16 would be assessed, considering the main response variable as a 50% reduction in the Eczema Area and Severity Index (EASI), EASI-50. In addition, the intensity reduction of the pruritus according to the Numerical Rating Scale (NRS) as well as the variation in the quality of life according to the Dermatology Life Quality Index (DLQI). Results The baseline EASI, NRS and DLQI values were respectively: 23, 6 and 23. Three days after first administration, the patient suffered from headache, low-grade fever and intense itching. One month later lesions were clearer and smaller, but the patient developed intense conjunctivitis requiring treatment with levocabastine. The EASI, NRS and DLQI values at week 16 were respectively: 7, 8.3 and 9. The EASI percentage reduction was 66%. Three months' later conjunctivitis persisted, not improved with antihistamines, and topical corticosteroids. In addition, the patient referred episodes of anxiety and erectile dysfunction. These AEs were reported to the Pharmacovigilance Centre. All this caused treatment discontinuation. Conclusion Clinical improvement was evident, also quantitatively according to the used scales. Post-injection EAs are common in most patients. In this case, conjunctivitis was limiting and forced treatment suspension. EAs not described in the literature previously were found and associated with dupilumab, given the temporal match. According to subsequent experience with other patients, prophylaxis with artificial tears can be effective in the prevention of conjunctivitis, showing that dupilumab is an effective alternative in patients refractory to other therapies. REFERENCES AND/OR ACKNOWLEDGEMENTSThanks to the Dermatology Department for its collaboration.
There were therapeutic indications in 129 of the prescriptions, of which 22.5% were for skin and soft-tissue infections, followed by 15.5% complicated urinary tract infections and 9.3% pneumonia. Amoxicillin-clavulanate was the most prescribed antibiotic for treatment and prophylaxis purposes (48.1% and 29.8% respectively). According to syndrome, worst guideline compliance was observed in complicated urinary tract infections 57.9% and skin and soft-tissue infections (65.5%). Conclusion In our setting, adequate acquisition definition, compliance with local guidelines, obtaining of microbiological samples and certain clinical syndromes (skin and soft tissue and urinary) were the main variables identified to prioritise ASP-targeted intervention.
Material and methods A prospective study (June-September 2019) was carried out. Variables included demographics, duration of PN, indication for PN, type of PI and degree of acceptance. The data were obtained from medical and pharmaceutical nutrition records. Results Fifty-four patients were registered (71% men, average age 65 years (range 39-87)). The average duration of PN was 11 days (1-39). A total of 176 interventions were recorded (3.3 PIs/patient): 91.5% during follow-up and 8.5% after finishing PN. Distribution of PIs according to diagnosis were: polyvalent critical patients (48.1%); postoperative complications (29.6%); colorectal surgery (9.2%); upper gastrointestinal tract surgery (5.7%); pancreatitis (3.7%); and liver diseases (3.7%). According to the type of PI: 36.6% were related to a change in the composition of macronutrients, and 61% of these PIs were related to proteins (78%-increase in order to cover the nitrogen requirements), 23.7% were related to lipids (71%-restriction due to triglycerides >400) and 15.3% were related with carbohydrates (100%-decrease in the supply due to high levels of glycaemia); 31.7% were related to a change in the amount of electrolytes (53%-extra supply; 47%-restriction), with phosphorus being the electrolyte which generated the highest number of PIs (45%); 18.6% were related to addition of insulin in the PN; 10.6% were related to a request for a nutritional profile; and 2.5% were related to cycling of PN due to cholestasis. Most of the PIs (88.7%) were accepted by physicians. Conclusion and relevance The majority of interventions were due to changes in the composition of macronutrients and micronutrients of the PN, adjusting to the constant changes in the needs of critically ill patients. The high number of PIs per patient and the high degree of acceptance by physicians highlight the significant role of the hospital pharmacist in the nutritional control of critically ill patients.
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