical forms: undetermined (30.6%) and virchowian (24.3%); single lesion (34.8%); no affected nerves (86.7%); degree of disability zero (70.6%); bacilloscopy not performed (26.7%); therapeutic regimen 12 doses (53.7%) and no reaction (70.8%). Regarding the mode of input, predominated new case (88.8%); mode of output, cure (87.9%) and detection mode: spontaneous demand (45.8%). Out of 2,106 registered contacts, 60.6% were examined. Leprosy is endemic to Parnaíba, State of Piauí. It is noteworthy that the hyperendemic detection rates occurred during years when there was intensification of active search for contacts and cases in the population.

Role of Glucagon in Automated Insulin Delivery.

Treatment of type 1 diabetes with exogenous insulin often results in unpredictable daily glucose variability and hypoglycemia, which can be dangerous. Automated insulin delivery systems can improve glucose control while reducing burden for people with diabetes. One approach to improve treatment outcomes is to incorporate the counter-regulatory hormone glucagon into the automated delivery system to help prevent the hypoglycemia that can be induced by the slow pharmacodynamics of insulin action. This article explores the advantages and disadvantages of incorporating glucagon into dual-hormone automated hormone delivery systems.

A new approach in the treatment of pediatric hypertrophic burn scars: Tixel-associated topical triamcinolone acetonide and 5-fluorouracil delivery.

BACKGROUND: Pediatric hypertrophic burn scars are challenging to treat due to their widespread nature and pain associated with the treatment. Intralesional triamcinolone acetonide (TAC) injection with or without 5-fluorouracil (5FU) is considered first-line treatment for severe hypertrophic scars. The pain associated with the procedure, the uneven topography, and epidermal atrophy, all limit the application of this treatment modality. AIMS: We sought to evaluate the clinical effectiveness and safety profile of a novel thermomechanical system (Tixel, Novoxel) for transdermal delivery of a topical solution containing TAC and 5-FU in the treatment of hypertrophic scars. PATIENTS/METHODS: A retrospective study of pediatric hypertrophic burn scars treated between 2015 and 2017 was performed. Epidemiologic, treatment data, effectiveness score, and safety were reviewed. RESULTS: Four children (one male and three females, ages 3-10 years old) with hypertrophic burn scars treated with the Tixel device were evaluated. Mean scar VSS was reduced from 8.4 ± 0.8-5.2 ± 0.5 (P-value - .001) after eight treatments. The mean improvement of toughness, thickness, color, and general aesthetic impression was 3.1 ± 0.43 â†’ 2.2 ± 0.31, 3.4 ± 0.5 â†’ 1.9 ± 0.63, 2.7 ± 0.21 â†’ 2.4 ± 0.25, and 3.23 ± 0.44 â†’ 1.6 ± 0.64, respectively. Mean treatment pain VAS score was 1.74 ± 0.9. Patient's parents rated their satisfaction level as "moderate-high." No topical or systemic complications were observed. CONCLUSION: Thermomechanical decomposition of the stratum corneum, in combination with topical application of TAC and 5-FU, is a safe, relatively painless, and efficient modality for the treatment of pediatric hypertrophic burn scars.

Stability of probiotics with antibiotics via gastric tube by simple suspension method: An in vitro study.

Data on the stability of probiotics with antibiotics delivered via gastric tube using the simple suspension method (SSM) are limited. Therefore, we investigated bacterial survivability in probiotics treated with antibiotics prepared by the SSM in vitro. Probiotics and antibiotics were suspended in 20 mL of sterilized hot water (55 °C) and then 1-mL of the suspensions were taken each at 10, 60, 120, 180 and 360 min. Thereafter, the samples were inoculated on 3 media and cultured at 37 °C for 24 h. Survival of probiotic strains was measured in colony-forming units. The growth of Clostridium butyricum did not change without antibiotics at all experimental times, but in the case of Enterococcus faecium tended to increase. On the other hand, the viable bacterial number of C. butyricum was decreased significantly by treatment with cefdinir, tosufloxacin, clarithromycin, or azithromycin, but was not altered by levofloxacin, minocycline, or vancomycin. The viable bacterial number of E. faecium was significantly decreased by treatment with tosufloxacin, levofloxacin, minocycline, vancomycin, or azithromycin, and was significantly increased by clarithromycin. In conclusion, our results suggest that the efficacy of probiotic therapies might be reduced by the SSM when specific antibiotics are used. Moreover, antibiotics might inhibit probiotic growth, although some probiotics are spore-forming and have high minimum inhibitory concentrations. Additionally, early administration of non-spore-forming bacteria might be desirable. Therefore, when patients are administered therapy combining probiotics and antibiotics by the SSM, we should consider the characteristics of the probiotics and the administration times.

