BackgroundLaryngeal papillomatosis is a neoplasm of the larynx that is due to infection by the human papillomavirus (HPV). It can appear during the first year of life, or during adulthood, which increases the probability of becoming malignant. It is characterised by tumours within the voice box, vocal cords or the air duct, causing breathing problems, dysphagia, stridor and sore throat. The treatment of choice is surgery, but some patients require adjuvant treatment, such as cidofovir or alpha interferon.PurposeTo describe the efficacy and safety of treatment with interferon alpha 2A in laryngeal papillomatosis.Material and methodsA 1-year-old female patient was diagnosed with laryngeal papillomatosis serotype 6 from perinatal transmission with a diagnosis confirmed by bronchoscopy and laboratory tests. The patient showed signs of inspiratory and expiratory stridor, tachypnoea, elongated expiration with subcostal, suprasternal and intercostal retractions. She had to be operated on 6 times for the appearance of polyps on the vocal cords until finally doctors conducted a tracheostomy. Despite the interventions, the patient still maintained inspiratory and expiratory stridor so treatment with alpha interferon was the next step.ResultsAccording to the literature, treatment was started with a first week dose of 100 000 IU/kg, followed by a dose of interferon three times per week, varying the dose with the patient´s weight changes. Treatment showed no lesion progression. The last control bronchoscopy showed no lesions. It allowed prolongation of the frequency of consultations from 1 to 2 months. A possible adverse effect was described, because of the appearance of dominant face erythematous lesions after administration of some doses. Also, the onset of fever following a dose of interferon occurred once.ConclusionThe results showed that interferon alpha 2A was an effective and relatively safe treatment in this patient for the treatment of laryngeal papillomatosis. However, these results cannot be considered final, because the treatment was used in just one patient for 5 months. More studies and patients are needed to consider interferon alpha 2A as a good alternative treatment to patients with laryngeal papillomatosis.No conflict of interest.
BackgroundIn phase 1, 2 and 3 trials of nab-paclitaxel, substantial clinical activity was noted in patients with advanced pancreatic cancer.We conducted an observational study to assess the effectiveness and safety of this therapy in real clinical practice.PurposeTo analyse the effectiveness and safety of metastatic pancreatic cancer treated with nab-paclitaxel. To compare overall survival (OS) with the results published in the literature.Material and methodsAn ambipective, multicentre, observational study was carried out in a third level hospital.Inclusion criteria were: patients diagnosed with metastatic pancreatic cancer treated with nab-paclitaxel plus gemcitabine since the drug was included in the hospital´s service.The variables collected were: age, sex, weight (kg), size (cm), body surface (m²), pancreatic tumour location, site of metastatic disease, number of metastatic diseases, ECOG at baseline and after TAC, level of carbohydrate antigen 19.9 (CA 19.9), level of GPT, GOT, bilirubin and serum haemoglobin, neutrophil counts and adverse events grade 3 or higher.The principal effectiveness endpoint was OS.OS was analysed with the Kaplan-Meier method with SPSS software.Data were obtained by the pharmacy dispensation program (ATHOS) and clinical charts.Results28 patients were included from March 2012 to August 2015. 50% were male, with a mean age of 62 ± 2 years.ECOG at baseline was 1 in 65% and 0 in 27% of patients. The most frequent pancreatic tumour location was the pancreas´s head, and the most frequent metastatic site was the liver.Mean CA 19.9, GPT, GOT, bilirubin, serum haemoglobine and neutrophil levels were 11, 250.41, 33.31, 0.71,122 and 5.7, respectively.Most often reported adverse events grade 3 or higher were: fatigue (2.4%), diarrhoea (2.4%), sickness (2.4) and alopecia (11%). 4.8% of patients developed more than one adverse event.The mean OS was 13.18 (95% CI 7.1 to 19.3) months.ConclusionMetastatic pancreatic patients benefited from treatment with nab-paclitaxel in terms of OS. Nab-paclitaxel was well tolerated overall.No conflict of interest.
BackgroundSurveys of satisfaction are an important tool to learn the strengths and weaknesses of the service and to assess influential factors to improve the quality of care provided.PurposeTo assess the degree of satisfaction of health professionals on the pharmacy service. To analyse the factors that have influenced the results and identify areas for improvement.Material and methodsObservational and retrospective study. Annual satisfaction surveys were reviewed for the period 2011–2014. The surveys assessed the degree of satisfaction across 24 items based on closed questions that were scored: 1=strongly disagree; 2=disagree; 3=neither agree nor disagree; 4=agree; 5=strongly agree.The mean scores per item were analysed per professional category and per hospital (maternity and children hospital MCH; general hospital (GH), rehabilitation and trauma hospital (RTH). A quantitative analysis was conducted with these data using Excel 2010.Results296 surveys were conducted: 55 in 2011; 46 in 2012; 94 in 2013; and 101 in 2014. The average score per ítem was highest in doctors compared with other healthcare staff. As for hospitals studied, MCH had a higher mean score per item.In general for all centres: In 2012 a clear decrease in the valuation was observed.In 2013 the scores improved significantly.In 2014 the highest values were obtained compared with previous years.The best valued items were: “The personal attention of professional pharmacy”, “The quality of the preparations “ and “drug distribution system in unit dose provides the rational use drug “.The worst rated items were: “management procedures with the pharmacy is easy”, ”The consumption information that facilitates pharmacy seems adequate”.Factors that have influenced and explain the results are: In 2012, incorporation of a comprehensive system of procurement, reducing working hours and a change in the pharmacy computer system.In 2013–2014, implementation of electronic prescribing in the GH.In 2014, automation project for MCH.ConclusionThe services provided by the pharmacy are valued positively. Factors such as electronic prescribing and the automation system have been able to improve the quality of services provided.No conflict of interest.
