Although herpes zoster virus usually affects sensory nerves, it can also damage motoneurons. Injury to the phrenic nerve has been described previously, but only anecdotally. We report on a case of left hemidiaphragmatic paralysis with severe axonal degeneration secondary to cervical herpes zoster, and describe its clinical, radiological, pulmonary function and electromyographic evolution during an 18-month follow-up.
Background Waldenstrom’s macroglobulinemia (MW) is an uncommon lymphoproliferative disorder of the B cells, associated with overproduction of the monoclonal component Immunoglobulin M (IgM). Purpose To analyse the treatment and outcome of patients with MW. Materials and Methods Observational, retrospective and descriptive study of all patients diagnosed with MW from 2001 to the present day. A cytostatic dispensing programme (OncoGest) and the electronic history (Selene) were used to gather the following data: gender, age, year of diagnosis, previous treatments, treatment regime, adverse reactions. The treatment response was rated according to symptom let-up and decrease in the serum IgM. Results 8 MW patients were included, their average age was 72 years old (rank: 51–82), of which 50% were male. The symptoms with which patients presented before commencing treatment included: asthenia (100%), anorexia, peripheral neuropathy (37.5%), anaemia (25%), hyperviscosity syndrome (62.5%); 40% of patients required a session of plasmapheresis. Various treatment regimens were used: Two of the patients commenced treatment with fludarabine, one started with cladribine and two with chlorambucil. Patients with fludarabine had a good response and in the other three cases the response was quite low; as a result, treatment was changed to weekly rituximab until the symptoms stopped and the IgM decreased. Three of the patients started treatment with weekly rituximab with a good response in two of the cases and one had a low response so the treatment was changed to rituximab with cladribine. All patients except one who is currently receiving rituximab and cladribine have had relapses after the first treatment. They were treated with weekly rituximab until the symptoms stopped, except in two of the cases, who currently continue with maintenance rituximab every two and three months respectively. As regards tolerance and adverse reactions, neutropenia appeared in just one patient treated with chlorambucil, the treatments were well tolerated by the remaining patients. Conclusions Various drugs are used for the treatment of MW: chlorambucil, fludarabine, cladribine and rituximab, alone or in combination. The treatment regimen the most commonly used, especially if weekly rituximab, especially for those patients that have had relapses with other treatments. Weekly rituximab is a treatment with a good response rate and is well tolerated. No conflict of interest.
Background The ‘Study on patient safety in primary health care’ (APEAS), published in 2008 by the Spanish Health Ministry declared that 48% of adverse events (AEs) detected in these patients were due to medicines errors (MEs). The Institute for Safe Medication Practices (ISMP) promotes the development of internal systems to report medicines-related incidents in hospitals in order to achieve effective preventative measures. PurposeTo analyse total errors in an intravenous mixing unit and establish checkpoints to prevent them. Materials and MethodsProspective observational study (August–December 2011) which included outpatients who might be exposed to an error with intravenous medicines. The variables were: Wrong drug, original prescription service, prescription type (manual or printed), who detected the error and process error (prescription, validation, preparation or administration). Errors were classified according to severity category and error type based on the taxonomies listed in ISMP Spain. The errors observed and reported by the staff involved with the process were recorded by the pharmacist. The differences between frequencies were checked with the Chi-Square statistical test. ResultsThe total error frequency (EF) was 1.27%. The drugs most frequently involved were natalizumab (2.43%), infliximab (1.23%) and intravenous immunoglobulin (1.23%). No statistically significant differences between EF of each drug and the mean frequency were detected (P = 0.94, 0.76 and 0.94). The services involved were: Gastrointestinal (2.98%), Neurology (1.57%), Rheumatology (1%), Haematology (0.15%) and Oncology (0.035%). Only in the Haematology and Oncology services were differences from the average found (P = 0.038, p = 0.001). Most failed orders were manual (67%). All incidents occurred in the prescribing process and were detected by the pharmacist during validation. No errors reached the patient (category B). In the classification by error type: 67% were incorrect date (periodicity in the cycle), 22% dosage (50% excess) and 11% in the rate of administration. Conclusions After reviewing the results we can assume that the main checkpoints where our activities should focus on are the following: incorrect date, dosage and rate of administration. A possible methodological bias can be considered because the data were collected in the pharmacy unit and all errors were prescription errors – no pharmacy or process errors. No conflict of interest.
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