A randomized, open-label, single-visit, crossover study simulating triple-drug delivery with Ellipta compared with dual inhaler combinations in patients with COPD.

Background: Administering maintenance COPD therapy with a combination of multiple inhalers may increase inhaler errors. This study evaluated the potential benefits of using a single Ellipta dry powder inhaler (DPI) compared with two combinations of DPIs commonly used to deliver triple maintenance therapy. Methods: Patients receiving inhaled COPD medication were enrolled in this multicenter, randomized, open-label, placebo-device, crossover study with a 2×2 complete block design (NCT0298218), which comprised two substudies: Ellipta vs Diskus + HandiHaler (substudy 1) or Turbuhaler + HandiHaler (substudy 2). Patients demonstrated inhaler use after reading the relevant patient information leaflet (PIL). A trained investigator assessed user errors (critical errors [errors likely to result in no or significantly reduced medication being inhaled] and overall errors). The primary endpoint was the proportion of patients making ≥1 critical error after reading the PIL. The secondary endpoints included error rates during ≤2 reassessments following investigator instruction (if required), instruction time, and patient preference. Results: After reading the PIL, significantly fewer patients made critical errors with Ellipta compared with Diskus + HandiHaler (9% [7/80] vs 75% [60/80], respectively; P<0.001) or Turbuhaler + HandiHaler (9% [7/79] vs 73% [58/79], respectively; P<0.001). The number of patients making overall errors was also lower with Ellipta vs tested inhaler combinations (P<0.001 for each substudy). The median instruction time needed for error-free use was shorter with Ellipta in substudies 1 and 2 (2.7 and 2.6 minutes, respectively) vs either combination (10.6 [Diskus + HandiHaler] and 11.3 minutes [Turbuhaler + HandiHaler], respectively). Significantly more patients preferred Ellipta over Diskus + HandiHaler or Turbuhaler + HandiHaler overall for taking their COPD medication (81% vs 9% and 84% vs 4%, respectively) and per the number of steps for taking their COPD medication (89% vs 8% and 91% vs 5%, respectively). Conclusion: Fewer patients with COPD made critical errors with the single DPI, and patients required less instruction time, compared with each dual DPI combination.

Recomendaciones para la elaboración y administración de fármacos antituberculosos en niños. Segunda fase del Proyecto Magistral de la Red Española de Estudio de la Tuberculosis Pediátrica (pTBred) / Recommendations for the preparation and administration of antituberculosis drugs in children. Second phase of the Magistral Project of the Spanish Network for the Study of Paediatric Tuberculosis (pTBred)

La Red Española de Estudio de la Tuberculosis Pediátrica ha evidenciado una falta de consenso nacional en la administración de antituberculosos en niños, propiciada por la escasez de presentaciones pediátricas específicas. Es prioritario homogeneizar el tratamiento de la tuberculosis en niños en nuestro país. Un grupo de expertos españoles en tuberculosis infantil y en el área de medicamentos pediátricos proponen una actuación conjunta, con la finalidad de mejorar esta situación en nuestro medio. Para ello se constituye un Grupo de Trabajo, liderado por pTBred, en el que participan otras 5 sociedades e instituciones científicas. Se proponen las siguientes fórmulas magistrales en forma de suspensión o solución oral para el tratamiento de la tuberculosis en niños: isoniacida 50mg/ml, pirazinamida 100mg/ml y etambutol 50mg/ml. Se especifican materias primas, periodo de validez y condiciones de conservación y administración. Se establecen recomendaciones para el uso de fármacos combinados a dosis fijas. Si no se consigue la dosis apropiada mediante fármacos combinados a dosis fijas, y no se dispone de fórmula magistral, se recomienda la administración mediante comprimidos triturados. El adecuado cumplimiento terapéutico y la administración de dosis óptimas de los fármacos antituberculosos constituyen pilares fundamentales en el control y erradicación de la enfermedad. La oportunidad de disponer de este documento multidisciplinar en España favorecerá el correcto tratamiento de la tuberculosis pediátrica, y será una guía útil para todos los pediatras y farmacéuticos que lo precisen

