SummaryWhat is known and objectives: Most antineoplastic drugs are highly toxic and have low therapeutic indexes, which can result in drug-related problems. In this context, pharmacist interventions may play an important role in the success of the treatment.The objective of this study was to examine the effects of pharmacist interventions on adult outpatients with cancer using antineoplastic drugs. Methods:A literature search was performed using PubMed, ISI Web of Science and LILACS databases from January 1990 to April 2016, using MeSH terms or text words related to pharmacist interventions, cancer and outpatient care. Studies published in English, Portuguese or Spanish on the effects of pharmacist interventions in outcome measures in adult outpatients with cancer were included. Two independent authors performed study selection and data extraction with a consensus process. The articles were analysed according to previously established criteria, such as country, study design, setting, population, type of cancer, description of the intervention and control groups, outcomes, main conclusions and study limitations. Results and discussion:A total of 874 records were identified, of which 11 satisfied the inclusion criteria. The studies were conducted mainly in the United States and included patients aged >50 years. Most studies had a before-after design. Pharmacist interventions primarily included educating and counselling patients on the management of adverse events. Rates of nausea and vomiting control, medication adherence and patient satisfaction were the most common outcome measures; a significant benefit in these parameters as a result of pharmacist interventions was noted in most studies. What is new and conclusion:The findings from this systematic review indicate that pharmacist interventions can improve outcome measures in outpatients with cancer.However, the collective quality of the studies was poor and gaps identified indicate that further research is needed to provide more robust results. K E Y W O R D Scancer, pharmaceutical care, pharmacists, systematic review

EC was more effective in patients with acute AF and resulted in a shorter length of stay in the ED than PC. Adverse events were small in number and transient in both groups of patients. Clinical trials registration number NCT00933634.

Objectives-Point-of-care lung sonography has theoretical usefulness in numerous diseases; however clinical indications and the impact of this technique have not been fully investigated. We aimed to describe the current use of point-of-care lung sonography.Methods-A 2-year prospective observational study was performed by pulmonologists in an Italian university hospital. Techniques, indications, consequences of lung sonography, and barriers to the examination were analyzed. Conclusions-Point-of-care lung sonography performed by pulmonologists is quick and feasible and could be widely used for different clinical indications with a potentially high clinical impact. The widespread use of this technique may have a relevant clinical impact in several indications.

Hypothyroidism has been shown to occur in HIV disease. Thyroid function of patients affected by AIDS and leishmaniasis is unknown. Here we report the case of an AIDS advanced patient developing hypothyroidism during leishmaniasis. The thyroid disorder might have been caused by infiltration of the gland by Leishmania. An additive impact of HIV in thyroid function impairment is suggested.

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According to the study results, rhythm at the time of ED discharge is a poor indicator of the short-term evolution of AF.

Background Although the most known feature of SARS-CoV-2 associated infection is a mild to severe pneumonia, increasing evidence suggests the existence of an infection-associated risk of both arterial and venous thromboembolism (VTE), but the exact magnitude of this phenomenon is still unknown. Given that, it is important for the Emergency Physician to remember that a SARS-CoV-2 associated respiratory failure can be caused not only by the pulmonary parenchymal inflammation that characterizes the pneumonia, but also by an associated pulmonary thromboembolism. Case report A healthy 73-years old woman admitted to the ED for dyspnea, fever and thoracic pain. Cardiac ultrasound, electrocardiogram and clinical findings suggested a diagnosis of cardiogenic obstructive shock due to acute pulmonary embolism, successfully treated with thrombolysis. A CT angiography confirmed the pulmonary embolism (EP) diagnosis and showed bilateral pneumonia, caused by SARS-CoV-2 infection. Conclusion Considering the high prevalence of thromboembolic events in COVID-19 patients it is mandatory for the emergency physician to systematically evaluate signs of pulmonary thromboembolism, in order to perform the most patient-tailored therapy as soon as possible.

Patients with chronic obstructive pulmonary disease (COPD) during an episode of acute or acute on chronic respiratory failure due to infection present a special problem with regard to the relief of hypoxia. In a prospective, randomized, multicenter controlled trial, we evaluated the efficacy of oxygen delivery by Ventimask compared with Venturi mask in patients affected by exacerbation of COPD and mild acidosis before starting with non-invasive bilevel-positive airway pressure (PAP). The study involved 80 patients with exacerbation of COPD divided in two groups: Group A=40 patients randomized to Ventimask plus standard therapy and Group B=40 patients randomised to Ventury mask plus standard therapy. The primary endpoint was to evaluate the efficacy of oxygen therapy with Ventimask compared with Venturi mask in terms of avoiding the need for non-invasive bilevel-PAP during the 1st h and reducing PaCO 2 retention. Twenty-five patients (62%) started with bilevel-PAP in Group A and 28 (70%) in Group B (not significant). There were no significant changes in arterial blood gases values between the two groups. In Group A, pH and PaCO 2 were 7.32±0.11 and 68.5±13.6 mmHg at admission, and 7.33±0.05 and 64.8±4.9 mmHg after 1 h (not significant). In Group B, pH and PaCO 2 were, respectively, 7.32±0.11 and 65.7±13.6 mmHg at admission, and 7.33±0.03 and 64.0±5.5 mmHg after 1 h (not significant). Our conclusion did not show any significant differences between the two oxygen masks delivery in terms of preventing the need of bilevel-PAP and reducing PaCO 2 , despite the trend towards a reduction of the utilization of non-invasive positive pressure ventilation was in favor of Ventimask.