A case of pulmonary coinfection by Strongyloides stercoralis and Pneumocystis jiroveci has been detected in an AIDS patient treated in the Respiratory Intensive Care Unit of the Muñiz Hospital. At diagnosis, the patient presented cough with mucopurulent expectoration, dyspnea, fever, bilateral pulmonary infiltrates on the chest X-ray, negative bacilloscopy for acid fast bacteria and a CD4(+) T lymphocytes count of 52 cells/µL. The microbiological diagnosis was achieved by microscopic observation of the respiratory secretions obtained by bronchoalveolar lavage, while the wet mount examination revealed rhabditiform and filariform larvae of the nematode and foamy exudates, pathognomonic of the pulmonary pneumocystosis. It was the unique case of this association among about 3 000 samples performed in our laboratory in the last 10 years and diagnosed by microscopy. Other complementary stains (a rapid modification of Grocott, Kinyoun and Giemsa) were applied to the smears after the diagnosis of mycotic and parasitary infections achieved by fresh microscopy. Both physicians and microbiologists should take into account the possible coexistence of respiratory pathogens in immunocompromised patients, such as those with AIDS.
BackgroundDose optimization, such as dose reduction or dose spacing, is nowadays presented as a therapeutic strategy to be followed in patients with rheumatoid arthritis (RA) who have managed to reach and maintain clinical remission for a while. This strategy reduces the frequency of adverse effects and promotes cost savingsMethodsPatients with RA (Criteria ACR 1987) of the CREATE registry (patients who was treated in real life conditions) who had clinical remission (DAS28 <2.6) of at least 6 months of duration on November 1, 2013, constituted the cohort of patients who were optimized for the dose received. According to the consensus of the Spanish Societies of Rheumatology and Hospital Pharmacy, the optimization of doses meant the reduction of between 20 and 50% of the same.A multidisciplinary team of rheumatologists and clinical pharmacists in a third-level hospital was involved in decision-making on treatment and dose reduction, which involved the application of protocols and the follow-up of patients at least every two months.ResultsA prospective follow-up of 70 patients with RA who had received optimized doses of biological therapy for 3 years, with a mean age of 56.9 (13.7) years, of which 78.6% were women, 68.8% were positive rheumatoid factor and 66.7% ACPA +.The relapse occurred in 41.8% (at first year), 56.7% (at second year) and 62.7% (at third year). There were no statistical differences between these last 2 percentages. The median survival time of the optimization regimen was 15.24 (4.65) months (95% CI: 4.66–25.83). No statistically significant differences were found when comparing patients according to the optimized drug (antiTNF versus non-anti-TNF) (test log.rank: 0.239, p: 0.625).When relapse occurs, the patient returns to normal doses prior to optimization of the drug. Our data show that 62.7% of the patients in whom the relapse occurs at 3 years, maintains DAS28 <2,6 (P<0.05) when dose was returned to the manufacturer recommended dose.The 37.3% (95% CI: 26.72%, 49.28%) patients maintained the optimization pattern throughout the follow-up without relapse, with an average DAS28 of 1.99 (1.07) at 3 years. Comparing these patients with those who relapse, they achieved significantly lower DAS28 values at both (p: 0.028) and at three years (p: 0.025)Conclusions The strategy of dose reduction of biological therapies in patients with established RA that achieve sustained remission is possible in 37.3% of cases in real clinical practice (CREATE Registry) and it was maintained for 3 years.The probability of occurrence of relapse decreases after 2 years of treatment with an optimized regimen in those patients who have not relapsed before.This strategy is possible in patients with persistently controlled disease and in view of our results, it is independent of the drug administered (antiTNF versus non-antiTNF).After 3 years of follow-up, all patients maintained clinical remission (DAS 28 <2.6) despite relapses, and after resumption of the usual dose, all of them reached the therapeutic goal again.Patients ...
Background Lipids of TPN can cause liver toxicity in premature infants, so it is important to evaluate the introduction of new emulsions Purpose To describe the safety of two lipid emulsions used in the compounding of total parenteral nutrition (TPN) for premature infants. Materials and methods A retrospective study of two time periods, 2009 and 2010, of preterm infants population whit TPN. The analysis excluded those cases of death, sepsis and those who had a liver disease. 20 children received parenteral nutrition with lipid emulsion derived from soybean oil (Intralipid ®), from August to December 2009. In the second group were evaluated 19 children, whose lipid emulsion was derived from olive oil (ClinOleic ®) in the period from August to December 2010. The authors evaluated the following criteria: levels of bilirubin and liver enzymes (ALT/AST) and maximum insulin requirements (IU/kg/h). Results 39 infants within 72 h of life completed the study. The group that received parenteral nutrition with soybean oil derived (n=20) showed a mean gestational age of 31.4 weeks (27-34) and an average weight of 1.64 kg (0.76-2.8), the second group with lipids olive oil derived (n=19) 30.4 weeks (28-32) of age and weighing 1.82 kg (0.6-.2.28). Bilirubin levels were similar in both groups: soybean 8.4 mg / dl (2.4-20.02) and olive 9.1 mg / dl (2,52-16.9). There were no significant differences in levels of liver enzymes AST of 43.6 U/L (17-235.3) and ALT of 5.21 U/L (4.1-9.2) and oil olive group AST 43.1 U/L (19.2-170.3) and 13.7 U/L (5.2-37.3) ALT. In the study population also did not show higher insulin requirements in any of the two groups referred to maximum needs, 0.034 UI/kg/h (0.02-0.03) versus 0.036 IU/kg/day (0.02-0.035). Conclusions Both lipid emulsions were well tolerated, showing no difference in hepatic damage. The results suggest that both lipid preparations have similar safety profile in preterm parenteral nutrition.
