Background Improving the haemoglobin levels preoperatively leads to a reduction in transfusions required. Intravenous iron III sucrose (IVI), with a good safety profile, represents a new therapeutic option for the treatment of anaemia. Purpose To determine whether IVI administration in postoperative colorectal cancer (CRC) decreases the number of transfusions required. Materials and methods Retrospective case-control study in patients undergoing CRC surgery in the years 2008, 2009 and 2010, matched by age (±3 years), sex, type of surgery, tumour stage and surgical approach. Variables recorded: sex, age, tumour location, tumour stage, type of surgery, surgical approach, haemoglobin prior to surgery (Hbs) and at discharge (Hbd), number of transfusions after surgery (Ts) and doses of IVI received. Statistical analysis: Pearson's χ2 test or Fisher's exact test and Student's t or Mann-Whitney test using SPSS 15.0. software. Results The number of patients was 342, of which 104 were paired into 2 groups of 52 patients (G1-IVI treated and G2-IVI untreated), 33 men and 19 women per group, with a mean age of 70.9±11.1 and 70.6±10.9 years, respectively. Tumour location in both groups: rectum (25/22), left colon (15/17), and right colon (12/13). Tumour stage in both groups: III in 36.5%, 0 in 26.9%, IV in 13.5%, I in 11.5% and II in 11.5%. Type of surgical procedure in both groups: anterior resection of rectum in 36.4%, left and right colectomy in 28.8% and 21.2%, respectively. Surgical approach: 92.3% by laparotomy and 7.7% by laparoscopy. Hbs was 12.3±1.6 g/dl (G1) and 12.8±1.9 µg/dl (G2)(p=0.133), and Hbd was 10±1.1 g/dl (G1) and 10.6±1.2 µg/dl (G2)(p=0.012). Ts was 3±1.6 (G1) and 3.3±3 (G2)(p=0.682). 28.8% and 30.8% in groups 1 and 2, respectively, were transfused (p=0.830). The mean dose of IVI was 592±445 mg. Conclusions Administration of IVI does not appear to decrease transfusion requirements, possibly because bone marrow physiologically requires a period longer than the hospital stay to increase haemoglobin levels. Additional studies are needed to show more clearly the value of IVI.
Background Bendamustine is approved in Spain for the treatment of chronic lymphocytic leukaemia (CLL), Non Hodgkin Lymphoma (NHL) and multiple myeloma (MM). The most frequent adverse reactions are haematological. Usually patients require supportive treatment with granulocyte colony-stimulating factors (G-CSF) for neutropenia and erythropoietins for anaemia. Purpose To describe the approach to neutropenia and anaemia caused by bendamustine in patients diagnosed with NHL, CLL and MM in our Hospital Materials and MethodsDescriptive and retrospective study of patients treated with bendamustine between November 2008 and February 2012 in our hospital. We collected data on age, sex, diagnosis, neutrophils count and haemoglobin before treatment and after receiving bendamustine, the proportion of patients requiring G-CSF (filgrastim or pegfilgrastim) or erythropoietins (darbepoetin alfa). Average number of G-CSF and erythropoietins doses. ResultsA total of 38 patients received bendamustine, of whom 13 were women and 25 were men, with a mean age of 67 years old. 28 patients were diagnosed with NHL, 4 with MM and 6 with LLC. Before treatment, the neutrophils count was 4,846/mm³ and haemoglobin 11.7 g/dL. Later these figures were 2,440/mm³ for neutrophils and haemoglobin 11 g/dl. 73.7% of patients required G-CSF and 10.5% erythropoietins. The median number of doses of G-CSF and darbepoetin alfa respectively were 6 and 2.5. Conclusions Bendamustine appears well tolerated. Supportive treatment with G-CSF is required in the majority of patients to maintain neutrophil count. This is not the case for anaemia, which occurs less frequently, requiring less rescue treatment. However these patients require close monitoring during treatment. No conflict of interest.