The Spanish Network for the Study of Paediatric Tuberculosis has shown a lack of national consensus on the treatment of tuberculosis in children, partly due to the unavailability of paediatric presentations of antituberculosis drugs. The harmonisation of tuberculosis treatment in children is a priority in Spain. A joint action is proposed by a group of Spanish experts in childhood tuberculosis and in the area of Paediatric Pharmacology. To this end, a pTBred-led workgroup of members from five scientific bodies has been created. Drug pharmaceutical compounding in oral suspensions or oral solutions are recommended as follows: isoniazid 50mg/mL, pyrazinamide 100mg/mL, and ethambutol 50mg/mL. Raw materials, period of validity, and storage conditions are specified. Recommendations for the use of fixed-dose combination drugs are also established. If oral solutions/suspensions or fixed-dose combination drugs are not appropriate, the use of crushed tablets is recommended. Adherence to treatment and optimal dosing of antituberculosis drugs are critical in the control and eradication of TB. This multidisciplinary document provides an opportunity to promote the appropriate treatment of paediatric tuberculosis in Spain, and should become a useful tool for paediatricians and pharmacists

Antiagregación plaquetaria dual y nivel de hemoglobina: un estudio observacional / Dual antiplatelet therapy and haemoglobin level: an observational study

Introducción. Determinar el grado de asociación entre la terapia de antiagregación plaquetaria dual (TAAD) (clopidogrel y ácido acetilsalicílico) y el nivel de hemoglobina (Hb) en la práctica clínica. Material y métodos. Estudio retrospectivo. Se incluyeron todos los pacientes con TAAD durante al menos 6 meses, siendo el tamaño muestral necesario de 63 pacientes. Se determinó la Hb antes de la TAAD y el valor más próximo al cierre del estudio, la duración del tratamiento y las prescripciones o enfermedades que pudieran disminuir la Hb. Se calculó la variación de Hb tras TAAD y la aparición o empeoramiento de anemia previa. Se comparó la Hb previa y la posterior mediante prueba t para muestras apareadas. La aparición de anemia fue la variable dependiente en un análisis de regresión logística. Resultados. Se incluyeron 122 casos. Noventa y dos eran varones (75,4%), con una edad media de 74,5 (DE 9,9) años. La duración de la TAAD era de 19,3 (11,8) meses, siendo la Hb previa de 14,3 (1,4) y la posterior de 12,8 (1,9) g/dl. Había anemia pretratamiento en 11 casos (9,1%) y postratamiento en 56 (45,9%). La comparación de medias mostró un descenso de 1,5 (1,6) (IC95% 1,2-1,8; p<0,001) g/dl, asociándose la anemia postratamiento a la edad, causas concomitantes de anemia, hemorragias en el seguimiento y, de forma inversa, al nivel de Hb pretratamiento. Conclusiones. La TAAD se asocia con un descenso de la Hb, apareciendo anemia o empeoramiento de la misma en cerca de la mitad de los sujetos, y siendo este efecto más probable en los pacientes con hemorragias en el seguimiento y en presencia de otras causas de anemia (AU)

