Relationship between Lactate Dehydrogenase and survival in patients with non-small cell lung cancer receiving immunotherapy. / Relación entre el lactato deshidrogenasa y la supervivencia en pacientes con cáncer de pulmón no microcítico que reciben tratamiento con inmunoterapia.

OBJECTIVE: The expression level of programmed death ligand 1 (PD-L1) is the only approved biomarker for predicting response to immunotherapy, yet its efficacy is not always consistent. Lactate dehydrogenase (LDH) has been associated with tumor aggressiveness and poorer prognosis across various cancer types and may serve as a useful biomarker for monitoring treatment response. The objective of this study is to analyze the relationship between LDH levels prior to the start of treatment with immune checkpoint inhibitors (ICIs) and clinical outcomes in patients with non-small cell lung cancer (NSCLC). METHOD: A retrospective study was conducted including patients diagnosed with NSCLC who were treated with at least three cycles of immunotherapy. Data on demographics, clinical and pathological characteristics, treatment received, pre-treatment LDH levels, and clinical outcomes such as treatment response and overall survival (OS) were analyzed. RESULTS: A total of 181 patients diagnosed with NSCLC were included. Elevated pre-treatment LDH levels (more than 244 U/l) were associated with significantly reduced OS. The median survival was 548 days in patients with LDH less than 244 U/l, compared to 332 days in those with LDH more than 244 U/l (p = 0.037). Among men, OS was greater in the LDH less than 244 U/l group (623 days) versus 332 days in the LDH more than 244 U/l group (p = 0.043). In patients with metastatic disease, OS was higher in those with LDH less than 244 U/l (474 days) compared to 249 days in those with LDH more than 244 U/l (p = 0.023). In patients receiving both immunotherapy and chemotherapy, OS was greater in those with LDH less than 244 U/l (623 days) compared to 281 days in the LDH more than 244 U/l group (p = 0.042). CONCLUSIONS: High levels of LDH prior to the start of treatment with ICIs are associated with lower treatment efficacy and a worse prognosis of the disease, especially in male, metastatic patients with a PD-L1 expression level less than 1%.

Hair loss induced by lopinavir-ritonavir.

A 38-year-old Caucasian woman with uncontrolled human immunodeficiency virus (HIV) infection was treated with highly active antiretroviral therapy (HAART) consisting of zidovudine, lamivudine, and nevirapine. Because her therapeutic response was inadequate, the HAART regimen was changed to abacavir, lamivudine, and lopinavir-ritonavir. Three months after this therapy was started, the patient developed progressive and notable hair loss. Her hair became fair and thin, and her appearance deteriorated considerably. Hair loss due to HAART was diagnosed. Lopinavir-ritonavir was stopped, and efavirenz was substituted; abacavir and lamivudine were continued. After 4 weeks, her hair growth substantially improved, as evidenced by rapid growth of new hair. Her general condition also improved. No relapse was observed with the new HAART regimen, and the patient's hair loss completely reversed in 8 weeks. Alopecia is a possible adverse event in HIV-infected patients treated with protease inhibitors, particularly indinavir. Our patient's severe and generalized alopecia was temporally related to the initiation and discontinuation of lopinavir-ritonavir. On the basis of the Naranjo adverse drug reaction probability scale, the adverse reaction was considered probable. Although generalized hair loss due to lopinavir-ritonavir is rare, clinicians should be aware of this potential adverse reaction of this widely used drug. If alopecia is severe or particularly distressing to the patient, the offending drug should be discontinued, and therapy with another HIV drug should be started.

Programa multidisciplinario de prevención de errores de medicación en un hospital / Developing a multidisciplinary medication safety program in a hospital

Los errores de medicación (EM) son una de las principales causas de acontecimientos adversos prevenibles en el ámbito hospitalario, y se estima que afectan a un 1,8% (rango, 1,3-7,8%) de los pacientes ingresados. Por ello, se promueve el desarrollo e implantación de prácticas efectivas para mejorar la seguridad del sistema de utilización de medicamentos. El objetivo de este artículo es describir las principales fases de un programa interno de notificación y prevención de incidentes por medicamentos en un hospital, y comentar algunos aspectos que pueden facilitar su abordaje. Se destaca la importancia de contar con el compromiso explícito del equipo directivo para transformar la cultura de la institución y disponer de los recursos necesarios, así como constituir un comité multidisciplinario integrado por farmacéuticos, médicos, enfermeras y representantes del equipo directivo. Este comité debe fomentar la creación de una cultura de seguridad y paralelamente desarrollar los procedimientos necesarios para conocer, evaluar y mejorar continuamente la seguridad del sistema de utilización de los medicamentos. Esto supone una secuencia de actuaciones que incluyen, en primer lugar, el establecimiento de métodos para detectar los EM que ocurren, entre los cuales se comentan la notificación voluntaria, por ser el método básico, y los sistemas automatizados de alerta. A continuación se debe realizar el análisis y evaluación de los EM detectados, para identificar los fallos existentes en el sistema. Finalmente, el paso fundamental del programa es la implantación de medidas de mejora en función de los fallos detectados y el seguimiento de los resultados en términos de prevención de errores

Medication errors (ME) constitute one of the main causes of preventable adverse events in hospital settings, affecting an estimated 1.8% (range, 1.3-7.8%) of hospitalized patients. Concerns over this problem are leading to the development and implantation of effective practices designed to improve the safety of the medication use system. The objective of this article was to describe the principal steps of an internal program for reporting and preventing medication-related incidents in a hospital and to discuss certain aspects that might facilitate putting such a program into practice. The importance of obtaining an explicit commitment from the hospital administration to transform the culture of the institution and to provide the necessary resources, as well as to create a multidisciplinary committee including pharmacists, physicians, nurses, and administrators is emphasized. This committee should be charged with encouraging the creation of a culture of safety and at the same time with developing the procedures required to continually study, evaluate, and improve the safety of the medication use system. All of this presupposes a sequence of actions that includes, first of all, the establishment of methods for detecting MEs when they occur, which may include voluntary reporting, as the basic method, and computer alert systems. Next, analysis and evaluation of the detected MEs should be carried out to identify existing faults in the system. Finally, the fundamental step in the program is the implantation of measures for improvement according to the failures detected, with appropriate follow-up of results in terms of error prevention