Background
It has been reported that clinical evaluation consistently underestimates the severity of hidradenitis suppurativa (HS).
Objective
To determine the usefulness of ultrasound as a diagnostic ...tool in HS compared with clinical examination and to assess the subsequent modification of disease management.
Methods
Cross‐sectional multicentre study. Severity classification and therapeutic approach according to clinical vs. ultrasound examination were compared.
Results
Of 143 HS patients were included. Clinical examination scored 38, 70 and 35 patients as Hurley stage I, II and III, respectively; with ultrasound examination, 21, 80 and 42 patients were staged with Hurley stage I, II and III disease, respectively (P < 0.01). In patients with stage I classification as determined by clinical examination, 44.7% changed to a more severe stage. Clinical examination indicated that 44.1%, 54.5% and 1.4% of patients would maintain, increase or decrease treatment, respectively. For ultrasound examination, these percentages were 31.5%, 67.1% and 1.4% (P < 0.01). Concordance between clinical and ultrasound intra‐rater examination was 22.8% (P < 0.01); intra‐rater and inter‐rater (radiologist) ultrasound agreement was 94.9% and 81.7%, respectively (P < 0.01).
Limitations
The inability to detect lesions that measure ≤0.1 mm or with only epidermal location.
Conclusion
Ultrasound can modify the clinical staging and therapeutic management in HS by detecting subclinical disease.
Background and ImportanceThere is a need to carefully prescribe drugs with a narrow therapeutic range and pharmacokinetic reports on their serum concentrations are the necessary tool for this ...commitment.Aim and ObjectivesEvaluate the impact of pharmacokinetic reports on clinical decision.Material and MethodsA prospective analysis was conducted in a secondary care hospital between March and August 2020 including adult patients with at least one serum concentration of valproic acid, amikacin, carbamazepine, cyclosporine, digoxin, phenytoin, phenobarbital, lithium, gentamicin, theophylline, vancomycin and voriconazole.Dialyzed and non-admitted patients were excluded. Data was obtained from medical records and pharmacokinetic software. The variables collected were: age, sex, prescribed drug, clinical department, pharmacokinetic report and medical decision.Results166 patients with 613 pharmaceutical interventions were recorded. Ninety-five (57.2%) were women with a mean age of 73 years (28-100), mean weight 66 kg (40.5-139.2) and mean serum creatinine 1 mg/dL (0.3-12.5).The number of pharmacokinetic reports were digoxin: 265 (43.2%); vancomycin: 139 (22.7%); valproic acid: 79 (12.9%); lithium: 69 (11.3%); amikacin: 17 (2.8%); carbamazepine: 10 (1.6%); theophylline: 9 (1.5%); phenytoin: 8 (1.3%); gentamicin: 8 (1.3%); cyclosporine: 4 (0.7%); phenobarbital: 3 (0.5%); voriconazole: 2 (0.3%).Pharmacokinetic reports according to the prescribing clinical department: internal medicine: 223 (36.4%), psychiatry: 100 (16.3%); and cardiology: 71 (11.6%) were the main ones.The physician's acceptance of the pharmacokinetic reports according to the drug were digoxin: 112 (37.6%); vancomycin: 74 (24.8%); valproic acid: 43 (14.4%); lithium: 38 (12.8%); amikacin: 13 (4.4%); phenytoin: 4 (1.3%); theophylline: 4 (1.3%); gentamicin: 3 (1.0%); carbamazepine: 2 (0.7%); cyclosporine: 2 (0.7%); phenobarbital: 2 (0.7%); voriconazole: 1 (0.3%).Acceptance of pharmaceutical recommendations by major clinical services were internal medicine: 110 (36.9%); psychiatry: 54 (18.1%); and geriatrics: 32 (10.7%).Accepted recommendations were dose maintenance: 202 (75.4%); dose suspension: 26 (72.2%); dose reduction: 41 (68.3%); dose increase: 26 (66.7%).The pharmacokinetic reports accepted 295 (73.2%). 8% were not accepted due to patient discharge or death.Conclusion and RelevanceA pharmacokinetic area supports clinicians in order to establish the safest and most effective dosing regimens.A high percentage of pharmacokinetic reports were accepted, however, it is necessary to increase this percentage by talking to physicians and remarking the importance of this activity.References and/or AcknowledgementsConflict of InterestNo conflict of interest
Background and importanceTofacitinib and baricitinib were recently approved for rheumatoid arthritis (RA) treatment. This was a breakthrough because of their oral administration and new mechanism of ...action.Aim and objectivesTo analyse tofacitinib and baricitinib treatment for RA and adverse effects (AE) after starting treatment in a second level hospital.Material and methodsA retrospective observational study was conducted in all patients starting baricitinib and tofacitinib treatment until September 2019. The collected variables were sex, age, previous disease modifying antirheumatic drugs (DMARD) and biological treatments, and AEs detected (through review of electronic medical history).ResultsForty-seven patients were included (12.8% men; mean age 57±12.6 years). Twenty-six (53.2%) received baricitinib. All patients had been previously treated with any DMARD. Twenty-six (55.3%) patients had received any biologic agent, and the average number of previous biological treatments was 1.7. Twenty-four AEs were detected in 15 different patients (31.9%). Eight patients with baricitinib (30.8%) presented any of the following AEs: upper respiratory tract infection (4), fatigue (2), changes in blood pressure (2), skin and mucous lesions (2), oesophageal candidiasis (1), headache (1), anxiety (1), arthralgia (1) and hair loss (1). Six patients treated with tofacitinib (28.6%) presented any AEs: headache (2), fatigue (2), respiratory infection (1), herpes infection (1), joint swelling (1) changes in blood pressure (1), pruritus (1), insomnia (1) and blurred vision (1).In two cases, baricitinib was suspended for no clinical improvement, and in four cases for AEs (two for skin and mucous lesions, one for hair loss and fatigue, and other for fatigue). Tofacitinib was suspended for inefficacy in four cases and one AE (insomnia), leading to a dose reduction in one patient.Conclusion and relevanceThe population that started RA treatment with tofacitinib and baricitinib in our hospital were mostly middle aged women with at least one previous treatment with DMARD. More than half of the patients had received some biologic previously. In spite of the limitations of this study (probable underestimation of AEs because they were not always recorded on the clinal history), tofacitinib and baricitinib showed an acceptable profile of adverse reactions, similar to those described on both technical data sheets.References and/or acknowledgementsNo conflict of interest.