Introduction. To determine the degree of association between dual antiplatelet therapy (DAPT) (clopidogrel plus acetylsalicylic acid) and haemoglobin (Hb) in clinical practice. Material and methods. A retrospective longitudinal analysis was conducted on all patients on DAPT for at least 6 months. The required sample size was 63 patients. Hb value was determined before DAPT and at least 6 months after, as well as length of treatment, drugs, and diseases that might reduce the Hb. Changes in Hb after DAPT and the emergence or worsening of pre-existing anaemia was determined. Before and after Hb was compared using the t-test for paired samples. The occurrence of anaemia was considered dependent variable in a logistic regression analysis. Results. A total of 122 cases were included. There were 92 (75.4%) males, and the mean age was 74.5 (SD 9.9) years. DAPT duration was 19.3 (11.8) months. The pre-treatment Hb was 14.3 (1.4) g/dl and 12.8 (1.9) g/dl post-treatment. The prevalence of pre-DAPT anaemia was 9.1% (11 cases), and 45.9% post-treatment (56 cases). Comparison of means showed a decrease of 1.5g/dl (1.6) (95% CI; 1.2-1.8, P<.001). Anaemia post-treatment was associated with concomitant causes of anaemia, bleeding in the follow-up, and inversely with pre-treatment Hb level. Conclusions. DAPT is associated with a decrease in Hb. Anaemia or worsening of previous anaemia appeared in about half of the subjects, and this effect was most likely in patients with bleeding in the follow-up and if other causes of anaemia were present (AU)

Mordedura por víbora hocicuda (Vipera latastei) / Vipera latastei (Hocicuda viper) bite

No disponible

The combinational therapy of trastuzumab and cetuximab inhibits tumor growth in a patient-derived tumor xenograft model of gastric cancer

Purpose: Gastric cancer (GC) is one of the leading causes of cancer mortality worldwide. Although therapeutic strategies for GC have improved, the prognosis for advanced GC remains poor. Herein, the present study sought to design a personalized cancer therapy specific to a stage III GC patient. Methods: The tumor was surgically removed and was used to establish a patient-derived tumor xenograft (PDTX) model utilizing nude mice. Various molecular-targeted anticancer treatments were tested in the study, including control (no treatment), bevacizumab, cetuximab, bevacizumab + cetuximab, trastuzumab, and trastuzumab + cetuximab. Results: Trastuzumab + cetuximab treatment exhibited the best antitumor growth effect, followed by trastuzumab, bevacizumab + cetuximab, cetuximab, and bevacizumab. Similarly, trastuzumab + cetuximab was also the most effective treatment at inducing apoptosis and cell cycle arrest in primary cultures of the patient’s gastric cancer cells. Among all treatments tested in the study, trastuzumab + cetuximab showed the most profound effect in reducing the protein expression of proliferation and metastatic markers (VEGF, MMP-7, EGFT, Ki-67 and, PCNA) in tumors obtained from PDTX models, which may be the mechanism underlying the profound antitumor growth effect exerted by trastuzumab + cetuximab. Conclusions: The data indicate that trastuzumab + cetuximab combinational therapy should be the most effective antitumor growth therapy for the GC patient whom we took the cancer cells from (AU)

No disponible

Aspectos inmunológicos de la leucemia mieloblástica aguda / An immunological approach to acute myeloid leukaemia

INTRODUCCIÓN: La leucemia mieloblástica aguda (LMA) constituye la segunda hemopatía maligna en la población pediátrica y una de las principales causas de mortalidad por cáncer infantil. La supervivencia se sitúa alrededor del 60% sin haber mejorado en las últimas décadas, por lo que son necesarios nuevos enfoques terapéuticos. El efecto antileucémico ejercido por los linfocitos y las células natural killer (NK) del sistema inmunológico está bien establecido en el trasplante de células madre hematopoyéticas pero también como estrategia de inmunoterapia adoptiva tras la quimioterapia de consolidación. PACIENTES Y MÉTODOS: De manera retrospectiva, se analizan las características clínicas de los pacientes diagnosticados de LMA en nuestro centro durante el período 1996-2014. Además en 10 leucemias agudas, 5 linfoides y 5 mieloides, se analizaron la intensidad media de fluorescencia de HLA-I, MICA-B, ULBP1-4, ligandos para los receptores de las células NK. RESULTADOS: Un total de 67 pacientes formaron parte de este análisis. La supervivencia libre de eventos con una mediana de seguimiento de 25 meses fue del 62% (IC del 95%, 55-67). Las LMA con menor supervivencia fueron las secundarias, las no M3 y las carentes de marcadores citogenéticos favorables. La probabilidad de recaída fue del 38% (IC del 95%, 31-45). La expresión de HLA-I y ULBP-4 fue significativamente menor en los blastos mieloides que en los linfoides. CONCLUSIONES: Nuestros resultados clínicos son similares a los descritos en la literatura. No se ha modificado significativamente la supervivencia en las últimas décadas y la probabilidad de recaída sigue siendo elevada. Los blastos mieloides podrían ser más susceptibles a las células NK al expresar menos HLA-I, por lo que estrategias de terapia celular podrían ser eficaces tal y como reportan otros grupos

