Nutrición parenteral domiciliaria en paciente con enfermedad de Crohn; a propósito de un caso / Home parenteral nutrition in Crohn's disease patient; a case report

Paciente diagnosticada de Enfermedad de Crohn con patrón inflamatorio que evoluciona a estenosante-perforante, provocando una perforación abdominal con peritonitis fecaloidea. Es sometida a tres intervenciones quirúrgicas, derivando en numerosas complicaciones y una evolución clínica tórpida. Dado el estado de desnutrición al ingreso se le prescribe Nutrición Parenteral Total (NPT), prolongándose la administración durante más de 10 meses. En este periodo se le suspende durante 5 días, pero la persistencia de una fístula enterocutánea provoca la restauración de la NPT. Tras su estabilización clínica, la paciente es dada de alta hasta recuperación de su estado nutricional necesario para realizar una cirugía de reconstrucción del intestino, continuando con NPT en su domicilio. Después de 7 meses y medio, la paciente con un estado nutricional óptimo, es sometida a la intervención quirúrgica, evolucionando favorablemente y suspendiendo la NPT a los 9 días (AU)

Patient diagnosed with Crohn's Disease with inflammatory pattern that evolves stenosing-piercing, causing abdominal perforation and fecal peritonitis. She was underwent to three surgeries, leading to numerous complications and a torpid clinical course. Given the state of malnutrition on admission it was prescribed Total Parenteral Nutrition (TPN), extending the administration for more than 10 months. In this period the TPN is suspended for 5 days, but the persistence of an enterocutaneous fistula causes the restoration of the TPN. After clinical stabilization, the patient is discharged to recover her nutritional status necessary to perform a bowel reconstruction surgery, continuing with TPN at home. After 7 and a half months, the patient with an optimal nutritional status, undergoes surgery, evolving favorably and suspending the TPN at 9 days (AU)

Amlodipine in pediatric patient with uncontrolled multifactorial hypertension. Formulation of amlodipine oral suspension.

OBJECTIVE: To describe the case of treatment with amlodipine in a poorly controlled hypertension in a pediatric patient diagnosed with tricodistrofia. CASE SUMMARY: Girl 5 years old, diagnosed of tricodistrofia included within the Tay-Sachs syndrome. As a consequence of a cardiac arrest suffered in the context of a respiratory distress syndrome associated with infection by influenza A, she developed hypertension initially treated with nifedipine and captopril. After several months of treatment and a poor control of the hypertension, a change of treatment was decided, substituting nifedipine by amlodipine (2.5 mg/24 hours orally) and captopril by enalapril (2.5 mg/24 hours orally). Pharmacy service is request to get a amlodipine syrup that allows a dose adjustment to the needs of the patient. After the change of treatment the patient begins to maintain diastolic blood pressure levels within the normal range, suspending the administration of enalapril, maintaining good control of blood pressure with amlodipine 2 mg/24 hours. DISCUSSION: Most of antihypertensive drugs used in adults do not have clinical trials to evaluate its effects in the pediatric population. Furthermore, the lack of familiarity with the pharmacokinetic characteristics of the child, raises problems to adjust the dose to the changing reality of a child. In this situation, clinical experience supports the use of some of these drugs in children with optimal results. With the addition to the pediatric field of calcium antagonists and ACE-inhibitors or ARB-II, they allow as to have greater potential therapeutic alternatives.

Efectividad y toxicidad de erlotinib en la farmacoterapia del cáncer de pulmón no microcítico / Efficacy and toxicity of erlotinib in non-small cell lung cancer treatment

Objetivo Evaluar la efectividad y toxicidad del erlotinib en pacientes con cáncer de pulmón no microcítico. Métodos Los pacientes se han seleccionado de una base de datos de dispensación a pacientes ambulatorios. El periodo de tiempo seleccionado fue de enero 2008 a enero 2010 y para la recolección de datos se empleó la historia clínica del paciente en formato electrónico y en papel. Como medida de respuesta hemos usado los criterios RECIST (Response Evaluation Criteria in Solid Tumors), también hemos medido el tiempo hasta la progresión y la supervivencia global. La toxicidad se evaluó según la Common Terminology Criteria for Adverse Events (CTCAE).Resultados Se encontraron respuestas parciales en 5/46 pacientes y criterios de enfermedad estable en 14/46 pacientes. El tiempo hasta progresión de la enfermedad fue 4,01 meses (mediana 2,33 meses) y la supervivencia global 5,63 meses (mediana 4,67). Las toxicidades más frecuentes fueron exantema, anorexia, astenia, infecciones y efectos adversos gastrointestinales. Los pacientes que desarrollaron toxicidad cutánea tuvieron un tiempo hasta la progresión y una supervivencia global mayor (estadísticamente significativo) que el grupo que no la desarrolló (media de tiempo hasta la progresión: 7,87 meses versus 2,76; media supervivencia global: 10,74 meses versus 3,98).Conclusiones Los hallazgos del análisis de supervivencia indican una efectividad menor en nuestra población de pacientes en relación con otras publicaciones y las reacciones adversas describen el patrón esperado. A pesar de tener en cuenta nuestra principal limitación, el tamaño de la muestra, podría tratarse de una alternativa para los pacientes con cáncer de pulmón no microcítico (AU)