Background and ImportanceFalls in the elderly have a multifactorial component, among these factors, one of the main causes is chronic consumption of benzodiazepines (BZD).Aim and ObjectivesTo ...describe the prevalence of chronic consumption of anxiolytic BZD in elderly people who have suffered falls within hospital admission schemes.Material and MethodsCross-sectional descriptive and observational study in a health area. We identified through the Minimum Basic Data Set (CMBD) patients older than 64 years with hospital admission with code W19.XXXA (Unspecified acute fall, initial contact) according to the International Classification of Diseases version 10, between 2017 and 2021. Variables collected: date of birth, sex, comorbidities and Van Walraven Comorbidity Index.Chronic consumption (more than 4 weeks) of anxiolytic BZD (ATC-WHO code N05BA) recorded in the prescription billing system was analysed in these patients. Patients who had picked up BZD at the community pharmacy during the fall episode were the ones selected.Data were analysed using Stata/BE v17 statistical software.Results1585 patients (63.8% female) with acute fall code hospital admission between 2017 and 2021 were identified. Median age at admission was 82.6 IQR 11.5. And median of Van Walraven Comorbidity Index was 5.0 IQR 11.0, mainly: hypertension (49.0%), arrhythmias (29.5%) and diabetes (22.4%). Patients that had more than one fall episode represented 6.5% of total, with a median of 7.0 IQR 7.4 days of hospitalisation. Chronic anxiolytic BZD use during the fall episode was observed in 23.3% (77.3% female) of patients. The most frequently used anxiolytic BZD were lorazepam (48.6%), bromazepam (29.4%) and diazepam (14.3%), the first two being of short/intermediate half-life and diazepam of long half-life.Conclusion and RelevanceAlmost a quarter of the study population with unspecified acute falls were chronic anxiolytic BZD users, mainly with a short/intermediate half-life. Because BZD use in the elderly is a causative factor in falls, it is necessary to adjust treatment, recommending de-prescription or gradual dose reduction where possible.References and/or AcknowledgementsConflict of InterestNo conflict of interest
Background and importance Clostridium difficile (CD) colonises the human intestinal tract after the normal flora has been disrupted (in association with antibiotic therapy). Clinical guidelines use ...fidaxomicin as first-line treatment in patients at greater risk for recurrence (age >65 years, compromised immunity, severe CD infection) in accordance with 2021 Infectious Diseases Society of America (IDSA).Aim and objectivesEvaluation of the cost increase in the treatment of CD if patients are treated with fidaxomicin instead of vancomycin after the failure of first-line treatment or as first-line treatment according to the age recommendations of the IDSA.Material and methodsRetrospective observational study that included patients diagnosed with pseudomembranous colitis and treated with oral vancomycin for CD from 1 October 2020 to 30 September 2021. Clinical sources used were from FarmaTools and the Electronic Medical Record Selene.Results97 patients were analysed; 48.45% men, median age 72 (SD 16) years. 9 were empirically treated. 88 pacients were positive for CD. 5 patients died from another pathology during treatment (3 during the first-line and 2 during the second-line treatment).73 patients (75.26%) (43.84% men) only needed one line of treatment with vancomycin to achieve a cure. The cost of vancomycin treatment for these patients was €3216.19 patients (19.59%) (63.16% men) required a second (15 patients) or third line (4 patients) of treatment after the failure of the previous lines. The cost of vancomycin treatment for these patients was €2266. These patients could have been treated with fidaxomicin. The total cost would have been increased to €30 300.71 patients (73%) at the time of diagnosis were older than 65 years; 83% first line, 9.86% second line and 7.14% third line. The cost of vancomycin treatment for these patients was €5461. Following the IDSA criteria, these patients could have been treated from the beginning with fidaxomicin. The total cost would have been increased to €102 453.Conclusion and relevanceThe use of fidaxomicin represents a very high increase in healthcare costs compared to vancomycin. In our study all the patients were cured with the use of vancomycin. It should also be noted that in clinical trials and meta-analyses, fidaxomicin achieves a modest superior efficacy compared to vancomycin.References and/or acknowledgementsConflict of interestNo conflict of interest
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