INTRODUCTION: Acute myeloid leukaemia (AML) is the second haematological malignancy in the paediatric population, and one of the leading causes of childhood cancer mortality. Survival is currently around 60%, with no improvement in last decades, suggesting that new therapeutic approaches are needed. The anti-leukaemia effect mediated by the lymphocytes and natural killer (NK) cells of the immune system has been established in haematopoietic stem cell transplantation, and also as adoptive immunotherapy after consolidation chemotherapy schemes. PATIENTS AND METHODS: A retrospective study was conducted on the clinical characteristics of patients diagnosed and treated for AML in our centre during 1996-2014. The mean fluorescence intensities of HLA-I, MICA/B and ULBP1-4, ligands for NK cell receptors, were also analysed in ten new diagnosed leukaemia cases, five myeloid and five lymphoid. RESULTS: A total of 67 patients were used in this analysis. With a median follow up of 25 months, the event-free survival was 62% (95% CI: 55-67). Secondary AML, non-M3 phenotype, and the absence of favourable cytogenetic markers had a lower survival. The probability of relapse was 38% (95% CI: 31-45). The expression of HLA-I and ULBP-4 was significantly lower in myeloid than in lymphoid blast cells. CONCLUSIONS: Our clinical results are similar to those described in the literature. Survival did not significantly change in recent decades, and the likelihood of relapse remains high. Myeloid blasts might be more susceptible to the cytotoxicity of NK cells through their lower expression of HLA-I. NK therapy strategies in minimal disease situation could be effective, as reported by other groups

Disfunción en el trastorno por déficit de atención/hiperactividad: evaluación y respuesta al tratamiento / Dysfunction in attention deficit hyperactivity disorder: assessment and response to treatment

El trastorno por déficit de atención/hiperactividad (TDAH) es un trastorno heterogéneo y complejo sintomá- ticamente. Su sintomatología cardinal, la presencia de problemas disejecutivos, la desregulación emocional de muchos de ellos y la propia comorbilidad, entre otros, condicionarán su expresión clínica y la disfunción. La tipificación del TDAH como ‘trastorno’ requiere una evaluación precisa del término ‘disfunción’ o ‘repercusión’. Los avances en la tipificación y cuantificación de la sintomatología característica del TDAH deberían trasladarse a la medición y objetivación de la disfunción. La estimación de la disfunción como una simple interferencia, por clara que sea, podría llevar a una sobreestimación del diagnóstico de este trastorno. Del mismo modo que es ineludible su estimación para el diagnóstico, es igualmente necesaria para la correcta evaluación de la eficacia de las intervenciones terapéuticas, especialmente a medio y largo plazo. Son necesarios estudios adicionales en este sentido para valorar la eficacia de los tratamientos, sean farmacológicos o no, en diferentes dominios (relación social, aprendizaje, autoestima, calidad de vida, siniestralidad…) (AU)

