generated more oscillation in plasma levels. For qualitative variables, absolute and relative frequencies were obtained, and for quantitative variables, the median (IQR) were used. For hypothesis contrast, Fisher's exact test or the Mann-Whitney U test was performed according to the type of variable. Results 45 patients were included, 23 received voriconazole and 22 isavuconazole. Median age was 62 years (56-67) for those receiving voriconazole versus 63 years (54-68) for those receiving isavuconazole (p=0.91). 34.8% (n=8) of patients treated with voriconazole achieved concentrations of tacrolimus >20 ng/mL (toxic concentration) within 10 days from the start of the combination compared with 14.3% (n=3) of patients treated with isavuconazole (p=0.1685). The median standard deviation of plasma concentrations was 3.76 ng/mL (2.89-4.5) with voriconazole versus 3.17 ng/mL (1.4-5) with isavuconazole (p=0.272). The proportion of patients who temporarily discontinued tacrolimus treatment due to high level concentrations and associated toxicity was 18.2% (n=4) with isavuconazole versus 34.8% (n=8) with voriconazole (p=0.318). Regarding tolerance to treatment, 28.57% of patients treated with isavuconazole had side effects associated with azole, compared with 82.6% of those treated with voriconazole (p<0.005). Treatment had to be suspended due to these side effects in 47.82% (n=11) of patients treated with voriconazole and in no patient treated with isavuconazole (p<0.005). Conclusion and relevance Treatment with isavuconazole resulted in fewer tacrolimus poisonings, although the difference was not statistically significant. In addition, treatment with isavuconazole was found to be safer, had fewer side effects and did not require antifungal discontinuation.
particularly in treatment modifications of anxiolytics and sedatives.This study suggests that pharmacists may find it difficult to achieve anticholinergic burden reductions by suggesting AD changes to physicians and patients.
Background and importance Nutritional support by the parenteral route aims to prevent and recover nutritional deficits whenever enteral nutrition is insufficient or contraindicated. Caloric requirements must be calculated according to the degree of metabolic stress, percentage of ideal weight and extent of intestinal failure. During parenteral nutrition (PN) complications such as hydroelectrolyte and metabolic imbalance may occur (eg, refeeding syndrome), which increase morbidity and mortality among patients. Aim and objectives Monitoring the effectiveness of the protocol established in 2006 that provides for the PN onset within 72 hours with caloric restriction (in the first 24 hours starts with 50% of caloric needs, in 48 hours with 75%, and in 72 hours and following with 100%), as well as evaluating compliance with the recommendations of the American Society for Parenteral and Enteral Nutrition/European Society for Clinical Nutrition and Metabolism (ASPEN/ESPEN) PN guidelines. Material and methods Retrospective analysis of biochemical parameters (albumin, total protein, C-reactive protein (CRP), serum creatinine (Cr), potassium, phosphate and magnesium) in patients with PN. Data were collected through the patient's clinical records and the calculation of nutritional needs was carried out using the Harris-Benedict formula. Results Forty patients (14 women and 26 men) were analysed in the period April-August 2021 (age 72±12 years). The majority of patients were in Surgery Ward (78% patients). PN bags administered: 82% 1600 kcal, 13% 2200 kcal and 5% 1400 kcal. Gastric neoplasms and peritonitis were the main diagnoses associated with NP. The average onset of NP administration was 9±7 days. All patients showed high CRP (>5 mg/dL), low total protein (<6.6 g/dL) and 85% of patients showed hypoalbuminaemia at onset of PN. Although, daily analyses of the recommended electrolytes were not performed, it was observed that 20% developed hypokalaemia, 18% hypophosphataemia and 8% hypomagnesaemia. No refeeding syndrome was diagnosed in the studied sample. Conclusion and relevanceThe start of 72-hour PN protocol with caloric restriction allowed avoidance of the refeeding syndrome, which usually appears within the first 7 days after the onset of PN. The compliance of ESPEN/ASPEN guidelines for daily monitoring of electrolytes was not observed for all patients. So, it will be proposed to reinforce pharmaceutical interventions, as well as developing together with the clinical team a monitoring protocol for patients under PN.
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