BackgroundThe appropriate dose and frequency of omalizumab in patients with severe asthma was determined in clinical trials based on body weight (kg) and baseline IgE (IU/mL). However, in clinical practice a conversion chart promoted by stakeholders is used for dose determination.PurposeTo assess the correlation between omalizumab´s estimated dose calculated from the formula used in pivotal clinical trials (PCT) and prescribed omalizumab dose in clinical practice. We also aimed to analyse the effectiveness of omalizumab based on FEV modifications from baseline.Material and methodsAsthmatic patients treated with omalizumab up to July 2015 were evaluated retrospectively. Demographic data (gender and age), body weight, posology (dose and frequency), duration of treatment, baseline and current IgE level, and baseline and current FEV were recorded. Omalizumab estimated dose was calculated according to the PVT formula at baseline: 0.016*weight*IgE (UI/mL) every 4 weeks or 0.008*weight*IgE (UI/mL) every 2 weeks. For patients treated with omalizumab for 3 or more years current weight and IgE was used instead of baseline data to assess omalizumab´s estimated dose. Also, to analyse the effectiveness of treatment, we calculated the difference in FEV from baseline. Statistical analysis were performed using SPSS15.Results60 patients met the inclusion criteria. 68.3% were female and mean age was 51.8 years (range 16–80). Mean FEV improvement from baseline was 9.69% (range -25%-51.1%). This meant that 56.9% of patients developed an improvement in FEV but 25% had worsening FEV and in 18.3% of patients these data were missing. Comparison between the prescribed dose and estimated dose from the PCT formula showed a concordance of doses in only 20% of cases. Based on these data, 46.3% of patients would benefit from omalizumab dose reduction. Also, 36.7% of patients had a lower prescribed dose than omalizumab’s estimated dose based on the PCT formula. Nevertheless, 61.1% of these patients would not need an increase in dose based on FEV improvement from baseline.ConclusionWe found a great discrepancy between estimated omalizumab dose by the PCT formula and the prescribed omalizumab dose in clinical practice. By using the formula we optimised the efficiency of treatment with omalizumab.No conflict of interest.
BackgroundAlthough parenteral nutrition (PN) is a lifesaving therapy in undernourished patients, its use may be associated with metabolic complications.PurposeTo analyse the incidence of metabolic complications associated with PN administration in patients admitted to the intensive care unit (ICU).Material and methodsObservational and retrospective study. All patients who received PN in the ICU between January and March 2017 were included. Demographic, clinic and nutrition information were obtained from Diraya® and Kabisoft®.Demographics, indication, duration, venous access, composition of the nutrition and associated complications were registered.Hyperglycaemia (>200 mg/dl), hypoglycaemia (<60 mg/dl), electrolytic alterations (EA) (sodium and/or potassium), hypertriglyceridaemia (>250 mg/dl), hypercholesterolaemia (>200 mg/dl), creatinine (>3 mg/dl), urea (>60 mg/dl), metabolic acidosis y cholestasis (alkaline phosphatase (AF) >380 UI/L, and glutamic transaminase (GGT) >50 UI/L of bilirubin >1.2 mg/dl) were the parameters considered metabolic complications. Rate and density of incidence (number of episodes per 100 days of parenteral nutrition in case of the most frequent) were determined.ResultsThirty-six patients were included (52.7% males), the average age was 64.75±10.37 years.PN indications were: intestinal resection 30.5%, fistula or perforation 11.1%, intestinal obstruction 16.7%, suture dehiscence 13.9%, paralytic ileus 8.3%, ulcerative colitis 5.6% and others 16.7%.10±10 days was the median duration of the PN and 10±11 days the median of the ICU stay.Central vias channelled were jugular 50%, subclavian 25% and femoral 13.9%.All patients had daily analysis of glucaemia, sodium, potassium, urea, creatinine and pH. 33.3% also had cholesterol and triglycerides determination, and 47.2% had FA, GGT and bilirrubina determinations as well.88.9% of the patients presented metabolic complications associated with the PN: 71% presented more than one complication.Incidence of complications: EA 63.9% (5.01 per 100 days); hyperglycaemia 52.8% (4.14 per 100 days); hyperuricaemia 33.3% (2.6 per 100 days); hypercreatininaemia 16.7% (1.03 per 100 days); metabolic acidosis 31.3% (1.09 per 100 days). None presented hypercholesterolaemia and six presented hypertriglyceridaemia.The alterations presented in those patients whose AF, GGT and bilirubin were determined, were 23.5%, 52.9% and 29.4%, respectively.ConclusionMetabolic complications in patients admitted to the ICU were frequent, underscoring electrolytic alterations and hyperglycaemia. These results were in accord with the consulted bibliography.No conflict of interest
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