BackgroundTwitter® (www.twitter.com) has become a useful digital tool for professional networking, update of knowledge and communication in the Spanish hospital pharmacy community.It is estimated that the number of Spanish Hospital pharmacists (SHP) is approximately 3,500, but the rate of SHP using Twitter is not well known.PurposeTo estimate what percentage of SHP have an active Twitter account.Material and methodsA cross-sectional descriptive study was carried out from 26 September 2017 to 14 October 2017.A new Twitter profile was created in privacy mode on the Google Chrome browser.SHP profiles were identified through the ‘snowball’ method following a four-steps procedure:Searching by keywords and hashtag on Twitter: ‘#FarmaciaHospitalaria’ + ‘Farmacia Hospitalaria’ + ‘Farmacéutica de Hospital’ + ‘Farmacéutico de Hospital’ + ‘Farmacia de Hospital’ + ‘Farmacéutica especialista’ + ‘Farmacéutico especialista’+ ‘Farmacia Hospital’ + ‘Hospital Pharmacist’ + ‘Hospital Pharmacy’ + ‘FIR’ and ‘#FIR’.Finding twitter lists related to ‘Farmacia Hospitalaria’ after searching on Google ‘inurl:lists inurl:Farmacia Hospitalaria site:twitter. com’.Followers and lists of Spanish Society of Hospital Pharmacist (@sefh_).Using ‘Who to follow’ functionality on Twitter.Inclusion criteria were:Twitter accounts self–identified as HP or HP resident or shown as prespecified keywords in their biography.The exclusion criteria were:Non–institutional or personal profiles related with hospital pharmacy.Private companies profiles.Profiles without photo.Non–Spanish accounts.Each Twitter profile that met the inclusion criteria was followed by the new created account.To export the following accounts database and to analyse the data, two online tools were used: Twittonomy and Google Sheets, respectively.ResultsA total of 698 Twitter accounts were identified as SHP. Most of them (64.2%, n=448) corresponded with feminine profiles, and the rest were masculine (26.5%, n=185) or non-determined (9.3%, n=65).The number of institutional profiles was 22 (five associated with theSpanish Society of Hospital Pharmacy and 17 associated with their work teams).At the time of the study 25 Spanish Hospital Pharmacy Departments have an active Twitter profile.The rate of SHP with a Twitter account was 18.1%.ConclusionThere are many institutional Twitter accounts associated with the Spanish Society of Hospital Pharmacy.Despite being a relevant hospital pharmacist community, the rate of SHP with a presence on Twitter is still low.References and/or AcknowledgementsSociedad Española de Farmacia Hospitalaria (SEFH). SEFH, como organizarnos. Jornadas ‘EL POTENCIAL DE la SEFH’, puesta al día (07/06/2017) https://www. sefh. es/sefhjornadas/48_Sefh_como_organizarnos. pdfNo conflict of interest
BackgroundThe number of medical apps has increased exponentially in recent years, with more than 2 30 000 available.Because of the lack of regulation, some of these apps may offer inaccurate content or may not reach the minimum quality standards in order to be used by healthcare professionals.PurposeAnalyse the availability of drug interaction checker apps for mobile devices and their quality according to the Mobile App Rating Scale (MARS score).Material and methodsCross-sectional study performed in October 2017 to find and classify the best mobile applications to check drug interactions according to MARS score.A search was conducted on two major mobile platforms: Apple’s App Store and Google Play Store. The keyword used to identify the initial sample was ‘drug interaction’.The exclusion criteria were:No drug searcher available or drug searcher only available for a specific drug class.No health and fitness or medicine category.No English language.Pay subscription app.Not updated in the last 36 months.The selected apps were downloaded in a smartphone and in a tablet of both systems in order to be analysed. The app’s quality and reliability was measured by means of MARS. This is an app quality rating tool that provides a measure of different features of health apps. It consists of 19 items clustered in four categories: engagement, functionality, aesthetics and information. Each item is rated in a 1–5 points scale (1-inadequate to 5-excellent).The degree of agreement between the selected apps was not analysed.Data collection and statistical analysis were performed in a Google Drive spreadsheet.ResultsOf the 139 apps identified, 12 met the inclusion and exclusion criteria. The mean MARS score was 3.01 (1.93–4.28). The mean social score was 4.03. The five apps with best MARS score (0–5) were ‘Medscape’ (4. 28), ‘Drugs.com Medication Guide’ (4.08), ‘Pharmacist Pro-Drug Interaction Checker’ (3.61), ‘Pocket Pharmacist’ (3.55) and ‘Assist UK-Drug Interactions’ (3.26).ConclusionThere is a high amount of apps to check drug interactions but only few have enough quality to be used with guarantees by healthcare professionals in their clinical activity.Reference and/or Acknowledgements1. Stoyanov SR, et al. Mobile app rating scale: a new tool for assessing the quality of health mobile apps. JMIR mHealth and uHealth2015.No conflict of interest
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