Attention deficit hyperactivity disorder (ADHD) is a heterogeneous, symptomatically complex disorder. Its cardinal symptom, the presence of dysexecutive problems, emotional dysregulation of many of them and its own comorbidity, among others, will condition its clinical expression and the dysfunction. Classifying ADHD as a ‘disorder’ calls for an accurate assessment of the terms ‘dysfunction’ or ‘repercussion’. The progress made in the classification and quantification of the symptoms characterising ADHD should be applied to measuring and objectifying dysfunction. Considering dysfunction as a simple interference, however clear it may be, could lead to an overestimation of the diagnosis of this disorder. Just as its estimation is essential for a diagnosis, it is also necessary for the correct evaluation of the efficacy of the therapeutic interventions, especially in the medium and long term. Further studies are needed in this sense to appraise the efficacy of the treatments, whether pharmacological or not, in different domains (social relationship, learning, self-esteem, quality of life, accidents, etc.) (AU)

Metotrexato en el tratamiento de la artritis psoriásica / Methotrexate in the treatment of psoriatic arthritis

A pesar de la falta de evidencia sólida en la bibliografía, las recomendaciones de los diferentes grupos internacionales para el tratamiento de la artritis psoriásica sitúan al metotrexato como el fármaco de primera elección. La experiencia clínica acumulada por los reumatólogos con el metotrexato, su perfil de seguridad y el nivel de retención que demuestran los registros nacionales, avalan dicha posición en el algoritmo terapéutico. Sin embargo faltan evidencias sobre su eficacia en otras manifestaciones extraarticulares de la artritis psoriásica, por lo que no se recomienda para el tratamiento de la entesitis ni de la espondilitis. En artritis psoriásica, a diferencia de la artritis reumatoide, no se ha demostrado que el tratamiento combinado sea superior al anti-TNFa. Sin embargo, el metotrexato puede alargar la supervivencia de los fármacos anti-TNFa, fundamentalmente la de los anticuerpos. Se requieren ensayos clínicos controlados para determinar la eficacia del metotrexato en la entesitis y dactilitis psoriásica, así como su papel en la terapia combinada (AU)

Despite the lack of solid evidence in the literature, methotrexate (MTX) is recommended as the first choice drug for the treatment of psoriatic arthritis (PsA) by distinct international groups. This position in the therapeutic algorithm is supported by the clinical experience of MTX accumulated by rheumatologists, its safety profile and retention level shown by national registries. However, there is a lack of evidence on the effectiveness of MTX in other extra-articular manifestations of PsA and therefore it is not recommended for the treatment of enthesitis and spondylitis. Combination therapy has not been shown to be superior to anti-TNFa therapy in PsA, unlike rheumatoid arthritis. However, MTX may prolong the survival of anti-TNFa drugs, mainly that of antibodies. Controlled clinical trials are required to determine the efficacy of MTX in enthesitis and psoriatic dactylitis, as well as its role in combination therapy (AU)

Enfermedad de Hansen y ginecomastia / No disponible

La lepra es una de las causas de ginecotelia, sin embargo poco se ha publicado sobre este signo común y generalmente ignorado. La prevalencia de ginecomastia, una complicación bien conocida de la lepra en pacientes varones adultos, es poco reportada. El tratamiento temprano tiene un efecto notable en la reducción de la misma. Presentamos el caso de un varón con lepra multibacilar con ginecotelia y ginecomastia, en el curso de la enfermedad

Leprosy is one of the causes of gynaecothelia, however little has been published on this common and generally ignored sign. The prevalence of gynecomastia, a well known leprosy complication in adult male patients, is little reported. Early treatment has a marked effect in reducing it. Here we present the case of a man with multibacillary leprosy who had been associated gynaecothelia and gynecomastia in the course of the disease

Evaluación positiva de medicamentos: junio y julio 2014 / Positive assessment of drugs: June and July of 2014

Se reseñan los medicamentos ya evaluados por la Agencia Española de Medicamentos y Productos Sanitarios hechos públicos en junio, julio y agosto de 2014, y considerados de mayor interés para el profesional sanitario. Se trata de opiniones técnicas positivas que son previas a la autorización y comercialización del medicamento

The drugs assessed by the Spanish Agency for Medicines and Health Products made public in June, July and August of 2014, and considered of interest to the healthcare professional, are reviewed. These are positive technical reports prior to the autho-rization and placing on the market of the product

Impact of a pill box clinic to improve systolic blood pressure in veterans with uncontrolled hypertension taking 3 or more antihypertensive medications.