Background In renal failure, alteration in the pharmacokinetics increases the frequency of overdoses. Purpose To evaluate pharmaceutical care using a computer programme for drug dose adjustment in renal failure. Materials and Methods The study period lasted from September 2011 to January 2012 (inclusive), in a 420-bed hospital. Every day creatinine values over 130 mmol/l were filtered. Treatment was reviewed and we obtained creatinine clearance values (Crockcoft & Gault) of selected patients. After consulting the drug dose adjustment on the sheet and in Micromedex, a report was sent with the pharmaceutical recommendation. ResultsThere were 68 interventions for the 2147 patients studied: Internal Medicine (34) Cardiology (1), Short Stay Unit (5), Orthopaedics (7), Urology (5), Haematology (7) Surgery (5), Neurology (1), Intensive Care Unit (ICU) (2) Oncology (1). 55.9% of notifications were for changes in the dose of enoxaparin (38), 11.8% of amoxicillin-clavulanic acid (8), piperacillin-tazobactam 14.7% (10), 8.8% levofloxacin (6), 2.9% meropenem (2), 2.9% ciprofloxacin (2), 1.5% imipenem (1) and 1.5% aztreonam (1). The proportion of suggested changes accepted was 58.8% (40). 5.9% (4) discontinued treatment, 5.9% (4) were discharged and 29.4% (20) not changed. Of the latter, five were for changes in the pattern of enoxaparin in trauma patients, another 5 from Internal Medicine and 2 more from Haematology and ICU. The rest of them were changes in the pattern of antibiotics (imipenem 1, 2 levofloxacin, 1 meropenem, 1 ciprofloxacin, piperacillin-tazobactam 3) that were given out in the different services. Conclusions A high percentage of doctors followed the recommendations. Part of the unaccepted tally corresponds to trauma patients whose prophylactic regimen of enoxaparin (40 mg/24 h) was not modified due to the service criteria. Some of the antibiotic prescriptions were not changed because of the severity of the patient’s illness (1 levofloxacin and 1 Internal Medicine Meropenem Imipenem Oncology and 1). The rest were rejected without explanation. No conflict of interest.
Background Pneumonia is one of the most common causes of mortality in geriatric patients. The appropriate antibiotic treatment of this pathology can decreases the mortality rate in the patient group. Purpose To study the features of the patients with community acquired pneumonia (CAP) and the use of antibiotics in their treatment. Materials and methods We selected 102 hospitalised patients who met the CAP criteria. Demographics, stay, comorbidities, smoking/drinking habits, microbiological tests performed and empirical antibiotic treatment were collected. Finally, we compared the treatment we found with clinical practice guidelines. Results Of the 102 patients selected (58.8% men and 41.2% woman) 75 (73.5%) of patients were over 65, and the median age was 70. The average stay was 8.6 days. The most frequent comorbidities in patients with CAP were diabetes in 31 patients (30.4%) and onco-haematology disease in 26 patients (25.5%) follow by respiratory disease in 22 patients (21.6%). The most common empirical treatments were fluoroquinolone monotherapy (36.27%) and fluoroquinolone associated with B-lactam (38.25%). Finally 14 (87.5%) of the 16 who died had at least one comorbidity, and 5 (31.25%) had at least three comorbidities. Conclusions Patients with CAP included in the study were treated in accordance with clinical guidelines. In patients with comorbidities there is a greater risk of dying. No conflict of interest.
Background Many authors have hypothesised that cardiovascular disorders and age-related macular degeneration (AMD) share common antecedents and suggested that novel biomarkers associated with CVD be evaluated for their potential relationship with AMD. Purpose To analyse the effect of anti-VEGF treatment on homocysteine levels and CRP (C-Reactive Protein) levels in patients with AMD. Materials and methods A total of 43 patients with exudative AMD and with no previous anti-VEGF treatment were treated with two anti-VEGF treatments: ranibizumab and pegaptanib sodium. The follow up was 6 months. The homocysteine (HCY) and CRP levels were determined before and after treatment. HCY levels were measured quantitatively using an intensifying immunonephelometric particle test in a BN ProSpec analyzer (Tiez, 1995) and CRP analysis was performed by an immunoturbidimetric test (Eda et al. 1998). Results Mean plasma homocysteine level at baseline was 13.1 ± 4.2 mmol/L in patients treated with pegaptanib and at 6 months these values had not changed. In the same way the patients treated with ranibizumab showed no changes in mean baseline plasma homocysteine (12.8 ± 2.5 mmol/L) after intravitreal treatment with ranibizumab. The mean homocysteine values were within the normal range, between 5–20 mmol/L. Of all patients analysed, only 3 of them initially had CRP levels above normal (5–10 mg /L). After antiangiogenic treatment with both ranibizumab and pegaptanib there was a significant increase in CRP. In patients with normal values, anti-angiogenic treatment produced no significant changes. Conclusions We did not find any results in our study to suggest that anti-VEGF treatment in patients with AMD increases cardiovascular risk predictors. No conflict of interest.
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