Objective To evaluate the efficacy and toxicity of erlotinib in patients with non-small cell lung cancer. Method Patients were selected from an outpatients’ dispensing database. The time period selected was from January 2008 to January 2010. Data was collected from patient's medical history - electronic and paper based. We used Response Evaluation Criteria in Solid Tumours (RECIST) to measure response and measured time to progression and overall survival. Toxicity was evaluated according to the Common Terminology Criteria for Adverse Events (CTCAE).Results We found partial response in 5/46 patients and stable disease in 14/46 patients. Time to disease progression was 4.01 months (median 2.33 months) and overall survival was 5.63 months (median 4.67). The most common toxicities were rash, anorexia, asthenia, infection and gastrointestinal side effects. Patients who developed skin toxicity had a (statistically significant) greater time to progression and overall survival rate than the group that did not develop this toxicity (mean time to progression: 2.76 vs. 7.87 months; mean overall survival: 10.74 months vs. 3.98).Conclusions Survival analysis findings suggest lower efficacy in our patient population in comparison with data seen in other publications, and adverse events followed the expected pattern. Although our greatest limitation was sample size, which must be kept in mind, this therapy could be an alternative for patients with non-small cell lung cancer (AU)

[Home parenteral nutrition in Crohn's Disease patient: a case report]. / Nutrición parenteral domiciliaria en paciente con enfermedad de Crohn: a propósito de un caso.

Patient diagnosed with Crohn's Disease with inflammatory pattern that evolves stenosing-piercing, causing abdominal perforation and fecal peritonitis. She was underwent to three surgeries, leading to numerous complications and a torpid clinical course. Given the state of malnutrition on admission it was prescribed Total Parenteral Nutrition (TPN), extending the administration for more than 10 months. In this period the TPN is suspended for 5 days, but the persistence of an enterocutaneous fistula causes the restoration of the TPN. After clinical stabilization, the patient is discharged to recover her nutritional status necessary to perform a bowel reconstruction surgery, continuing with TPN at home. After 7 and a half months, the patient with an optimal nutritional status, undergoes surgery, evolving favorably and suspending the TPN at 9 days.

[Efficacy and toxicity of erlotinib in non-small cell lung cancer treatment]. / Efectividad y toxicidad de erlotinib en la farmacoterapia del cáncer de pulmón no microcítico.

OBJECTIVE: To evaluate the efficacy and toxicity of erlotinib in patients with non-small cell lung cancer. METHOD: Patients were selected from an outpatients' dispensing database. The time period selected was from January 2008 to January 2010. Data was collected from patient's medical history - electronic and paper based. We used Response Evaluation Criteria in Solid Tumours (RECIST) to measure response and measured time to progression and overall survival. Toxicity was evaluated according to the Common Terminology Criteria for Adverse Events (CTCAE). RESULTS: We found partial response in 5/46 patients and stable disease in 14/46 patients. Time to disease progression was 4.01 months (median 2.33 months) and overall survival was 5.63 months (median 4.67). The most common toxicities were rash, anorexia, asthenia, infection and gastrointestinal side effects. Patients who developed skin toxicity had a (statistically significant) greater time to progression and overall survival rate than the group that did not develop this toxicity (mean time to progression: 2.76 vs. 7.87 months; mean overall survival: 10.74 months vs. 3.98). CONCLUSIONS: Survival analysis findings suggest lower efficacy in our patient population in comparison with data seen in other publications, and adverse events followed the expected pattern. Although our greatest limitation was sample size, which must be kept in mind, this therapy could be an alternative for patients with non-small cell lung cancer.

[The TPN of newborn infants: the rationalization of the calculations and of the prescription]. / NPT de neonatos: racionalización de los cálculos y de la presecripción.

We try to simplify the calculus of TPN necessities in newborns adjusting the most common bibliography tabulated values to mathematical equations. Values are transformed into factors: Fn (g of N/Kg of weight), Fk (no protein Kcal/g of N), Fg (glucose Kcal/total Kcal) and Fv (volume/total Kcal) that can be correlated with the analytical state of patient, weight and nutrition day. Once the functions were established we automated calculations using a spreadsheet program that simplifies and make easier the TPN elaboration.