BACKGROUND: Two-thirds of Americans who are prescribed antihypertensive medications are not at a blood pressure (BP) goal of <140/90 mmHg, and low adherence is identified as a primary cause of inadequate control. Improved adherence to antihypertensive medications has been shown to enhance BP control and reduce the risk of cardiovascular complications. This study investigated the effectiveness of a pill box clinic to improve BP in veterans with uncontrolled hypertension taking 3 or more antihypertensive medications. OBJECTIVES: To (a) investigate the reduction of systolic BP by 10 mmHg from pre-intervention to post-intervention (primary outcome) and (b) investigate the percentage of patients meeting goal blood pressure--as defined by The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7)--and percentage of patient adherence to antihypertensive medications (secondary outcomes). METHODS: Patients with uncontrolled hypertension currently taking at least 3 antihypertensive medications were enrolled in this prospective pre/post study. Under the supervision of a pharmacist, each patient was provided two 7-day pill boxes to organize all antihypertensive medications. In addition, baseline BP and previous history of nonadherence were documented. Following the initial encounter, patients attended 2 follow-up appointments, at 2 and 4 weeks, for refill of pill boxes, BP measurement, and adherence assessment. A chi-square test was used for categorical outcomes and logistic regression for nominal outcomes as well as descriptive statistics, as appropriate. RESULTS: Sixty patients were enrolled, with 50 completing appointments 1 and 2, and 45 completing all 3 appointments. Of those, 24% and 31% achieved at least a 10 mmHg reduction in systolic BP from baseline to appointments 2 and 3, respectively (P = 0.438). Systolic BP readings for appointments 1, 2, and 3 were not statistically significant (mean [SD]: 134.1 [11.8], 131.9 [9.4], and 130.6 [11.4], respectively). Goal BP per JNC7 was achieved by 44% and 51% of patients at appointments 2 and 3, respectively, compared with baseline (P = 0.201). All patients had ≥ 80% adherence to antihypertensive medications, assessed via pill counts at the second and third appointments. CONCLUSION: Although results were not statistically significant, the pill box clinic resulted in clinically significant reductions in systolic BP by 10 mmHg, as well as an increased number of patients meeting prescribed BP goals.

Delivery interaction between co-infused medications: an in vitro modeling study of microinfusion.

OBJECTIVE: To test the hypothesis that steady-state drug delivery by continuous infusion is predictably affected by a second drug infusion in the same lumen. BACKGROUND: Clinicians commonly administer two drugs by continuous infusion through one central venous catheter lumen (co-infusion). To limit fluid delivery, low flow rate carriers transport concentrated drug solutions; a method called microinfusion. How microinfusion delivery of one drug is affected by a second drug infusion has not been explored. METHODS: Two water-soluble dyes, tartrazine and erioglaucine, infused at 3 ml · h(-1), modeled drug delivery through a four stopcock linear manifold and catheter lumen. A pump drove a carrier fluid (10 ml · h(-1)). After tartrazine reached steady-state delivery, erioglaucine entered downstream or upstream of the tartrazine infusion. Quantitative spectrophotometry measured dye delivery. RESULTS: Starting erioglaucine's infusion upstream of tartrazine's entry caused a transient tartrazine bolus (duration 10 min, peak drug delivery 20% higher than target levels). Starting erioglaucine's infusion downstream produced a similar amplitude, briefer, bolus. Stopping the erioglaucine infusion caused a transient reduction in tartrazine delivery. Measured delivery profiles were comparable to prediction models. CONCLUSIONS: We confirmed the hypothesis that delivery of one infused drug is transiently affected by starting or stopping a second drug infusion in the same line. The magnitude of the changes can be estimated quantitatively. The clinical impact depends on the drugs being co-infused and patient sensitivity, but could be clinically important; the findings have safety implications for infused medication delivery to critically ill or anesthetized children. We recommend minimizing infusion system dead volumes, connecting the most essential infusion(s) to the main fluid pathway as close as possible to the patient, and recognizing the potential for unintended alterations in delivery when multiple drugs co-infuse.