Objective: The aim of the present study is to investigate the effect of antioxidant polyphenol-rich pomegranate juice (PJ) supplementation for 5 weeks on patients with stable chronic obstructive pulmonary disease (COPD), since the oxidative stress plays a major role in the evolution and pathophysiology of COPD. Design: A randomized, double-blind, placebo-controlled trial was conducted. Subjects: A total of 30 patients with stable COPD were randomly distributed in two groups (15 patients each). Interventions: Both groups consumed either 400 ml PJ daily or matched placebo (synthetic orange-flavoured drink) for 5 weeks. Trolox Equivalent Antioxidant Capacity (TEAC) of PJ, blood parameters (14 haematological and 18 serobiochemical), respiratory function variables, bioavailability of PJ polyphenols (plasma and urine) and urinary isoprostane (8-iso-PGF 2a ) were evaluated. Results: The daily dose of PJ (containing 2.66 g polyphenols) provided 4 mmol/l TEAC. None of the polyphenols present in PJ were detected in plasma or in urine of volunteers. The most abundant PJ polyphenols, ellagitannins, were metabolized by the colonic microflora of COPD patients to yield two major metabolites in both plasma and urine (dibenzopyranone derivatives) with no TEAC. No differences were found (P40.05) between PJ and placebo groups for any of the parameters evaluated (serobiochemical and haematological), urinary 8-iso-PGF 2a , respiratory function variables and clinical symptoms of COPD patients. Conclusions: Our results suggest that PJ supplementation adds no benefit to the current standard therapy in patients with stable COPD. The high TEAC of PJ cannot be extrapolated in vivo probably due to the metabolism of its polyphenols by the colonic microflora. The understanding of the different bioavailability of dietary polyphenols is critical before claiming any antioxidantrelated health benefit. Sponsorship: 'Fundació n Séneca' (Murcia, Spain), Project PB/18/FS/02 and Spanish CICYT, Project AGL2003-02195.
Background As the result of Resolution SC 0403/10 of December 22, 2010 in the region of Andalucia (Spain) some medicines for outpatient treatment are no longer dispensed in community pharmacies but in hospital pharmacies, given that they require special surveillance, supervision and control. Purpose To determine the savings made by dispensing oral cytostatic drugs in a third-level hospital. Materials and methods Descriptive observational study of the oral cytostatics dispensed between December 2010 and March 2013. Data were collected from APD software. We determined: The total expenditure on dispensing cytostatics for out-patients, The percentage of this expenditure relative to the total expenditure on all oral medicines for outpatients, The cost savings, The most expensive active ingredients. Results The value of oral cytostatics totalled 6,731,547.87 € during the period of study. This meant 6.37% of the total amount of out-patient prescriptions for oral medicines for the same period. These prescriptions would have cost € 7,141,037.52 if they had been made at community pharmacies. Therefore, these results equate to a saving of € 409,489.64. The active ingredients that affected the cost most were imatinib and sunitinib. Conclusions Hospital dispensing of oral cytostatics led to a cost saving of 5.73% when compared to community pharmacy dispensing. Two factors explain this cost saving: The Avoidance of Any Commercial Expenditure Undertaken by Community Pharmacies The Optimisation of Resources Driven by Patients Taking the Exact Amount Needed of the Drug as They Are Required to Return Any Untaken Medicine When Completing or Changing Their Treatment No conflict of interest.
A57and disability prevalence by age group through national databases of healthcare attentions. A systematic literature search and a modified Delphi were performed to obtain other necessary information like mortality, disability distribution by severity, and duration of sequelae. These data were then used to estimate CVD burden of disease for Colombia. DALY estimation considered recent methodological changes introduced in Global Burden of Disease 2010 study. Updated life expectancy tables, no discount rate, and absence of age-weighting are the main changes from previous methodology. Sensitivity analysis was performed to evaluate the impact of changing these parameters. CVD burden of disease was also estimated for the five year period 2009-2013. Results: We estimated 1.31 incident cases of CVD/1,000 for Colombia in 2014. DALY, years of life lost due to premature death (YLL) and years lost due to disability (YLD) were 14/1,000, 7.1/1,000 and 6.9/1,000, respectively. Sensitivity analyses showed important differences in the estimation, when parameters of the estimation changed. ConClusions: CVD incidence, mortality and burden of disease estimations performed in this study agree with data from other studies. CVD is a relevant cause of disability and mortality in Colombia. This disease is a priority for Colombian health policy. Identifying the most vulnerable groups is essential to create effective prevention and promotion programs. PCV100The UPTake of NoN-ViTamiN k oral aNTiCoagUlaNTs iN irelaNd: BalaNCiNg CosT-effeCTiVeNess aNalysis aNd BUdgeT imPaCT
BackgroundTransplantation-associated thrombotic microangiopathy (TMA) is a feared complication of allogeneic hematopoietic stem cell transplantation (HSCT) owing to its high rate of mortality. The use of calcineurin inhibitors or sirolimus for graft-versus-host disease (GVHD) prophylaxis has been suggested as a potential risk factor.PurposeTo analyse the incidence of TMA in patients undergoing HSCT who received ciclosporin as prophylaxis against GVHD; to investigate the cause of this phenomenon.Material and methodsRetrospective observational study that reviewed the medical records of patients who had suffered from TMA after allogeneic HSCT in the haematology service of a tertiary hospital from 2010 to 2014. To obtain the results, the diagnostic criteria associating TMA with the bone marrow transplant of the International Working Group were measured.ResultsOf the 50 patients undergoing allogeneic HSCT, 10 suffered ciclosporin-associated TMA. In 4 TMA emerged with the addition of ciclosporin to sirolimus and in 6 when sirolimus was added to ciclosporin. The reason for the addition of these immunosuppressants was acute GVHD in 3 patients and in 7 due to chronic GVHD. The response to TMA was to suspend ciclosporin and maintain sirolimus and corticosteroids in 4 patients whereas in 6 both ciclosporin and sirolimus were suspended. In 4 patients phenytoin was added, in 2 haemodialysis was performed, in 3 plasmapheresis was done and in 1 rituximab was administered. In all the cases the duration of active levels of basal ciclosporin after it had been suspended was about two or four months.ConclusionThe appearance of TMA in patients undergoing allogeneic HSCT is a concern. All cases present moderate to severe haemolytic anaemia, negative direct Coombs, thrombocytopenia, elevated LDH and creatinine, schistocytes >4% and kidney disorders. The cause of the sustained increase in the time of ciclosporin levels is still unknown, it is thought that an ABCB1 genetic polymorphism can produce this phenomenon.References and/or acknowledgementsPharmacogeneticsNo conflict of interest.
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